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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Of all malignant neoplasms&#44; lung cancer &#40;LC&#41; causes the greatest number of deaths worldwide&#46; Prognosis is poor&#44; with 5-year survival rates of between 10&#37; and 20&#37; in most countries&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;2</span></a> For many years&#44; the possibility of long-term survival was limited almost exclusively to patients who were candidates for complete surgical resection&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a> However&#44; in the last 25 years&#44; new chemotherapy &#40;CT&#41; regimens combined with various thoracic radiotherapy &#40;TRT&#41; programs have been introduced&#44; increasing favorable responses in patients with advanced locoregional disease&#44; some of whom have achieved long-term survival&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">4&#8211;6</span></a> More recently&#44; new drugs aimed at specific molecular targets have been developed for the treatment of selected LC subgroups with certain molecular and genetic features&#46; These compounds have provided favorable and enduring outcomes in some stage IV patients&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a> although there is still very little data available on 5-year life expectancy&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Late disease recurrence and second primary tumors &#40;SPT&#41; are relatively common among the small proportion of patients who achieve prolonged survival&#46; Reports have been published on this topic in resected patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">8&#8211;12</span></a> but few have focused on the evolution of long-term LC survivors who did not receive surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">13&#8211;15</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In this study&#44; we analyzed the evolution of our LC patients with &#8805;3 years&#8217; survival&#44; in order to determine the rate of recurrence and second tumors&#44; and the times to these events&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This was a retrospective study&#44; in which we reviewed the clinical records of 1769 patients with LC diagnosed between 1991 and 2009 &#40;both inclusive&#41;&#58; 310 underwent resection with or without neoadjuvant or adjuvant treatment&#59; 1009 received CT&#44; TRT&#44; or combined CT and TRT&#44; and 450 received palliative care only&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In total&#44; 218 patients with a cytohistological diagnosis of LC and overall survival &#8805;3 years &#40;12&#46;3&#37; of those examined&#41; were included&#44; irrespective of treatment received&#46; The following data recorded at the time of diagnosis were collected&#58; age&#44; sex&#44; smoking habit&#44; histologic type&#44; TNM stage &#40;IASCL 2009 classification&#41;&#44; and treatment modality&#46; In the follow-up period&#44; patients with a diagnosis of LC were examined at least 3 times a year during the first 2 years and once a year after the third year&#46; Patients who had received CT or TRT were seen more frequently during the first 2 years&#46; Patients diagnosed before the end of 2009 were included&#44; and the study was closed in December 2014&#44; so the minimum follow-up period for survivors was 5 years&#46; Intercurrent diseases occurring during this period were recorded&#44; and in many cases the incidence of extrapulmonary cancers was retrieved from the records and electronic documentation held in other departments and specialist units&#44; and from biopsy reports relating to other organs&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">To differentiate between recurrence of the primary tumor and second primary pulmonary tumor &#40;SPPT&#41;&#44; we used the criteria of Martini and Melamed&#44; with the interval proposed by Detterbeck&#44;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">16&#44;17</span></a> defining second primary tumor as&#58; &#40;1&#41; different histologic type&#59; &#40;b&#41; different lung site&#44; in the absence of mediastinal node involvement&#59; or &#40;c&#41; time to occurrence &#62;4 years&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The rate of recurrence and pulmonary and extrapulmonary SPTs are expressed in number of cases&#47;100 person-years&#44; for which the sum of the follow-up times until the last contact with each patient was computed&#46; To evaluate their magnitude&#44; these rates were compared with incidence rates of LC in the general population in our setting&#44;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">18&#44;19</span></a> thus providing an estimated relative risk&#46; With regard to SPT rates&#44; comparisons were made with figures from any Spanish region for which protocolized cancer population registries are available<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a> &#40;to date&#44; no such registries are available in our region&#41;&#46; In view of the small number of women in our series&#44; all comparisons were made with male populations only&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Statistical analysis&#58; means were compared using the Student <span class="elsevierStyleItalic">t</span>-test&#46; For comparison of percentages&#44; the <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test was used&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ethics committee approval&#58; although this was an observational study&#44; authorization was requested and obtained from the Ethics Committee of our hospital&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Demographic characteristics&#44; smoking habit and histologic type of the 218 patients included with survival &#8805;3 years are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the distribution of TNM stages by therapeutic strategy&#58; &#40;1&#41; surgery or &#40;2&#41; other treatment&#44; namely&#58; 20 patients received CT only&#44; 3 received TRT only&#44; 55 received a combination of CT and TRT&#44; and 4 received palliative care only&#46; The great majority of the surgical patients &#40;<span class="elsevierStyleItalic">n</span>&#61;136&#41; were in stages I and II&#44; in contrast to those who received medical treatment &#40;<span class="elsevierStyleItalic">n</span>&#61;84&#41; &#8211; the latter group had more advanced tumors &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The follow-up time of patients was between 5 and 23 years&#44; except for those who died before the 5-year time point&#46; Patient evolution was classified as shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#58; &#40;a&#41; 63 were survivors with no evidence of recurrence or second cancers&#59; &#40;b&#41; 24 had died for reasons other than recurrence or second cancer&#59; &#40;c&#41; 65 had recurrence &#40;local or distant&#41; or progression of their first tumor&#44; of whom 61 had died and 4 had survived&#59; &#40;d&#41; 26 developed an SPPT&#44; of whom 15 had died&#44; and &#40;e&#41; 24 developed 1 or more SPTs outside the lung&#44; of whom 18 had died&#46; Finally&#44; for 16 &#40;7&#46;3&#37; of the 218&#41;&#44; vital status could be determined&#44; but insufficient data were available on their medical condition&#44; due to failure to attend the planned visit or moving to another community or country&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The mean interval and range from LC diagnosis until recurrence or appearance of a second pulmonary or extrapulmonary tumor are listed in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46; These intervals were divided into 3 groups&#58; &#40;a&#41; &#60;3 years&#59; &#40;b&#41; 3&#8211;5 years&#59; and &#40;c&#41; &#62;5 years&#46; Most recurrences &#40;60&#46;9&#37;&#41; were detected during the first 3 years&#44; and only 7&#46;8&#37; appeared after 5 years&#46; In contrast&#44; the appearance of second tumors was much more common after 5 years in both pulmonary &#40;84&#46;6&#37;&#41; and extrapulmonary &#40;66&#46;6&#37;&#41; sites&#46; In the case of second pulmonary tumors&#44; in 11 cases the histologic types of the first and second tumors were the same&#59; in these&#44; the different site of the second tumor&#44; the lack of mediastinal lymph node involvement&#44; and the time until occurrence suggested that the lesion was a second primary tumor&#44; rather than the alternative diagnosis of recurrence of the first&#46; In the other 14 cases&#44; the histologic types were different in the first and second tumors&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows the sites of the second extrapulmonary tumors&#58; the most common were the colon &#40;6 cases&#41; and the bladder &#40;4 cases&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Incidence of &#40;a&#41; SPP&#44; &#40;b&#41; extrapulmonary cancer&#44; or &#40;c&#41; any cancer in the group of men&#44; expressed by number of cases&#47;100 person-years&#44; was analyzed according to the type of the first LC&#46; The SPP rates were&#58; &#40;a&#41; 1&#46;29 person-years in adenocarcinomas&#59; &#40;b&#41; 1&#46;7 in epidermoid cancers&#59; &#40;c&#41; 3&#46;19 in small cell disease&#59; and &#40;d&#41; 1&#46;15 in the group of &#8220;other types&#8221; &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;&#46; These rates were also analyzed according to whether patient received or did not receive TRT for treatment of their first tumor&#44; with or without additional treatment&#46; As can be seen&#44; there are practically no differences between the groups in this regard &#40;<a class="elsevierStyleCrossRef" href="#tbl0035">Table 7</a>&#41;&#46; Finally&#44; the rates of second cancers observed in men were compared with the incidence in the general population aged 40 years or more of the same sex in our geographical region<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">18&#44;19</span></a> and the rates published in protocolized registries in other provinces in Spain<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0040">Table 8</a>&#41;&#46; The overall relative risk of cancer &#40;or a second cancer&#44; in our patients&#41; was almost 3 times higher than in the general population of a similar age&#44; although the greatest component of the increase in risk was due to the increase in LC risk &#40;relative risk greater than 7&#41;&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><elsevierMultimedia ident="tbl0040"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Population aging in the Western world and the availability of improved treatments has contributed to a situation in which it is not uncommon to see multiple cancers in a single patient&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">14&#44;15</span></a> In lung cancer&#44; most studies with long-term follow-up were performed in patients initially treated at early stages&#44; and these patients have shown increased incidences of second cancers compared to cancer rates observed in the general population&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">8&#8211;12</span></a> Since incidence depends on the duration of the follow-up&#44; it is more appropriate to express the incidence rate in terms of 100 person-years&#44; which takes into account not only the number of patients&#44; but also the overall length of follow-up&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In this study&#44; we analyzed the evolution of our LC patients who had survived more than 3 years&#44; irrespective of histologic type or treatment received&#44; over a very long follow-up period&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Overall survival after LC is poor&#44;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">2&#44;3</span></a> and in our unselected case series&#44; only 12&#46;3&#37; survived more than 3 years&#46; The chances of recurrence or second primary cancers in these patients is very high&#46; Thus&#44; 65 &#40;32&#46;2&#37;&#41; of our 202 patients with documented follow-up presented local or distant disease recurrence&#46; Kelsy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a> found that mean times to local or distant recurrence in patients who were resected in early stages of the disease were 14&#46;1 and 12&#46;5 months&#44; respectively&#46; We observed a longer time to recurrence &#40;36 months&#41; because we only included patients who had survived 3 years or more&#46; However&#44; in addition to this mean value&#44; it is also interesting&#44; from a clinical point of view&#44; to study the events over wide intervals&#46; Thus&#44; in our experience&#44; while most recurrences occurred during the first 3 years &#40;60&#46;9&#37;&#41;&#44; they remained relatively common up to the 5-year time point &#40;31&#46;3&#37; of recurrences were detected between 3 and 5 years&#41;&#46; After 5 years&#44; the probability of recurrence falls&#58; we only detected 5 in our series &#40;7&#46;8&#37;&#41;&#46; This distribution of recurrence by interval is quite close to that reported for a series of patients with non-small cell lung cancer&#44; resected in stage I&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a> even though our patients differed in many aspects &#40;different stages&#44; types&#44; and treatments&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">With respect to SPT in LC patients&#44; the incidence of SPPT in resected patients has attracted particular attention&#44; with studies&#44; practically all retrospective&#44; reporting rates of 1&#8211;2 cases&#47;100 person-years&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9&#44;14</span></a> Although the rate in one prospective study was reported to be 4&#47;100&#44; lower rates were found in another prospective analysis in patients resected with disease stages II and III&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a> Other authors<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a> have studied the incidence of SPT &#40;both pulmonary and extrapulmonary&#41; in patients with small cell lung cancer with &#62;2 years survival post-diagnosis&#58; they reported rates of 2&#8211;13&#47;100 person-years and high relative risks compared to the expected rates in the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a> Our experience was similar to that of other groups&#44;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">8&#44;13&#8211;18</span></a> in that SPPTs were the most common second primary tumors&#44; with rates of 1&#46;79&#47;100 person-years&#44; accounting for almost half of all SPTs&#46; When these rates were classified according to the initial primary tumor type&#44; we found that most occurred after small-cell lung cancer&#46; While very few reports have been published in this area&#44; our finding coincides with the results of Johnson et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">As the rate of LC among men in our population is high&#44;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">17&#44;18</span></a> we compared the SPPT rate with rate of LC in the general population of men older than 40 years in our area and found a relative risk of 7&#46;19&#46; The incidence of other cancers was also greater than recorded in the general population of other Spanish regions&#44; although the relative risk was lower &#40;1&#46;9&#41;&#46; While we did not identify publications analyzing this aspect in case studies of LC patients from Spain&#44; Kawahara et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a> reported a Japanese series of small-cell lung cancer patients&#44; in which they detected a relative risk of 3&#46;6 SPT and 7 SPPT compared to the general population&#46; It would be interesting to know if our results from a largely male group of LC cases could be extrapolated to women&#44; in whom tumor types follow a different distribution&#46; However&#44; until very recently&#44; the incidence of LC in women in our setting was very low&#44; so this question could not be fully analyzed&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">With regard to the interval&#44; SPPTs can appear at any time&#44; but generally do so 3 or 4 years after the first primary tumor&#46; Aziz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a> found a mean interval of 46 months in patients resected for early stage disease&#59; Keller<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">21</span></a> reported 36 or 43 months in patients resected in stages II and IIIA&#44; depending on the adjuvant treatment modality&#59; Jeremic et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a> found that after 5 years&#44; the SPPT rate increased from 1&#46;1 to 2&#46;2&#47;100 person-years in early stage patients treated with radiotherapy only&#44; although second extrapulmonary tumors occurred more commonly during the first 5-year period&#46; In small-cell lung cancer treated with CT and TRT&#44; most SPPTs are also detected after 4 or 5 years&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a> In contrast&#44; Duchateau et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a> in non-small cell lung cancer patients at various stages treated with various strategies &#40;surgery&#44; CT or TRT&#41;&#44; found that 80&#37; of SPTs &#40;pulmonary or extrapulmonary&#41; appeared within the first year&#46; Nevertheless&#44; the follow-up period in that study was short&#44; and all patients were included&#44; many of whom had short overall survival&#46; Our cases&#44; all of whom survived 3 or more years&#44; were followed up for much longer periods &#40;5&#8211;23 years&#41; and give a broader picture&#46; Accordingly&#44; we found a much greater mean interval to recurrence or SPT &#40;86 months&#41; and the great majority of SPPTs &#40;84&#46;6&#37;&#41; appeared more than 5 years after the first tumor&#46; We believe that the differences reported in the literature are due to differences in patient characteristics &#40;histologic types&#44; stages&#44; and treatment modalities&#41; and study methodology&#44; but most SPPTs occur after the 4th or 5th year&#44; in contrast to primary tumor recurrence&#44; which occurs mainly during the first 3 years&#46; These intervals coincide with the guidelines offered by Detterbeck et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a> for distinguishing between primary tumor recurrences and SPPT in cases which may be unclear&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Several retrospective studies have attempted to explain the reasons for this high rate of second primary cancers&#46; Kawahara et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a> and Johnson et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a> believe that persistent smoking and thoracic radiotherapy to the first tumor may be a contributing factor&#46; However&#44; Jeremic et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a> conclude that while the rate of second primary cancers in patients with early-stage non-small cell lung cancer treated with radiotherapy is higher&#44; it does not differ substantially from that of patients with the same disease stages treated with surgery alone&#46; We compared the rates of pulmonary and extrapulmonary SPT in 2 groups of patients&#44; 1 treated with TRT and 1 not treated with TRT&#44; and found no differences &#40;<a class="elsevierStyleCrossRef" href="#tbl0035">Table 7</a>&#41;&#46; As TRT was not the only treatment administered&#44; we cannot draw definitive conclusions on its influence&#44; but our results do not pinpoint a significant role for radiotherapy in the incidence of SPPT&#46; To confirm this issue&#44; large prospective studies would be needed in patients treated with TRT alone&#44; followed up for more than 10 years&#44; after which time the carcinogenic effects of radiation may be revealed&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">In any case&#44; the greater incidence of SPT in patients with LC who did not receive radiotherapy would still need to be explained&#46; The most plausible hypothesis for this phenomenon was proposed over 50 years ago by Slaughter et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a> to explain the development of multiple primary tumors in oral cancers&#46; Their &#8220;field cancerization&#8221; or &#8220;condemned mucosa&#8221; theory was subsequently applied to other organs&#44; such as the head and neck&#44; lung&#44; esophagus&#44; etc&#46;&#44; and refers to the generalized damage caused to the mucosa in different sites in the form of precancerous lesions susceptible to degenerating into cancer&#46; This concept is particularly applicable to the effects of smoking on the upper airways and the bronchi&#44; and has been recently taken up again by Braahuis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">24</span></a> These authors&#44; using molecular techniques to analyze a series of precancerous lesions&#44; observed cells in the tumor-free margins of head and neck cancers with genetic alterations linking them with the cells of the resected tumor&#46; As regards LC&#44; this concept offers not only a plausible explanation of the high frequency of SPPT but also of the common association between LC and head and neck cancer&#44; perceived some time ago&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a> In our patients&#44; all of whom were smokers or former smokers&#44; several of the SPTs involved the larynx&#44; the esophagus&#44; and the oral cavity&#44; and like other authors&#44; we also found high numbers of SPTs in the colon&#44; the bladder&#44; and the stomach &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#58; smoking has been established as a causative factor in all these entities&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Despite the long follow-up period recorded in our patients&#44; the retrospective nature of this study rules out a comprehensive survey of second cancers&#46; To achieve this&#44; a long prospective study designed to carry out an exhaustive search for new tumors would be necessary&#44; and would most likely uncover even greater relative risks&#46; In our study&#44; the estimation of the relative risk was indirect&#44; and we were obliged to consult the registries of other regions in Spain&#44; if only to compare the incidence of second cancers in general&#46; However&#44; we believe that inter-regional differences in Spain are not significant enough to substantially alter our final estimations&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0120" class="elsevierStylePara elsevierViewall">In LC patients with long-term survival beyond the period for possible recurrence&#44; the carcinogenic effects of smoking on multiple organs persist long after the 5-year time point&#46; The most susceptible organ for developing a second tumor is the lung&#44; and after 5 years&#44; a second primary tumor is more likely than a recurrence of the first tumor&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of Interests</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that they do not have any conflict of interests&#46;</p></span></span>"
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            1 => "Relapse"
            2 => "Second primary tumors"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">As cancer survival improves&#44; the appearance of multiple tumors in a single patient is becoming more common&#46; The aim of this study was to analyze long-term evolution&#44; focusing particularly on disease recurrence and second primary tumors&#44; in patients with lung cancer &#40;LC&#41; and &#8805;3 years overall survival&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective study of 1769 patients with LC&#46; A total of 218 &#40;136 treated with surgery and 82 with other treatments&#41;&#44; followed up for between 5 and 23 years were enrolled&#46; LC progress and intercurrent diseases were recorded&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 65 patients presented tumor relapse&#44; of which 60&#46;9&#37; occurred in the first 3 years&#59; 26 patients developed secondary primary tumors &#40;84&#46;6&#37; after 5 years&#41; and 24 developed 2 or more second extrapulmonary tumors &#40;66&#46;6&#37; after 5 years&#41;&#44; most of which were smoking-related&#46; The incidence of second primaries was greater than the expected incidence of cancer in the general population matched for age and sex&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The multiple carcinogenic effect of smoking persists and manifests in various organs&#44; more than 5 years after the diagnosis of LC&#44; even in patients with long survival&#46; After 5 years&#44; a second tumor is more likely than a relapse of the primary disease&#44; and the lung is the most common site of development of a second tumor&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Al mejorar la supervivencia del c&#225;ncer&#44; la presencia de tumores m&#250;ltiples en un paciente es cada vez m&#225;s frecuente&#46; El objetivo del estudio ha sido analizar la evoluci&#243;n a largo plazo&#44; especialmente las posibles recidivas y segundos tumores primarios&#44; en pacientes con c&#225;ncer de pulm&#243;n &#40;CP&#41; y supervivencia &#8805;3 a&#241;os&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de 1&#46;769 pacientes con CP&#46; Se incluyen 218 &#40;136 tratados con cirug&#237;a y 82 con otros tratamientos&#41; con supervivencia global &#8805;3 a&#241;os&#44; de cualquier estirpe y seguidos durante un per&#237;odo entre 5 y 23 a&#241;os&#46; Se registr&#243; la evoluci&#243;n del CP y las enfermedades intercurrentes&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Un total de 65 presentaron recidiva del tumor&#44; de los cuales el 60&#44;9&#37; apareci&#243; en los 3 primeros a&#241;os&#59; 26 desarrollaron segundos primarios pulmonares &#40;84&#44;6&#37; despu&#233;s de 5 a&#241;os&#41; y 24&#44; 2 o m&#225;s segundos extrapulmonares &#40;66&#44;6&#37; despu&#233;s de 5 a&#241;os&#41;&#44; la mayor&#237;a relacionados con el tabaco&#46; La incidencia de segundos primarios fue superior a la incidencia esperable de c&#225;ncer en poblaci&#243;n general de similar edad y g&#233;nero&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El efecto carcinog&#233;nico m&#250;ltiple del tabaco persiste y se manifiesta en diversos &#243;rganos despu&#233;s de pasados 5 a&#241;os tras el diagn&#243;stico de CP&#44; incluso en pacientes que han tenido una larga supervivencia&#46; Despu&#233;s de 5 a&#241;os&#44; un segundo tumor es m&#225;s probable que una recidiva del primero y el pulm&#243;n es el &#243;rgano con mayor probabilidad de desarrollar un segundo tumor&#46;</p></span>"
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            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
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      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0060">Please cite this article as&#58; S&#225;nchez de Cos Escu&#237;n J&#44; Rodr&#237;guez L&#243;pez DP&#44; Utrabo Delgado I&#44; Gallego Dom&#237;nguez R&#44; Sojo Gonz&#225;lez MA&#44; Hern&#225;ndez Valle M&#46; Recidivas y segundos tumores en el c&#225;ncer de pulm&#243;n de larga supervivencia&#46; Arch Bronconeumol&#46; 2016&#59;52&#58;183&#8211;188&#46;</p>"
      ]
    ]
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      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
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        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Men&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Women&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Total cases</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">204 &#40;93&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;6&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">218 &#40;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="char" valign="top"><span class="elsevierStyleItalic">Age in years</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean &#40;range&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;4 &#40;39&#8211;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;6 &#40;42&#8211;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;1 &#40;39&#8211;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="char" valign="top"><span class="elsevierStyleItalic">Age distribution</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;50 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;10&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;35&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;11&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>51&#8211;69 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">109 &#40;53&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">116 &#40;53&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;70 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74 &#40;36&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;14&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76 &#40;34&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="char" valign="top"><span class="elsevierStyleItalic">Smoking habit</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130 &#40;60&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;28&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">134 &#40;61&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Former smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74 &#40;39&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;21&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77 &#40;35&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Non-smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211; &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;60&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="char" valign="top"><span class="elsevierStyleItalic">Histologic type</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Epidermoid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">117 &#40;57&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">118 &#40;54&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Adenocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;18&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;85&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;22&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Large cell&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;3&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211; &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Non-small cell<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;7&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211; &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;6&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Small cell&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;10&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211; &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;10&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;2&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            1 => array:3 [
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              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Adenosquamous&#44; mucoepidermoid&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">General Characteristics of Lung Cancer Patients with Survival &#8805;3 Years&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">TNM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94 &#40;69&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;6&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101 &#40;46&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;18&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;6&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;13&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IIIa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;11&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;36&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;20&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IIIb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;48&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41 &#40;18&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;12&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">136 &#40;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82 &#40;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">218 &#40;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Surgery with or without neoadjuvant or adjuvant treatment&#46;</p>"
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            1 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Chemotherapy alone &#40;20&#41;&#59; thoracic radiotherapy alone &#40;3&#41;&#59; chemotherapy and thoracic radiotherapy &#40;55&#41;&#59; palliative medication only &#40;4&#41;&#46;</p>"
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          ]
        ]
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">TNM Staging by Therapeutic Modality Applied&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Deaths <span class="elsevierStyleItalic">n</span> &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Survivors at Last Visit<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Surviving with no evidence of recurrence or second primary tumor</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63 &#40;75&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Died due to non-cancer death with no evidence of recurrence or second primary tumor</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;20&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Patients with recurrence or progression of primary tumor &#40;local or distant&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61 &#40;51&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Patients with a second primary lung tumor</span><br><span class="elsevierStyleHsp" style=""></span>1st and 2nd same histologic type<br><span class="elsevierStyleHsp" style=""></span>1st and 2nd different histologic types&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;12&#46;7&#41;<br>7 &#40;5&#46;9&#41;<br>8 &#40;6&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;13&#46;1&#41;<br>4 &#40;4&#46;8&#41;<br>7 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Patients with second primary tumor in an extrapulmonary site</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;15&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Total number of patients with documented follow-up</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">118 &#40;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84 &#40;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Patients with insufficient follow-up data</span><a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Total</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">132&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Evolution&#44; Recurrences and Incidence of Second Tumors&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Recurrence of Primary Tumor&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#46;1 &#40;12&#8211;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&#46;7 &#40;19&#8211;180&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#46;1 &#40;24&#8211;234&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;60&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;16&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Interval between 3 and 5 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;31&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;13&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;16&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Interval &#62;5 year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;7&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;84&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;66&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Site of Second Primary Tumor&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Colon&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;12&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stomach&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;9&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lip and oral cavity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;9&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prostate&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Larynx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;6&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;6&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;6&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Others<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;12&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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            1 => array:3 [
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Epidermoid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Adenocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Small Cell&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Other<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;57&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;72&nbsp;\t\t\t\t\t\t\n
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      "titulo" => "References"
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        0 => array:2 [
          "identificador" => "bibs0005"
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            0 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global surveillance of cancer survival 1995&#8211;2009&#58; analysis of individual data for 25 676 887 patients from 279 population based registries in 67 countries &#40;CONCORDE&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Allemani"
                            1 => "H&#46;K&#46; Weir"
                            2 => "H&#46; Carreira"
                            3 => "R&#46; Harewood"
                            4 => "D&#46; Spika"
                            5 => "X&#46; Si wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2014"
                        "paginaInicial" => "62038"
                        "paginaFinal" => "62039"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cancer survival in Australia&#44; Canada&#44; Denmark&#44; Norway&#44; Sweden&#44; and the UK&#44; 1995&#8211;2007 &#40;the International Cancer Benchmarking Partnership&#41;&#58; an analysis of population-based cancer registry data"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;P&#46; Coleman"
                            1 => "D&#46; Forman"
                            2 => "H&#46; Bryant"
                            3 => "J&#46; Butjer"
                            4 => "B&#46; Rachet"
                            5 => "C&#46; Maringe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(10)62231-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2011"
                        "volumen" => "377"
                        "paginaInicial" => "127"
                        "paginaFinal" => "138"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21183212"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:2 [
                        "titulo" => "SEER Cancer Statistics Review&#44; 1975&#8211;2011"
                        "serieFecha" => "2015"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Final results of phase III trials in regionally advanced unresectable non small cell lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46; Sause"
                            1 => "P&#46; Kolesar"
                            2 => "S&#46; Taylor"
                            3 => "D&#46; Johnson"
                            4 => "R&#46; Livingston"
                            5 => "R&#46; Komaki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2000"
                        "volumen" => "117"
                        "paginaInicial" => "358"
                        "paginaFinal" => "364"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10669675"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A randomized trial of radical surgery &#40;RS&#41; versus thoracic radiotherapy &#40;TRT&#41; in patients with stage IIIA-N2 non-small cell lung cancer &#40;NSCLC&#41; after response to induction chemotherapy &#40;ICT&#41;&#46; &#40;EORTC 08941&#41;"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "EORTC Lung Cancer Group"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Van Meerbeeck"
                            1 => "G&#46; Kramer"
                            2 => "P&#46;E&#46; van Schil"
                            3 => "C&#46; Legrand"
                            4 => "E&#46;F&#46; Smit"
                            5 => "F&#46;M&#46; Schramel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Clin Oncol"
                        "fecha" => "2005"
                        "volumen" => "23"
                        "numero" => "Suppl 16"
                        "paginaInicial" => "7015"
                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small cell lung cancer&#58; a phase III randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;S&#46; Albain"
                            1 => "R&#46;S&#46; Swann"
                            2 => "V&#46;R&#46; Rusch"
                            3 => "A&#46;T&#46; Turrisi"
                            4 => "F&#46;A&#46; Shepherd"
                            5 => "C&#46;J&#46; Smith"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(09)60737-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2009"
                        "volumen" => "374"
                        "paginaInicial" => "379"
                        "paginaFinal" => "386"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19632716"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of new chemotherapeutic and targeted agents on survival in stage IV non-small cell lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;L&#46; Yu"
                            1 => "Ch&#46; Simmons"
                            2 => "J&#46;Ch&#46; Victor"
                            3 => "D&#46; Han"
                            4 => "S&#46; Hogeveen"
                            5 => "N&#46; Leighl"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1634/theoncologist.2011-0079"
                      "Revista" => array:6 [
                        "tituloSerie" => "Oncologist"
                        "fecha" => "2011"
                        "volumen" => "16"
                        "paginaInicial" => "1307"
                        "paginaFinal" => "1315"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21835896"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0170"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of local recurrence and second primary tumors in resected stage I lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Martini"
                            1 => "M&#46;S&#46; Bains"
                            2 => "M&#46;E&#46; Burt"
                            3 => "M&#46;F&#46; Zakowski"
                            4 => "P&#46; McCormack"
                            5 => "V&#46;W&#46; Rusch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0022-5223(95)70427-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "1995"
                        "volumen" => "109"
                        "paginaInicial" => "120"
                        "paginaFinal" => "129"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7815787"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            8 => array:3 [
              "identificador" => "bib0175"
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                0 => array:2 [
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                      "titulo" => "Metachronous lung cancer&#58; the role of improved postoperative surveillance"
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                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46;J&#46; Scott"
                          ]
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2003.11.052"
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                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2004"
                        "volumen" => "127"
                        "paginaInicial" => "633"
                        "paginaFinal" => "635"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15001890"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0180"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The results of modern surgical therapy for multiple primary lung cancers"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;A&#46; Adenobojo"
                            1 => "D&#46;M&#46; Moritz"
                            2 => "Ch&#46;A&#46; Danby"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1997"
                        "volumen" => "112"
                        "paginaInicial" => "693"
                        "paginaFinal" => "701"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9315801"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0185"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Local recurrence after surgery for early stage lung cancer&#46; An 11-year experience with 975 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;R&#46; Kelsey"
                            1 => "L&#46;B&#46; Marks"
                            2 => "D&#46; Hollis"
                            3 => "J&#46;L&#46; Hubbs"
                            4 => "N&#46;E&#46; Ready"
                            5 => "Th&#46;A&#46; D&#8217;Amico"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/cncr.24625"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "2009"
                        "volumen" => "115"
                        "paginaInicial" => "5218"
                        "paginaFinal" => "5227"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19672942"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The management of second primary lung cancers&#46; A single centre experience in 15 years"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "T&#46;M&#46; Aziz"
                            1 => "R&#46;A&#46; Saad"
                            2 => "J&#46; Glasser"
                            3 => "A&#46;N&#46; Jilaihawi"
                            4 => "D&#46; Prakash"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Cardio Thorac Surg"
                        "fecha" => "2002"
                        "volumen" => "21"
                        "paginaInicial" => "527"
                        "paginaFinal" => "533"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Second primary tumours in more than 2-year disease-free survivors of small-cell lung cancer in Japan&#58; the role of smoking cessation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Kawahara"
                            1 => "S&#46; Ushijima"
                            2 => "T&#46; Kamimori"
                            3 => "N&#46; Kodama"
                            4 => "M&#46; Ogawara"
                            5 => "K&#46; Matsui"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Cancer"
                        "fecha" => "1998"
                        "volumen" => "78"
                        "paginaInicial" => "409"
                        "paginaFinal" => "412"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9703291"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Second lung cancers in patients after treatment for an initial lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46;E&#46; Johnson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Natl Cancer Inst"
                        "fecha" => "1998"
                        "volumen" => "90"
                        "paginaInicial" => "1335"
                        "paginaFinal" => "1345"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9747865"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Second primary tumors involving non-small cell lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;J&#46; Duchateau Ch"
                            1 => "M&#46;P&#46;M&#46; Stokkel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.127.4.1152"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2005"
                        "volumen" => "127"
                        "paginaInicial" => "1152"
                        "paginaFinal" => "1158"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15821189"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multiple primary lung cancers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "N&#46; Martini"
                            1 => "N&#46;R&#46; Melamed"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "1975"
                        "volumen" => "70"
                        "paginaInicial" => "606"
                        "paginaFinal" => "612"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/170482"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Special treatment issues"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46;C&#46; Detterbeck"
                            1 => "D&#46;R&#46; Jones"
                            2 => "K&#46;H&#46; Kernstine"
                            3 => "K&#46;S&#46; Naunheim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2003"
                        "volumen" => "123"
                        "paginaInicial" => "244S"
                        "paginaFinal" => "258S"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12527583"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidencia de carcinoma broncopulmonar en Extremadura durante el a&#241;o 1998"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; S&#225;nchez de Cos Escu&#237;n"
                            1 => "J&#46;A&#46; Riesco Miranda"
                            2 => "J&#46; Ant&#243;n Mart&#237;nez"
                            3 => "P&#46; D&#237;az Santamar&#237;a"
                            4 => "L&#46; M&#225;rquez P&#233;rez"
                            5 => "J&#46;F&#46; 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"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estudio multic&#233;ntrico epidemiol&#243;gico-cl&#237;nico de c&#225;ncer de pulm&#243;n en Espa&#241;a &#40;estudio EpicliCP-2003&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; S&#225;nchez de Cos Escu&#237;n"
                            1 => "L&#46; Miravet"
                            2 => "J&#46; Abal"
                            3 => "A&#46; N&#250;&#241;ez"
                            4 => "J&#46; Hern&#225;ndez"
                            5 => "A&#46;M&#46; Casta&#241;ar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2006"
                        "volumen" => "42"
                        "paginaInicial" => "446"
                        "paginaFinal" => "452"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17040660"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Forman"
                            1 => "F&#46; Bray"
                            2 => "D&#46;H&#46; Brewster"
                            3 => "M&#46; Gombe"
                            4 => "C&#46; Balawa"
                            5 => "B&#46; Kohler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1965"
                        "editorial" => "IARC"
                        "editorialLocalizacion" => "Lyon"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Second primary tumors following adjuvant therapy of resected stages II and IIIa non-small cell lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;M&#46; Keller"
                            1 => "M&#46;G&#46; Vangel"
                            2 => "H&#46; Wagner"
                            3 => "J&#46; Schiller"
                            4 => "A&#46; Herskovic"
                            5 => "R&#46; Komaki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lung Cancer"
                        "fecha" => "2003"
                        "volumen" => "42"
                        "paginaInicial" => "79"
                        "paginaFinal" => "86"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14512191"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Second cancers occurring in patients with early stage non-small cell lung cancer treated with chest radiation therapy alone"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Jeremic"
                            1 => "Y&#46; Shibamato"
                            2 => "L&#46; Acimovic"
                            3 => "N&#46; Nikolic"
                            4 => "A&#46; Dagovic"
                            5 => "J&#46; Aleksandrovic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/jco.2001.19.4.1056"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Oncol"
                        "fecha" => "2001"
                        "volumen" => "19"
                        "paginaInicial" => "1056"
                        "paginaFinal" => "1063"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11181669"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#8220;Field cancerization&#8221; in oral stratified squamous epithelium&#46; Clinical implications of multicentric origin"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;P&#46; Slaugther"
                            1 => "H&#46;W&#46; Southwick"
                            2 => "W&#46; Smejkal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "1953"
                        "volumen" => "6"
                        "paginaInicial" => "963"
                        "paginaFinal" => "968"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13094644"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A genetic explanation of Slaughter&#39;s concept of field cancerization&#58; evidence and clinical implications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "B&#46;J&#46;M&#46; Braakhuis"
                            1 => "M&#46;P&#46; Tabor"
                            2 => "J&#46;A&#46; Kummer"
                            3 => "C&#46;R&#46; Leemans"
                            4 => "R&#46;H&#46; Brakenhoff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cancer Res"
                        "fecha" => "2009"
                        "volumen" => "63"
                        "paginaInicial" => "1729"
                        "paginaFinal" => "1730"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Second malignant tumors in patients with laryngeal carcinoma&#58; diagnosis&#44; treatment and prevention"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; McDonald"
                            1 => "Ch&#46; Haie"
                            2 => "Ph&#46; Rubin"
                            3 => "D&#46; Nelson"
                            4 => "L&#46;D&#46; Divers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Radiat Oncol"
                        "fecha" => "1989"
                        "volumen" => "17"
                        "paginaInicial" => "457"
                        "paginaFinal" => "465"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Smoking and mortality &#8211; beyond established causes"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46;D&#46; Carter"
                            1 => "Ch&#46;C&#46; Abnet"
                            2 => "D&#46; Feskanich"
                            3 => "N&#46;D&#46; Freedman"
                            4 => "P&#46; Hartge"
                            5 => "C&#46;E&#46; Lewis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2015"
                        "volumen" => "377"
                        "paginaInicial" => "631"
                        "paginaFinal" => "640"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
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