Computed tomography (CT) predicts accurately the pathologic tumour size in stage I non-small-cell lung cancer (NSCLC).

INTRODUCTION: In stage I non-small-cell lung cancer (NSCLC) tumour size has been the most consistent determinant of survival. The choice of therapy option is based on accurate definition of the stage. The aim of our study is to correlate tumour size by computed tomography scan (CT) with pathologic size and to determine possible prognostic factors in surgically resected pathologic stage IA and IB NSCLC patients. METHODS: Retrospective review of CT scans and medical history data from 89 pathologic stage I NSCLC patients. Clinical prognostic factors analysed were age, gender, smoking status, pulmonary function, performance status (PS), surgical procedure, histopathology, vessel invasion, pleural infi ltration, tumour size and number of lymph nodes resected. According to the new TNM classification for lung cancer, tumour size was divided into five groups (I: <2 cm, II: 2-3 cm, III: 3-5 cm, IV: 5-7 cm and V: >7 cm). RESULTS: After a median surveillance of 55.2 months, 42 patients relapsed and 55 had died. The 5-year progressionfree survival was 55.7% and 5-year overall survival (OS) 49.9% (median 58.97 months). None of the clinical parameters analysed were predictors of OS. Significant correlation was found between tumour size in CT scan and pathologic stage (Pearson 0.75). CONCLUSIONS: In our analysis with 89 surgically resected stage IA and IB NSCLC patients we found a good correlation between clinical and pathologic tumour size by CT scan. The prognoses factors analysed had no significant impact on survival.

[Gastric cancer in a general hospital. Santa Rosa Hospital. Experience]. / Cáncer gástrico en un hospital general: Hospital Santa Rosa.

PURPOSE: Determine the frequency of gastric cancer and its clinical and pathological characteristics, clinical stages, surgical treatment, morbimortality and survival in a general hospital. MATERIALS AND METHODS: Retrospective, descriptive study on 71 consecutive patients diagnosed with gastric cancer at the Santa Rosa Hospital from January 1, 2005 to January 31, 2008. RESULTS: During the study period, 71 cases of gastric adenocarcinoma were confirmed by histopathology. This disease is more frequent in men, with a 1.54 to 1 ratio, as compared to women. The most frequent age of appearance is between the fifth and seventh decades of life. Distal tumors (81.7%) are four times more common than proximal tumors (18,3%). The most common histological type was carcinoma in signet-ring cells (40.8%). The most frequent degree of differentiation was Undifferentiated (42.3%). A 62% (n=44) of patients entered the operating room. The resectability rate was 68% (n=30). The advanced stage was the most common form of presentation in patients (97.2%), while the early stage was rare (2.8%). The most frequent surgeries were the distal subtotal gastrectomy (73.3%) and the total gastrectomy (26.7%). The D2 (73.3%) dissection was performed. The mortality rate was 6.7% and the morbidity rate was 26.7%. Survival was better in patients who underwent resection than in patients who only underwent biopsy or were unresectable, evidencing statistical significance. CONCLUSION: Gastric cancer is diagnosed in a late stage and surgical treatment plays a pivotal role and, even in advanced cases, morbidity/mortality is acceptable for the initial experience at a third-level general hospital. It is necessary to carry out screening program to detect the disease in earlier stages.

Cáncer Gástrico en un Hospital General: Hospital Santa Rosa / Gastric cancer in a general hospital. Santa Rosa Hospital. experience

OBJETIVO: Determinar la frecuencia de cáncer gástrico y sus características clínico patológicas, estadios clínicos, tratamiento quirúrgico, morbimortalidad y sobrevida en un hospital general. MATERIALES Y MÉTODOS: Estudio retrospectivo, descriptivo, de 71 pacientes consecutivos diagnosticados con cáncer gástrico en el Hospital Santa Rosa desde el 1 de enero 2005 hasta el 31 de enero 2008. RESULTADOS: En el periodo de estudio se confirmaron por histopatologia 71 casos de adenocarcinoma gástrico. El sexo masculino es el más frecuente, con una relación de 1,54 a 1 con respecto al sexo femenino. La edad de presentación más frecuente se encuentra entre la 5ta y 7ma década de vida. Los tumores distales (81,7 por ciento) son cuatro veces más frecuentes que los proximales (18,3 por ciento). El tipo histológico más frecuente fue el carcinoma en células de anillo de sello (40,8 por ciento). El grado de diferenciación más frecuente fue el Indiferenciado (42,3 por ciento). El 62 por ciento (n=44) ingresó a sala de operaciones. La tasa de resecabilidad fue de 68 por ciento (n=30). El estadío clínico avanzado ha sido la forma depresentación más frecuente de los pacientes (97,2 por ciento), mientras que el estadío precoz ha sido raro (2,8 por ciento). La cirugía más frecuente fue la gastrectomía subtotal distal (73,3 por ciento) y gastrectomía total (26,7 por ciento). La disección realizada fue la D2 (73,3 por ciento). La tasa de mortalidadfue 6,7 por ciento y morbilidad de 26,7 por ciento. La sobrevida fue mejor en los pacientes que tuvieron resección frente a los que sólo se les realizó biopsia o fueron irresecables, evidenciandosignificancia estadística. CONCLUSIÓN: El cáncer gástrico se diagnóstica en etapa tardía y el tratamiento quirúrgicojuega un rol fundamental e incluso en casos avanzados, la morbimortalidad es aceptable para la experiencia inicial en un Hospital general de tercer nivel. Es necesario realizar programas de tamizaje para detectar la enfermedad en...

PURPOSE: Determine the frequency of gastric cancer and its clinical and pathological characteristics, clinical stages, surgical treatment, morbimortality and survival in ageneral hospital. MATERIALS AND METHODS: Retrospective, descriptive study on 71 consecutive patients diagnosed with gastric cancer at the Santa Rosa Hospital from January 1, 2005 to January 31, 2008. RESULTS: During the study period, 71 cases of gastric adenocarcinoma were confirmed by histopathology. This disease is more frequent in men, with a 1.54 to 1 ratio, as compared to women. The most frequent age of appearance is between the fifth and seventh decadesof life. Distal tumors (81.7 per cent) are four times more common than proximal tumors (18,3 per cent).The most common histological type was carcinoma in signet-ring cells (40.8 per cent). The mostfrequent degree of differentiation was Undifferentiated (42.3 per cent). A 62 per cent (n=44) of patients entered the operating room. The resectability rate was 68 per cent (n=30). The advanced stagewas the most common form of presentation in patients (97.2 per cent), while the early stage was rare (2.8 per cent). The most frequent surgeries were the distal subtotal gastrectomy (73.3 per cent) and the total gastrectomy (26.7 per cent). The D2 (73.3 per cent) dissection was performed. The mortality rate was 6.7 per cent and the morbidity rate was 26.7 per cent. Survival was better in patients who underwent resection than in patients who only underwent biopsy or were unresectable, evidencing statistical significance. CONCLUSIÓN: Gastric cancer is diagnosed in a late stage and surgical treatment playsa pivotal role and, even in advanced cases, morbidity/mortality is acceptable for the initial experience at a third-level general hospital. It is necessary to carry out screening program to detect the disease in earlier stages.

Clinical surrogate markers of survival in advanced non-small cell lung cancer (NSCLC) patients treated with second-third line erlotinib.

BACKGROUND: Inhibition of the EGFR pathway is a useful strategy in the treatment of patients with advanced NSCLC. The aim of this study is to assess predictive clinical parameters of efficacy. METHODS AND PATIENTS: Sixty-two patients with advanced NSCLC were treated with erlotinib as second-third line (150 mg/day). Baseline patient characteristics were: performance status (PS) 1: 92%; median age, 58 years; males, 73%; adenocarcinoma, 45%; current/former smokers, 83%. During erlotinib treatment, 35% of patients had no rash, 32.3% had grade 1 rash, 26% had grade 2 rash and 6.5% patients developed grade 3 rash. RESULTS: For patients with grades 2-3 rash vs. those with grades 0-1 rash, time to tumor progression (TTP) and overall survival (OS) were 92 vs. 41 days (p=0.0381) and 244 vs. 131 days (p=0.011), respectively. For patients with non-smoking history and current/former smokers, TTP and OS were 136 vs. 42 days (p=0.0015) and 324 vs. 133 days (p=0.0242), respectively. In addition, rash grade and smoking history were found to have a highly significant impact on TTP and OS, according to the Cox model. CONCLUSIONS: Grade > or =2 rash and non-smoking history are associated with improved TTP and OS in advanced NSCLC patients treated with erlotinib.