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Càncer de coll uterí; Platí; Topotecan Cáncer de cuello uterino; Platino; Topotecan Cervical cancer; Platinum; Topotecan Objective To determine whether a non‑platinum chemotherapy doublet improves overall survival (OS) among patients with recurrent/metastatic cervical carcinoma. Methods Gynecologic Oncology Group protocol 240 is a phase 3, randomized, open-label, clinical trial that studied the efficacy of paclitaxel 175 mg/m2 plus topotecan 0.75 mg/m2 days 1–3 (n = 223) vs cisplatin 50 mg/m2 plus paclitaxel 135 or 175 mg/m2 (n = 229), in 452 patients with recurrent/metastatic cervical cancer. Each chemotherapy doublet was also studied with and without bevacizumab (15 mg/kg). Cycles were repeated every 21 days until progression, unacceptable toxicity, or complete response. The primary endpoints were OS and the frequency and severity of adverse effects. We report the final analysis of OS. Results At the protocol-specified final analysis, median OS was 16.3 (cisplatin-paclitaxel backbone) and 13.8 months (topotecan-paclitaxel backbone) (HR 1.12; 95% CI, 0.91–1.38; p = 0.28). Median OS for cisplatin-paclitaxel and topotecan-paclitaxel was 15 vs 12 months, respectively (HR 1.10; 95% CI,0.82–1.48; p = 0.52), and for cisplatin-paclitaxel-bevacizumab and topotecan-paclitaxel-bevacizumab was 17.5 vs 16.2 months, respectively (HR 1.16; 95% CI, 0.86–1.56; p = 0.34). Among the 75% of patients in the study population previously exposed to platinum, median OS was 14.6 (cisplatin-paclitaxel backbone) vs 12.9 months (topotecan-paclitaxel backbone), respectively (HR 1.09; 95% CI, 0.86–1.38;p = 0.48). Post-progression survival was 7.9 (cisplatin-paclitaxel backbone) vs 8.1 months (topotecan-paclitaxel backbone) (HR 0.95; 95% CI, 0.75–1.19). Grade 4 hematologic toxicity was similar between chemotherapy backbones. Conclusions Topotecan plus paclitaxel does not confer a survival benefit to women with recurrent/metastatic cervical cancer, even among platinum-exposed patients. Topotecan-paclitaxel should not be routinely recommended in this population. This study was supported by the following National Cancer Institute and Genentech grants: NRG Oncology (1U10CA180822), NRG Operations (U10CA180868) and NCORP grant UG1CA189867.

Healthcare workers were more than essential during the COVID-19 pandemic, a fact that is recognized by societies the world over. However, in many countries, healthcare workers are not satisfied with their working conditions, which has resulted in frequent protests and strikes. One such country is Spain. How can the theory of social dialogue contribute to explaining and improving healthcare workers' conditions during a healthcare crisis such as this one? In this paper, we aim to explore what it is really like for healthcare professionals working under these challenging circumstances, and link their experience to the theory of social dialogue in order to engage in a double process of contribution: from practice to theory and vice versa. In order to do so, we first explore the real-world problems encountered by professionals, focusing particularly on cases in Spain, before reviewing theoretical approaches to the study of social dialogue in organizations, an area that has received very little attention in the revised academic literature. Finally, we show how constructive social dialogue can be an effective tool for improving working conditions for healthcare workers. Keywords: Healthcare workers; COVID-19; Collective Labor Conflict; Social Dialogue.

Early breast cancer; Event-free survival; Pathologic complete response Cáncer de mama temprano; Supervivencia libre de eventos; Respuesta patológica completa Càncer de mama precoç; Supervivència lliure d'esdeveniments; Resposta patològica completa The standard-of-care for patients with pathological complete response (pCR) after neoadjuvant human epidermal growth factor receptor 2 (HER2)-targeted therapy plus chemotherapy is continuation of HER2-targeted therapy in the adjuvant setting. Our objective was to evaluate risk of recurrence or death in these patients and determine if outcomes differed by the HER2-targeted regimen received in each setting. We analyzed patient-level data from five randomized trials evaluating trastuzumab, pertuzumab, or both as part of systemic neoadjuvant and adjuvant therapy for HER2-positive early breast cancer, and assessed event-free survival (EFS) in 1763 patients. Patients with pCR had decreased risk of an EFS event versus those with residual disease (unadjusted hazard ratio [HR] = 0.35; 95% confidence interval [CI]: 0.27–0.46). Regardless of pCR status, after adjusting for baseline factors, reduction in EFS event risk was greater in patients administered pertuzumab/trastuzumab in both settings versus those administered only trastuzumab in both settings (HR = 0.36; 95% CI: 0.26–0.49), or pertuzumab/trastuzumab in the neoadjuvant setting and only trastuzumab in the adjuvant setting (HR = 0.67; 95% CI: 0.47–0.96). Patients with pCR had longer EFS than those with residual disease. Patients treated with pertuzumab/trastuzumab in both the neoadjuvant and adjuvant settings had the lowest risk of breast cancer recurrence. The analysis was funded by F. Hoffmann-La Roche, Ltd.

Background Despite atezolizumab and bevacizumab (A + B) is currently the first‐line treatment for hepatocellular carcinoma (HCC) patients, some patients will not be adequate for this combination. In the setting of sorafenib some adverse events have been proposed as prognostic factors. Objective To characterize the early diarrhoea development as prognostic factor in 344 HCC patients. Methods The development of early diarrhoea in sorafenib treatment defined as patients who developed diarrhoea and needed dose modification within the first 60 days of treatment (e‐diarrhoea) and 3‐grouping variables were analysed: Patients with e‐diarrhoea, patients who developed diarrhoea after the first 60 days of treatment (L‐diarrhoea) and patients that never developed diarrhoea (never diarrhoea). Results The median overall survival in sorafenib treated patients was significantly different across groups (6.8 months for e‐diarrhoea, 26.7 months for L‐diarrhoea and 13.3 months for never‐diarrhoea). The emergence of e‐diarrhoea was associated with poor outcomes (hazard ratio [HR] 1.84 [95%CI 1.15–2.95]), while there was no increased/decreased risk of dismal evolution in patients with L‐diarrhoea (HR 0.66 [95%CI 0.42–1.03]). Conclusion The emergence of e‐diarrhoea in HCC patients treated with sorafenib is an early predictor of dismal evolution under this therapy. Thus, prompt identification of these non‐responders may be useful for an early switch to second‐line therapies., Key Summary Established knowledge on this subject Diarrhoea is a frequent adverse event of sorafenib and its emergence has been associated to better outcomes. What are the significant and/or new findings of this study? Early diarrhoea (e‐diarrhoea) in hepatocellular carcinoma patients treated with sorafenib is an early predictor of dismal evolution.Diarrhoea under sorafenib should not be taken as a predictive parameter of lack of benefit.E‐diarrhoea could be used as clinical biomarker for switching to second‐line therapies.

Purpose: To determine graft and patient survival and adverse events in patients who undergo orthotopic kidney transplantation. Methods: We performed a systematic review and meta-analysis. We search in Medline, Embase, and Central from inception to nowadays. We included observational studies with patients who undergo orthotopic kidney transplantation. The primary outcomes were overall patient and graft survival. We pooled the information in a frequency meta-analysis with a 95% CI. We analyzed bias with the STROBE statement. Results: Of the 106 papers initially retrieved, four met the inclusion criteria. Vascular and urinary tract complications were reported in 19% and 15%, respectively. The overall patient survival was 92% 95%CI (88% to 95%), I2 = 0%, and the overall graft survival was 88% 95 CI (83% to 91%), I2 = 0%. Conclusion: Our analysis showed a high survival rate in patients and kidney grafts after orthotopic kidney transplantation, with a similar complication rate compared to a heterotopic kidney transplant.

Background Eribulin, a nontaxane synthetic inhibitor of microtubule dynamics, is widely used to manage locally advanced or metastatic breast cancer (MBC). Eribulin has demonstrated immunomodulatory activity on the tumour microenvironment. Baseline neutrophil-to-lymphocyte ratio (NLR), a marker of immune status, may predict progression-free survival in eribulin treatment. This post hoc analysis assessed predictors for overall survival (OS). Methods The phase 3 open-label study (EMBRACE) of eribulin versus treatment of physician’s choice (TPC) in patients with MBC provided source data. Baseline absolute lymphocyte counts (ALCs) and NLR were evaluable in 751 and 713 patients, respectively. Results Eribulin prolonged OS versus TPC in patients with baseline ALC ≥ 1500/µl (hazard ratio [HR] 0.586; 95% confidence interval [CI] 0.437–0.784; P P = 0.989). Univariate and multivariate analyses were performed and identified baseline ALC as a potential predictor of OS in eribulin-treated patients. Interaction analysis of OS supported 1500/µl as a potentially differential cutoff value. NLR at a cutoff value of 3 was associated with prolonged OS (eribulin group). However, similar results were also observed in the TPC group, without apparent interaction effect, suggesting that NLR may be a general prognostic marker rather than a specific predictor of OS for eribulin. Discussion This hypothesis-generating study speculates that baseline ALC may be an independent predictor for longer OS in eribulin-treated MBC patients and could be clinically impactful because it can be evaluated without the need for additional invasive procedures. Trial Registration www.ClinicalTrials.gov code: NCT00388726

Objective To create an electronic frailty index (eFRAGICAP) using electronic health records (EHR) in Catalunya (Spain) and assess its predictive validity with a two-year follow-up of the outcomes: homecare need, institutionalization and mortality in the elderly. Additionally, to assess its concurrent validity compared to other standardized measures: the Clinical Frailty Scale (CFS) and the Risk Instrument for Screening in the Community (RISC). Methods The eFRAGICAP was based on the electronic frailty index (eFI) developed in United Kingdom, and includes 36 deficits identified through clinical diagnoses, prescriptions, physical examinations, and questionnaires registered in the EHR of primary health care centres (PHC). All subjects > 65 assigned to a PHC in Barcelona on 1st January, 2016 were included. Subjects were classified according to their eFRAGICAP index as: fit, mild, moderate or severe frailty. Predictive validity was assessed comparing results with the following outcomes: institutionalization, homecare need, and mortality at 24 months. Concurrent validation of the eFRAGICAP was performed with a sample of subjects (n = 333) drawn from the global cohort and the CFS and RISC. Discrimination and calibration measures for the outcomes of institutionalization, homecare need, and mortality and frailty scales were calculated. Results 253,684 subjects had their eFRAGICAP index calculated. Mean age was 76.3 years (59.5% women). Of these, 41.1% were classified as fit, and 32.2% as presenting mild, 18.7% moderate, and 7.9% severe frailty. The mean age of the subjects included in the validation subsample (n = 333) was 79.9 years (57.7% women). Of these, 12.6% were classified as fit, and 31.5% presented mild, 39.6% moderate, and 16.2% severe frailty. Regarding the outcome analyses, the eFRAGICAP was good in the detection of subjects who were institutionalized, required homecare assistance, or died at 24 months (c-statistic of 0.841, 0.853, and 0.803, respectively). eFRAGICAP was also good in the detection of frail subjects compared to the CFS (AUC 0.821) and the RISC (AUC 0.848). Conclusion The eFRAGICAP has a good discriminative capacity to identify frail subjects compared to other frailty scales and predictive outcomes.

BackgroundThe COVID-19 pandemic confirmed that respiratory nurses are critical healthcare providers. Limited knowledge is available about appropriate education to prepare nurses to deliver high-quality respiratory care. A survey was developed by the International Coalition for Respiratory Nursing (ICRN) group to identify the need for a respiratory nursing core curriculum.MethodA 39-item survey was distributed to 33 respiratory nursing experts in 27 countries. Questions asked about current roles, perception of need, expectations for a core curriculum project and respiratory content in nursing education in their countries.Results30 responses from 25 countries were analysed; participants predominantly worked in academia (53.3%, 16/30) and clinical practice (40%, 12/30). In total, 97% (29/30) confirmed a need for a core respiratory nursing curriculum. Post-registration nursing programmes at bachelor (83.3%, 25/30) and masters (63.3%, 19/30) levels include internal/medical nursing care; less than half identified separate respiratory nursing content. The core educational programme developed should include knowledge (70%, 21/30), skills (60%, 18/30), and competencies (50%, 15/30), with separate paediatric and adult content.ConclusionSurvey results confirm a wide variation in nursing education and respiratory nursing education across the world, with many countries lacking any formal educational programmes to prepare nurses capable of providing enhanced quality respiratory care. These findings support the need for a core respiratory curriculum. To advance this significant work the ICRN group plans to conduct a Delphi study to identify core curriculum requirements for respiratory nursing education at pre-registration and advanced educational levels to flexibly meet each country's specific educational requirements for recognition of respiratory nursing speciality practice.

Treballs Finals de Grau en Estadística UB-UPC, Facultat d'Economia i Empresa (UB) i Facultat de Matemàtiques i Estadística (UPC), Curs: 2021-2022, Tutor: Martin Ríos Alcolea, El análisis de supervivencia se suele utilizar en diversos estudios clínicos para estudiar el tiempo de un paciente hasta que presente un cierto evento (muerte, contraer una enfermedad. . . ). En este trabajo se aplicarán métodos no paramétricos de análisis de supervivencia a un caso muy particular: los récords en carreras que ha habido en los juegos olímpicos. Se planteará desde un enfoque de análisis de supervivencia una serie de preguntas al que se dará respuesta con diversas técnicas que se usarían en el campo de la medicina como la estimación de la función supervivencia. Según los resultados analizados con los test de Cox-mantel, de Logrank, y de Kruskal-Wallis podemos concluir que en las pruebas de 100m, 200m y 10.000m las mujeres baten los records más rápido que los hombres, mientras que en las otras categorías estudiadas son similares. Este comportamiento distinto en esas categorías indicaría que o bien los records de los hombres y mujeres en esas pruebas evolucionan de manera diferente, o bien son debidos a otros parámetros como el número de atletas total de cada género en la categoría o el desarrollo científico y técnico adaptado a cada género y prueba.

A shiny app is presented with two main goals: 1) to fit a MSM from specific data in a friendly way (programming skills are not required); 2) to predict the clinical evolution for a given patient based on the previous MSM. For illustrative purposes, we show how the app works using data from a multicohort study of more than 5,000 hospitalized adult COVID-19 patients from 8 Catalan hospitals during the first five waves of the pandemic. Different models have been fitted for the first Catalan pandemic wave, including as states the main outcomes (discharge and death) together with objective interventions during hospitalization such as non-invasive or invasive mechanical ventilation. The application and the underlying model are intended to be very useful for clinicians and to enhance the approach in modelling the course of other diseases with different stages of severity.

BACKGROUND: Application of the MSKCC and IMDC models is recommended for prognostication in metastatic renal cell cancer (mRCC). Patient classification in MSKCC and IMDC risk groups in real-world observational studies is often hampered by missing data on required pre-treatment characteristics. OBJECTIVE: To evaluate the effect of application of easy-to-use logical, or deductive, imputation on MSKCC and IMDC risk classification in an observational study setting. PATIENTS AND METHODS: We used data on 713 mRCC patients with first-line sunitinib treatment from our observational European multi-centre study EuroTARGET. Pre-treatment characteristics and follow-up were derived from medical files. Hospital-specific cut-off values for laboratory measurements were requested. The effect of logical imputation of missing data and consensus versus hospital-specific cut-off values on patient classification and the subsequent models’ predictive performance for progression-free and overall survival (OS) was evaluated. RESULTS: 45% of the patients had missing data for≥1 pre-treatment characteristic for either model. Still, 72% of all patients could be unambiguously classified using logical imputation. Use of consensus instead of hospital-specific cut-offs led to a shift in risk group for 12% and 7% of patients for the MSKCC and IMDC model, respectively. Using logical imputation or other cut-offs did not influence the models’ predictive performance. These were in line with previous reports (c-statistic ∼0.64 for OS) CONCLUSIONS: Logical imputation leads to a substantial increase in the proportion of patients that can be correctly classified into poor and intermediate MSKCC and IMDC risk groups in observational studies and its use in the field should be advocated.

We propose a joint model able to explain the association between body-weight fluctuation and overall mortality. Weight over time is defined in terms of a linear mixed model, and time-to-death is modelled through a proportional hazards model that incorporates body-weight fluctuation as well as baseline covariates. Competing causes of death are addressed by means of a stratified proportional hazards model. The models are applied to data from the PREDIMED study, an intervention trial conducted in Spain to assess prevention of cardiovascular disease in a population at high cardiovascular risk.

Hepatorenal syndrome (HRS) is a common complication of advanced cirrhosis. It is characterised by renal failure and major disturbances in circulatory function and it is caused by intense vasoconstriction of the renal circulation. Liver transplantation is the treatment of choice for HRS. However, it is not always possible owing to the short survival expectancy. Also, in the last years it has also been proved that the syndrome can be reversed by the simultaneous administration of albumin and arterial vasoconstrictors such as terlipressin. The main aim of this study is to assess the survival of HRS patients that are being treated with albumin, vasopressors or both of them and check whether their response to those treatments is determinant for their survival. To do so, classical competing risks analysis will be performed but also, some other techniques, such as the inclusion of time-varying covariates and the use of landmarking and multi-state models will be introduced. Finally, the results obtained with all the different methods will be compared and discussed.

To assess severity markers and outcomes of patients with systemic sclerosis (SSc) with or without pulmonary arterial hypertension (PAH-SSc/non-PAH-SSc), and the impact of interstitial lung disease (ILD) on PAH-SSc. Non-PAH-SSc patients from the Spanish SSc registry and PAH-SSc patients from the Spanish PAH registry were included. A total of 364 PAH-SSc and 1589 non-PAH-SSc patients were included. PAH-SSc patients had worse NYHA-functional class (NYHA-FC), worse forced vital capacity (FVC) (81.2 ± 20.6% vs 93.6 ± 20.6%, P

Endometrial cancer is the fourth most common cancer in women and the fifth most common cancer overall in the European Union (EU). The role of chronic inflammation on endometrial cancer risk remains unclear beyond as an underlying mechanism of obesity and physical activity. Although it is known that chronic inflammation plays an important role in carcinogenesis, diet may be crucial in regulating this chronic inflammation. The objective of this project is to assess the associaiton between the inflammatory potential of the diet and the risk of endometrial cancer (overall, according to menopausal status and BMI categories) and the endometrial cancer survival.

Clients investments are a major source of revenue for the banking sector. Knowing which clients to offer an investment product is a great competitive advantage for commercial banks. Many models for customer and banking prediction have been developed over the past few decades. The purpose of this study is to address the problem of predicting a first-time investor using survival analysis techniques as an alternative to traditional classification models. In this thesis, survival analysis is done in two ways. First, univariate analysis is performed using Kaplan Meier survival curves to estimate the contribution of each covariate in customers investing behavior. Secondly, a Cox proportional hazard model is developed using a set of covariates to determine the risk of investing for the first time. The data is obtained from a Brazilian commercial bank between 2018 and 2021. Results show that there are clear differences in customer characteristics affecting the likelihood of investing for the first time and the timeframes within which that is likely to take place.

This is an Accepted Manuscript of an article published by Taylor & Francis Group in Maritime Policy & Management on Published online: 12 Sep 2021, available online at: http://www.tandfonline.com/10.1080/03088839.2021.1972175. The Yangtze River Delta multi-port system (YMPS) receives increasing attention due to its relevance in world trade and excellent competitiveness in the container traffic market. To insight into the development pattern of YMPS, this paper proposes a method that combines the Hierarchical Clustering with compositional data (CoDa) exploratory tools (i.e., biplot and dendrogram) to explore the temporal and spatial evolution of the YMPS from 1992 to 2019. CoDa describes parts of some whole (i.e., frequency and percentage), conveying relative information in the ratios between its components. Container traffic share in a multi-port region is typical CoDa. Traditional statistical approaches to CoDa could lead to spurious correlations and erroneous conclusions. However, using suitable CoDa techniques, such as the centered log-ratio (clr) transformation, can effectively avoid these misinterpretations. The novel method can simultaneously find the temporal and spatial characteristics. The findings indicate that the development of the YMPS has gone through four stages and the evolution of the YMPS is characterized by a tendency towards a ‘multi-core development’ and faces a differentiated pattern of ‘peripheral port challenges’. The analysis further improves the port system’s evolutionary model and explains the underlying reason for the YMPS development. CoDa techniques also provide a new perspective for the temporal and spatial evolution of the transport discipline. This work was supported by the Ministerio de Ciencia, Innovación y Universidades under project Methods for Compositional analysis of Data (CODAMET) [grant number RTI2018-095518-B-C22, 2019-2021] and 111 Project [grant number D21013]

Background The purpose of our study was to develop an online calculator to estimate the effect of docetaxel triplets (DPF) in first line of advanced gastric cancer (AGC), and to assess the external validity of docetaxel trials in individual patients. Methods The study includes patients with HER2(-) AGC treated with platin and fluoropyrimidine (PF) or with DPF in first line. Treatment effect and interactions were assessed using Bayesian accelerated failure time models. Result The series comprises 1376 patients; 238 treated with DPF and 1138 with PF between 2008 and 2019. DPF was associated with increased progression-free survival (PFS) and overall survival (OS) with time ratio (TR) 1.27 (95% credible interval [CrI], 1.15–1.40), and TR 1.19 (95% CrI, 1.09–1.27), respectively. Serious adverse events were more common with DPF, particularly hematological effects (32% vs 22%). Younger participants received greater DPF dose density without achieving greater disease control, while severe toxicity was likewise higher. DPF yielded superior OS in Lauren intestinal (TR 1.27, 95% CrI, 1.08–1.11) vs diffuse subtype (TR 1.17, 95% CrI, 1.09–1.24) and the probability of increasing OS > 15% was 90% vs 67% in each subtype, respectively. The effect dwindles over time, which can be attributed to pathological changes and clinical practice changes. Conclusion Our study confirms the effect of DPF is highly dependent on several clinical–pathological variables, with discreet and gradually declining benefit over platinum doublets in later years, at the expense of increased toxicity. These results may help to underpin the idea that external validity of AGC trials should be revised regularly.

Chronic myeloid leukemia; BCR-ABL1 transcripts; Response to imatinib Leucemia mieloide crónica; Transcripciones de BCR-ABL1; Respuesta al imatinib Leucèmia mieloide crònica; Transcripcions BCR-ABL1; Resposta a imatinib The most frequent BCR-ABL1-p210 transcripts in chronic myeloid leukemia (CML) are e14a2 and e13a2. Imatinib (IM) is the most common first-line tyrosine–kinase inhibitor (TKI) used to treat CML. Some studies suggest that BCR-ABL1 transcript types confer different responses to IM. The objective of this study was to correlate the expression of e14a2 or e13a2 to clinical characteristics, cumulative cytogenetic and molecular responses to IM, acquisition of deep molecular response (DMR) and its duration (sDMR), progression rate (CIP), overall survival (OS), and treatment-free remission (TFR) rate. We studied 202 CML patients, 76 expressing the e13a2 and 126 the e14a2, and correlated the differential transcript expression with the above-mentioned parameters. There were no differences in the cumulative incidence of cytogenetic responses nor in the acquisition of DMR and sDMR between the two groups, but the e14a2 transcript had a positive impact on molecular response during the first 6 months, whereas the e13a2 was associated with improved long-term OS. No correlation was observed between the transcript type and TFR rate.

El uso de nuevos medicamentos en el campo de la oncología ha proporcionado una mejora en la supervivencia de los pacientes con cáncer. Por lo tanto, el uso de medicación en condiciones diferentes a las autorizadas, llamada mediación especial (ME) es cada vez más frecuente en este campo. El objetivo de este trabajo es mejorar la identificación de pacientes con escasa probabilidad de beneficiarse de la ME incorporando en el modelo de predicción nuevos parámetros clínicos y de laboratorio, que la literatura indica que tendrán un impacto pronóstico. Se construyó un modelo predictivo mediante el modelo de Cox. Se realizó una selección de las variables mediante una eliminación backward. El modelo predictivo final incluyó las variables: ECOG, IMC, tipo de tumor, hemoglobina, ratio neutrófilos/linfocitos, ratio plaquetas/linfocitos, líneas previas por enfermedad metastásica y número de sitios metastásicos. Se construyó una escala pronóstica que diferenciaba 4 grupos de riesgo.

Les escales de valoració al pacient politraumàtic són essencials per al seu maneig i pronòstic. Podem definir índexs de gravetat o probabilitat de supervivència. Segons quins paràmetres analitzi, podem parlar d'escales fisiològiques, anatòmiques, bioquímiques i els índexs de probabilitat de supervivència. El BISS és un model de probabilitat provat a Holanda que ha demostrat ser objectiu. El nostre treball consisteix en la validació del BISS als nostres pacients. Durant dos anys vàrem recollir 354 pacients podent incloure només 167 al nostre estudi. Els resultats van ser significatius amb l'estudi posterior, però degut a la gran pèrdua de pacients no podem afirmar la nostra hipòtesi. Las escalas de valoración al paciente politraumático son esenciales para su manejo y pronóstico. Podemos definir índices de gravedad o probabilidad de supervivencia. Según qué parámetros analice, podemos hablar de escalas fisiológicas, anatómicas, bioquímicas y los índices de probabilidad de supervivencia. El BISS es un modelo de probabilidad probado en Holanda que ha demostrado ser objetivo. Nuestro trabajo consiste en la validación del BISS en nuestros pacientes. Durante dos años recogimos 354 pacientes pudiendo incluir sólo 167 en nuestro estudio. Los resultados fueron significativos con el estudio anterior, pero debido a la gran pérdida de pacientes no podemos afirmar nuestra hipótesis.

The rising prevalence of gambling disorder (GD) among women has awakened considerable interest in the study of therapeutic outcomes in females. This study aimed to explore profiles of women seeking treatment for GD based on a set of indicators including sociodemographic features, personality traits, clinical state at baseline, and cognitive behavioral therapy (CBT) outcomes. Two-step clustering, an agglomerative hierarchical classification system, was applied to a sample of n = 163 women of ages ranging from 20 to 73 years-old, consecutively attended to by a clinical unit specialized in the treatment of G. Three mutually exclusive clusters were identified. Cluster C1 (n = 67, 41.1%) included the highest proportion of married, occupationally active patients within the highest social status index. This cluster was characterized by medium GD severity levels, the best psychopathological functioning, and the highest mean in the self-directedness trait. C1 registered 0% dropouts and only 14.9% relapse. Cluster C2 (n = 63; 38.7%) was characterized by the lowest GD severity, medium scores for psychopathological measures and a high risk of dropout during CBT. Cluster C3 (n = 33; 20.2%) registered the highest GD severity, the worst psychopathological state, the lowest self-directedness level and the highest harm-avoidance level, as well as the highest risk of relapse. These results provide new evidence regarding the heterogeneity of women diagnosed with GD and treated with CBT, based on the profile at pre- and post-treatment. Person-centered treatments should include specific strategies aimed at increasing self-esteem, emotional regulation capacities and self-control of GD women.

We investigated the clinicopathological features and prognostic factors of patients with peripheral T-cell lymphoma (PTCL) in 13 sites across Spain. Relevant clinical antecedents, CD30 expression and staining pattern, prognostic indices using the International Prognostic Index and the Intergruppo Italiano Linfomi system, treatments, and clinical outcomes were examined. A sizeable proportion of 175 patients had a history of immune-related disorders (autoimmune 16%, viral infections 17%, chemo/radiotherapy-treated carcinomas 19%). The median progression-free survival (PFS) and overall survival (OS) were 7·9 and 15·8 months, respectively. Prognostic indices influenced PFS and OS, with a higher number of adverse factors resulting in shorter survival (P 15% of cells were positive in anaplastic lymphoma kinase-positive and -negative anaplastic large-cell lymphoma and extranodal natural killer PTCL groups. We observed PTCL distribution across subtypes based on haematopathological re-evaluation. Poor prognosis, effect of specific prognostic indices, relevance of histopathological sub-classification, and response level to first-line treatment on outcomes were confirmed. Immune disorders amongst patients require further examination involving genetic studies and identification of associated immunosuppressive factors., This study was sponsored by Takeda.

Treballs Finals de Grau en Estadística UB-UPC, Facultat d'Economia i Empresa (UB) i Facultat de Matemàtiques i Estadística (UPC), Curs: 2019-2020. Tutor: Klaus Langohr, [cast] El c ancer es una enfermedad que lleva muchos a~nos siendo una de las principales causas de mortalidad del mundo. Se han obtenido una gran cantidad de datos del c ancer colorrectal en Estados Unidos para un per odo temporal que va desde 1975 hasta 2016. El objetivo de este trabajo ha sido estudiar los factores asociados a la supervivencia del c ancer colorrectal a trav es del Modelo de Cox y Modelo de Vida Acelerada. Al dividirse la base de datos en dos ejes temporales, una de pacientes diagnosticados entre los a~nos 1975 y 1984 y otra con los diagnosticados entre 2004 y 2011, se ha comprobado como la supervivencia de este tipo de tumor ha mejorado para los tiempos m as recientes. Adem as, se ha podido comprobar como las personas afroamericanas tienen una menor supervivencia. Como cab a esperar el riesgo de muerte en un plazo de cinco a~nos desde el diagn ostico del tumor es mayor para las personas que carecen de seguro m edico privado, las que tienen m as edad, las que tienen un tama~no de tumor m as grande y las que tienen un c ancer de grado m as alto., [eng] Cancer is a disease that has been one of the world's leading causes of mortality for many years. A large amount of colorrectal cancer data has been obtained in the United States from 1975 to 2016. The objective of this work will be to study the factors associated with the survival of colorrectal cancer using the Cox Model and the Accelerated failure time model. Due to dividing the database into two smaller ones, one with patients diagnosed between 1975 and 1984 and the other with those diagnosed between 2004 and 2011, it has been found that the survival of this type of tumour has improved. Furthermore, it has been veri ed that African- American people have lower survival. As expected, the 5-year risk of death is higher for people without private health insurance, those who are older, those with larger tumour size, and those with higher-grade cancer.

Conflicts of Interest: M.G.-F. provided consultancy services to Pfizer, Novartis, Jazz Pharmaceuticals and Astellas. R.G.-D. provided consultancy services to Abbie, Novartis, Bristol-Myers Squibb, and Janssen, and received research funding from Bristol-Myers Squibb. F.F.-M. received a grant from Incyte Corporation (FFIS-CNT-2020-8) and from CTI Biophama Corp (CFE/BI/72-19; FFIS-CNT-2019-4). The remaining authors declare no competing financial interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. Funding: This research was supported by an unrestricted grant from Novartis Pharmaceutical. The opinions expressed in this article are those of the authors and do not necessarily reflect those of Novartis. Acknowledgments: The authors thank all of the patients and their families who contributed to this study and the participating site study data coordinators. This article was produced through the collaborative efforts of the Spanish Group of Ph-negative Myeloproliferative Neoplasms (GEMFIN). The study was sponsored by Novartis Pharmaceuticals, Inc. The comorbidity burden is an important risk factor for overall survival (OS) in several hematological malignancies. This observational prospective study was conducted to evaluate the impact of individual comorbidities on survival in a multicenter series of 668 patients with primary myelofibrosis (PMF) or MF secondary to polycythemia vera (PPV-MF) or essential thrombocythemia (PET-MF). Hypertension (hazard ratio (HR) = 4.96, p < 0.001), smoking (HR = 5.08, p < 0.001), dyslipidemia (HR = 4.65, p < 0.001) and hepatitis C virus (HCV) (HR = 4.26, p = 0.015) were most adversely associated with OS. Diabetes (HR = 3.01, p < 0.001), pulmonary disease (HR = 3.13, p < 0.001) and renal dysfunction (HR = 1.82, p = 0.037) were also associated with an increased risk of death. Multivariate analysis showed that pulmonary disease (HR = 2.69, p = 0.001), smoking (HR = 3.34, p < 0.001), renal dysfunction (HR = 2.08, p = 0.043) and HCV (HR = 11.49, p = 0.001) had a negative impact on OS. When ruxolitinib exposure was included in the model, the effect of each comorbidity on survival was modified. Therefore, individual comorbidities should be taken into account in determining the survival prognosis for patients with MF.

Resumen: La supervivencia relativa se ha utilizado habitualmente como medida de la evolución temporal del exceso de riesgo de mortalidad en cohortes de pacientes diagnosticados de cáncer, teniendo en cuenta la mortalidad de una población de referencia. Una vez estimado el exceso de riesgo de mortalidad pueden calcularse tres probabilidades acumuladas a un tiempo T: 1) la probabilidad de fallecer asociada a la causa de diagnóstico inicial (enfermedad en estudio), 2) la probabilidad de fallecer asociada a otras causas, y 3) la probabilidad de supervivencia absoluta en la cohorte a un tiempo T. Este trabajo presenta la aplicación WebSurvCa (https://shiny.snpstats.net/WebSurvCa/), mediante la cual los registros de cáncer de base hospitalaria y poblacional, y los registros de otras enfermedades, estiman dichas probabilidades en sus cohortes seleccionando como población de referencia la mortalidad de la comunidad autónoma que consideren. Abstract: Relative survival has been used as a measure of the temporal evolution of the excess risk of death of a cohort of patients diagnosed with cancer, taking into account the mortality of a reference population. Once the excess risk of death has been estimated, three probabilities can be computed at time T: 1) the crude probability of death associated with the cause of initial diagnosis (disease under study), 2) the crude probability of death associated with other causes, and 3) the probability of absolute survival in the cohort at time T. This paper presents the WebSurvCa application (https://shiny.snpstats.net/WebSurvCa/), whereby hospital-based and population-based cancer registries and registries of other diseases can estimate such probabilities in their cohorts by selecting the mortality of the relevant region (reference population). Palabras clave: Cáncer de mama, Supervivencia neta, Supervivencia relativa, Exceso de mortalidad, Riesgos competitivos, Keywords: Breast cancer, Net survival, Relative survival, Excess mortality, Competing risk

Long-term survival; Prognostic factor; Small-cell lung cancer Supervivencia a largo plazo: Factor pronóstico; Cáncer de pulmón de células pequeñas Supervivència a llarg termini; Factor pronòstic; Càncer de pulmó de cèl·lules petites Introduction SCLC is one of the most lethal malignancies. Classically, staging has been performed using a dual classification distinguishing limited from the extensive stage. This study aimed to evaluate the prognostic value of TNM staging in a real-world population of patients with SCLC. Methods Patients were selected from the Surveillance Epidemiology and End Results database. Chi-square bivariate analysis was used for the association of binary qualitative variables. A multivariate Cox regression analysis was performed to determine the impact of these prognostic factors on median overall survival (mOS) and long-term survival. Results A total of 26,221 patients were included (50.7% men, 55.7% ≥65 y, 82% White). At diagnosis, 18,574 (70.83%) presented metastases, which were more frequent in the liver (n = 11,896, 64%). In the overall population, mOS was 8 (7.86–8.14) months, which decreased according to each increasing category of TNM staging (p < 0.0001). The worse mOS was found among patients with stage IV SCLC (6 mo, 95% confidence interval: 5.83–6.17). Long-term survival decreased according to TNM staging, with patients having stage IV SCLC exhibiting the lowest survival rates at all follow-up time points. Within stage IV, the lowest mOS values were found in patients greater than or equal to 65 years and in those with liver metastases. Among the TNM stages corresponding to the limited stage, stage IB revealed the lowest hazard ratios value for risk of death compared with stage IA (hazard ratio = 1.161, 95% confidence interval: 0.97–1.40, p = 0.114), which increased gradually within the limited-stage SCLC. In the multivariate analysis, TNM staging, male sex, and older age resulted in poor prognostic factors for survival. Conclusions TNM staging seems to define prognosis in patients with SCLC in the real-world setting, particularly for those patients with earlier disease. This study was sponsored by Roche Farma S.A., Spain.

Treballs Finals del Màster de Ciències Actuarials i Financeres, Facultat d'Economia i Empresa, Universitat de Barcelona, Curs: 2019-2020, Tutoria: M. Mercedes Claramunt, En el presente documento se detalla el uso del reaseguro como modalidad utilizada por las empresas aseguradoras para ver el efecto que tiene sobre las mismas tanto a nivel financiero como para mitigar los efectos sobre la solvencia. En concreto se estudiará el reaseguro en modalidad de vida y pensiones y su implicación en los SCR de vida y enfermedad. Asimismo, se estudiarán los efectos del Reaseguro en la nueva modalidad de IFRS-17.

Medical research frequently focuses on the relationship between quality of life (QoL) and survival time of subjects. QoL may be one of the most important factors that could be used to predict survival, making it worth identifying factors that jointly affect survival and QoL. We propose a semiparametric joint model that consists of item response and survival components, where these two components are linked through latent variables. Several popular ordinal models are considered and compared in the item response component, while the Cox proportional hazards model is used in the survival component. We estimate the baseline hazard function and model parameters simultaneously, through a profile likelihood approach. We illustrate the method using an example from a clinical study.