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Is 18F-FDG-PET/CT prognostic factor for survival in patients with small cell lung cancer? Single center experience
É o 18F -FDG-PET/CT um fator de prognóstico para a sobrevivência em pacientes com cancro pulmonar de pequenas células? Experiência num único centro
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"apellidos" => "Dostbil" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 7 => array:3 [ "nombre" => "S." "apellidos" => "Altındag" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 8 => array:3 [ "nombre" => "A." "apellidos" => "Isıkdogan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Dicle University, Department of Medical Oncology, Diyarbakir, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Dicle University, Department of Internal Medicine, Diyarbakir, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Dicle University, Department of Nuclear Medicine, Diyarbakir, Turkey" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "É o <span class="elsevierStyleSup">18</span>F -FDG-PET/CT um fator de prognóstico para a sobrevivência em pacientes com cancro pulmonar de pequenas células? Experiência num único centro" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1453 "Ancho" => 1394 "Tamanyo" => 90137 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Survival of patients according to performance status.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Lung cancer is the most common among cancer-related deaths in both men and women in worldwide. Small cell lung cancer (SCLC) represents approximately 15% of all diagnosed lung cancers cases.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> SCLC is associated with a more rapid tumor doubling time, a high growth fraction and early widespread dissemination. As a result of this, overall survival (OS) rates for these patients are disappointingly low.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The Veterans Administration Lung Study Group two-tiered staging system was used to classify SCLC as either limited disease (LD) or extended disease (ED) which was primarily based on compatibility for treatment options.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Despite its practical usefulness and prognostic advantage, this staging system is not accurate enough to reflect tumor burden, and it is insufficient to predict survival in some patients.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Very different prognostic factors in several trials have been identified for survival in patients with SCLC<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–7</span></a>; however, none of these prognostic factors are sufficiently reliable to base treatment decision on. Even though fluorine-18 deoxyglucose positron emission tomography computed tomography (<span class="elsevierStyleSup">18</span>F-FDG-PET/CT) scan is widely utilized in staging SCLC, it is not standard work-up for SCLC with respect to international guidelines. Owing to the fact that a number of studies in patients with a variety of malignant tumours<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–13</span></a> have shown that metabolic activity on <span class="elsevierStyleSup">18</span>F-FDG-PET/CT is correlated with survival, there are few studies about the impact of <span class="elsevierStyleSup">18</span>F-FDG-PET/CT for survival in SCLC patients.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14–17</span></a> There remains an ambiguity as to whether <span class="elsevierStyleSup">18</span>F-FDG-PET/CT in patients receiving first-line etoposide plus cisplatin (EP) chemotherapy will provide reliable prognostic knowledge about survival.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We performed a retrospective analysis of the prognostic implication of <span class="elsevierStyleSup">18</span>F-FDG-PET/CT for patients with SCLC. The aim of this study was to investigate the prognostic significance of the characteristics of patients in SCLC. Specifically, we investigated the prognostic implication of <span class="elsevierStyleSup">18</span>F-FDG-PET/CT for OS in the patients receiving first-line EP chemotherapy.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patient population</span><p id="par0025" class="elsevierStylePara elsevierViewall">We retrospectively reviewed 54 patients with histologically or cytologically proven SCLC who had undergone pre-treatment <span class="elsevierStyleSup">18</span>F-FDG-PET/CT scanning from September 2007 to November 2011 in the Dicle University, School of Medicine, Department of Medical Oncology. They met the following inclusion criteria; (1) 18 or more years old; (2) a histologic or cytologic diagnosis of SCLC; (3) no previous chemotherapy or radiotherapy; (4) there was sufficient clinical data recorded in medical records; (5) they had to have a measurable disease, as defined by Response Evaluation Criteria in Solid Tumours (RECIST).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients were identified as having DM on the basis of elevated fasting glucose level (>126<span class="elsevierStyleHsp" style=""></span>mg/dL), and a history of DM or medication use, such as insulin or oral hypoglycemic agents.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Patients with LD underwent concurrent chemoradiotherapy, which consisted of chemotherapy and thoracic radiotherapy. Both LD and ED patients were receiving first-line EP chemotherapy. The EP regimen consisted of 100<span class="elsevierStyleHsp" style=""></span>mg/m<span class="elsevierStyleSup">2</span> etoposide on days 1 and 30<span class="elsevierStyleHsp" style=""></span>mg/m<span class="elsevierStyleSup">2</span> cisplatin on days 1–3, every 3 weeks.</p><p id="par0040" class="elsevierStylePara elsevierViewall">All had SCLC. Patients who had received prior treatment were excluded.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">FDG-PET imaging</span><p id="par0045" class="elsevierStylePara elsevierViewall">FDG-PET was carried out in all cases within 6 weeks before SRBT. All patients fasted for at least 4<span class="elsevierStyleHsp" style=""></span>h before the <span class="elsevierStyleSup">18</span>F-FDG-PET/CT examination though oral hydration with glucose-free water was given. When peripheral blood glucose level before administration of <span class="elsevierStyleSup">18</span>F-FDG was <150<span class="elsevierStyleHsp" style=""></span>mg/dL, patients received an intravenous injection of 3.70–4.44<span class="elsevierStyleHsp" style=""></span>MBq/kg of FDG. Whole-body FDG-PET was scanned using the same scanner, Biograph 6 PET/CT scanner (CTI/Siemens, Knoxville, TN). The axes of both systems were mechanically aligned so that the patient could be moved from the CT scanner to the PET scanner gantry. The resulting of PET and CT scans co-registered on the same hardware. Then, 1 hour after the injection, CT and PET scans were performed. Images from the level of the middle skull to the proximal thigh were obtained. CT scan was implemented with the following settings: 110<span class="elsevierStyleHsp" style=""></span>kV; 80<span class="elsevierStyleHsp" style=""></span>mA; tube rotation time, 0.8<span class="elsevierStyleHsp" style=""></span>s/rotation per pitch, and section thickness, 3.0<span class="elsevierStyleHsp" style=""></span>mm (whole body CT had 307 or 356 slices). The PET and CT scans were obtained during normal tidal breathing. The PET scans were done immediately after the CT scans. The PET/CT scans were obtained in 3D mode at 3<span class="elsevierStyleHsp" style=""></span>min per bed position.</p><p id="par0050" class="elsevierStylePara elsevierViewall">As a semi-quantitative analysis, the maximum standardized uptake value (SUVmax) was achieved by placing region of interest (ROIs) over the lesions that had been determined as suspicious on visual assessment. SUVmax of the pulmonary tumor was calculated in all cases using a 3D acquisition and the following formula:<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0055" class="elsevierStylePara elsevierViewall">The maximum standardized uptake value (SUVmax) was represented by the counts per second of the voxel showing the maximum radioactivity in the volume of interest encompassing the tumor divided by the volume of the voxel (mL).</p><p id="par0060" class="elsevierStylePara elsevierViewall">PET data were iteratively reconstructed using an ordered subset expectation maximization algorithm and segmented attenuation correction (2 iterations, 8 subsets) and the CT data. Co-registered scans were displayed using dedicated software (e-soft-PET; Siemens Medical Solutions).</p><p id="par0065" class="elsevierStylePara elsevierViewall">Two experienced nuclear medicine physicians, who were unaware of the clinical results, viewed and quantitatively analyzed the PET images.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Factors analyzed</span><p id="par0070" class="elsevierStylePara elsevierViewall">Eleven potential prognostic variables were chosen on the basis of previously published clinical trials. The variables were divided into categories: age (<65 or ≥65), gender (male or female), performance status (PS) (0–1, 2–3), stage (LD or ED), weight loss ≥5% with previous 3 months (present or absent), diabetes mellitus (present or absent), smoking history (present or absent), SUVmax values (<13.0 or ≥13.0), laboratory parameters [(albumin, LDH, blood sugar) (</p><p id="par0075" class="elsevierStylePara elsevierViewall">The values of SUVmax were detected between 5 and 20 in prior studies <span class="elsevierStyleItalic">with log-rank probability values to determine a prognostic cutoff point for SUVmax</span>. Because no statistically significant value was found, SUVmax was dichotomized at its median of 12.9 in present study.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">All of the analyses were performed using the SPSS statistical software program package (SPSS version 11.5 for windows). The differences in the clinical characteristics between the two groups were analyzed by chi-square test and student t test. Overall survival (OS) was calculated from the start of the first cycle of chemotherapy to the date of death from any cause or the date of the last follow-up. Overall survival was estimated using the Kaplan–Meier method. The Cox proportional hazards regression model was used to determine statistical significant variables related to survival. Differences were assumed to be significant when <span class="elsevierStyleItalic">p</span> value was less than 0.05.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Patient characteristics</span><p id="par0085" class="elsevierStylePara elsevierViewall">Between September 2007 and November 2011, 54 patients with SCLC were enrolled in this study. The median age of patients was 57 years (range 28–80) with 50 (92.6%) males and 4 (7.4%) females. The number of patients with a PS score 0–1 was 34 (63.0%). Thirty patients (55.6%) were diagnosed as having extended disease and 24 patients (44.4%) had limited disease. The estimated median OS with LD was 17.3 months (95% CI, 8.9–25.7 months). Median OS of the treated ED patients was 8.4 months (95% CI, 7.1–9.8 months). The patients’ baseline characteristics are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Prognostic factor analysis</span><p id="par0090" class="elsevierStylePara elsevierViewall">The results of univariate analysis are summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. Among the eleven variables of univariate analysis, three variables were identified as having prognostic significance: Performance status (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001), stage (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.02) and diabetes mellitus (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.05). Multivariate analysis included the three prognostic significance factors in univariate analysis. The results of multivariate analysis are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. Multivariate analysis by Cox proportional hazard model showed that performance status and stage were considered independent prognostic factors for survival (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.002 respectively) (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">SCLC is very sensitive to radiotherapy and chemotherapy while it is associated with a faster tumor doubling time, a high growth fraction and early widespread dissemination. As a result of this, overall survival rates for these patients are disappointingly low. Patients eligible for chemotherapy should be selected very carefully.</p><p id="par0100" class="elsevierStylePara elsevierViewall">There are a number of studies about this activity as shown on FDG PET in relation to survival in SCLC<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14–17</span></a>; the importance of <span class="elsevierStyleSup">18</span>F-FDG-PET/CT for survival in patients receiving first-line EP chemotherapy is still subject to controversy. Although Lee et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> showed that the degree of SUVmax was strongly associated with an increase in overall survival, Zhu et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and Van der Leest et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> on the contrary found no observable prognostic value of SUVmax. In our multivariate analysis, we found that SUVmax value was not a factor associated with survival. The inconsistency of results may be partly explained by blood glucose level of the patient, time to imaging, the biological characteristics of tumor cells and treatment modality.</p><p id="par0105" class="elsevierStylePara elsevierViewall">A poor PS is usually accepted as a negative prognostic factor for all cancer patients.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18–20</span></a> The importance of PS was also confirmed in advanced SCLC patients.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Our study showed that poor PS is an associated independent risk factor for survival.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The median survival for limited disease is 14–16 months and only 8–11 months for extensive disease with effective treatment. The overall 5-year survival rate is under 10%.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,21</span></a> In previous studies, many authors<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15,17</span></a> have shown that the tumor stage at initial presentation was the most important prognostic factor for survival in patients with SCLC. Similarly, stage was found to be an independent prognostic factor of survival in the present study. In our study, the estimated median OS for LD was 17.3 months (95% CI, 8.9–25.7 months) and only 8.4 months (95% CI, 7.1–9.8 months) for ED.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The present study has got some limitations. Firstly, it is based on retrospective studies. Secondly, the number of patients was small. Thirdly, we did not evaluate the type of DM, duration of diabetes and the types of diabetic therapy used. Fourthly, the limit described of 150<span class="elsevierStyleHsp" style=""></span>mg/dl of patient blood glucose level may lower the sensitivity of <span class="elsevierStyleSup">18</span>F-FDG-PET/CT. A number of the studies have shown that plasma glucose competes with <span class="elsevierStyleSup">18</span>F-FDG uptake of malignant lesions; for this reason it is claimed that hyperglycemia may reduce and impair <span class="elsevierStyleSup">18</span>F-FDG uptake of tumors.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22–25</span></a> However, Mirpour et al.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> and Roy et al.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> showed that the quality of PET/CT images is sufficient to provide a trustworthy clinical opinion, even in those patients with serum glucose level above 180<span class="elsevierStyleHsp" style=""></span>mg/dL. Accordingly, the Society of Nuclear Medicine guidelines for PET/CT advocates that <span class="elsevierStyleSup">18</span>F-FDG should not be administered when plasma glucose level is over 150–200<span class="elsevierStyleHsp" style=""></span>mg/dL (8.3–11.1<span class="elsevierStyleHsp" style=""></span>mmol/L).<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> The European Association of Nuclear Medicine also recommends that glycemia should ideally not exceed 130<span class="elsevierStyleHsp" style=""></span>mg/dL, and the test should be rescheduled if the serum glucose level is higher than 200<span class="elsevierStyleHsp" style=""></span>mg/dL (7.2<span class="elsevierStyleHsp" style=""></span>mmol/L).<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> In fact, there are several points of controversy outstanding. The <span class="elsevierStyleSup">18</span>F-FDG tumoural uptake process in hyperglycemia is not yet fully understood.</p><p id="par0120" class="elsevierStylePara elsevierViewall">In conclusion, performance status and stage were identified as important prognostic factors, while FDG uptake of the primary lesions was not associated with the prognostic importance for survival in patients with SCLC. These findings may also facilitate pretreatment prediction of survival and can be used for selecting patients for the correct choice of treatment. Therefore, prospective and larger clinical trials are needed.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ethical disclosures</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Protection of human and animal subjects</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Confidentiality of data</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Right to privacy and informed consent</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicts of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres547679" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Result" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec565558" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres547678" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultado" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec565559" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patient population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "FDG-PET imaging" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Factors analyzed" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Patient characteristics" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Prognostic factor analysis" ] ] ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0055" "titulo" => "Ethical disclosures" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Right to privacy and informed consent" ] 3 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflicts of interest" ] ] ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-11-27" "fechaAceptado" => "2013-03-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec565558" "palabras" => array:3 [ 0 => "Small cell lung cancer" 1 => "Prognostic factors" 2 => "<span class="elsevierStyleSup">18</span>F-FDG-PET/CT" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec565559" "palabras" => array:3 [ 0 => "Cancro pulmonar de pequenas células" 1 => "Fatores de prognóstico" 2 => "<span class="elsevierStyleSup">18</span>F-FDG-PET/CT" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Although a number of studies in patients with a variety of malignant tumors have shown that metabolic activity on fluorine-18 deoxyglucose positron emission tomography computed tomography (<span class="elsevierStyleSup">18</span>F-FDG-PET/CT) is correlated with survival, there are few studies about the impact of <span class="elsevierStyleSup">18</span>F-FDG-PET/CT for survival in small cell lung cancer (SCLC) patients. There is still some ambiguity as to whether FDG PET in patients with SCLC will ensure prognostic knowledge for survival. We performed a retrospective analysis of prognostic implication of <span class="elsevierStyleSup">18</span>F-FDG-PET/CT in patients with SCLC.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We retrospectively reviewed 54 patients with histologically or cytologically proven SCLC who had undergone pre-treatment <span class="elsevierStyleSup">18</span>F-FDG-PET/CT scanning between September 2007 and November 2011 in the Dicle University, School of Medicine, Department of Medical Oncology. SUVmax and other potential prognostic variables were chosen for analysis in this study. Univariate and multivariate analyses were conducted to identify prognostic factors associated with survival.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Result</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Among the eleven variables of univariate analysis, three variables were identified as having prognostic significance: Performance status (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001), stage (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.02) and diabetes mellitus (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.05).</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Multivariate analysis showed that performance status and stage were considered independent prognostic factors for survival (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.002 respectively).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">In conclusion, performance status and stage were identified as important prognostic factors, while <span class="elsevierStyleSup">18</span>F-FDG-PET/CT uptake of the primary lesions was not associated with prognostic importance for survival in patients with SCLC.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Result" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Embora uma série de estudos em pacientes com uma diversidade de tumores malignos tenham demonstrado que a atividade metabólica na tomografia computorizada por emissão de positrões de deoxiglucose marcada com flúor-18 (<span class="elsevierStyleSup">18</span>F-FDG-PET/CT) está correlacionada com a sobrevivência, existem poucos estudos sobre o impacto do <span class="elsevierStyleSup">18</span>F-FDG-PET/CT para a sobrevivência em pacientes com cancro pulmonar de células pequenas (SCLC). Ainda existe alguma ambiguidade de que, em pacientes com SCLC, o FDG PET forneça informações importantes relativamente de prognóstico para a sobrevivência. Realizámos uma análise retrospetiva da implicação no prognóstico de <span class="elsevierStyleSup">18</span>F-FDG-PET/CT em pacientes com SCLC.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Analisámos retrospetivamente 54 pacientes com SCLC comprovado histologicamente ou citologicamente, que tinham realizado <span class="elsevierStyleSup">18</span>F-FDG-PET/CT entre setembro de 2007 e novembro de 2011, na Universidade de Dicle, Faculdade de Medicina, Departamento de Oncologia Médica. Foram escolhidas a SUVmax e outras potenciais variáveis de prognóstico para a análise neste estudo. Foram realizadas análises univariadas e multivariadas para identificar os fatores de prognóstico associados à sobrevivência.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultado</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Entre as 11 variáveis da análise univariada, 3 variáveis foram identificadas como tendo significância para o prognóstico. Estado Geral (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001), estádio (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,02) e diabetes mellitus (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,05).</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A análise multivariada mostrou que o Estado Geral e o estádio foram considerados fatores de prognóstico independentes para a sobrevivência (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,002 respetivamente).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusão</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Em conclusão, o Estado Geral e o estádio foram identificados como importantes fatores de prognóstico, enquanto a absorção de <span class="elsevierStyleSup">18</span>F-FDG-PET/CT das lesões primárias não se associou ao prognóstico para a sobrevivência em pacientes com SCLC.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultado" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1453 "Ancho" => 1394 "Tamanyo" => 90137 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Survival of patients according to performance status.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1589 "Ancho" => 1534 "Tamanyo" => 86969 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Survival of patients according to stage.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristic \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">No. of patients (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (92.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (7.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Age, median (range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 (28–80) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Age</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (87.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>≥65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (13.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Performance status</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0–1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (63.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2–3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (3.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Smoking history</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Current or former \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 (85.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Never \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (7.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (7.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Weight loss</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (63.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (20.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (16.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Diabetes mellitus</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (74.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (7.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (18.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Stage</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (44.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ED \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (55.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SUVmax, median \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (4.2–29.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Laboratory parameters, median</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Albumin, g/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LDH, U/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">248 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Blood sugar, mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">103 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab884632.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The general characteristics of the patients.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \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">Log-rank test value \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">Degrees of freedom \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">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.28 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.86 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Stage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Smoking history \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Performance status \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Weight loss \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">SUVmax, median \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.66 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Laboratory parameters, median \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Albumin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LDH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Blood sugar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.18 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab884631.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Univariate analysis of survival time by categorical variable.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameter \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">OR \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">%95 CI \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">p</span>-Value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Performance status \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.42–15.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Stage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.93–21.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab884633.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Multivariate analysis of prognostic factors.</p>" ] ] 5 => array:5 [ "identificador" => "eq0005" "tipo" => "MULTIMEDIAFORMULA" "mostrarFloat" => false "mostrarDisplay" => true "Formula" => array:5 [ "Matematica" => "SUV   =   Mean ROI activity   (MBq/ml)/Injected dose   (MBq)Body weight   (g)×1decay factor of F-18" "Fichero" => "STRIPIN_si1.jpeg" "Tamanyo" => 6818 "Alto" => 80 "Ancho" => 405 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cancer incidence and mortality in Europe, 2004" "autores" => array:1 [ 0 => 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 4 | 12 |
| 2024 October | 45 | 55 | 100 |
| 2024 September | 51 | 35 | 86 |
| 2024 August | 57 | 48 | 105 |
| 2024 July | 51 | 47 | 98 |
| 2024 June | 44 | 33 | 77 |
| 2024 May | 51 | 54 | 105 |
| 2024 April | 52 | 47 | 99 |
| 2024 March | 49 | 45 | 94 |
| 2024 February | 36 | 31 | 67 |
| 2024 January | 28 | 30 | 58 |
| 2023 December | 28 | 45 | 73 |
| 2023 November | 31 | 45 | 76 |
| 2023 October | 35 | 45 | 80 |
| 2023 September | 26 | 50 | 76 |
| 2023 August | 40 | 35 | 75 |
| 2023 July | 35 | 40 | 75 |
| 2023 June | 27 | 21 | 48 |
| 2023 May | 55 | 33 | 88 |
| 2023 April | 42 | 24 | 66 |
| 2023 March | 81 | 38 | 119 |
| 2023 February | 63 | 32 | 95 |
| 2023 January | 41 | 30 | 71 |
| 2022 December | 62 | 37 | 99 |
| 2022 November | 80 | 57 | 137 |
| 2022 October | 48 | 45 | 93 |
| 2022 September | 42 | 36 | 78 |
| 2022 August | 84 | 49 | 133 |
| 2022 July | 85 | 61 | 146 |
| 2022 June | 63 | 39 | 102 |
| 2022 May | 55 | 43 | 98 |
| 2022 April | 43 | 54 | 97 |
| 2022 March | 33 | 63 | 96 |
| 2022 February | 43 | 54 | 97 |
| 2022 January | 42 | 41 | 83 |
| 2021 December | 33 | 52 | 85 |
| 2021 November | 54 | 48 | 102 |
| 2021 October | 39 | 47 | 86 |
| 2021 September | 24 | 40 | 64 |
| 2021 August | 41 | 46 | 87 |
| 2021 July | 30 | 28 | 58 |
| 2021 June | 48 | 47 | 95 |
| 2021 May | 99 | 40 | 139 |
| 2021 April | 164 | 93 | 257 |
| 2021 March | 165 | 33 | 198 |
| 2021 February | 108 | 30 | 138 |
| 2021 January | 64 | 32 | 96 |
| 2020 December | 51 | 25 | 76 |
| 2020 November | 65 | 22 | 87 |
| 2020 October | 62 | 25 | 87 |
| 2020 September | 61 | 30 | 91 |
| 2020 August | 66 | 28 | 94 |
| 2020 July | 72 | 30 | 102 |
| 2020 June | 93 | 23 | 116 |
| 2020 May | 93 | 29 | 122 |
| 2020 April | 93 | 25 | 118 |
| 2020 March | 86 | 13 | 99 |
| 2020 February | 83 | 35 | 118 |
| 2020 January | 103 | 17 | 120 |
| 2019 December | 60 | 27 | 87 |
| 2019 November | 93 | 21 | 114 |
| 2019 October | 64 | 11 | 75 |
| 2019 September | 81 | 13 | 94 |
| 2019 August | 139 | 12 | 151 |
| 2019 July | 110 | 20 | 130 |
| 2019 June | 124 | 20 | 144 |
| 2019 May | 127 | 13 | 140 |
| 2019 April | 105 | 22 | 127 |
| 2019 March | 190 | 16 | 206 |
| 2019 February | 139 | 12 | 151 |
| 2019 January | 179 | 44 | 223 |
| 2018 December | 128 | 8 | 136 |
| 2018 November | 49 | 1 | 50 |
| 2018 October | 75 | 9 | 84 |
| 2018 September | 52 | 8 | 60 |
| 2018 August | 36 | 31 | 67 |
| 2018 July | 38 | 18 | 56 |
| 2018 June | 51 | 19 | 70 |
| 2018 May | 60 | 21 | 81 |
| 2018 April | 65 | 20 | 85 |
| 2018 March | 77 | 18 | 95 |
| 2018 February | 35 | 9 | 44 |
| 2018 January | 45 | 19 | 64 |
| 2017 December | 52 | 17 | 69 |
| 2017 November | 78 | 17 | 95 |
| 2017 October | 56 | 23 | 79 |
| 2017 September | 58 | 16 | 74 |
| 2017 August | 59 | 13 | 72 |
| 2017 July | 38 | 22 | 60 |
| 2017 June | 42 | 14 | 56 |
| 2017 May | 46 | 15 | 61 |
| 2017 April | 9 | 7 | 16 |
| 2017 March | 15 | 9 | 24 |
| 2017 February | 14 | 8 | 22 |
| 2017 January | 25 | 11 | 36 |
| 2016 December | 25 | 8 | 33 |
| 2016 November | 27 | 5 | 32 |
| 2016 October | 40 | 6 | 46 |
| 2016 September | 91 | 10 | 101 |
| 2016 August | 33 | 4 | 37 |
| 2016 July | 18 | 12 | 30 |
| 2016 June | 5 | 0 | 5 |
| 2016 May | 31 | 0 | 31 |
| 2016 April | 37 | 3 | 40 |
| 2016 March | 46 | 20 | 66 |
| 2016 February | 59 | 28 | 87 |
| 2016 January | 45 | 22 | 67 |
| 2015 December | 68 | 17 | 85 |
| 2015 November | 52 | 22 | 74 |
| 2015 October | 42 | 18 | 60 |
| 2015 September | 45 | 18 | 63 |
| 2015 August | 48 | 9 | 57 |
| 2015 July | 41 | 7 | 48 |
| 2015 June | 32 | 3 | 35 |
| 2015 May | 60 | 11 | 71 |
| 2015 April | 55 | 17 | 72 |
| 2015 March | 64 | 11 | 75 |
| 2015 February | 62 | 12 | 74 |
| 2015 January | 64 | 17 | 81 |
| 2014 December | 64 | 19 | 83 |
| 2014 November | 70 | 15 | 85 |
| 2014 October | 91 | 17 | 108 |
| 2014 September | 71 | 21 | 92 |
| 2014 August | 62 | 22 | 84 |
| 2014 July | 64 | 10 | 74 |
| 2014 June | 82 | 7 | 89 |
| 2014 May | 66 | 9 | 75 |
| 2014 April | 57 | 10 | 67 |
| 2014 March | 89 | 24 | 113 |
| 2014 February | 78 | 41 | 119 |
| 2014 January | 103 | 42 | 145 |
| 2013 December | 79 | 45 | 124 |
| 2013 November | 95 | 34 | 129 |
Show all
