Carta al Director
Mortalidad en cáncer de pulmón y en enfermedad pulmonar obstructiva crónica
Mortality in Lung Cancer and COPD
Joan B. Soriano
Programa de Epidemiología e Investigación Clínica, Fundación Caubet-CIMERA Illes Balears, Hospital Joan March, Bunyola, Mallorca, España
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Menos trabajo a cambio de una terapia limitada" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "280" "paginaFinal" => "281" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "The Athlete With Asthma and the new 2010 Anti-Doping Regulations. 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Soriano" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Joan B." "apellidos" => "Soriano" "email" => array:1 [ 0 => "jbsoriano@caubet-cimera.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Programa de Epidemiología e Investigación Clínica, Fundación Caubet-CIMERA Illes Balears, Hospital Joan March, Bunyola, Mallorca, España" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Mortality in Lung Cancer and COPD" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p class="elsevierStylePara elsevierViewall">En el interesante artículo de Abal et al<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a> titulado «Cáncer de pulmón y EPOC: una asociación frecuente» se evalúa una amplia cohorte clínica de 996 pacientes obtenida a lo largo de 5 años. Su primera conclusión es relevante y actual: la asociación de ambas patologías es frecuente, y el diagnóstico histológico más frecuente es el carcinoma escamoso; sin embargo, es más difícil asimilar su segunda e importante conclusión, que la supervivencia de los pacientes con cáncer de pulmón y EPOC es mayor que en los pacientes con cáncer de pulmón sin EPOC. Este segundo hallazgo parece contrario a todo lo publicado anteriormente respecto a las comorbilidades de ambas patologías, remitiéndonos a la excelente revisión en estas mismas páginas por Díez Herranz<a class="elsevierStyleCrossRef" href="#bib2"><span class="elsevierStyleSup">2</span></a> en 2001 u otras fuentes más recientes<a class="elsevierStyleCrossRefs" href="#bib3"><span class="elsevierStyleSup">3–5</span></a>. Incluso se ha descrito también una mayor mortalidad en no fumadores con ambas condiciones<a class="elsevierStyleCrossRef" href="#bib6"><span class="elsevierStyleSup">6</span></a>. Los mismos autores se sorprenden, hipotetizando en la «Discusión» sobre un posible sesgo de diagnóstico y sobre que quizás los pacientes con EPOC se diagnostican de cáncer de pulmón antes que los pacientes sin EPOC. Probablemente, un reanálisis de sus datos permitiría reconsiderar dicha conclusión, basada en la visualización de las curvas de supervivencia de Kaplan-Meier (fig. 1) y obteniendo una diferencia significativa de p=0,016 mediante la prueba de Mantel-Haenszel (rangos logarítmicos). Quizás y debido a las diferencias basales entre ambos grupos (tabla 4), sería más apropiado realizar un modelo de regresión de Cox ajustado por las variables significativas en el análisis bivariado, incluyendo sexo, edad, tabaquismo y estadio del cáncer de pulmón u otras. El tiempo en meses/años entre el diagnóstico de EPOC y el de cáncer también podría modelizarse. Finalmente, aunque en «Métodos» se indica que el diagnóstico y la clasificación de la EPOC se efectuaron según las directrices GOLD, sería de interés repetir el mismo modelo eliminando aquellos EPOC diagnosticados en ausencia de espirometría.</p><p class="elsevierStylePara elsevierViewall">Aunque tal como aseveran Brody y Spira<a class="elsevierStyleCrossRef" href="#bib3"><span class="elsevierStyleSup">3</span></a> la mayoría de fumadores nunca desarrollarán ni EPOC ni cáncer de pulmón, es importante profundizar en la relación entre ambos.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cáncer de pulmón y EPOC: una asociación frecuente" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Abal Arca" 1 => "I. Parente Lamelas" 2 => "R. Almazán Ortega" 3 => "J. Blanco Pérez" 4 => "M.E. Toubes Navarro" 5 => "P. Marcos Velázquez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2009.07.005" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2009" "volumen" => "45" "paginaInicial" => "502" "paginaFinal" => "507" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19748721" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enfermedad pulmonar obstructiva crónica y cáncer de pulmón:implicaciones prácticas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Díez-Herranz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2001" "volumen" => "37" "paginaInicial" => "240" "paginaFinal" => "247" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11412516" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "State of the art. Chronic obstructive pulmonary disease, inflammation, and lung cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.S. Brody" 1 => "A. Spira" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1513/pats.200603-089MS" "Revista" => array:6 [ "tituloSerie" => "Proc Am Thorac Soc" "fecha" => "2006" "volumen" => "3" "paginaInicial" => "535" "paginaFinal" => "537" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16921139" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Kiri VA, Soriano JB, Visick G, Fabbri L. Recent trends in lung cancer and its association with COPD: an analysis using the UK GP Research Database. Prim Care Respir J 2009 Sep 15. pii: pcrj-2009-02-0021. <a class="elsevierStyleInterRef" href="http://dx.doi.org/10.4104/pcrj.2009.00048">doi:10.4104/pcrj.2009.00048</a>. [Epub ahead of print]" ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inhaled corticosteroids and risk of lung cancer among COPD patients who quit smoking" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V.A. Kiri" 1 => "L.M. Fabbri" 2 => "K.J. Davis" 3 => "J.B. Soriano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2008.07.024" "Revista" => array:6 [ "tituloSerie" => "Respir Med" "fecha" => "2009" "volumen" => "103" "paginaInicial" => "85" "paginaFinal" => "90" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18793832" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic obstructive pulmonary disease is associated with lung cancer mortality in a prospective study of never smokers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.C. Turner" 1 => "Y. Chen" 2 => "D. Krewski" 3 => "E.E. Calle" 4 => "M.J. Thun" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200612-1792OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2007" "volumen" => "176" "paginaInicial" => "285" "paginaFinal" => "290" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17478615" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000004600000005/v1_201305150319/S0300289609004608/v1_201305150319/es/main.assets" "Apartado" => array:4 [ "identificador" => "9222" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the Director / Cartas al Director" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000004600000005/v1_201305150319/S0300289609004608/v1_201305150319/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289609004608?idApp=UINPBA00003Z" ]
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