Marcadores tumorales y cáncer de pulmón. ¿Qué hay de nuevo? / No disponible

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[Overall long-term survival in lung cancer analyzed in 610 unselected patients]. / Supervivencia global a largo plazo en el cáncer de pulmón. Análisis de una serie de 610 pacientes no seleccionados.

INTRODUCTION AND OBJECTIVES: Many studies of lung cancer survival are carried out in patients selected for certain features that usually influence prognosis favorably. The objective of this study was to assess the overall survival of unselected patients with a diagnosis of lung cancer in our practice. PATIENTS AND METHODS: We studied 610 patients for whom survival information was available, a population comprising 88% of the 694 with lung cancer diagnosed in our hospital from 1991 through 1998. The variables analyzed for their correlation with survival were age, sex, histology, tumor-node-metastasis (TNM) stage, treatment, and time of diagnosis (with patients grouped by 2-year periods). RESULTS: The cases of 596 men and 14 women with a mean age of approximately 67 years were studied. Small cell tumors were found in 141, non-small cell tumors in 447, and other tissue types in 22. Surgical excision was carried out on 118 (19.3%), and treatment was confined to control of symptoms for 6.4% of the patients with small cell tumors and 40.5% of those with non-small cell cancer. Symptomatic treatment alone was more common for patients older than 70 years (52.5%) and less common during the last 2 years of the study period (1997-1998: 19%). Overall 5-year survival was 7.9% (2.8% in small cell cancer and 9.4% in non-small cell cancer). Survival rates were lower in patients over 70 years of age. Significant differences in survival were seen for successive TNM stages, with the exception of IIIA and IIIB. The 1997-1998 period saw better survival rates, at 40.8% after 1 year and 11.2% after 5 years. CONCLUSIONS: The survival rates in lung cancer patients in our hospital practice are low because the rate of surgical resections is low owing to the high percentage of cases found in advanced stages. Our observations are similar to those reported from other European countries.

Nuevas dianas y estrategias terapéuticas en el cáncer de pulmón / New therapeutic targets and strategies in lung cancer

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Tendencias actuales en el tratamiento del carcinoma broncopulmonar no microcítico localmente avanzado. Tratamientos combinados de quimioterapia y radioterapia / Current trends in the treatment of locally advanced non-small cell bronchopulmonary carcinoma

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[Incidence of bronchopulmonary carcinoma in Extremadura in 1998]. / Incidencia de carcinoma broncopulmonar en Extremadura durante el año 1998.

OBJECTIVES: Our main objective was to determine the incidence of bronchopulmonary cancer in Extremadura (Spain). We also studied the presence of risk factors such as smoking and exposure to other carcinogens. MATERIAL AND METHODS: This prospective study used a protocol followed by all hospitals in Extremadura; enrolled were patients with a diagnosis of bronchopulmonary carcinoma in 1998 who lived habitually in the region. Cyto-histological confirmation of the diagnosis was sought or, when such confirmation was unavailable, diagnostic agreement among researchers was based on clinical, radiological and/or endoscopic data. RESULTS: The incidences adjusted to world population were 53.4, 2.16 and 25.3 per 100,000 inhabitants for men, women and the entire population sample, respectively. Patterns in the provinces of Cáceres and Badajoz were very similar. Of 433 cases recorded, 95% were men and 78% were aged 60 years or older. Cyto-histological confirmation of diagnosis was available for 92.2%. Most tumors were epidermoid (41.1%). The time between the start of smoking and diagnosis was significantly shorter in heavier smokers.

Incidencia del carcinoma broncopulmonar en Extremadura durante el año 1998 / Incidence of bronchopulmonary carcinoma in Extremadura (Spain) in 1998

Objetivos: El objetivo primario ha sido conocer la incidencia de carcinoma broncopulmonar en la Comunidad de Extremadura. También se ha estudiado la presencia de factores de riesgo como el tabaquismo y otros carcinógenos. Material y métodos: Se ha realizado un estudio prospectivo mediante un protocolo común con participación de todos los hospitales de Extremadura. Se incluyeron los pacientes diagnosticados de carcinoma broncopulmonar durante 1998 que residían de modo habitual en la región. Se exigió la confirmación citohistológica o, cuando no se pudo disponer de la misma, la concordancia en el diagnóstico de carcinoma broncopulmonar entre diferentes participantes en el estudio, basada en datos clínicos, radiológicos y/o endoscópicos. Resultados: Las tasas de incidencia estandarizadas según población mundial fueron: 53,4, 2,16 y 25,3/100.000 habitantes para varones, mujeres y el total de la población, respectivamente. La distribución entre las provincias de Cáceres y Badajoz fue muy similar. De 433 casos registrados, el 95 por ciento fueron varones y el 78 por ciento tenían una edad >= 60 años. Se obtuvo confirmación citohistológica de carcinoma broncopulmonar en el 92,2 por ciento de los pacientes. Predominó la estirpe epidermoide (41,1 por ciento). El intervalo de tiempo entre el inicio del hábito tabáquico y el diagnóstico del carcinoma broncopulmonar fue significativamente menor en los fumadores de consumo más intenso. (AU)

Sobre el concepto de down-staging en el carcinoma broncopulmonar y su traducción al castellano / On the concept of "down-staging" in broncho-pulmonary carcinoma and its translation to Spanish

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[Diagnostic utility of carcinoembryonic antigen, neuron-specific enolase and squamous cell carcinoma antigen in malignant pleural effusion]. / Utilidad del antígeno carcinoembrionario, enolasa neuroespecífica y antígeno de células escamosas (en líquido pleural y suero) en el diagnóstico del derrame pleural maligno.

We evaluated the diagnostic utility of the carcinoembryonic antigen (CEA), neuron-specific enolase (NSE) and squamous cell carcinoma antigen (SCC Ag.) in malignant pleural effusion (MPE). CEA, NSE and SCC Ag, blood and pleural levels were quantified by enzyme immunoassay (EIA) in 85 patients with pleural effusions: 35 non malignant pleural effusions, and 50 MPE; 42 with lung carcinoma (LC), and 8 with extrapulmonary carcinoma. The sensitivity and specificity was compared to cytological results of the pleural fluid. The sensitivities of CEA7 NSE and SCC Ag. (in pleural fluid) were 59.5%, 48.7% and 16.7% respectively in patients with LC (specificity higher than 90%). Using a combination with CEA and NSE, the sensitivity reached 80.9% (specificity, 91.4%). The cytology of pleural fluid was positive in 45.2%. The pleural/blood ratios did not improve the diagnostic performance. In patients with extrapulmonary carcinoma, the sensitivity of these tumor markers was lower. The combination of CEA and NSE pleural levels is useful in the diagnostic approach to the patient with pleural effusion. A high level of NSE is suggestive of small cell lung cancer (SCLC).

Nasal intermittent positive pressure ventilation. Analysis of its withdrawal.

Nasal intermittent positive pressure ventilation (NIPPV) applied during sleep has been demonstrated to be useful in the treatment of restrictive thoracic diseases (RTD). The purpose of this study was to evaluate the repercussions of a withdrawal period from NIPPV of 15 days. This would be sufficient time for patients to go on trips without the respirator. It was hypothesized that once daytime improvement was achieved and was stable, it could be maintained for this period of time. Five volunteer patients with severe RTD who had been receiving treatment with nocturnal NIPPV for at least 2 months before and who had improved at least 5 mm Hg in daytime PO2 and PCO2 were included in the study. No significant differences were disclosed clinically or with arterial blood gas levels, spirometry results, lung volumes, airway resistances, or maximal muscle pressures 15 days following the withdrawal. However, in the sleep studies, a severe worsening of gas exchange was observed, mainly during rapid eye movement (REM) sleep, as well as a trend toward a more disturbed sleep pattern and more important alterations in cardiac rhythm. Consequently, withdrawing the treatment with nocturnal NIPPV cannot be recommended, at least for this particular removal period. Moreover, alterations in daytime gas exchange were found to originate in those produced during REM sleep through the blunting of the respiratory center to CO2. The NIPPV obstructs this mechanism, preventing the deterioration of gas exchange during sleep.

[The usefulness of serum neuron-specific enolase in the clinical management of small-cell lung carcinoma]. / Utilidad de la enolasa neuroespecífica sérica en el manejo clínico del carcinoma microcítico de pulmón.

The utility of neuron-specific enolase (NSE) for the diagnosis and management of small cell lung cancer (SCLC) is analyzed. Serum concentrations of NSE were measured in 69 healthy adults, 106 patients with non-neoplastic pneumopathy (NNP), 16 with pulmonary metastasis of extrapulmonary origin (PMEO), 126 with non-small cell lung cancer (NSCLC), and 77 with SCLC. Repeated analyses were carried out for patients in the last group during and after treatment, and survival time was recorded. NSE was high in 77.6% of patients with SCLC [50% in cases with limited disease (LD) and 93.6% in those with extensive disease (ED)]. NSE was high in 10.3% of those with NSCLC, in 11.5% of those with PMEO, and in 2.8% of those with NNP. NSE decreased 100% in SCLC patients achieving full remission after treatment and in 25% of those responding poorly. Later, this marker increased in 81.2% of those experiencing relapse, and in 6.2% of these the increased preceded symptoms. Initial NSE concentrations had prognostic value (p = 0.003) that was independent of disease stage (LD or ED). NSE is of great diagnostic and prognostic value in SCLC, accurately reflecting tumor size. Posttreatment changes closely parallel disease activity.

[Bronchopulmonary carcinoma. An epidemiological and clinical study of 157 cases]. / Carcinoma broncopulmonar. Estudio epidemiológico-clínico de 157 casos.

During the last 5 years (1982-1986), a diagnosis of primary bronchopulmonary cancer was made in 157 patients. The mean rate of incidence for males in our province was 25.7 per 100,000 and per year. Among patients with neoplasia, the rate of smokers approached 100%. There was a direct relation between younger age at presentation and higher number of cigarettes per day. In ex-smokers the clinical development of the disease was later than in current smokers. The results regarding the following variables are also reported: professional background, past history, initial symptoms, time to diagnosis (for each histologic type) and radiological findings.