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This study sought to ascertain whether there might be an association between radon concentrations and age, gender, histologic type, and tumor stage at diagnosis.Lung cancer cases from different multicenter case-control studies were analyzed, and clinical data were retrieved from electronic health records and personal interviews. A radon device was placed in all dwellings of participants, and we then tested the existence of an association between residential radon and lung cancer characteristics at diagnosis.Of the total of 829 lung cancer cases included, 56.7% were smokers or ex-smokers. There was no association between indoor radon concentrations and age, gender, histologic type or tumor stage at diagnosis. Median indoor radon concentrations increased with age at diagnosis for men, but not for women. When analyzing participants exposed to more than 1000 Bq/mThere seems to be no association between radon and age, gender, histologic type or tumor stage at diagnosis. Higher radon exposure is more frequent in the case of small-cell lung cancer.

Stage III non-small cell lung cancer (NSCLC) includes a highly heterogeneous group of patients with differences in the extent and localization of disease. Many aspects of stage III disease are controversial. The data supporting treatment approaches are often subject to a number of limitations, due to the heterogeneous patient populations involved in the trials. Furthermore, the definition of stage III disease has changed over time, and early studies were frequently inadequately powered to detect small differences in therapeutic outcome, were not randomized, or had a limited follow-up times. Major improvements in therapy, including the use of more active chemotherapy agents and refinements in radiation and surgical techniques, also limit the interpretation of earlier clinical trials. Lastly, improvements in pretreatment staging have led to reclassification of patients with relatively minimal metastatic disease as stage IV rather than stage III, leading to an apparent increase in the overall survival of both stage III and IV patients. Median overall stage III NSCLC survival ranges from 9 to 34 months. Higher survival rates are observed in younger Caucasian women with good performance status, adenocarcinoma, mutations, stage IIIA, and in patients with multidisciplinary-team-based diagnoses.

El cáncer de pulmón (CP) en nunca fumadores es una entidad clínica distinta. Es más frecuente en mujeres, en estadio avanzado, con presencia de mutaciones y si su histología es adenocarcinoma. No parece existir relación entre la exposición a radón y las características al diagnóstico aunque se sugiere cierta relación entre concentraciones elevadas (> 1.000 Bq/m3) y el CP de célula pequeña en estadio extenso. La supervivencia del CP descrita en la literatura para los nunca fumadores parece mayor que la de los fumadores. Los datos de esta tesis parecen confirman la mayor supervivencia de los pacientes nunca fumadores. La supervivencia mediana de los nunca fumadores fue mayor en los pacientes de menor edad, con adenocarcinoma, presencia de mutaciones en genes diana y estadio al diagnóstico más precoz. Los casos con exposición a concentraciones de radón residencial superiores a 300 Bq/m3 obtuvieron una peor supervivencia a 3 y 5 años del diagnóstico. Por otro lado, la supervivencia a 5 años del diagnóstico de los pacientes con CP no parece estar influida por polimorfismos en genes que participan en las vías de reparación del ADN, excepto para el grupo de pacientes que reciben radioterapia o quimio-radioterapia y presentan la mutación ERCC1 rs3212986. En aquellos casos que reciben estos tratamientos se observa una mayor toxicidad ante la presencia de mutaciones en los genes OGG1 rs1052133 (CG) y ERCC1 rs11615.

Polymorphisms in DNA repair pathways may play a relevant role in lung cancer survival in never-smokers. Furthermore, they could be implicated in the response to chemotherapy and toxicity of platinum agents. The aim of this study was to evaluate the influence of various genetic polymorphisms in the BER and NER DNA repair pathways on survival and toxicity in never-smoker LC patients. The study included never-smokers LC cases diagnosed from 2011 through 2019, belonging to the Lung Cancer Research In Never Smokers study. A total of 356 never-smokers cases participated (79% women; 83% adenocarcinoma and 65% stage IV). Survival at 3 and 5 years from diagnosis was not associated with genetic polymorphisms, except in the subgroup of patients who received radiotherapy or chemo-radiotherapy, and presented with ERCC1 rs3212986 polymorphism. There was greater toxicity in those presenting OGG1 rs1052133 (CG) and ERCC1 rs11615 polymorphisms among patients treated with radiotherapy or chemo-radiotherapy, respectively. In general, polymorphisms in the BER and NER pathways do not seem to play a relevant role in survival and response to treatment among never-smoker LC patients.

Background: Respiratory rehabilitation (RR) has demonstrated efficacy within the comprehensive treatment of patients with stable COPD. Aim: To determine the clinical impact of RR in patients with stable COPD in our area. Methods: Descriptive analysis of the pre and post-intervention data of patients who during the last 6 years underwent an RR program. Statistical package for the social sciences (SPSS, version 22) software was used for statistical analysis. Results: 88 patients whose characteristics are shown in Table 1 were included. 71 (80.7%) completed the program. Two months after RR, significant differences in the 6-minute walking test (6MWT) with respect to baseline (X +38.4, SD 73.2, p There was a significant decrease in the assistance to the emergency services between the year before and after (0.89, SD 1.43 vs 0.55, SD 1.02; p 0.012). There were no differences in income or in the amount of days of admission. Conclusion: RR achieves a clinical improvement in patients with stable COPD. 6MWT is an useful tool to evaluate the effect of RR. It is important to refer patients with stable COPD to RR programs.

We aimed to evaluate lung cancer survival in never-smokers, both overall and specifically by sex, exposure to residential-radon, age, histological type, and diagnostic stage. We included lung cancer cases diagnosed in a multicentre, hospital-based, case-control-study of never-smoker patients, diagnosed from January-2011 to March-2015 (Lung Cancer Research In Never Smokers study). 369 never-smokers (79% women; median age 71 years; 80% adenocarcinoma; 66% stage IV) were included. Median overall survival, and at one, 3 and 5 years of diagnosis was 18.3 months, 61%, 32% and 22%, respectively. Higher median survival rates were obtained for: younger age, adenocarcinoma, actionable mutations, and earlier-stage at diagnosis. Higher indoor radon showed a higher risk of death in multivariate analysis. Median lung cancer survival in never-smokers seems higher than that in ever-smokers. Patients with actionable mutations have a significantly higher survival. Higher indoor-radon exposure has a negative effect on survival.

Background: The prognosis of a patient with Covid-19 pneumonia is uncertain. Our objective was to establish a predictive model of disease progression to facilitate early decision-making. Methods: A retrospective study was performed of patients admitted with Covid-19 pneumonia, classified as severe (admission to the intensive care unit, mechanic invasive ventilation, or death) or non-severe. A predictive model based on clinical, analytical, and radiological parameters was built. The probability of progression to severe disease was estimated by logistic regression analysis. Calibration and discrimination (receiver operating characteristics curves and AUC) were assessed to determine model performance. Findings: During the study period 1,152 patients presented with Covid-19 infection, of whom 229 (19.9%) were admitted for pneumonia. During hospitalization, 51 (22.3%) progressed to severe disease, of whom 26 required ICU care (11.4); 17 (7.4%) underwent invasive mechanical ventilation, and 32 (14%) died of any cause. Five predictors determined within 24 hours of admission were identified: Diabetes, Age, Lymphocyte count, SaO2, and pH (DALSH score). The prediction model showed a good clinical performance, including discrimination (AUC 0.87 CI 0.81, 0.92) and calibration (Brier score = 0.11). In total, 0%, 12%, and 50% of patients with severity risk scores ≤5%, 6-25%, and >25% exhibited disease progression, respectively. Interpretation: A simple risk score based on five factors predicts disease progression and facilitates early decision-making according to prognosis. Funding Statement: This project was funded by the Carlos III Health Institute, Spain, Grant/Award Number: COV20/00404; Ministry of Economy and Competitiveness (SPAIN) and the European Regional Development Fund (FEDER). Declaration of Interests: The authors declare no conflicts of interest associated with this publication. Ethics Approval Statement: The study was conducted in accordance with the guidelines of the Declaration of Helsinki and the principles of good clinical practice and was approved by the Institutional Review Board (IRB) of the Galician Health Service on April 3, 2020 (#2020/194). Informed consent forms were waived by the IRB.

The authors regret not having included the following funding in the paper “Spanish Society of Neumology and Thoracic Surgery”. Project number 848. 2019 call. The authors would like to apologise for any inconvenience caused.

Lung cancer incidence among never smokers has increased in recent decades with 10-30% of all lung cancers occurring in never smokers, where exposure to residential radon is the leading cause of this disease. Lung cancer survival is low, ranging from 12% to 16% at 5 years of diagnosis. There is scant evidence to date on survival from this disease in never smokers. We aim to evaluate lung cancer survival in never smokers and ascertain whether there might be differences regarding smokers, through a systematic review applying predefined inclusion and exclusion criteria. 17 Studies were included. Never-smoker lung cancer patients seem to experience longer survival times than do smokers or ex-smokers. Lung cancer in never smokers displays distinctive clinical characteristics, is more frequent among women, is diagnosed at more advanced stages, and the predominant histologic type is adenocarcinoma. Further studies are necessary to ascertain lung cancer survival among never smokers.