Chemotherapy and Survival in Advanced Non-Small Cell Lung Carcinoma: Is Pneumologists' Skepticism Justified?

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Non-Small Cell Lung Carcinoma: Is Pneumologists' Skepticism Justified?" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "273" "paginaFinal" => "277" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José Antonio Gullón Blanco, Isabel Suárez Toste, Ramón Fernández Álvarez, Gemma Rubinos Cuadrado, Agustín Medina González, Rosa Galindo Morales, Isidro Jesús González Martín" "autores" => array:7 [ 0 => array:5 [ "preGrado" => "Dr." "nombre" => "José Antonio" "apellidos" => "Gullón Blanco" "email" => array:1 [ 0 => "jose993@separ.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor1" ] ] ] 1 => array:2 [ "nombre" => "Isabel" "apellidos" => "Suárez Toste" ] 2 => array:2 [ "nombre" => "Ramón" "apellidos" => "Fernández Álvarez" ] 3 => array:2 [ "nombre" => "Gemma" "apellidos" => "Rubinos Cuadrado" ] 4 => array:2 [ "nombre" => "Agustín" "apellidos" => "Medina González" ] 5 => array:2 [ "nombre" => "Rosa" "apellidos" => "Galindo Morales" ] 6 => array:2 [ "nombre" => "Isidro Jesús" "apellidos" => "González Martín" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Neumología, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr. J.A. Gullón Blanco La Marina, 49,4.° izqda. Edificio Gaviota C. 38001 Santa Cruz de Tenerife. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-09-26" "fechaAceptado" => "2005-11-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154393" "palabras" => array:4 [ 0 => "Non-small lung carcinoma" 1 => "Advanced stages" 2 => "Chemotherapy" 3 => "Survival" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154394" "palabras" => array:4 [ 0 => "Carcinoma de pulmón no microcítico" 1 => "Estadios avanzados" 2 => "Quimioterapia" 3 => "Supervivencia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "ObjectiveFew studies have assessed whether the advantage chemotherapy has been shown to have in treating advanced non-small lung carcinoma in clinical trials is transferrable to normal health care activity. This could explain the skepticism of a large number of pneumologists towards this treatment. The objective of our study was to analyze prognostic factors related to survival and to see whether cytostatic treatment was an independent predictor. Patients and methodsPatients enrolled in the study had been diagnosed with non-small cell carcinoma in stages IV or IIIB with pleural or N2-N3 involvement and with [a performance status of 2 or below according to the Eastern Cooperative Oncology Group (ECOG). Survival was analyzed with regard to the following variables: age, sex, comorbidity, weight loss, laboratory test results, histological type, ECOG score, TNM staging, and treatment. The Student t test, the χ2 test, the Kaplan-Meier method, the log-rank test, and Cox regression analysis were used in the statistical analysis. ResultsWe enrolled 190 patients (157 men and 33 women) with a mean (SD) age of 61.75 (10.85) years (range, 33–85 years). Of these patients, 144 received cytostatic treatment and 46 palliative treatment. The median survival was 31 weeks and was related to absence of weight loss (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.26–2.39; P=.001), cytostatic treatment (HR, 1.85; 95% CI, 1.25–2.76; P=.002), and ECOG score of 0 to 1 (HR, 2.84; 95% CI, 1.62–5.00; P=.0001). In patients with ECOG scores of 0 to 1, weight loss and treatment were significant prognostic factors. Survival in the ECOG 2 group was 15 weeks for patients undergoing cytostatic treatment and 11 weeks for patients with symptomatic treatment. ConclusionsIn normal clinical practice, chemotherapy significantly prolongs survival in patients with performance status of less than 2, more time being gained if there is no associated weight loss. We conclude that the reluctance shown by many pneumologists toward using this treatment is not entirely justified." ] "es" => array:1 [ "resumen" => "ObjetivoPocas series han valorado si el beneficio que en los ensayos clínicos muestra la quimioterapia en el carcinoma broncogeAnico no microcítico en estadios avanzados es trasladable a la actividad asistencial habitual, lo que podría explicar el escepticismo de gran parte de los neumólogos. En este contexto, el objetivo de nuestro trabajo es analizar factores pronósticos relacionados con la supervivencia y si el tratamiento citostático influye de manera independiente. Pacientes y métodosSe incluyó a pacientes diagnosticados de carcinoma no microcítico en estadios IV y IIIb con afectación pleural o N2-N3 y grado de actividad, según el Eastern Cooperative Oncology Group (ECOG), menor o igual a 2. Se relacionaron con la supervivencia las siguientes variables: edad, sexo, comorbilidad, peArdida de peso, pará-metros analíticos, tipo histológico, ECOG, TNM y tratamiento. Para el análisis estadístico se emplearon las pruebas de la t de Student, de la χ2, el método de Kaplan-Meier, el test de rangos logarítmicos y el modelo de regresión de Cox. ResultadosSe incluyó en el estudio a 190 enfermos (157 varones y 33 mujeres), con una edad media (± desviación estándar) de 61,75 ± 10,85 años (rango: 33–85), de los cuales 144 recibieron tratamiento citostático y 46 paliativo. La mediana de supervivencia fue de 31 semanas y se relacionó con: ausencia de peArdida de peso (razón de probabilidad [HR] = 1,73; intervalo de confianza [IC] del 95%, 1,26–2,39; p = 0,001), tratamiento citostático (HR = 1,85; IC del 95%, 1,25–2,76; p = 0,002) y ECOG 0–1 (HR = 2,84; IC del 95%, 1,62–5,00; p = 0,0001). En el grupo ECOG 0–1 mostraban significado pronóstico la pérdida de peso y el tratamiento. La supervivencia en ECOG 2 fue de 15 semanas en los pacientes con tratamiento citostático y de 11 semanas en aquellos con tratamiento sintomático. ConclusionesEn la práctica clínica habitual la quimioterapia prolonga la supervivencia significativamente en los pacientes con grado de actividad inferior a 2 y esta ganancia es mayor si no existe pérdida de peso asociada. Por tanto, creemos que la opinión poco favorable que muestra gran parte de los neumólogos acerca de este tratamiento no parece plenamente justificada." ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chemotherapy in advanced non-small cell lung cancer: a meta-analysis using update data on individual patients from 52 randomised clinical trials" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Non-small Cell Lung Cancer Collaborative Group" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "BMJ" "fecha" => "1995" "volumen" => "311" "paginaInicial" => "899" "paginaFinal" => "909" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7580546" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chemotherapy for advanced non-small-cell lung cancer: how much benefit is enough?" 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