array:23 [
  "pii" => "S1579212906602668"
  "issn" => "15792129"
  "doi" => "10.1016/S1579-2129(06)60266-8"
  "estado" => "S300"
  "fechaPublicacion" => "2005-09-01"
  "aid" => "60266"
  "copyright" => "Sociedad Española de Neumología y Cirugía Torácica (SEPAR)"
  "copyrightAnyo" => "2005"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "Arch Bronconeumol. 2005;41:478-83"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 2332
    "formatos" => array:3 [
      "EPUB" => 110
      "HTML" => 1610
      "PDF" => 612
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S157921290660267X"
    "issn" => "15792129"
    "doi" => "10.1016/S1579-2129(06)60267-X"
    "estado" => "S300"
    "fechaPublicacion" => "2005-09-01"
    "aid" => "60267"
    "copyright" => "Sociedad Española de Neumología y Cirugía Torácica (SEPAR)"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Arch Bronconeumol. 2005;41:484-8"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1859
      "formatos" => array:3 [
        "EPUB" => 97
        "HTML" => 1157
        "PDF" => 605
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Articles</span>"
      "titulo" => "Use of Blood Products in Patients Treated Surgically for Stage I Non-Small Cell Lung Cancer"
      "tienePdf" => "en"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "484"
          "paginaFinal" => "488"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46;C&#46; Pe&#241;alver, J&#46; Padilla, C&#46; Jord&#225;, J&#46; Escriv&#225;, J&#46; Cer&#243;n, V&#46; Calvo, A&#46; Garc&#237;a, J&#46; Pastor, E&#46; Blasco"
          "autores" => array:9 [
            0 => array:3 [
              "preGrado" => "Dr&#46;"
              "nombre" => "J&#46;C&#46;"
              "apellidos" => "Pe&#241;alver"
            ]
            1 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Padilla"
            ]
            2 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Jord&#225;"
            ]
            3 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Escriv&#225;"
            ]
            4 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Cer&#243;n"
            ]
            5 => array:2 [
              "nombre" => "V&#46;"
              "apellidos" => "Calvo"
            ]
            6 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Garc&#237;a"
            ]
            7 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Pastor"
            ]
            8 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Blasco"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921290660267X?idApp=UINPBA00003Z"
    "url" => "/15792129/0000004100000009/v1_201305150225/S157921290660267X/v1_201305150225/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S1579212906602656"
    "issn" => "15792129"
    "doi" => "10.1016/S1579-2129(06)60265-6"
    "estado" => "S300"
    "fechaPublicacion" => "2005-09-01"
    "aid" => "60265"
    "copyright" => "Sociedad Espa&#241;ola de Neumolog&#237;a y Cirug&#237;a Tor&#225;cica &#40;SEPAR&#41;"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "edi"
    "cita" => "Arch Bronconeumol. 2005;41:475-7"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1830
      "formatos" => array:3 [
        "EPUB" => 93
        "HTML" => 1124
        "PDF" => 613
      ]
    ]
    "en" => array:8 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorials</span>"
      "titulo" => "Predicting Poor Outcome of Pneumonia"
      "tienePdf" => "en"
      "tieneTextoCompleto" => 0
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "475"
          "paginaFinal" => "477"
        ]
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "R&#46; Men&#233;ndez, A&#46; Torres"
          "autores" => array:2 [
            0 => array:3 [
              "preGrado" => "Dr&#46;"
              "nombre" => "R&#46;"
              "apellidos" => "Men&#233;ndez"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Torres"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212906602656?idApp=UINPBA00003Z"
    "url" => "/15792129/0000004100000009/v1_201305150225/S1579212906602656/v1_201305150225/en/main.assets"
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Articles</span>"
    "titulo" => "Characteristics of Lung Cancer in a Region in Northern Spain"
    "tieneTextoCompleto" => 0
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "478"
        "paginaFinal" => "483"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "M&#46;A&#46; Alonso-Fern&#225;ndez, M&#46; Garc&#237;a-Clemente, C&#46; Escudero-Bueno"
        "autores" => array:4 [
          0 => array:5 [
            "preGrado" => "Dr&#46;"
            "nombre" => "M&#46;A&#46;"
            "apellidos" => "Alonso-Fern&#225;ndez"
            "email" => array:1 [
              0 => "migu67&#64;separ&#46;es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor1"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "M&#46;"
            "apellidos" => "Garc&#237;a-Clemente"
          ]
          2 => array:2 [
            "nombre" => "C&#46;"
            "apellidos" => "Escudero-Bueno"
          ]
          3 => array:1 [
            "colaborador" => "for the Asturian Society of Respiratory Disease &#40;ASTURPAR&#41; Lung Cancer Working Group &#40;GACP&#41;"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor1"
            "etiqueta" => "&#42;"
            "correspondencia" => "Correspondence&#58; Dr&#46; M&#46;A&#46; Alonso-Fern&#225;ndez&#46; Servicio de Neumolog&#237;a I&#46; Hospital Universitario Central de Asturias&#46; Dr&#46; Bellmunt&#44; s&#47;n&#46; 33006 Oviedo&#46; Asturias&#46; Espa&#241;a"
          ]
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2004-11-03"
    "fechaAceptado" => "2005-04-16"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Key Words"
          "identificador" => "xpalclavsec154144"
          "palabras" => array:3 [
            0 => "Lung cancer"
            1 => "Incidence"
            2 => "Survival"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec154143"
          "palabras" => array:3 [
            0 => "C&#225;ncer de pulm&#243;n"
            1 => "Incidencia"
            2 => "Supervivencia"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:1 [
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">TO gather information on the disease characteristics and survival rate of patients diagnosed with bronchogenic carcinoma in the respiratory medicine departments of hospitals in Asturias&#44; Spain&#46;</p> <span class="elsevierStyleSectionTitle">Patientsand methods</span><p class="elsevierStyleSimplePara elsevierViewall">This was a retrospective observational study carried out using a standardized data collection protocol&#46; All cases of lung cancer diagnosed during 2001 were included provided there was cytologic or histologic confirmation or they fulfilled a series of clinical&#44; radiological&#44; and&#47;or endoscopic criteria consistent with such a diagnosis&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Standard incidence rates adjusted to the world population were 22&#46;4&#44; 42&#46;6&#44; and 4&#46;6 per 100&#8200;000 population for the whole population&#44; men&#44; and women respectively&#46; The mean &#40;SD&#41; age was 67 &#40;10&#46;9&#41; years&#44; and 92&#37; of the patients were men&#46; Overall&#44; 98&#37; of the men and 44&#37; of the women were smokers&#46; Diagnosis was confirmed by cytologic or histologic findings in 92&#37; of patients&#44; and the majority were non-small cell tumors &#40;81&#46;4&#37;&#41;&#46; At the time of diagnosis&#44; 65&#37; of the patients had advanced disease&#44; with distant metastasis in 26&#46;6&#37; of the non-small cell cancers and 52&#46;8&#37; of the small cell cancers&#46; Patients received surgical treatment in 21&#46;3&#37; of cases&#44; chemotherapy alone or combined with radiation therapy in 43&#46;1&#37;&#44; and radiation therapy alone in 9&#46;3&#37;&#46; In 26&#46;2&#37; of patients only palliative care was given&#46; Overall&#44; median survival in weeks was 36&#46;4 &#40;95&#37; confidence interval &#91;CI&#93;&#44; 29&#46;4-43&#46;4&#41;&#46; Median survival by treatment type was as follows&#58; 69&#46;3 &#40;95&#37; CI&#44; 49-9&#46;5&#41; for surgery&#59; 39&#46;6 &#40;95&#37; CI&#44; 31&#46;2-48&#41; for chemotherapy alone or with radiation therapy&#59; 30 &#40;95&#37; CI&#44; 15&#46;4-44&#46;6&#41; for radiation therapy alone&#59; and 13&#46;3 &#40;95&#37; CI&#44; 5&#46;9-20&#46;6&#41; for patients who received palliative care alone &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;05&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">The findings with respect to age&#44; sex&#44; incidence&#44; histology&#44; extent of tumor&#44; and smoking status of patients with bronchogenic carcinoma in our region do not differ significantly from those reported for other areas of Spain&#46; Current smoking is the primary cause of the high prevalence of this disease&#46; Twenty-six percent of patients received only palliative care&#46; The percentage of patients treated with surgery was low&#46;</p>"
      ]
      "es" => array:1 [
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Conocer las caracter&#237;sticas y supervivencia del carcinoma broncog&#233;nico &#40;CB&#41; diagnosticado en las unidades de neumolog&#237;a del Principado de Asturias&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un estudio observacional retrospectivo en el que se ha empleado un protocolo com&#250;n de recogida de datos&#46; Se incluyeron los CB diagnosticados en el a&#241;o 2001 con confirmaci&#243;n citohistol&#243;gica o por concordancia basada en datos cl&#237;nicos&#44; radiol&#243;gicos y&#47;o endosc&#243;picos&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Las tasas de incidencia est&#225;ndar para toda la poblaci&#243;n&#44; varones y mujeres&#44; ajustadas a la poblaci&#243;n mundial fueron de 22&#44;4&#44; 42&#44;6 y 4&#44;6&#47;100&#46;000 habitantes&#44; respectivamente&#46; El 92&#37; era var&#243;n&#59; la edad media &#40;&#177; desviaci&#243;n est&#225;ndar&#41; fue de 67 &#177; 10&#44;9 a&#241;os&#46; Ten&#237;a h&#225;bito tab&#225;quico el 98&#37; de los varones y el 44&#37; de las mujeres&#46; Se alcanz&#243; confirmaci&#243;n citohistol&#243;gica en el 92&#37; y la mayor&#237;a era CB no microc&#237;ticos &#40;81&#44;4&#37;&#41;&#46; En el momento del diagn&#243;stico el 65&#37; de los pacientes ten&#237;a enfermedad avanzada&#44; con met&#225;stasis a distancia en el 26&#44;6&#37; de los CB no microc&#237;ticos y en el 52&#44;8&#37; de los de c&#233;lulas peque&#241;as&#46; Se trat&#243; con cirug&#237;a el 21&#44;3&#37; de los casos&#44; con quimioterapia sola o asociada a radioterapia el 43&#44;1&#37;&#44; con radioterapia exclusivamente el 9&#44;3&#37; y recibi&#243; tratamiento paliativo el 26&#44;2&#37;&#46; La mediana de supervivencia global&#44; en semanas&#44; fue de 36&#44;4 &#40;intervalo de confianza &#91;IC&#93; del 95&#37;&#44; 29&#44;4-43&#44;4&#41; y para los distintos tratamientos fue la siguiente&#58; para la cirug&#237;a&#44; 69&#44;3 &#40;IC del 95&#37;&#44; 49-9&#44;5&#41;&#59; para la quimioterapia sola o asociada a radioterapia&#44; 39&#44;6 &#40;IC del 95&#37;&#44; 31&#44;2-48&#41;&#59; para la radioterapia sola&#44; 30 &#40;IC del 95&#37;&#44; 15&#44;4-44&#44;6&#41;&#44; y para el paliativo&#44; 13&#44;3 &#40;IC del 95&#37;&#44; 5&#44;9-20&#44;6&#41; &#40;p &#60; 0&#44;05&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">En nuestra regi&#243;n&#44; las caracter&#237;sticas del CB en cuanto a edad&#44; sexo&#44; incidencia&#44; histolog&#237;a&#44; extensi&#243;n tumoral y tabaquismo no difieren significativamente de las halladas en otras &#225;reas del &#225;mbito nacional&#46; El tabaquismo activo es la causa fundamental de su alta prevalencia&#46; Se ofreci&#243; solamente tratamiento de soporte al 26&#37;&#46; El porcentaje de pacientes quir&#250;rgicos es bajo&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "REFERENCES"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:31 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "El c&#225;ncer de pulm&#243;n en Espa&#241;a&#46; Revisi&#243;n epidemiol&#243;gica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "I Izarzuzaga Lizarraga"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "1992"
                        "volumen" => "28"
                        "paginaInicial" => "311"
                        "paginaFinal" => "319"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Instituto Nacional de Estad&#237;stica"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "titulo" => "Estad&#237;sticas del movimiento natural de la poblaci&#243;n&#46; Defunciones seg&#250;n la causa de muerte"
                        "fecha" => "2001"
                        "editorial" => "Banco de datos de series TEMPUS 4&#46;02"
                        "editorialLocalizacion" => "Madrid"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "Available from&#58; http&#47;&#47;&#58;www&#46;ine&#46;es"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mortalidad por c&#225;ncer de pulm&#243;n&#58; inicio de declive en los varones de Barcelona"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "JR Villalb&#237;"
                            1 => "MI Pasar&#237;n"
                            2 => "M Nebot"
                            3 => "C Borrel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2001"
                        "volumen" => "117"
                        "paginaInicial" => "727"
                        "paginaFinal" => "731"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "WD Travis"
                            1 => "LB Travis"
                            2 => "SS Devessa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "1995"
                        "volumen" => "75"
                        "paginaInicial" => "191"
                        "paginaFinal" => "202"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8000996"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "MP Morote G&#243;mez"
                            1 => "R Alonso de la Torre L&#243;pez"
                            2 => "M Echevarr&#237;a Rodr&#237;guez"
                            3 => "MV Arg&#252;elles Su&#225;rez"
                            4 => "A Losada Garc&#237;a"
                            5 => "AF Campos de la Fuente"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "titulo" => "Incidencia del c&#225;ncer en Asturias 1990-1993&#46; Registro de Tumores del Principado de Asturias"
                        "fecha" => "1998"
                        "editorial" => "Consejer&#237;a de Servicios Sociales del Principado de Asturias&#46; Informe t&#233;cnico n&#46;&#176; 11"
                        "editorialLocalizacion" => "Oviedo"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "MP Morote G&#243;mez"
                            1 => "JA &#193;lvarez Riesgo"
                            2 => "JR Quir&#243;s Garc&#237;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "titulo" => "Supervivencia del c&#225;ncer de pulm&#243;n en Asturias"
                        "fecha" => "2001"
                        "editorial" => "Consejer&#237;a de Salud y Servicios Sanitarios"
                        "editorialLocalizacion" => "Oviedo"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "in collaboration with Sobin LH and pathologists from 14 countries"
                          "etal" => false
                          "autores" => array:5 [
                            0 => "WD Travis"
                            1 => "TV Colbi"
                            2 => "B Corrin"
                            3 => "Y Shimosato"
                            4 => "E Brambilla"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "edicion" => "3rd ed&#46;"
                        "titulo" => "World Health Organization International histological classification of tumours&#46; Histological typing of lung and pleural tumours"
                        "fecha" => "1999"
                        "editorial" => "Springer-Verlag"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Normativa actualizada &#40;1998&#41; sobre el diagn&#243;stico y estadificaci&#243;n del carcinoma broncog&#233;nico&#46; Recomendaciones SEPAR"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R Rami Porta"
                            1 => "JC Duque Medina"
                            2 => "JR Hern&#225;ndez Hern&#225;ndez"
                            3 => "A L&#243;pez Encuentra"
                            4 => "J S&#225;nchez de Cos Escu&#237;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "1998"
                        "volumen" => "39"
                        "paginaInicial" => "437"
                        "paginaFinal" => "452"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14533992"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Ministerio de Sanidad y Consumo"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:5 [
                        "edicion" => "3rd ed&#46;"
                        "titulo" => "Clasificaci&#243;n Internacional de Enfermedades &#40;9&#46;<span class="elsevierStyleSup">a</span> revisi&#243;n&#41;&#46; Modificaci&#243;n cl&#237;nica"
                        "fecha" => "1996"
                        "editorial" => "Ministerio de Sanidad y Consumo"
                        "editorialLocalizacion" => "Madrid"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "International Data Base&#46; U&#46;S&#46; Bureau of the Census"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "WWW" => array:1 [
                        "link" => "Available from&#58; http&#47;&#47;&#58;www&#46;census&#46;gov&#47;cgi-biu&#47;ipc&#47;idbagg"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Age and the treatment of lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "JS Brown"
                            1 => "D Erant"
                            2 => "C Trask"
                            3 => "AG Davidson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "1996"
                        "volumen" => "51"
                        "paginaInicial" => "564"
                        "paginaFinal" => "568"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8693434"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidencia del carcinoma broncopulmonar en Castilla y Le&#243;n durante el a&#241;o 1997&#46; Estudio multic&#233;ntrico de la Sociedad Castellano-Leonesa de Patolog&#237;a Respiratoria &#40;SOCALPAR&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Grupo de estudio del carcinoma broncopulmonar de la SOCALPAR"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2000"
                        "volumen" => "36"
                        "paginaInicial" => "313"
                        "paginaFinal" => "318"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10932340"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidencia del carcinoma broncopulmonar en Extremadura durante el a&#241;o 1998"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J S&#225;nchez de Cos Escu&#237;n"
                            1 => "JA Riesgo Miranda"
                            2 => "J Ant&#243;n Mart&#237;nez"
                            3 => "P D&#237;az Santamar&#237;a"
                            4 => "L M&#225;rquez P&#233;rez"
                            5 => "JF Medina Gallardo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2000"
                        "volumen" => "36"
                        "paginaInicial" => "381"
                        "paginaFinal" => "384"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11000927"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estudio epidemiol&#243;gico del c&#225;ncer de pulm&#243;n en el norte de la provincia de Castell&#243;n"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L Miravet"
                            1 => "S Pel&#225;ez"
                            2 => "A Paradis"
                            3 => "M Arnad"
                            4 => "F Cabad&#233;s"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2001"
                        "volumen" => "37"
                        "paginaInicial" => "298"
                        "paginaFinal" => "301"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11562314"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "C&#225;ncer de pulm&#243;n en el &#193;rea Sanitaria de A Coru&#241;a&#58; incidencia&#44; abordaje cl&#237;nico y supervivencia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C Montero"
                            1 => "M Rosales"
                            2 => "I Otero"
                            3 => "M Blanco"
                            4 => "G Rodr&#237;guez"
                            5 => "S Peterga"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2003"
                        "volumen" => "39"
                        "paginaInicial" => "209"
                        "paginaFinal" => "216"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12749803"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Smoking cessation and lung cancer in the UK since 1950&#58; combination of national statistics with two case-control studies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R Peto"
                            1 => "S Darby"
                            2 => "M Deo"
                            3 => "P Silcocks"
                            4 => "E Whitley"
                            5 => "R Doll"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2000"
                        "volumen" => "32"
                        "paginaInicial" => "322"
                        "paginaFinal" => "329"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidencia del c&#225;ncer de pulm&#243;n en la provincia de &#193;vila&#46; A&#241;o 2002 y tendencias en una d&#233;cada"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "JR Hern&#225;ndez Hern&#225;ndez"
                            1 => "JA Tapias del Pozo"
                            2 => "P Moreno Canelo"
                            3 => "A Rodr&#237;guez Puebla"
                            4 => "S Paniagua Tejo"
                            5 => "JC S&#225;nchez Marcos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2004"
                        "volumen" => "40"
                        "paginaInicial" => "304"
                        "paginaFinal" => "310"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15225516"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "C&#225;ncer de pulm&#243;n en mujeres"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A L&#243;pez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2001"
                        "volumen" => "37"
                        "paginaInicial" => "55"
                        "paginaFinal" => "57"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11181237"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management and survival of patients with lung cancer in Scotland diagnosed in 1995&#58; results of a national population based study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A Gregor"
                            1 => "CS Thomson"
                            2 => "DH Brewster"
                            3 => "PL Stroner"
                            4 => "J Davidson"
                            5 => "RJ Fergusson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2001"
                        "volumen" => "56"
                        "paginaInicial" => "212"
                        "paginaFinal" => "217"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11182014"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An epidemiological study of lung cancer&#58; history and histological types in a general population in northern Finland"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R M&#228;kitaro"
                            1 => "P P&#228;&#228;KK&#246;"
                            2 => "E Huhti"
                            3 => "R Bloigu"
                            4 => "VL Kinnula"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "1999"
                        "volumen" => "13"
                        "paginaInicial" => "436"
                        "paginaFinal" => "440"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10065694"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidencia&#44; tendencia y supervivencia del c&#225;ncer de pulm&#243;n por tipos histol&#243;gicos en Guip&#250;zcoa &#40;1983-1992&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K Solaun"
                            1 => "JM Santo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "1999"
                        "volumen" => "199"
                        "paginaInicial" => "208"
                        "paginaFinal" => "214"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10364792"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evoluci&#243;n del carcinoma broncog&#233;nico pulmonar en el norte de la provincia de Castell&#243;n 1993-2002"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L Miravent"
                            1 => "A Pradis"
                            2 => "M Pel&#225;ez"
                            3 => "M Arnal"
                            4 => "F Calad&#233;s"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2004"
                        "volumen" => "40"
                        "paginaInicial" => "553"
                        "paginaFinal" => "557"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15574268"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "United States lung carcinoma incidence trends&#46; Declining for most histologic types among males&#44; increasing among females"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "W Travis"
                            1 => "J Lubin"
                            2 => "L Ries"
                            3 => "S Devesa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/(SICI)1097-0142(19960615)77:12<2464::AID-CNCR8>3.0.CO;2-M"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "1996"
                        "volumen" => "77"
                        "paginaInicial" => "2464"
                        "paginaFinal" => "2470"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8640694"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cigarette smoking and changes in the histopathology of lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M Thun"
                            1 => "C Lally"
                            2 => "J Flannery"
                            3 => "E Calle"
                            4 => "C Heath"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Natl Cancer Inst"
                        "fecha" => "1997"
                        "volumen" => "89"
                        "paginaInicial" => "1580"
                        "paginaFinal" => "1586"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9362155"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The changing pattern of lung carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "O Auerbach"
                            1 => "L Garfinkel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "1991"
                        "volumen" => "68"
                        "paginaInicial" => "1973"
                        "paginaFinal" => "1977"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1655232"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Smoking and lung cancer&#58; scientific challenges and opportunities"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "EL Wynder"
                            1 => "D Hoffman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer Res"
                        "fecha" => "1994"
                        "volumen" => "54"
                        "paginaInicial" => "5284"
                        "paginaFinal" => "5295"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7923155"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tendencias actuales en el tratamiento del carcinoma broncopulmonar no microc&#237;tico localmente avanzado&#46; Tratamientos combinados de quimioterapia y radioterapia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J Cabrera"
                            1 => "J Mu&#241;oz"
                            2 => "J S&#225;nchez de Cos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2001"
                        "volumen" => "37"
                        "paginaInicial" => "435"
                        "paginaFinal" => "443"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11734125"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ten-year survey of lung cancer treatment and survival in hospitals of United States"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "WA Fry"
                            1 => "JL Phillips"
                            2 => "HR Menck"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "C&#225;ncer"
                        "fecha" => "1999"
                        "volumen" => "86"
                        "paginaInicial" => "1867"
                        "paginaFinal" => "1876"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10547562"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Variation in survival of patients with lung cancer in Europe 1985-1989&#46; EUROCARE Working Group"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "MLG Janssen-Heijnen"
                            1 => "G Gatte"
                            2 => "D Forman"
                            3 => "R Capoceccia"
                            4 => "JWW Coebergh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cancer"
                        "fecha" => "1998"
                        "volumen" => "34"
                        "paginaInicial" => "2191"
                        "paginaFinal" => "2196"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10070286"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Supervivencia global a largo plazo en el c&#225;ncer de pulm&#243;n&#46; An&#225;lisis de una serie de 610 pacientes seleccionados"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J S&#225;nchez de Cos"
                            1 => "C Disdier"
                            2 => "J Corral"
                            3 => "JA Riesco"
                            4 => "MA Sojo"
                            5 => "JF Masa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2004"
                        "volumen" => "40"
                        "paginaInicial" => "268"
                        "paginaFinal" => "274"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15161593"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Survival analysis of untreated patients with non-small-cell lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E Vrdoljak"
                            1 => "K Mise"
                            2 => "D Sapunar"
                            3 => "A Rozga"
                            4 => "M Marusic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1994"
                        "volumen" => "106"
                        "paginaInicial" => "1797"
                        "paginaFinal" => "1800"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7988203"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15792129/0000004100000009/v1_201305150225/S1579212906602668/v1_201305150225/en/main.assets"
  "Apartado" => null
  "PDF" => "https://static.elsevier.es/multimedia/15792129/0000004100000009/v1_201305150225/S1579212906602668/v1_201305150225/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212906602668?idApp=UINPBA00003Z"
]
Share
Journal Information
Vol. 41. Issue 9.
Pages 478-483 (September 2005)
Share
Share
Download PDF
More article options
Vol. 41. Issue 9.
Pages 478-483 (September 2005)
Original Articles
Full text access
Characteristics of Lung Cancer in a Region in Northern Spain
Visits
4287
M.A. Alonso-Fernández
Corresponding author
migu67@separ.es

Correspondence: Dr. M.A. Alonso-Fernández. Servicio de Neumología I. Hospital Universitario Central de Asturias. Dr. Bellmunt, s/n. 33006 Oviedo. Asturias. España
, M. García-Clemente, C. Escudero-Bueno, for the Asturian Society of Respiratory Disease (ASTURPAR) Lung Cancer Working Group (GACP)
This item has received
Article information
Abstract
Bibliography
Download PDF
Statistics
Objective

TO gather information on the disease characteristics and survival rate of patients diagnosed with bronchogenic carcinoma in the respiratory medicine departments of hospitals in Asturias, Spain.

Patientsand methods

This was a retrospective observational study carried out using a standardized data collection protocol. All cases of lung cancer diagnosed during 2001 were included provided there was cytologic or histologic confirmation or they fulfilled a series of clinical, radiological, and/or endoscopic criteria consistent with such a diagnosis.

Results

Standard incidence rates adjusted to the world population were 22.4, 42.6, and 4.6 per 100 000 population for the whole population, men, and women respectively. The mean (SD) age was 67 (10.9) years, and 92% of the patients were men. Overall, 98% of the men and 44% of the women were smokers. Diagnosis was confirmed by cytologic or histologic findings in 92% of patients, and the majority were non-small cell tumors (81.4%). At the time of diagnosis, 65% of the patients had advanced disease, with distant metastasis in 26.6% of the non-small cell cancers and 52.8% of the small cell cancers. Patients received surgical treatment in 21.3% of cases, chemotherapy alone or combined with radiation therapy in 43.1%, and radiation therapy alone in 9.3%. In 26.2% of patients only palliative care was given. Overall, median survival in weeks was 36.4 (95% confidence interval [CI], 29.4-43.4). Median survival by treatment type was as follows: 69.3 (95% CI, 49-9.5) for surgery; 39.6 (95% CI, 31.2-48) for chemotherapy alone or with radiation therapy; 30 (95% CI, 15.4-44.6) for radiation therapy alone; and 13.3 (95% CI, 5.9-20.6) for patients who received palliative care alone (P<.05).

Conclusions

The findings with respect to age, sex, incidence, histology, extent of tumor, and smoking status of patients with bronchogenic carcinoma in our region do not differ significantly from those reported for other areas of Spain. Current smoking is the primary cause of the high prevalence of this disease. Twenty-six percent of patients received only palliative care. The percentage of patients treated with surgery was low.

Key Words:
Lung cancer
Incidence
Survival
Objetivo

Conocer las características y supervivencia del carcinoma broncogénico (CB) diagnosticado en las unidades de neumología del Principado de Asturias.

Pacientes y métodos

Se ha realizado un estudio observacional retrospectivo en el que se ha empleado un protocolo común de recogida de datos. Se incluyeron los CB diagnosticados en el año 2001 con confirmación citohistológica o por concordancia basada en datos clínicos, radiológicos y/o endoscópicos.

Resultados

Las tasas de incidencia estándar para toda la población, varones y mujeres, ajustadas a la población mundial fueron de 22,4, 42,6 y 4,6/100.000 habitantes, respectivamente. El 92% era varón; la edad media (± desviación estándar) fue de 67 ± 10,9 años. Tenía hábito tabáquico el 98% de los varones y el 44% de las mujeres. Se alcanzó confirmación citohistológica en el 92% y la mayoría era CB no microcíticos (81,4%). En el momento del diagnóstico el 65% de los pacientes tenía enfermedad avanzada, con metástasis a distancia en el 26,6% de los CB no microcíticos y en el 52,8% de los de células pequeñas. Se trató con cirugía el 21,3% de los casos, con quimioterapia sola o asociada a radioterapia el 43,1%, con radioterapia exclusivamente el 9,3% y recibió tratamiento paliativo el 26,2%. La mediana de supervivencia global, en semanas, fue de 36,4 (intervalo de confianza [IC] del 95%, 29,4-43,4) y para los distintos tratamientos fue la siguiente: para la cirugía, 69,3 (IC del 95%, 49-9,5); para la quimioterapia sola o asociada a radioterapia, 39,6 (IC del 95%, 31,2-48); para la radioterapia sola, 30 (IC del 95%, 15,4-44,6), y para el paliativo, 13,3 (IC del 95%, 5,9-20,6) (p < 0,05).

Conclusiones

En nuestra región, las características del CB en cuanto a edad, sexo, incidencia, histología, extensión tumoral y tabaquismo no difieren significativamente de las halladas en otras áreas del ámbito nacional. El tabaquismo activo es la causa fundamental de su alta prevalencia. Se ofreció solamente tratamiento de soporte al 26%. El porcentaje de pacientes quirúrgicos es bajo.

Palabras clave:
Cáncer de pulmón
Incidencia
Supervivencia
Full text is only aviable in PDF
REFERENCES
[1]
I Izarzuzaga Lizarraga.
El cáncer de pulmón en España. Revisión epidemiológica.
Arch Bronconeumol, 28 (1992), pp. 311-319
[2]
Instituto Nacional de Estadística.
Estadísticas del movimiento natural de la población. Defunciones según la causa de muerte, Banco de datos de series TEMPUS 4.02, (2001),
[3]
JR Villalbí, MI Pasarín, M Nebot, C Borrel.
Mortalidad por cáncer de pulmón: inicio de declive en los varones de Barcelona.
Med Clin (Barc), 117 (2001), pp. 727-731
[4]
WD Travis, LB Travis, SS Devessa.
Lung cancer.
Cancer, 75 (1995), pp. 191-202
[5]
MP Morote Gómez, R Alonso de la Torre López, M Echevarría Rodríguez, MV Argüelles Suárez, A Losada García, AF Campos de la Fuente, et al.
Incidencia del cáncer en Asturias 1990-1993. Registro de Tumores del Principado de Asturias, Consejería de Servicios Sociales del Principado de Asturias. Informe técnico n.° 11, (1998),
[6]
MP Morote Gómez, JA Álvarez Riesgo, JR Quirós García.
Supervivencia del cáncer de pulmón en Asturias, Consejería de Salud y Servicios Sanitarios, (2001),
[7]
WD Travis, TV Colbi, B Corrin, Y Shimosato, E Brambilla, in collaboration with Sobin LH and pathologists from 14 countries.
World Health Organization International histological classification of tumours. Histological typing of lung and pleural tumours, 3rd ed., Springer-Verlag, (1999),
[8]
R Rami Porta, JC Duque Medina, JR Hernández Hernández, A López Encuentra, J Sánchez de Cos Escuín.
Normativa actualizada (1998) sobre el diagnóstico y estadificación del carcinoma broncogénico. Recomendaciones SEPAR.
Arch Bronconeumol, 39 (1998), pp. 437-452
[9]
Ministerio de Sanidad y Consumo.
Clasificación Internacional de Enfermedades (9.a revisión). Modificación clínica, 3rd ed., Ministerio de Sanidad y Consumo, (1996),
[10]
International Data Base. U.S. Bureau of the Census.
[11]
JS Brown, D Erant, C Trask, AG Davidson.
Age and the treatment of lung cancer.
Thorax, 51 (1996), pp. 564-568
[12]
Grupo de estudio del carcinoma broncopulmonar de la SOCALPAR.
Incidencia del carcinoma broncopulmonar en Castilla y León durante el año 1997. Estudio multicéntrico de la Sociedad Castellano-Leonesa de Patología Respiratoria (SOCALPAR).
Arch Bronconeumol, 36 (2000), pp. 313-318
[13]
J Sánchez de Cos Escuín, JA Riesgo Miranda, J Antón Martínez, P Díaz Santamaría, L Márquez Pérez, JF Medina Gallardo, et al.
Incidencia del carcinoma broncopulmonar en Extremadura durante el año 1998.
Arch Bronconeumol, 36 (2000), pp. 381-384
[14]
L Miravet, S Peláez, A Paradis, M Arnad, F Cabadés.
Estudio epidemiológico del cáncer de pulmón en el norte de la provincia de Castellón.
Arch Bronconeumol, 37 (2001), pp. 298-301
[15]
C Montero, M Rosales, I Otero, M Blanco, G Rodríguez, S Peterga, et al.
Cáncer de pulmón en el Área Sanitaria de A Coruña: incidencia, abordaje clínico y supervivencia.
Arch Bronconeumol, 39 (2003), pp. 209-216
[16]
R Peto, S Darby, M Deo, P Silcocks, E Whitley, R Doll.
Smoking cessation and lung cancer in the UK since 1950: combination of national statistics with two case-control studies.
BMJ, 32 (2000), pp. 322-329
[17]
JR Hernández Hernández, JA Tapias del Pozo, P Moreno Canelo, A Rodríguez Puebla, S Paniagua Tejo, JC Sánchez Marcos.
Incidencia del cáncer de pulmón en la provincia de Ávila. Año 2002 y tendencias en una década.
Arch Bronconeumol, 40 (2004), pp. 304-310
[18]
A López.
Cáncer de pulmón en mujeres.
Arch Bronconeumol, 37 (2001), pp. 55-57
[19]
A Gregor, CS Thomson, DH Brewster, PL Stroner, J Davidson, RJ Fergusson, et al.
Management and survival of patients with lung cancer in Scotland diagnosed in 1995: results of a national population based study.
Thorax, 56 (2001), pp. 212-217
[20]
R Mäkitaro, P PääKKö, E Huhti, R Bloigu, VL Kinnula.
An epidemiological study of lung cancer: history and histological types in a general population in northern Finland.
Eur Respir J, 13 (1999), pp. 436-440
[21]
K Solaun, JM Santo.
Incidencia, tendencia y supervivencia del cáncer de pulmón por tipos histológicos en Guipúzcoa (1983-1992).
Rev Clin Esp, 199 (1999), pp. 208-214
[22]
L Miravent, A Pradis, M Peláez, M Arnal, F Caladés.
Evolución del carcinoma broncogénico pulmonar en el norte de la provincia de Castellón 1993-2002.
Arch Bronconeumol, 40 (2004), pp. 553-557
[23]
W Travis, J Lubin, L Ries, S Devesa.
United States lung carcinoma incidence trends. Declining for most histologic types among males, increasing among females.
[24]
M Thun, C Lally, J Flannery, E Calle, C Heath.
Cigarette smoking and changes in the histopathology of lung cancer.
J Natl Cancer Inst, 89 (1997), pp. 1580-1586
[25]
O Auerbach, L Garfinkel.
The changing pattern of lung carcinoma.
Cancer, 68 (1991), pp. 1973-1977
[26]
EL Wynder, D Hoffman.
Smoking and lung cancer: scientific challenges and opportunities.
Cancer Res, 54 (1994), pp. 5284-5295
[27]
J Cabrera, J Muñoz, J Sánchez de Cos.
Tendencias actuales en el tratamiento del carcinoma broncopulmonar no microcítico localmente avanzado. Tratamientos combinados de quimioterapia y radioterapia.
Arch Bronconeumol, 37 (2001), pp. 435-443
[28]
WA Fry, JL Phillips, HR Menck.
Ten-year survey of lung cancer treatment and survival in hospitals of United States.
Cáncer, 86 (1999), pp. 1867-1876
[29]
MLG Janssen-Heijnen, G Gatte, D Forman, R Capoceccia, JWW Coebergh.
Variation in survival of patients with lung cancer in Europe 1985-1989. EUROCARE Working Group.
Eur J Cancer, 34 (1998), pp. 2191-2196
[30]
J Sánchez de Cos, C Disdier, J Corral, JA Riesco, MA Sojo, JF Masa.
Supervivencia global a largo plazo en el cáncer de pulmón. Análisis de una serie de 610 pacientes seleccionados.
Arch Bronconeumol, 40 (2004), pp. 268-274
[31]
E Vrdoljak, K Mise, D Sapunar, A Rozga, M Marusic.
Survival analysis of untreated patients with non-small-cell lung cancer.
Chest, 106 (1994), pp. 1797-1800
Copyright © 2005. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?