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ARTÍCULO ORIGINAL
Marcadores inflamatorios como factor pronóstico en el cáncer de próstata resistente a la castración metastásico
Inflammatory markers as prognostic factors in metastatic castration-resistant prostate cancer
M.J. Donate-Morenoa, M.V. Lorenzo-Sánchezb, I. Díaz de Mera-Sánchez Migallóna, L. Herraiz-Rayaa, J.A. Esper-Ruedaa, O. Legido-Gómeza, S. Rico-Marcoa, A.S. Salinas-Sáncheza,
Autor para correspondencia
assalinas@sescam.jccm.es

Autor para correspondencia.
a Servicio de Urología, Complejo Hospitalario Universitario de Albacete, Albacete, España
b Facultad de Medicina de Albacete, Departamento de Ciencias Médicas, Área de Urología, Universidad de Castilla La Mancha, Albacete, España
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Curvas de supervivencia seg&#250;n marcadores inflamatorios&#46; a&#41; Recuento total de neutr&#243;filos &#40;p &#61; 0&#44;008&#41;&#59; b&#41; ratio neutr&#243;filo&#47;linfocito &#40;p &#60; 0&#44;0001&#41;&#59; c&#41; ratio linfocito&#47;monocito &#40;p &#61; 0&#44;002&#41;&#59; d&#41; ratio plaquetas&#47;linfocito &#40;p &#61; 0&#44;017&#41;&#59; e&#41; &#237;ndice sist&#233;mico de inflamaci&#243;n &#40;p &#61; 0&#44;01&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El c&#225;ncer de pr&#243;stata es la neoplasia m&#225;s com&#250;n y la segunda causa de muerte por c&#225;ncer en el hombre<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a>&#46; Diversas opciones terap&#233;uticas hacen a la enfermedad localizada potencialmente curable<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">2</span></a>&#46; Sin embargo&#44; en fases diseminadas&#44; especialmente la resistente a castraci&#243;n &#40;CPRCm&#41;&#44; tienen peor pron&#243;stico<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Aunque existen varios f&#225;rmacos que prolongan la supervivencia en pacientes con CPRCm&#44; hay una escasez de biomarcadores que ayuden a estratificarlos en t&#233;rminos de pron&#243;stico y predicci&#243;n de respuesta a cada terapia&#44; por lo que las caracter&#237;sticas patol&#243;gicas del tumor&#44; niveles de PSA y su cin&#233;tica y criterios radiol&#243;gicos&#44; siguen siendo los procedimientos de uso convencional&#44; resultando insuficientes a la hora de seleccionar el tratamiento m&#225;s id&#243;neo&#44; predecir la respuesta a cada terapia y realizar un seguimiento adecuado<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">4&#8211;9</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">&#218;ltimamente&#44; se ha observado que el microambiente tumoral y&#44; particularmente la respuesta inflamatoria&#44; juegan un papel importante en diferentes etapas biol&#243;gicas del desarrollo tumoral&#44; tanto en la iniciaci&#243;n&#44; promoci&#243;n&#44; conversi&#243;n &#40;convencionalmente maligna&#41;&#44; invasi&#243;n y formaci&#243;n de met&#225;stasis&#44; comprob&#225;ndose que estos biomarcadores de inflamaci&#243;n pueden ser &#250;tiles para evaluar el pron&#243;stico&#46; Los indicadores en sangre que reflejan esta respuesta inflamatoria sist&#233;mica son una prote&#237;na <span class="elsevierStyleSmallCaps">C</span> reactiva elevada&#44; la hipoalbuminemia&#44; el aumento de niveles de algunas citoquinas y el aumento de los niveles de leucocitos y sus subtipos<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">5&#44;10</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La ratio neutr&#243;filo&#47;linfocito &#40;RN&#47;L&#41; es un marcador de inflamaci&#243;n sist&#233;mica con valor pron&#243;stico independiente en diferentes tipos de c&#225;ncer&#44; asoci&#225;ndose sus niveles elevados con un pron&#243;stico desfavorable&#46; Adem&#225;s&#44; representa un factor de respuesta terap&#233;utica&#44; sugiri&#233;ndose su uso para el control de tratamientos en diversos tumores&#46; Su f&#225;cil determinaci&#243;n&#44; reproducibilidad y bajo costo&#44; ha hecho que sea muy estudiado actualmente<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">4&#44;11</span></a>&#46; En el c&#225;ncer colorrectal&#44; se ha encontrado que los pacientes con RN&#47;L &#62; 5 presentan mayor riesgo de complicaciones perioperatorias y menor supervivencia global y libre de enfermedad<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a>&#46; En el c&#225;ncer de pulm&#243;n y p&#225;ncreas&#44; niveles altos en esta ratio se correlacionan con un pron&#243;stico desfavorable<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">13&#44;14</span></a>&#46; Tambi&#233;n se ha estimado un aumento del 10&#37; en el riesgo de muerte por c&#225;ncer g&#225;strico por cada punto de aumento en la RN&#47;L<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a>&#46; En pacientes con diferentes tipos de neoplasias en estadios terminales&#44; es un par&#225;metro &#250;til y simple para predecir su evoluci&#243;n cl&#237;nica&#44; siendo la esperanza de vida menor de cuatro semanas cuando la RN&#47;L &#62; 9&#44;21<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La ratio plaquetas&#47;linfocitos &#40;RP&#47;L&#41; tambi&#233;n es un marcador inflamatorio que puede ayudar a predecir el pron&#243;stico en algunos tumores&#46; Un aumento del RP&#47;L es un factor de riesgo independiente para menor supervivencia en pacientes con c&#225;ncer g&#225;strico avanzado en tratamiento con quimioterapia<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En el c&#225;ncer de pr&#243;stata&#44; la RN&#47;L ha sido evaluada en diferentes estudios que demuestran que una RN&#47;L elevada es un indicador de peor pron&#243;stico en los pacientes con CPRCm<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">3&#44;9&#44;18</span></a>&#46; Sin embargo&#44; no se han evaluado conjuntamente o por separado&#44; la utilidad de otros marcadores s&#233;ricos de inflamaci&#243;n en el pron&#243;stico del CPRCm&#46; El objetivo de nuestro estudio es analizar el valor pron&#243;stico de dichos marcadores en el CPRCm&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Presentamos un estudio prospectivo&#44; formado por una cohorte de 80 pacientes diagnosticados y tratados en nuestro servicio por CPRCm hasta diciembre 2018&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">De las historias cl&#237;nicas que se recogieron en el momento del diagn&#243;stico de CPRCm&#44; las siguientes variables&#58; edad&#44; Gleason y estadio TNM iniciales<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a>&#44; ECOG&#44; necesidad y tipo de analgesia&#44; tipo de met&#225;stasis &#40;&#243;seas&#44; ganglionares&#44; viscerales&#44; mixtas&#41;&#44; tratamiento de soporte &#243;seo &#40;denosumab o &#225;cido zoledr&#243;nico&#41;&#44; tratamiento quimioter&#225;pico&#44; tratamiento hormonal y tiempo de tratamiento con abiraterona &#40;ABT&#41; o enzalutamida &#40;ENZ&#41;&#44; tiempo en desarrollar met&#225;stasis&#44; evoluci&#243;n &#40;exitus&#41; y tiempo de seguimiento&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A partir del hemograma y bioqu&#237;mica realizados en el momento del diagn&#243;stico de CPRCm&#44; se recogieron los siguientes marcadores de inflamaci&#243;n&#58; cifras de neutr&#243;filos&#44; linfocitos&#44; monocitos y plaquetas&#44; recogi&#233;ndose cifras totales y se calcularon&#58;</p><p id="par0050" class="elsevierStylePara elsevierViewall">RN&#47;L&#58; valor de corte en tres<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Recuento total de neutr&#243;filos &#40;RTN&#41;&#58; punto de corte en 7&#46;500 neutr&#243;filos&#47;mcl<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Recuento total de plaquetas &#40;RTP&#41;&#58; punto de corte en 400&#46;000 plaquetas&#47;mcl<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">RP&#47;L&#58; 150 como punto de corte<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Ratio linfocito&#47;monocito &#40;RL&#47;M&#41;&#58; tres como punto de corte<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">23&#8211;25</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">&#205;ndice sist&#233;mico de inflamaci&#243;n &#40;ISI&#41;&#44; calculado seg&#250;n la f&#243;rmula plaquetas x neutr&#243;filos &#47;linfocitos&#46; Punto de corte 535&#46;000<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Datos bioqu&#237;micos&#58; Albumina plasm&#225;tica&#44; hemoglobina &#40;Hb&#41;&#44; fosfatasa alcalina &#40;FA&#41;&#44; lactato deshidrogenasa &#40;LDH&#41; y PSA al diagn&#243;stico de CPRCm&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">An&#225;lisis estad&#237;stico</span><p id="par0085" class="elsevierStylePara elsevierViewall">Realizamos un an&#225;lisis descriptivo de todas las variables y un an&#225;lisis bivariante mediante tablas de contingencia para variables cualitativas y comparaci&#243;n de medias en grupos independientes para cuantitativas&#46; Se utilizaron sus correspondientes test no param&#233;tricos cuando se vulneraron los supuestos de aplicaci&#243;n de las pruebas anteriores&#46; Se us&#243; test de correlaci&#243;n de Pearson para relacionar dos variables cuantitativas continuas&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Mediante un an&#225;lisis de la supervivencia &#40;m&#233;todo de tablas de vida y Kaplan-Meier&#41;&#44; calculamos la probabilidad de supervivencia al final de cada periodo&#46; El tiempo de supervivencia se obtuvo a partir de la fecha de exitus o de finalizaci&#243;n del estudio y la del diagn&#243;stico de CPRCm&#46; Se calcularon media y mediana de tiempo de supervivencia y sus intervalos de confianza&#44; procedi&#233;ndose al c&#225;lculo de las curvas de supervivencia&#44; compar&#225;ndolas mediante la prueba de Mantel-Haenszel &#40;<span class="elsevierStyleItalic">log rank</span>&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Finalmente se realiz&#243; un an&#225;lisis univariante y multivariante de riesgos proporcionales de Cox&#46; Para todo el an&#225;lisis estad&#237;stico se utiliz&#243; el paquete estad&#237;stico SPSS v&#46; 20&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Caracter&#237;sticas de la poblaci&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">La edad media de los 80 pacientes con CPRCm fue de 70&#44;2 a&#241;os &#40;mediana&#58; 72&#44;7 a&#241;os&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Al diagn&#243;stico&#44; la mediana de PSA fue de 52&#44;3 ng&#47;dL&#46; La mayor&#237;a presentaban un grado de Gleason de 4 &#43; 5 &#61; 9 &#40;18 pacientes&#44; 22&#44;5&#37;&#41;&#44; siendo el 83&#44;8&#37; de riesgo alto o muy alto&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se muestran el Gleason y estadios TNM al diagn&#243;stico inicial de los pacientes del estudio&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Tras el tratamiento inicial del c&#225;ncer de pr&#243;stata&#44; los pacientes tardaron una media de 30&#44;5 meses &#40;mediana&#58; 23&#44;1&#41; en hacerse resistentes a la castraci&#243;n&#44; permaneciendo como M0 durante una media de 4&#44;4 meses&#46; Tras la confirmaci&#243;n de CPRCm&#44; un 43&#44;8&#37; de los pacientes presentaron &#250;nicamente met&#225;stasis &#243;seas&#44; un 46&#44;2&#37; requer&#237;an alg&#250;n tipo de analgesia&#44; 63 sujetos &#40;78&#44;8&#37;&#41; iniciaron tratamiento con ABT y el 21&#44;8&#37; restante con ENZ&#46; El tiempo medio que los pacientes estuvieron en tratamiento con alguno de estos f&#225;rmacos fue de 11&#44;2 meses &#40;mediana&#58; 9 meses&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">El seguimiento de los pacientes oscil&#243; entre 0&#44;43 y 77&#44;1 meses con una media de 19 meses &#40;IC 95&#37;&#58; 15&#44;78-22&#44;42&#41; &#40;mediana de 14&#44;9&#41;&#46; Al final del seguimiento&#44; 32 pacientes &#40;35&#44;2&#37;&#41; continuaban con tratamiento hormonal y hab&#237;an fallecido 39 enfermos &#40;48&#44;8&#37;&#41;&#44; 31&#47;39 por causa tumoral&#46; El porcentaje total de exitus&#44; fue mayor entre los que recib&#237;an tratamiento de soporte &#243;seo &#40;71&#44;1&#37;&#41; &#40;p &#61; 0&#44;01&#41;&#44; necesitaban analgesia &#40;65&#44;9&#37;&#41; &#40;p &#61; 0&#44;001&#41; y en pacientes con niveles de FA elevados &#40;62&#44;5&#37;&#41; &#40;p &#61; 0&#44;025&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">La mediana de supervivencia fue de 24&#44;8 meses con una media de 33&#44;2 meses&#46; El tiempo de supervivencia se correlacion&#243; inversamente con la edad &#40;r &#61; -0&#44;273&#59; p &#61; 0&#44;009&#41;&#46; La probabilidad acumulada de supervivencia tras el primer a&#241;o fue del 76&#37;&#44; disminuyendo al 63&#37;&#44; 39&#37;&#44; 24&#37; y 18&#37; en el segundo&#44; tercer&#44; cuarto y quinto a&#241;o&#44; respectivamente&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Valor pron&#243;stico de variables cl&#237;nicas y otras al diagn&#243;stico</span><p id="par0125" class="elsevierStylePara elsevierViewall">La &#250;nica variable cl&#237;nica que se asoci&#243; con la supervivencia fue la necesidad de analgesia&#44; de forma que los pacientes bajo analgesia tuvieron menor tiempo de supervivencia que los que no la necesitaban&#58; 16&#44;8 <span class="elsevierStyleItalic">vs</span> 39&#44;1 meses &#40;p &#61; 0&#44;009&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Valor pron&#243;stico de variables anal&#237;ticas al diagn&#243;stico</span><p id="par0130" class="elsevierStylePara elsevierViewall">Hubo una correlaci&#243;n significativa con un menor tiempo de supervivencia la existencia de mayores niveles de RN&#47;L &#40;r &#61; -0&#44;328&#59; p &#61; 0&#44;003&#41;&#44; RP&#47;L &#40;r &#61; -0&#44;240&#59; p &#61; 0&#44;032&#41; y de ISI &#40;r &#61; -0&#44;242&#59; p &#61; 0&#44;03&#41; y una mayor supervivencia en sujetos con mayor nivel de albumina &#40;r &#61; 0&#44;310&#59; p &#61; 0&#44;005&#41; y hemoglobina &#40;r &#61; 380&#59; p &#60; 0&#44;001&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se muestran las medias y medianas de supervivencia de las variables anal&#237;ticas analizadas&#44; destacando que las medias y medianas de supervivencia fueron menores en&#58; pacientes con RTN &#62; 7&#46;500 &#40;p &#61; 0&#44;008&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>a&#41;&#44; en sujetos con RN&#47;L &#62; 3&#44; &#40;p &#60; 0&#44;0001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>b&#41;&#44; en los que ten&#237;an una RP&#47;L &#62; 150 &#40;p &#61; 0&#44;017&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>d&#41;&#59; y en los que el ISI fue mayor a 535&#46;000 se &#40;p &#61; 0&#44;01&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>e&#41;&#46; Por el contrario&#44; una RL&#47;M &#62; 3 se asoci&#243; a media y mediana de supervivencia mayor con relaci&#243;n a los que presentaban una RL&#47;M &#60; 3&#58; &#40;p &#61; 0&#44;002&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>c&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">Todas las variables bioqu&#237;micas mostraron significaci&#243;n estad&#237;stica con la supervivencia a excepci&#243;n de la fosfatasa alcalina&#44; de forma que la supervivencia fue significativamente mayor en enfermos con niveles normales o elevados de albumina &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>a&#41;&#44; en sujetos con LDH normal &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>b&#41;&#44; y en aquellos con Hb normal con relaci&#243;n a los sujetos con hipoalbuminemia &#40;p &#60; 0&#44;0001&#41;&#44; LDH aumentada &#40;p &#61; 0&#44;008&#41; y anemia &#40;p &#61; 0&#44;005&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>c&#41;&#46; Los valores de albumina &#40;r &#61; 0&#44;310&#59; p &#61; 0&#44;005&#41; y Hb r &#61; 0&#44;380&#59; p &#60; 00&#44;1 se correlacionaron con mayor tiempo de supervivencia&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">An&#225;lisis de regresi&#243;n de Cox</span><p id="par0145" class="elsevierStylePara elsevierViewall">En el an&#225;lisis univariante&#44; la edad al diagn&#243;stico de CPRCm&#44; la necesidad de analgesia&#44; un RTN &#62; 7&#46;500&#44; una RN&#47;L &#62; 3&#44; una RL&#47;M &#62; 3&#44; una RP&#47;L &#60; 150&#44; un ISI &#62; 535&#46;000&#44; hipoalbuminemia&#44; anemia y los enfermos con LDH elevada&#44; presentaron mayor riesgo de morir&#44; con HR que oscilaron entre 1&#46;053 por a&#241;o cumplido para la edad&#44; hasta 15&#44;3 en los enfermos con hipoalbuminemia &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">En el an&#225;lisis multivariante&#44; tras ajustar por las variables anteriores&#44; las variables que se relacionaron de forma independiente con la supervivencia fueron&#58; la necesidad de analgesia HR &#61; 20&#44;447&#44; RL&#47;M &#62; 3 &#40;HR &#61; 0&#44;266&#41; lo que indica que este &#237;ndice elevado tiene efecto beneficioso si la comparamos con una RL&#47;M &#60; 3&#44; y los pacientes con anemia e hipoalbuminemia que multiplicaron por 2&#44;5 y por 11&#44;7&#44; respectivamente&#44; la probabilidad de tener menor supervivencia <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discusi&#243;n</span><p id="par0155" class="elsevierStylePara elsevierViewall">Determinados &#237;ndices inflamatorios han demostrado su utilidad en el diagn&#243;stico y pron&#243;stico de diferentes tumores&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">El m&#225;s utilizado&#44; la ratio RN&#47;L&#44; es conocida como un marcador de respuesta inmune frente a varios est&#237;mulos&#44; asoci&#225;ndose sus niveles elevados con peor supervivencia y m&#225;s recurrencias&#46; Se cree que los neutr&#243;filos activados suprimen a los linfocitos&#44; caus&#225;ndoles una disminuci&#243;n de su actividad antitumoral&#44; lo que confiere peor pron&#243;stico<span class="elsevierStyleSup">3&#44;20</span>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">El RTN tambi&#233;n ha sido evaluado recientemente&#46; En mujeres con c&#225;ncer de ovario&#44; la neutrofilia &#40;&#62; 8&#46;000&#47;&#956;L&#41; junto a una RN&#47;L &#62; 4 se asociaron a menores tasas de supervivencia&#44; permitiendo estimar el pron&#243;stico y supervivencia de manera individualizada<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">En diversos tumores urol&#243;gicos los estudios tambi&#233;n relacionan los marcadores de inflamaci&#243;n con un mal pron&#243;stico&#46; En el c&#225;ncer de c&#233;lulas renales&#44; un metaan&#225;lisis demostr&#243; que una RN&#47;L &#62; 3 aumentaba el riesgo de recurrencia en tumores localizados y una reducci&#243;n del tiempo libre de enfermedad en avanzados<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">26</span></a>&#46; En pacientes con tumores testiculares de c&#233;lulas germinales&#44; una RN&#47;L &#60; 4 se relacionaba con una menor probabilidad de diseminaci&#243;n tumoral&#44; presentando peor pron&#243;stico aquellos con RN&#47;L &#62; 4&#44; permitiendo utilizar la RN&#47;L en la estadificaci&#243;n TNM<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">20&#44;27</span></a>&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">En el c&#225;ncer de pr&#243;stata&#44; un metaan&#225;lisis demostr&#243; que la RN&#47;L elevada era un indicador de peor pron&#243;stico de los pacientes con CPRCm&#44; no teniendo valor en casos localizados<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">3</span></a>&#46; En CPRCm&#44; varios estudios han demostrado que niveles elevados de RN&#47;L se asocian a peores datos de supervivencia&#44; tanto en pacientes tratados con nuevas terapias hormonales<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#44;9&#44;28</span></a>&#44; como con quimioterapia con docetaxel<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">5&#44;7</span></a> y cabacitaxel<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">En este estudio hemos observado que los pacientes con una RN&#47;L &#62; 3&#44; ten&#237;an una mediana de supervivencia menor que aquellos con RN&#47;L &#60; 3&#44; correlacion&#225;ndose inversamente con el tiempo de supervivencia&#46; Al analizar el RTN&#44; utilizando como punto de corte 7&#46;500 neutr&#243;filos&#47;&#956;L&#44; se observ&#243; que los pacientes con RTN &#62; 7&#46;500 presentaron peor pron&#243;stico y&#44; aunque no tuvieron una mayor mortalidad&#44; s&#237; presentaron menor tiempo de supervivencia&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Las plaquetas tambi&#233;n tienen un importante papel en el desarrollo de tumores malignos&#44; aumentando el inter&#233;s en evaluar el valor pron&#243;stico de la trombocitosis en pacientes con c&#225;ncer&#46; Hay varias explicaciones posibles para esta asociaci&#243;n&#46; En primer lugar&#44; las plaquetas podr&#237;an proteger a las c&#233;lulas tumorales de la cit&#243;lisis&#44; fomentando as&#237; la progresi&#243;n tumoral&#46; En segundo lugar&#44; las prote&#237;nas reguladoras de la angiog&#233;nesis&#44; implicadas en el crecimiento y la invasi&#243;n tumoral&#44; tambi&#233;n est&#225;n elevadas en plaquetas de pacientes con c&#225;ncer&#44; por lo que podr&#237;an estimular la angiog&#233;nesis&#46; Todos estos procesos potencian la formaci&#243;n de met&#225;stasis&#46; El RTP&#44; la RP&#47;L y la RN&#47;L fueron evaluados en un metaan&#225;lisis con el prop&#243;sito de demostrar su relaci&#243;n con el pron&#243;stico en pacientes con c&#225;ncer de colon&#46; Se observ&#243; que una RP&#47;L &#62; 150&#44; RN&#47;L &#62; 5 y un RTP &#62; 400&#46;000&#44; se asociaron con peor supervivencia&#44; aunque no hubo correlaci&#243;n con el periodo libre de enfermedad ni progresi&#243;n<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a>&#46; Nuestros resultados apoyan estos datos en pacientes con CPRCm&#58; un valor de RP&#47;L &#62; 150 se asoci&#243; a menor supervivencia&#46; Aunque no encontramos relaci&#243;n entre los niveles de RTP y supervivencia&#44; probablemente por el escaso n&#250;mero de pacientes con trombocitosis en nuestro estudio&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">La RL&#47;M&#44; es un biomarcador del microentorno del tumor y de la inmunidad del hu&#233;sped&#46; Se ha visto que los macr&#243;fagos originados en los monocitos circulantes est&#225;n asociados con la progresi&#243;n tumoral&#46; Una RL&#47;M disminuida se asoci&#243; con una menor supervivencia en varias neoplasias malignas<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">23</span></a>&#46; Un estudio de 181 pacientes con c&#225;ncer de vejiga tratados encontr&#243; que una RL&#47;M baja &#40;&#60; 3&#44;51&#41; fue un indicador de mal pron&#243;stico<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a> y tambi&#233;n lo fue en pacientes con carcinoma urotelial del tracto urinario superior&#44; en este caso valor&#225;ndose una RL&#47;M &#60; 3<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a>&#46; Nuestro trabajo&#44; tambi&#233;n evidenci&#243; que niveles bajos de RL&#47;M en sujetos con CPRCm tuvieron medianas de supervivencia menores&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">El ISI es un &#237;ndice inflamatorio calculado a partir de los recuentos de neutr&#243;filos&#44; linfocitos y plaquetas&#44; utilizado &#250;ltimamente como un biomarcador pron&#243;stico de algunos c&#225;nceres&#46; En el CPRCm los pacientes en tratamiento con abiraterona con niveles de ISI &#62; 535&#46;000 presentan una supervivencia menor<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a>&#44; dato confirmado en nuestro estudio donde fue un factor predictivo de menor supervivencia&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">El valor de los distintos marcadores inflamatorios puede verse influenciado por otros factores pron&#243;sticos para tener en cuenta como factores cl&#237;nicos &#40;tratamiento &#243;seo&#44; tipo de met&#225;stasis&#44; necesidad de analgesia y tratamiento quimioter&#225;pico previo&#41; y anal&#237;ticos &#40;PSA&#44; Albumina&#44; LDH&#44; Hb&#44; y FA&#41; que han sido tambi&#233;n analizados en este estudio&#46; La &#250;nica variable cl&#237;nica con valor pron&#243;stico fue la necesidad de analgesia y de las bioqu&#237;micas los niveles elevados de albumina y de Hb&#44; y normales de LDH&#44; que se asociaron a mayor supervivencia&#46; La necesidad de analgesia est&#225; influenciada por una mayor progresi&#243;n de la enfermedad&#44; lo cual incide en una menor supervivencia independientemente del tratamiento con analgesia&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">La anemia es un problema com&#250;n en pacientes con c&#225;ncer que tiene una patogenia multifactorial&#46; Por un lado&#44; los propios procesos neopl&#225;sicos y las diferentes modalidades de tratamientos pueden inducir d&#233;ficit de hierro&#44; vitamina B12 y de hormonas como la eritropoyetina&#46; Adem&#225;s&#44; la sobreexpresi&#243;n de ciertas citoquinas inflamatorias reduce la supervivencia de los hemat&#237;es&#44; alterando la eritropoyesis normal&#46; Se ha confirmado que la anemia se correlaciona con una menor supervivencia en pacientes con c&#225;ncer de vejiga&#44; afectando tambi&#233;n su calidad de vida<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a>&#46; En el c&#225;ncer de colon&#44; la anemia fue un predictor de menor supervivencia<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">30</span></a>&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Los pacientes con neoplasias malignas tienen tambi&#233;n una alta prevalencia de hipoalbuminemia&#44; consecuencia de la respuesta inflamatoria del organismo a la malignidad<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a>&#46; En c&#225;ncer colorrectal es un factor pron&#243;stico independiente de supervivencia&#44; adem&#225;s de un marcador b&#225;sico del estado nutricional&#46; Nuestros resultados son coincidentes con estos estudios<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">29&#8211;31</span></a>&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Nuestro estudio presenta varias limitaciones&#46; La primera es la discrepancia entre los valores de corte utilizados con los mencionados en otros estudios<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">20&#44;24</span></a>&#46; En este sentido&#44; no existe un valor de corte &#250;nico establecido&#44; lo cual puede deberse a diferencias en los m&#233;todos utilizados para su c&#225;lculo y a su distinta interpretaci&#243;n&#46; El usado en este estudio es el aplicado mayoritariamente en la literatura&#46; En segundo lugar&#44; el n&#250;mero relativamente peque&#241;o de pacientes englobados en nuestro estudio que&#44; sin embargo&#44; conforman una cohorte prospectiva con un completo y amplio seguimiento&#44; lo que da valor a nuestro estudio&#46; L&#243;gicamente&#44; futuros an&#225;lisis con mayor tama&#241;o muestral contribuir&#225;n a refrendar estos hallazgos&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; los valores de determinados marcadores inflamatorios se asocian con una menor supervivencia en pacientes con CPRCm y contribuyen a identificar a pacientes con peor pron&#243;stico&#46; Su facilidad de uso y determinaci&#243;n hace que deban considerarse su aplicaci&#243;n en pr&#225;ctica cl&#237;nica en el estudio y seguimiento de los pacientes con CPRCm&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Financiaci&#243;n</span><p id="par0225" class="elsevierStylePara elsevierViewall">Este trabajo no ha recibido ning&#250;n tipo de financiaci&#243;n&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicto de intereses</span><p id="par0230" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "Caracter&#237;sticas de la poblaci&#243;n"
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              "titulo" => "Valor pron&#243;stico de variables cl&#237;nicas y otras al diagn&#243;stico"
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              "titulo" => "Valor pron&#243;stico de variables anal&#237;ticas al diagn&#243;stico"
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              "titulo" => "An&#225;lisis de regresi&#243;n de Cox"
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            0 => "mCRPC"
            1 => "Prognostic"
            2 => "Inflammation"
            3 => "Lymphocytes"
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    "resumen" => array:2 [
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Los marcadores inflamatorios tienen valor pron&#243;stico en diferentes tumores por la intervenci&#243;n de los fen&#243;menos inflamatorios de las diferentes etapas del desarrollo tumoral&#46; El objetivo de este estudio es demostrar el valor pron&#243;stico de estos marcadores&#44; as&#237; como de otras variables cl&#237;nicas y anal&#237;ticas en pacientes con c&#225;ncer de pr&#243;stata metast&#225;sico resistente a la castraci&#243;n &#40;CPRCm&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes prospectivo realizado en 80 pacientes diagnosticados de CPRCm&#46; Se recogieron datos cl&#237;nicos y anal&#237;ticos&#44; estim&#225;ndose los siguientes marcadores inflamatorios&#58; recuento total de neutr&#243;filos &#40;RTN&#41;&#44; ratio neutr&#243;filo&#47;linfocito &#40;RN&#47;L&#41;&#44; recuento total de plaquetas &#40;RTP&#41;&#44; ratio plaquetas&#47;linfocito &#40;RP&#47;L&#41;&#44; ratio linfocito&#47;monocito &#40;RL&#47;M&#41; e &#237;ndice sist&#233;mico de inflamaci&#243;n &#40;ISI&#41;&#46; igualmente se determinaron los valores de alb&#250;mina&#44; hemoglobina &#40;Hb&#41;&#44; fosfatasa alcalina &#40;FA&#41; y lactato deshidrogenasa &#40;LDH&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Los pacientes con RTN&#62;7500&#44; RN&#47;L&#62;3&#44; RP&#47;L&#62;150&#44; RL&#47;M&#62;3 y&#47;o ISI&#62;535&#46;000&#44; presentaron una mediana de supervivencia significativamente menores que el resto de pacientes&#44; siendo el RTP el &#250;nico marcador que no mostr&#243; asociaci&#243;n significativa&#46; Adem&#225;s&#44; la RN&#47;L&#44; RP&#47;L y el ISI se correlacionaron inversamente con el tiempo de supervivencia&#46; Los pacientes con hipoalbuminemia&#44; anemia y valores elevados de LDH presentaron medianas de supervivencia significativamente menores&#46; La albumina y la hemoglobina presentaron a su vez una correlaci&#243;n directa con el tiempo total de supervivencia&#46; La necesidad de analgesia tambi&#233;n se asoci&#243; con una menor supervivencia&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los valores de determinados marcadores inflamatorios se asocian con menor supervivencia en pacientes con CPRCm&#44; pudiendo considerarse su uso en la pr&#225;ctica cl&#237;nica para evaluar el pron&#243;stico y estimar la supervivencia&#46;</p></span>"
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            "titulo" => "Material y m&#233;todos"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Inflammatory markers have prognostic value in various tumors due to the role of inflammatory phenomena at different stages of tumor development&#46; The aim of this study is to demonstrate the prognostic value of these markers&#44; as well as other clinical and analytical variables in patients with metastatic castration-resistant prostate cancer &#40;mCRPC&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Prospective cohort study carried out on 80 patients diagnosed with mCRPC&#46; Clinical and analytical data were collected&#44; and the following inflammatory markers were estimated&#58; Absolute Neutrophil Count &#40;ANC&#41;&#44; Neutrophil-Lymphocyte Ratio &#40;NLR&#41;&#44; Total Platelet Count &#40;TPC&#41;&#44; Platelet-Lymphocyte Ratio &#40;PLR&#41;&#44; Lymphocyte-Monocyte Ratio &#40;LMR&#41; and Systemic Inflammation Index &#40;SII&#41;&#46; The values of albumin&#44; hemoglobin &#40;Hb&#41;&#44; alkaline phosphatase &#40;ALP&#41; and lactate dehydrogenase &#40;LDH&#41; were also determined&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Patients with ANC&#62;7500&#44; NLR&#62;3&#44; PLR&#62;150&#44; LMR&#62;3 and&#47;or SII&#62;535&#44;000&#44; presented significantly lower median survival time than the remaining patients&#44; and TPC was the only marker which did not show a significant association&#46; Moreover&#44; NLR&#44; PLR and SII were inversely correlated with survival time&#46; Patients with hypoalbuminemia&#44; anemia&#44; and elevated LDH values had significantly lower median survival time&#46; Albumin and hemoglobin were directly correlated to overall survival time&#46; The need for analgesia was also associated with shorter survival&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The values of certain inflammatory markers are associated with shorter survival time in patients with mCRPC&#44; and their use in clinical practice can be considered to evaluate the prognosis and estimate survival&#46;</p></span>"
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        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#43;4&#61;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Desconocido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Estadio T&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">pT2c&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">pT3a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">pT3b&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">pT4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Desconocido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estadio N&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">pN0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">pN&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Desconocido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estadio M&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">cM0&#47;Mx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M1a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M1b&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M1c&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Desconocida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tratamiento hormonal &#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abiraterona&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enzalutamida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tipo de met&#225;stasis &#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#211;sea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#211;sea y ganglionar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#211;sea&#44; ganglionar y visceral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ganglionar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ganglionar y visceral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Necesidad de analgesia&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AINE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Opi&#225;ceos menores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Opi&#225;ceos mayores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Desconocido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Quimioterapia previa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Si&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tratamiento de soporte &#243;seo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#193;cido zoledr&#243;nico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Denosumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ecog&#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2443747.png"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas patol&#243;gicas al diagn&#243;stico inicial de c&#225;ncer de pr&#243;stata &#40;&#42;&#41; y datos cl&#237;nicos y patol&#243;gicos al diagn&#243;stico de CPRC &#40;&#42;&#42;&#41;</p>"
        ]
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        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabla "
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        "tabla" => array:1 [
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Media supervivencia</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mediana Supervivencia</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MEDIA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mediana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">RTN</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60; 7&#46;500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;0-36&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;2-30&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 7&#46;500&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#44;1-13&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">RTP</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;7-31&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bajos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;053&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;011 &#8211; 1&#44;097&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metastasico de inicio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;333&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;731 &#8211; 2&#44;432&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#46;s&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tipo de metastasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;270&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0708 &#8211; 2&#44;706&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#46;s&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tratamiento de soporte oseo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;526 &#8211; 1&#44;924&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#46;s&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Necesidad de analgesia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;238&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;198 &#8211; 4&#44;181&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tratamiento QMT previo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;352&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;321 &#8211; 5&#44;690&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#46;s&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RTN &#62; 7&#46;500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;857&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;310 &#8211; 26&#44;077&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RTP &#62; 400&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;072&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;280 &#8211; 15&#44;344&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#46;s&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RN&#47;L &#62; 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;553&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;785 &#8211; 7&#44;072&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RL&#47;M &#62; 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;320&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;149 &#8211; 0&#44;687&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RP&#47;L &#62; 150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;103&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;128 &#8211; 3&#46;921&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ISI &#60; 535&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;231&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;197 &#8211; 4&#44;157&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Psa al inicio de la RC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;000 &#8211; 1&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#46;s&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipoalbuminemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;301&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;763 &#8211; 49&#44;154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;569&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;303 &#8211; 5&#44;067&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento de FA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;731&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;911 &#8211; 2&#44;289&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&#46;s&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento de LDH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;956&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;338 &#8211; 6&#44;518&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2443748.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis de regresi&#243;n de Cox&#46; Variables asociadas en el modelo univariante</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabla 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
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Información del artículo
ISSN: 02104806
Idioma original: Español
DOI:10.1016/j.acuro.2020.08.001
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