Pronóstico de la infiltración ganglionar mediastínica (N2) en pacientes con carcinoma de pulmón de células no microcelulares (CPCNM) intervenidos con intenciones curativas
Prognosis in mediastinal lymph node invasion (N2) in patients with surgically treated non-small cell carcinoma of the lung
J. Durán Cantolla*
Servicio de Neumología. Hospital de Txagorritxu. Vitoria-Gasteiz
J.J. González Macíasa, R. Agüero Balbínb, M. Carbajo Carbajoc, F.J. Ortega Moralesc, M. Hernández Alonsoc, R. Ondiviela Graciad
a Servicios de Medicina Interna, Hospital General Marqués de Valdecilla. Santander
b Servicios de Neumología, Hospital General Marqués de Valdecilla. Santander
c Servicios de Cirugía Torácica, Hospital General Marqués de Valdecilla. Santander
d Servicios de Anatomía Patológica, Hospital General Marqués de Valdecilla. Santander
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"apellidos" => "Agüero Balbín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Carbajo Carbajo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0020" ] ] ] 3 => array:3 [ "nombre" => "F.J." "apellidos" => "Ortega Morales" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "M." "apellidos" => "Hernández Alonso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "R." "apellidos" => "Ondiviela Gracia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicios de Medicina Interna, Hospital General Marqués de Valdecilla. Santander" "etiqueta" => "a" "identificador" => "aff0010" ] 1 => array:3 [ "entidad" => "Servicios de Neumología, Hospital General Marqués de Valdecilla. Santander" "etiqueta" => "b" "identificador" => "aff0015" ] 2 => array:3 [ "entidad" => "Servicios de Cirugía Torácica, Hospital General Marqués de Valdecilla. Santander" "etiqueta" => "c" "identificador" => "aff0020" ] 3 => array:3 [ "entidad" => "Servicios de Anatomía Patológica, Hospital General Marqués de Valdecilla. Santander" "etiqueta" => "d" "identificador" => "aff0025" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Prognosis in mediastinal lymph node invasion (N<span class="elsevierStyleInf">2</span>) in patients with surgically treated non-small cell carcinoma of the lung" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Se presenta un estudio prospectivo sobre 148 pacientes diagnosticados de CPCNM intervenidos con finalidad terapéutica y seguidos entre 5 y 7 años, en los que se analiza el valor pronóstico de la invasión ganglionar mediastínica (N2) y su supervivencia a S años según sus diferentes características. De ellos, 42 pacientes (28,4%) eran N2. La supervivencia para esta población fue del 9%. De este grupo se seleccionaron 27 pacientes T2N2 (cuya supervivencia fue del 13%) y se dividieron según la infiltración ganglionar fuera intranodal (supervivencia del 39%) o extracapsular (supervivencia del 5%) (p ≤ 0,05). Así mismo, se consideró el valor pronóstico de las diferentes áreas ganglionares según los mapas propuestos por la American Thoracic Society (ATS). No hubo supervivientes para las áreas 2, 8 y 9 y ninguno sobrevivió más de 18 meses cuando estuvieron invadidas más de dos áreas. Por otra parte, se encontraron diferencias significativas en la supervivencia para la invasión de las áreas 10 y 11. Las conclusiones fueron: a) el N2 analizado de forma global tiene tan escasa supervivencia que no justifica la cirugía salvo bajo criterios de selección; b) la invasión extracapsular proscribe la cirugía con intenciones curativas; c) el valor pronóstico de las áreas ganglionares no está completamente esclarecido; sin embargo, las áreas 2, 8 y 9 parecen tener peor pronóstico que el resto, así como la infiltración de más de dos áreas, y d) el área 10 está mejor ubicada como N2 que como N,.</p></span>" ] "en" => array:1 [ "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">In this prospective study of 148 surgically treated patients with non-small cell carcinoma of the lung (NSCCL) who were followed for 5 to 7 years, we analyzed the prognostic value of mediastinic lymph node invasion (N2) and survival after 5 years depending on different characteristics. Forty-two (28.4%) patients were N2. Survival in this sample was 9%. Twenty-seven T2N2 patients (among whom survival was 13%) were selected from this group and classified according to whether lymph node invasion was intranodal (survival 39%) or extracapsular (survival 5%) (p ≤ 0.05). We also evaluated the prognostic value of different ganglionic areas in accordance to the maps suggested by the American Thoracic Society (ATS). There were no survivors for areas 2, 8 and 9, and no patient with invasion of more than two areas lived more than 18 months. Significant differences in survival were found among patients with invasion of areas 10 and 11. We conclude a) that global analysis of N, is of such little value in predicting survival that surgery is not justified unless screening criteria are applied; b) that extracapsular invasion rules out surgical treatment; c) that the prognostic value of ganglionic areas is not entirely clear, although the prognosis seems to be poorer for invasion of areas 2, 8 and 9 or invasion of more than 2 areas, and d) that invasion of area 10 would appear to be better classified as N2 than as N1</p></span>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 6 | 10 |
| 2024 October | 28 | 52 | 80 |
| 2024 September | 36 | 43 | 79 |
| 2024 August | 49 | 48 | 97 |
| 2024 July | 51 | 50 | 101 |
| 2024 June | 54 | 36 | 90 |
| 2024 May | 47 | 44 | 91 |
| 2024 April | 38 | 39 | 77 |
| 2024 March | 37 | 45 | 82 |
| 2024 February | 35 | 61 | 96 |
| 2024 January | 0 | 35 | 35 |
| 2023 December | 0 | 54 | 54 |
| 2023 November | 0 | 31 | 31 |
| 2023 October | 3 | 37 | 40 |
| 2023 September | 4 | 17 | 21 |
| 2023 August | 7 | 48 | 55 |
| 2023 July | 2 | 41 | 43 |
| 2023 June | 0 | 11 | 11 |
| 2023 May | 0 | 2 | 2 |
| 2023 April | 0 | 2 | 2 |
| 2023 March | 5 | 3 | 8 |
| 2023 February | 39 | 27 | 66 |
| 2023 January | 27 | 41 | 68 |
| 2022 December | 38 | 37 | 75 |
| 2022 November | 46 | 27 | 73 |
| 2022 October | 26 | 53 | 79 |
| 2022 September | 20 | 26 | 46 |
| 2022 August | 30 | 44 | 74 |
| 2022 July | 29 | 41 | 70 |
| 2022 June | 26 | 37 | 63 |
| 2022 May | 28 | 37 | 65 |
| 2022 April | 24 | 35 | 59 |
| 2022 March | 33 | 39 | 72 |
| 2022 February | 34 | 22 | 56 |
| 2022 January | 23 | 36 | 59 |
| 2021 December | 24 | 34 | 58 |
| 2021 November | 20 | 32 | 52 |
| 2021 October | 11 | 38 | 49 |
| 2021 September | 16 | 28 | 44 |
| 2021 August | 14 | 42 | 56 |
| 2021 July | 16 | 33 | 49 |
| 2021 June | 17 | 22 | 39 |
| 2021 May | 14 | 28 | 42 |
| 2021 April | 26 | 28 | 54 |
| 2021 March | 19 | 27 | 46 |
| 2021 February | 24 | 16 | 40 |
| 2021 January | 16 | 19 | 35 |
| 2020 December | 9 | 13 | 22 |
| 2020 November | 11 | 22 | 33 |
| 2020 October | 20 | 16 | 36 |
| 2020 September | 9 | 15 | 24 |
| 2020 August | 13 | 19 | 32 |
| 2020 July | 21 | 13 | 34 |
| 2020 June | 12 | 11 | 23 |
| 2020 May | 15 | 13 | 28 |
| 2020 April | 13 | 9 | 22 |
| 2020 March | 9 | 9 | 18 |
| 2020 February | 18 | 24 | 42 |
| 2020 January | 20 | 25 | 45 |
| 2019 December | 21 | 31 | 52 |
| 2019 November | 9 | 13 | 22 |
| 2019 October | 11 | 12 | 23 |
| 2019 September | 14 | 22 | 36 |
| 2019 August | 13 | 10 | 23 |
| 2019 July | 6 | 29 | 35 |
| 2019 June | 19 | 48 | 67 |
| 2019 May | 25 | 44 | 69 |
| 2019 April | 34 | 58 | 92 |
| 2019 March | 14 | 22 | 36 |
| 2019 February | 8 | 18 | 26 |
| 2019 January | 3 | 11 | 14 |
| 2018 December | 5 | 16 | 21 |
| 2018 November | 26 | 22 | 48 |
| 2018 October | 46 | 23 | 69 |
| 2018 September | 15 | 18 | 33 |
| 2018 May | 8 | 1 | 9 |
| 2018 April | 24 | 7 | 31 |
| 2018 March | 4 | 5 | 9 |
| 2018 February | 7 | 7 | 14 |
| 2018 January | 4 | 5 | 9 |
| 2017 December | 11 | 26 | 37 |
| 2017 November | 11 | 46 | 57 |
| 2017 October | 12 | 26 | 38 |
| 2017 September | 11 | 42 | 53 |
| 2017 August | 10 | 30 | 40 |
| 2017 July | 7 | 36 | 43 |
| 2017 June | 14 | 46 | 60 |
| 2017 May | 9 | 47 | 56 |
| 2017 April | 13 | 43 | 56 |
| 2017 March | 7 | 40 | 47 |
| 2017 February | 6 | 29 | 35 |
| 2017 January | 5 | 23 | 28 |
| 2016 December | 12 | 20 | 32 |
| 2016 November | 22 | 32 | 54 |
| 2016 October | 21 | 37 | 58 |
| 2016 September | 23 | 32 | 55 |
| 2016 August | 34 | 21 | 55 |
| 2016 July | 40 | 19 | 59 |
| 2016 June | 30 | 10 | 40 |
| 2016 May | 29 | 9 | 38 |
| 2016 April | 13 | 0 | 13 |
| 2016 March | 14 | 0 | 14 |
| 2016 February | 12 | 1 | 13 |
| 2016 January | 14 | 6 | 20 |
| 2015 December | 23 | 13 | 36 |
| 2015 November | 33 | 5 | 38 |
| 2015 October | 3 | 1 | 4 |
| 2015 September | 1 | 0 | 1 |
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