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Evaluation of the Treatment of Head and Neck Cutaneous Squamous Cell Carcinoma in the Elderly: A Survival Analysis
Evaluación del tratamiento del carcinoma epidermoide cutáneo de cabeza y cuello en la edad avanzada. Análisis de la supervivencia
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"referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Javier" "apellidos" => "Puertas Peña" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Cirugía Plástica, Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Geriatría, Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Cirugía Plástica, Hospital MAZ de Zaragoza, Zaragoza, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación del tratamiento del carcinoma epidermoide cutáneo de cabeza y cuello en la edad avanzada. Análisis de la supervivencia" ] ] "resumenGrafico" => array:2 [ "original" => 1 "multimedia" => array:5 [ "identificador" => "fig0010" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 748 "Ancho" => 1333 "Tamanyo" => 102776 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Cutaneous squamous cell carcinoma (cSCC) is the second most frequent non-melanoma skin cancer.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> In Spain, the annual incidence rate is estimated at 86 per 100<span class="elsevierStyleHsp" style=""></span>000 inhabitants.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">2</span></a> 75%–90% of these lesions appear in the head and neck.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">3</span></a> cSCC is the most frequent cancer capable of metastasizing,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a> which results in higher mortality rates. The 5-year survival of metastatic cSCC without treatment is less than 35%, and between 25 and 70% overall, depending on the bibliographic source consulted.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">4–8</span></a> Treatment of this tumor is radical excision, accompanied or not by cervical lymphadenectomy.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1,8–12</span></a> The latter is performed in the presence of metastatic nodules, which are identified according to current tumor staging guidelines as N1.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">13,14</span></a> It is necessary to know the characteristics of the tumor and whether it presents metastasis at the time of treatment. Regional treatment involving cervical lymphadenectomy is an aggressive therapeutic procedure. Although it is performed routinely in carcinoma of the head and neck mucosa, there is greater reluctance to perform it systematically in cutaneous carcinomas, as predicting lymphatic drainage pathways of this type of skin lesions has been observed to be difficult. In addition, this therapeutic technique is not free of complications, and lymphadenectomy has a mortality rate of 1%.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The aggressiveness of the technique raises concerns for surgeons who perform it, especially in seniors. In these patients, high mortality is assumed, and often due to causes other than the skin cancer itself. This phenomenon is known as ageism<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">15,16</span></a> and consists of age-related discrimination of patients in clinical practice. In such instances, the therapeutic indication is determined by the subjectivity of the physician and not by scientific evidence. In contrast, the short-form Charlson Index is a predictive scale of mortality, independent of age, which has been validated internationally. A value equal to or greater than 3 on this scale indicates a probability of high short-term mortality.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">17,18</span></a> The aim of this paper is to analyze the influence of age, the short-form Charlson Index and treatment on the survival of senior patients with head and neck cSCC.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">This is an observational, retrospective analytical study including all cSCC treated surgically by the Plastic Surgery Department at the Miguel Servet University Hospital (Zaragoza, Spain) from 2006 to 2011. The inclusion criteria were: cSCC, surgical treatment, and histological confirmation of invasive carcinoma. The exclusion criteria were: non-invasive carcinomas (carcinomas in situ), non-cutaneous carcinomas, and tumors treated by other departments. An analysis was conducted in which regional treatment was selected as a dependent variable. The sample was divided into two groups, depending on the presence (N1) or absence (N0) of cervical metastases. As independent variables, age and the short-form Charlson Comorbidity Index were also selected. The sample was grouped again according to these variables, by age group (<70, 70–79, 80–89, >90) and according to the Charlson Index (<3, ≥3). The following study variables were recorded: patient gender, age at the time of surgery, death (yes/no) and time of death, main cause of death (regional cSCC, metastasis, etc.), short-form Charlson index, tumor size (high risk: ≥5<span class="elsevierStyleHsp" style=""></span>cm; low risk: <5<span class="elsevierStyleHsp" style=""></span>cm), tumor differentiation grade (high risk: Broders III; low risk: Broders I, II), resection margins (negative, affected), tumor location (high risk: face and auricle, low risk: others), invasion of deep extradermal structures (yes/no); TNM stage, presence of metastasis (yes/no), regional treatment (yes/no).</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical Analysis</span><p id="par0020" class="elsevierStylePara elsevierViewall">A univariate survival analysis was performed: bivariate for each of the groups of independent variables according to whether the regional treatment was carried out or not; and multivariate. The following variables were included in the multivariate analysis: grouped age, short-form Charlson Index, gender, number of high-risk characteristics and regional treatment. The analysis was carried out in each of the groups, according to whether they developed metastasis (N1) or not (N0). To perform the bivariate survival analysis, mortality tables and the Wilcoxon test were used, and for the multivariate analysis, the Cox regression and the −2 log likelihood ratio test were used. Alpha=0.05 was considered statistically significant. All statistical analyses were conducted with the Statistical Package for Social Sciences, version 16.0 (SPSS Inc., Chicago, IL, USA).</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">We included 416 cases of cSCC. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> reflects the general data of the population under study. Most of the metastases (25 out of 26) occurred in patients over the age of 70. Twelve cases were not treated according to current clinical guidelines; in 6 cases, it was followed when the patient did not present metastasis (N0), and in 6 it was not followed when they did (N1). The mortality of the surgery by regional treatment was 3.33%. The univariate survival analysis showed that the N0 group had a median survival of 66.57 months, and the N1 group survival was 43.33 months. When the bivariate analysis was conducted on the group that did not develop metastasis (N0)—390 cases—and on N1 patients—26 cases—, the results obtained are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. Both in the N0 group and in the N1 group, as age or the value of the abbreviated Charlson Index increased, the survival time was shorter, regardless of the treatment received. These differences were not statistically significant (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">In the case of patients who presented cervical metastasis (N1), the subgroup that received regional treatment with a Charlson Index higher than 3 and the subgroup of patients younger than 70 years of age in whom lymphadenectomy was not performed could not be analyzed because neither subgroups had sufficient cases. The multivariate analysis of the N0 group showed the following results: 390 cases, 39.5% censored, grouped age variables (<span class="elsevierStyleItalic">P</span>=.0001, OR=1.488, 95% CI=[1.318; 1.679], abbreviated Charlson Index (<3, ≥3) (<span class="elsevierStyleItalic">P</span>=.001, OR=1.817, 95%CI=[1.257; 2.627]); gender, number of high risk characteristics and regional treatment (<span class="elsevierStyleItalic">P</span><.05). When applied to patients with N1 (26 cases, 30.8% censored), these were the results: regional treatment (<span class="elsevierStyleItalic">P</span>=.048, OR=0.15, 95%CI=[0.023; 0.981]), grouped age, Charlson Index, gender and number of high-risk characteristics (<span class="elsevierStyleItalic">P</span><.05).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">When deciding whether to perform cervical lymphadenectomy in a senior patient, the surgeon may be influenced by the age of the patient before conducting such an aggressive maneuver.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">15</span></a> The logical reaction is to think that, because the patient is an older person, surgery may be harmful and the patient will probably as the result of some other cause.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">16</span></a> This is more understandable the greater the patient's age. In this instance, the therapeutic indication is influenced by subjective information, which entirely depends on the beliefs and opinions of the surgeon. In the survival analysis, and considering only the patients who did not develop metastases, the only variables that have an influence on patient survival are age (<span class="elsevierStyleItalic">P</span>=.0001) and the abbreviated Charlson Index (<span class="elsevierStyleItalic">P</span>=.001). Each has an OR of 1.488 and 1.817, respectively, which indicates that the probability of death increases with age, and when adding a Charlson Index greater than or equal to 3. Gender and the number of high-risk tumor characteristics do not generate significant differences in the survival of this patient sample. The same thing happens with regional treatment. This variable is included in the multivariate analysis of N0 patients to determine its validity. The results demonstrate, as expected, that cervical lymphadenectomy in a patient who has not developed metastasis has no influence on survival. These data should be interpreted with caution, because, although the sample is large, the analysis shows a high number of censored data (39.5%).</p><p id="par0040" class="elsevierStylePara elsevierViewall">However, the same is not true in the group of patients with metastasized cervical lymph nodes (N1). In these patients, the multivariate analysis does not show that age or the Charlson index influence survival, and instead confirms the positive influence of the regional treatment (<span class="elsevierStyleItalic">P</span>=.048, OR=0.15), that is, that lymphadenectomy in these patients acts as a protective factor against mortality. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows that patients with N1 who received regional treatment have a longer survival than those who did not (100 vs 40 months). These differences are not statistically significant (<span class="elsevierStyleItalic">P</span>=.249). The same occurs with patients who did not develop metastases, which in this case act as a control group. N0 patients who received regional treatment have a lower median survival than those who did not (50 vs 67.73). Likewise, these differences were not statistically significant (<span class="elsevierStyleItalic">P</span>=.413).</p><p id="par0045" class="elsevierStylePara elsevierViewall">As age increased, the median survival in both groups decreased, regardless of the treatment received (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). However, these differences were not statistically significant. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows that the median survival was different in the N0 patient group, within each of the age groups but having received different treatments. In addition, as shown by the multivariate analysis, in this group of patients the treatment had no influence on survival (<span class="elsevierStyleItalic">P</span><.05). It cannot be stated, therefore, that patients with N0 have longer survival rates depending on whether or not they undergo lymphadenectomy.</p><p id="par0050" class="elsevierStylePara elsevierViewall">With the results of the bivariate survival analysis, this statement can be extrapolated to the N1 patient group, since their survival is not significantly greater according to the treatment received. However, the multivariate analysis confirmed the influence of treatment on the survival of N1 patients (<span class="elsevierStyleItalic">P</span>=.048). The mortality of N1 patients who had cervical lymphadenectomy was lower, but with these data it cannot be said that the survival time is longer or shorter than patients without cervical lymphadenectomy.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The Charlson Index has been shown to be a good indicator of mortality in patients who did not develop metastases (<span class="elsevierStyleItalic">P</span>=.001, OR=1.817), with an influence greater than age and whose OR was lower (1.488). This was not so in the group of patients with N1 tumors. This may have been due to the difference in the number of cases in each of the groups, and to the fact that N1 tumors have a more aggressive behavior, despite the treatment.</p><p id="par0060" class="elsevierStylePara elsevierViewall">To our knowledge, there are no previous studies that analyze the utility of age or the short-form Charlson Index as indicators for the survival of patients with this pathology.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The study does not show that either the Charlson Index or age is a good indicator for survival in patients with cSCC and cervical nodules. Older patients are the most affected by metastasis of these tumors. In order not to fall into the practice of ageism, the decision should not be made to perform an aggressive and curative treatment on the patient while anticipating mortality because the patient is older. Diagnostic and therapeutic options should be contemplated, along with how these factors influence survival.</p><p id="par0070" class="elsevierStylePara elsevierViewall">According to this study, regional treatment reduces the mortality of N1 cSCC, regardless of age and the value of the short-form Charlson Index. It does not demonstrate that treatment with cervical lymphadenectomy modifies the median survival time in these patients. Further studies, probably with larger samples, are necessary to present significant results. Age and the short-form Charlson Index are once again shown to be good indicators of mortality in patients with cSCC who do not develop cervical metastasis.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of Interests</span><p id="par0075" class="elsevierStylePara elsevierViewall">None of the authors have a conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1113407" "titulo" => "Graphical abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:3 [ "identificador" => "xres1113408" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0010" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 2 => array:2 [ "identificador" => "xpalclavsec1051196" "titulo" => "Keywords" ] 3 => array:3 [ "identificador" => "xres1113409" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusiones" ] ] ] 4 => array:2 [ "identificador" => "xpalclavsec1051195" "titulo" => "Palabras clave" ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 6 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical Analysis" ] ] ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of Interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-03-22" "fechaAceptado" => "2018-05-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1051196" "palabras" => array:4 [ 0 => "Ageism" 1 => "Senior patients" 2 => "Skin cancer" 3 => "Lymphadenectomy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1051195" "palabras" => array:4 [ 0 => "Ageísmo" 1 => "Paciente anciano" 2 => "Neoplasias cutáneas" 3 => "Linfadenectomía" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">It is unknown whether cervical lymphadenectomy as a treatment for cutaneous squamous cell carcinoma of the head and neck (cSCCh&n) increases survival in elderly patients. The aim of this study is to determine whether this procedure has an influence on the survival of these patients, and whether the Short-Form Charlson Comorbidity Index (<span class="elsevierStyleSmallCaps">CC</span>I-SF) can be used as an alternative to age in the surgeon's estimation of elderly patient mortality.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The study population included all patients diagnosed with cSCCh&n consecutively treated between 2006 and 2011. Non-invasive, non-cutaneous carcinomas were excluded. Patients were grouped according to their age (<70, 70–79, 80–89, >90), CCI-SF (<3, ≥3) and presence (N1) or absence (N0) of cervical metastases. The dependent variable was the performance or not of cervical lymphadenectomy. A univariate survival analysis was performed according to the presence of metastases, a bivariate analysis for each of the independent variables according to the received treatment and a multivariate analysis.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">416 cases were included. The mean survival time was greater in the N0 group. For each of the groups based on the presence of metastasis, the differences in the mean survival time according to age and CCI-SF were not significant, regardless of the treatment received. The multivariate analysis showed the influence of age (<span class="elsevierStyleItalic">P</span>=.0001, OR=1.488, 95%CI=[1.318; 1.679]) and CCI-SF (<span class="elsevierStyleItalic">P</span>=.001, OR=1.817, 95%CI=[1.257; 2.627]) in the N0 group. In the N1 group only regional treatment has a positive influence on survival (<span class="elsevierStyleItalic">P</span>=.048, OR=0.15, 95%CI=[0.023; 0.981]).</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">CCI-SF and age are good mortality indicators in cSCCh&n N0 patients, but not so in cSCCh&n N1 patients. In cSCCh&n N1 patients, regional treatment has a positive influence on survival. Differences cannot be affirmed in the mean survival time of patients with cSCCh&n, based on the development of metastases and the treatment given. New studies will be necessary.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0010" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducción</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Se desconoce si la linfadenectomía cervical para el tratamiento del carcinoma espinocelular cutáneo de cabeza y cuello (CECccyc) aumenta la supervivencia en el paciente de avanzada edad. El objetivo de este estudio es determinar si esta terapia influye en la supervivencia de estos pacientes, y conocer si el índice abreviado de Charlson (ICa) puede utilizarse como alternativa a la edad en la estimación de la supervivencia.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Métodos</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La población a estudio la componen todos los pacientes a quienes se diagnosticó CECccyc intervenidos consecutivamente entre 2006 y 2011. Se excluyeron los carcinomas no invasivos, no cutáneos. Se realiza una agrupación de los pacientes en función de la edad (<70, 70-79, 80-89, >90), ICa (<3, ≥3) y presencia (N1) o ausencia (N0) de metástasis cervicales. La variable dependiente es la realización o no de linfadenectomía cervical. Se efectúa un análisis de la supervivencia univariante según la presencia de metástasis; bivariante para cada una de las variables independientes según el tratamiento recibido; y multivariante.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Se incluyen 416 casos. El tiempo medio de supervivencia es mayor en el grupo N0. Para cada uno de los grupos según la presencia de metástasis, las diferencias en el tiempo medio de supervivencia según la edad y el ICa no son significativas, independientemente del tratamiento recibido. El análisis multivariante muestra la influencia de la edad (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,0001, OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1,488, IC95%<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>[1,318; 1,679]) y del ICa (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,001, OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1,817, IC95%<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>[1,257; 2,627]) sobre los pacientes N0. Respecto a los pacientes N1, solo la variable tratamiento regional tiene una influencia positiva sobre la supervivencia (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,048, OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,15, IC95%<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>[0,023; 0,981]).</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">El ICa y la edad son buenos indicadores de la mortalidad en pacientes CECccyc N0. No es así en pacientes CECccyc N1. En pacientes CECccyc N1 el tratamiento regional tiene una influencia positiva sobre la supervivencia. No se puede afirmar que existan diferencias en el tiempo medio de supervivencia de los pacientes con CECccyc en función de si han desarrollado metástasis o no y según el tratamiento recibido. Serán necesarios nuevos estudios.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Bernal Martínez ÁJ, Fernández Letamendi N, Delgado Martínez J, Gómez-Escolar Larrañaga L, Reola Ramírez E, Puertas Peña J. Evaluación del tratamiento del carcinoma epidermoide cutáneo de cabeza y cuello en la edad avanzada. Análisis de la supervivencia. Cir Esp. 2018;96:577–582.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1153 "Ancho" => 2491 "Tamanyo" => 153163 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Survival according to age, presence of metastasis and treatment received.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "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="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">N0 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>390) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">N1 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>26) \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="4" align="left" valign="top"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91 (21.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (1.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">299 (71.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (4.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Age</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><70 yrs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 (12.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>70–79 yrs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">118 (28.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (1.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>80–89 yrs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">168 (40.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (3.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>>90 yrs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 (12.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Death within 5 yrs</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">203 (48.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (2.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">187 (44.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (4.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Short-form Charlson</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">341 (82) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (5.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>≥3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 (11.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">High-risk size?</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No (<50<span class="elsevierStyleHsp" style=""></span>mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">245 (58.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (3.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes (≥50<span class="elsevierStyleHsp" style=""></span>mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">145 (34.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (2.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Broders high risk?</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No ( \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">310 (82.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (5.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes (III) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (10.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Margins</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Free \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">355 (85.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (3.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Affected \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 (8.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (2.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">High-risk location</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96 (23.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">294 (70.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (4.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Deep invasion</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">332 (79.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (2.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 (13.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (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="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">TNM</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>pT1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">215 (51.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>pT2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">102 (24.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>pT3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (3.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>pT4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 (13.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (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 " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Regional treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">366 (88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (4.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (5.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1903459.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">General Characteristics of the Study Sample.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "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="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">T. Regional (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>30) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No T. Regional (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>386) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean survival time \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="left" valign="top">N0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.413 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.249 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="8" align="left" valign="top">Aged</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top"><70</td><td class="td" title="table-entry " align="left" valign="top">N0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">96.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">130 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.898 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">N1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No cases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" 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 " rowspan="2" align="left" valign="top">70–79</td><td class="td" title="table-entry " align="left" valign="top">N0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69.17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">113.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.611 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">N1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.63 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">80–89</td><td class="td" title="table-entry " align="left" valign="top">N0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">56.92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.194 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">N1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">>90</td><td class="td" title="table-entry " align="left" valign="top">N0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.332 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">N1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.46 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="left" valign="top">I. Charlson s-f</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top"><3</td><td class="td" title="table-entry " align="left" valign="top">N0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.42 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">N1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.257 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">≥3</td><td class="td" title="table-entry " align="left" valign="top">N0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.331 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">N1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No cases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1903460.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Survival Analysis.</p>" ] ] 3 => array:5 [ "identificador" => "fig0010" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 748 "Ancho" => 1333 "Tamanyo" => 102776 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0095" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous squamous cell carcinoma: defining the high-risk variant" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 13 | 3 | 16 |
| 2024 September | 23 | 8 | 31 |
| 2024 August | 14 | 3 | 17 |
| 2024 July | 16 | 3 | 19 |
| 2024 June | 10 | 1 | 11 |
| 2024 May | 19 | 7 | 26 |
| 2024 April | 23 | 7 | 30 |
| 2024 March | 42 | 8 | 50 |
| 2024 February | 20 | 4 | 24 |
| 2024 January | 18 | 4 | 22 |
| 2023 December | 13 | 3 | 16 |
| 2023 November | 24 | 5 | 29 |
| 2023 October | 38 | 7 | 45 |
| 2023 September | 14 | 1 | 15 |
| 2023 August | 13 | 1 | 14 |
| 2023 July | 8 | 4 | 12 |
| 2023 June | 5 | 1 | 6 |
| 2023 May | 8 | 0 | 8 |
| 2023 April | 8 | 1 | 9 |
| 2023 March | 8 | 1 | 9 |
| 2023 February | 12 | 4 | 16 |
| 2023 January | 7 | 1 | 8 |
| 2022 December | 33 | 9 | 42 |
| 2022 November | 16 | 7 | 23 |
| 2022 October | 13 | 10 | 23 |
| 2022 September | 20 | 7 | 27 |
| 2022 August | 24 | 7 | 31 |
| 2022 July | 20 | 10 | 30 |
| 2022 June | 15 | 4 | 19 |
| 2022 May | 24 | 9 | 33 |
| 2022 April | 30 | 9 | 39 |
| 2022 March | 30 | 11 | 41 |
| 2022 February | 12 | 8 | 20 |
| 2022 January | 19 | 5 | 24 |
| 2021 December | 43 | 13 | 56 |
| 2021 November | 24 | 14 | 38 |
| 2021 October | 16 | 10 | 26 |
| 2021 September | 15 | 14 | 29 |
| 2021 August | 23 | 12 | 35 |
| 2021 July | 11 | 9 | 20 |
| 2021 June | 12 | 12 | 24 |
| 2021 May | 23 | 11 | 34 |
| 2021 April | 22 | 16 | 38 |
| 2021 March | 17 | 6 | 23 |
| 2021 February | 11 | 10 | 21 |
| 2021 January | 10 | 10 | 20 |
| 2020 December | 20 | 4 | 24 |
| 2020 November | 11 | 3 | 14 |
| 2020 October | 12 | 5 | 17 |
| 2020 September | 20 | 7 | 27 |
| 2020 August | 19 | 7 | 26 |
| 2020 July | 10 | 10 | 20 |
| 2020 June | 7 | 9 | 16 |
| 2020 May | 15 | 10 | 25 |
| 2020 April | 7 | 1 | 8 |
| 2020 March | 16 | 2 | 18 |
| 2020 February | 16 | 3 | 19 |
| 2020 January | 9 | 4 | 13 |
| 2019 December | 22 | 5 | 27 |
| 2019 November | 16 | 5 | 21 |
| 2019 October | 6 | 1 | 7 |
| 2019 September | 9 | 1 | 10 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 7 | 19 | 26 |
| 2019 June | 25 | 7 | 32 |
| 2019 May | 55 | 12 | 67 |
| 2019 April | 28 | 11 | 39 |
| 2019 March | 3 | 0 | 3 |
| 2019 February | 2 | 3 | 5 |
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