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La dosis única de instilación intravesical postoperatoria inmediata de quimioterapia no es superior al lavado continuo con suero
Immediate post-operative intravesical instillation of a single dose chemotherapy is not superior to continuous saline irrigation
L. Türkeria, N. Karşıyakalıa,
Autor para correspondencia
nejdetkarsiyakali@gmail.com

Autor para correspondencia.
, G. Aslanb, M. Akgülc, S. Baltacıd, D. Bolate, H. Şahinf, E. Karabayg, V. İzolh, İ. Tinayi, Members of Turkish Urooncology Association, Bladder Cancer Study Group ◊
a Department of Urology, Acibadem M.A. Aydinlar University, Altunizade Hospital, Istanbul, Turkey
b Department of Urology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
c Department of Urology, Namik Kemal University, Faculty of Medicine, Tekirdag, Turkey
d Department of Urology, Ankara University, Faculty of Medicine, Ankara, Turkey
e Department of Urology, University of Health Sciences, Bozyaka Training and Research Hospital, Izmir, Turkey
f Department of Urology, Mugla Sitki Kocman University, Faculty of Medicine, Mugla, Turkey
g Department of Urology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
h Department of Urology, Cukurova University, Faculty of Medicine, Adana, Turkey
i Department of Urology, Marmara University, Faculty of Medicine, Istanbul, Turkey
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            "entidad" => "Department of Urology&#44; Cukurova University&#44; Faculty of Medicine&#44; Adana&#44; Turkey"
            "etiqueta" => "h"
            "identificador" => "aff0040"
          ]
          8 => array:3 [
            "entidad" => "Department of Urology&#44; Marmara University&#44; Faculty of Medicine&#44; Istanbul&#44; Turkey"
            "etiqueta" => "i"
            "identificador" => "aff0045"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Autor para correspondencia&#46;"
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    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Immediate post-operative intravesical instillation of a single dose chemotherapy is not superior to continuous saline irrigation"
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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">La resecci&#243;n transuretral es la primera l&#237;nea de tratamiento y&#44; aunque se haya realizado una resecci&#243;n completa durante la resecci&#243;n transuretral del tumor de vejiga &#40;RTU&#41;&#44; puede observarse recidiva o progresi&#243;n del c&#225;ncer de vejiga &#40;CV&#41;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a>&#46; La probabilidad de recidiva y progresi&#243;n del tumor en general puede variar entre el 50 y el 80&#37;&#44;y entre el 5 y el 80&#37;&#44; respectivamente<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Por lo tanto&#44; se requiere un tratamiento adyuvante adicional para prevenir su aparici&#243;n&#44; incluso tras la resecci&#243;n completa del tumor de vejiga&#46; Se supone que la instilaci&#243;n &#250;nica postoperatoria inmediata de quimioterapia intravesical &#40;IQPI&#41; es una forma espec&#237;fica de tratamiento adyuvante que puede reducir la recidiva del CV sin invasi&#243;n muscular &#40;CVSIM&#41; destruyendo las c&#233;lulas tumorales flotantes y evitando la implantaci&#243;n de c&#233;lulas tumorales&#44; tanto en el lugar del tumor resecado&#44; como en el urotelio vesical normal<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">4&#8211;7</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Las gu&#237;as actuales recomiendan una IQPI en los pacientes que presumiblemente tienen un CVSIM de riesgo bajo o intermedio y aquellos con una puntuaci&#243;n de recurrencia de &#60;<span class="elsevierStyleHsp" style=""></span>5 seg&#250;n las tablas de riesgo de la European Organization of Research and Treatment of Cancer &#40;EORTC&#41; despu&#233;s de la RTU<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">1&#44;3</span></a>&#46; Varios metaan&#225;lisis han demostrado que la IQPI tras la RTU puede reducir las recidivas en comparaci&#243;n con el tratamiento &#250;nico de RTU<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">8&#8211;10</span></a>&#46; Sin embargo&#44; un metaan&#225;lisis reciente indic&#243; una mortalidad global m&#225;s elevada e incomprensible en los pacientes que recibieron IQPI&#44; lo que suscit&#243; dudas importantes en t&#233;rminos de su seguridad<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a>&#46; A partir de entonces&#44; las alternativas m&#225;s seguras y pr&#225;cticas tienen una mayor aceptaci&#243;n&#46; El lavado vesical continuo con suero salino &#40;LVCS&#41; puede ser una opci&#243;n posible para eliminar las c&#233;lulas tumorales flotantes y evitar la implantaci&#243;n de c&#233;lulas tumorales en el urotelio de la vejiga&#44; adem&#225;s de ser m&#225;s rentable y tolerable<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">11&#44;12</span></a>&#46; Estudios recientes informaron de una eficacia similar de IQPI e LVCS despu&#233;s de la RTU en cuanto a la recurrencia del tumor en pacientes con CVSIM<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">11&#8211;14</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">En este contexto&#44; nuestro objetivo fue evaluar si la IQPI es realmente necesaria tras la RTU en comparaci&#243;n con el LVCS solo&#44; en pacientes con CVSIM de riesgo bajo o intermedio mediante un estudio multic&#233;ntrico con seguimiento a largo plazo&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materiales y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Poblaci&#243;n del estudio</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se revisaron retrospectivamente las historias cl&#237;nicas de 1&#46;482 pacientes a los que se les realiz&#243; una RTU y se les diagnostic&#243; un CVSIM primario&#46; Los pacientes se inscribieron en 9 hospitales de referencia terciarios diferentes&#44; entre marzo de 1994 y agosto de 2020&#46; El Comit&#233; de &#201;tica Institucional local &#40;IRB No&#58;2021-05&#47;22&#41; aprob&#243; este estudio y todos los pasos se planificaron y llevaron a cabo seg&#250;n los principios de la Declaraci&#243;n de Helsinki y sus enmiendas posteriores&#46; No se obtuvo un consentimiento informado por escrito espec&#237;fico para este estudio&#44; ya que se trata de un estudio retrospectivo que utiliza una base de datos&#46; Sin embargo&#44; en el momento de su ingreso en el hospital&#44; se obtuvo un consentimiento informado estructurado seg&#250;n las pol&#237;ticas institucionales de cada centro para el uso de datos particulares de los pacientes en futuros estudios cient&#237;ficos&#46; Adem&#225;s&#44; todos los datos de los pacientes se anonimizaron en la fuente y en el momento de su registro en una base de datos espec&#237;fica del estudio&#44; lo que impidi&#243; la identificaci&#243;n de cualquier paciente concreto inscrito en este estudio&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas preoperatorias de los pacientes&#44; los par&#225;metros quir&#250;rgicos perioperatorios como la t&#233;cnica de RTU &#40;resecci&#243;n en bloque o est&#225;ndar&#41;&#44; la fuente de energ&#237;a &#40;monopolar&#44; bipolar o l&#225;ser&#41;&#44; la administraci&#243;n de IQPI y&#47;o LVCS&#44; el tipo de f&#225;rmaco de IQPI &#40;mitomicina-C&#44; epirubicina&#44; gemcitabina&#44; adriamicina&#44; etc&#46;&#41;&#44; el tiempo hasta la administraci&#243;n de la IQPI&#44; la duraci&#243;n del LVCS&#44; las complicaciones postoperatorias seg&#250;n la clasificaci&#243;n de complicaciones quir&#250;rgicas de Clavien-Dindo &#40;C-D&#41;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a>&#44; la duraci&#243;n de la estancia hospitalaria&#44; la duraci&#243;n del cateterismo&#44; as&#237; como los hallazgos patol&#243;gicos de las muestras de la RTU&#44; se registraron detalladamente para cada paciente&#46; La estratificaci&#243;n de los grupos de riesgo de los pacientes se calcul&#243; de acuerdo con las recomendaciones de las directrices de la Asociaci&#243;n Europea de Urolog&#237;a &#40;EAU&#41;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a>&#46; Adicionalmente&#44; se registraron minuciosamente los datos de recurrencia y&#47;o progresi&#243;n y de seguimiento de cada paciente&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El tama&#241;o del tumor se defini&#243; en funci&#243;n del di&#225;metro m&#225;s largo y el n&#250;mero de tumores se registr&#243; como &#250;nico o m&#250;ltiple seg&#250;n los hallazgos de la RTU&#46; Los informes de las muestras de patolog&#237;a fueron realizados por uropat&#243;logos experimentados en todos los centros seg&#250;n la clasificaci&#243;n TNM y las directrices de clasificaci&#243;n de la Organizaci&#243;n Mundial de la Salud&#46; Se excluyeron los pacientes con enfermedad recidivante&#44; aquellos con CVSIM de alto riesgo&#44; con histolog&#237;a diferente en la muestra patol&#243;gica&#44; los pacientes con antecedentes de quimioterapia intravesical &#40;IQPI o m&#225;s de una instilaci&#243;n&#41; y aquellos sin datos cl&#237;nicos sobre la administraci&#243;n de IQPI y&#47;o LVCS&#46; Tambi&#233;n se excluyeron del an&#225;lisis los pacientes con datos incompletos sobre el estado de recidiva y&#47;o progresi&#243;n&#44; aquellos con un tiempo de seguimiento inferior a 3 meses&#44; y&#47;o los perdidos en el seguimiento&#44; dejando un total de 594 pacientes con CVSIM primario para ser incluidos en el estudio&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Los pacientes se dividieron en 2 grupos seg&#250;n el tratamiento administrado de IQPI y&#47;o LVCS tras la RTU &#40;Grupo 1&#58; pacientes que recibieron solo LVCS&#59; Grupo 2&#58; pacientes que recibieron LVCS tras IQPI&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Los pacientes con CVSIM de riesgo bajo e intermedio tambi&#233;n se dividieron en subgrupos seg&#250;n el tratamiento administrado IQPI y&#47;o LVCS tras la RTU &#40;Grupo RB-1&#58; pacientes con CVSIM de riesgo bajo que recibieron solo LVCS&#59; Grupo RB-2&#58; pacientes con CVSIM de riesgo bajo que recibieron LVCS tras IQPI&#59; Grupo RI-1&#58; pacientes con CVSIM de riesgo intermedio que recibieron solo LVCS&#59; Grupo RI-2&#58; pacientes con CVSIM de riesgo intermedio que recibieron LVCS tras IQPI&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">An&#225;lisis estad&#237;stico</span><p id="par0055" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se realiz&#243; con el programa Statistical Package for the Social Sciences versi&#243;n 22&#46;0 &#40;IBM Corp&#46;&#44; Armonk&#44; NY&#44; EE&#46; UU&#46;&#41;&#46; Se utilizaron las pruebas de Kolmogorov-Smirnov y Shapiro-Wilk para comprobar la normalidad de los datos de las variables cuantitativas&#46; Las variables continuas se expresaron en mediana y rango intercuartil&#44; mientras que las variables categ&#243;ricas se expresaron en n&#250;mero y frecuencia&#46; Siempre que fue posible&#44; se utilizaron las pruebas de Chi-cuadrado de Pearson&#44; la prueba exacta de Fisher y la U de Mann-Whitney&#46; Se consider&#243; estad&#237;sticamente significativo un valor p de 2 colas de &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0060" class="elsevierStylePara elsevierViewall">De los pacientes&#44; 86 &#40;14&#44;5&#37;&#41; eran mujeres y 508 &#40;85&#44;5&#37;&#41; eran varones&#44; con una edad media de 69 &#40;60-78&#41; a&#241;os&#46; Del total&#44; 343 &#40;57&#44;7&#37;&#41; pacientes ten&#237;an un historial conocido de tabaquismo y 4 &#40;0&#44;7&#37;&#41; pacientes ten&#237;an un historial conocido de exposici&#243;n a sustancias qu&#237;micas en el trabajo&#46; La mediana de a&#241;os de consumo de tabaco era de 40 &#40;25-50&#41; y la mediana del &#237;ndice de masa corporal era de 26&#44;72 &#40;24&#44;82-29&#44;38&#41; kg&#47;m<span class="elsevierStyleSup">2</span>&#46; Se observ&#243; hidronefrosis preoperatoria en 17 &#40;3&#44;1&#37;&#41; pacientes&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En el momento de la RTU&#44; 401 &#40;67&#44;5&#37;&#41; pacientes ten&#237;an un tumor solitario mientras que 193 &#40;32&#44;5&#37;&#41; de ellos ten&#237;an tumores m&#250;ltiples&#46; La frecuencia de tumores &#8804;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm y &#62;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm fue de 463 &#40;77&#44;9&#37;&#41; y 131 &#40;22&#44;1&#37;&#41;&#44; respectivamente&#46; La distribuci&#243;n de los tumores papilares y s&#233;siles fue de 586 &#40;98&#44;7&#37;&#41; y 8 &#40;1&#44;3&#37;&#41;&#44; respectivamente&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Se realiz&#243; resecci&#243;n del tumor vesical en bloque en 61 &#40;10&#44;3&#37;&#41; pacientes&#44; y resecci&#243;n est&#225;ndar en 533 &#40;89&#44;7&#37;&#41; pacientes&#46; La frecuencia de pacientes en el grupo 1 y el grupo 2 fue de 361 &#40;60&#44;8&#37;&#41; y 233 &#40;39&#44;2&#37;&#41;&#44; respectivamente&#46; Los detalles de la terapia intravesical postoperatoria se resumen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Se administr&#243; mitomicina-C&#44; epirubicina y adriamicina a 112 &#40;18&#44;9&#37;&#41;&#44; 120 &#40;20&#44;2&#37;&#41; y 1 &#40;0&#44;2&#37;&#41; pacientes&#44; respectivamente&#46; Tanto la mediana de la duraci&#243;n del cateterismo&#44; como la de la estancia hospitalaria&#44; fue de 2 &#40;1-2&#41; d&#237;as&#46; Se observaron complicaciones postoperatorias tempranas menores &#40;&#8804;<span class="elsevierStyleHsp" style=""></span>Clavien-Dindo-2&#41; y mayores &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>Clavien-Dindo-3&#41; en 23 &#40;3&#44;9&#37;&#41; y 2 &#40;0&#44;3&#37;&#41; pacientes&#44; respectivamente&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Seg&#250;n los hallazgos patol&#243;gicos&#44; 5 &#40;0&#44;8&#37;&#41; pacientes presentaban una neoplasia urotelial papilar de bajo potencial maligno y 589 &#40;99&#44;2&#37;&#41; pacientes ten&#237;an tumores de bajo grado&#46; En 334 &#40;56&#44;2&#37;&#41; pacientes se observ&#243; la presencia de tejido de l&#225;mina muscular propia en las muestras patol&#243;gicas&#46; No se observ&#243; invasi&#243;n linfovascular en ning&#250;n paciente&#46; Seg&#250;n la estratificaci&#243;n del grupo de riesgo de la EAU&#44; 329 &#40;55&#44;4&#37;&#41; pacientes ten&#237;an una enfermedad de bajo riesgo&#44; mientras que 265 &#40;44&#44;6&#37;&#41; de los pacientes ten&#237;an una enfermedad de riesgo intermedio&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Se observ&#243; recurrencia de la enfermedad en 213 &#40;35&#44;9&#37;&#41; pacientes&#46; La mediana de tiempo hasta la primera recidiva fue de 14 &#40;7-27&#41; meses&#46; Se observ&#243; recurrencia de la enfermedad en los primeros 12 meses en 98 &#40;16&#44;5&#37;&#41; pacientes&#46; La mediana del tiempo de seguimiento fue de 32 &#40;16-66&#41; meses&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">No hubo diferencias entre los grupos en cuanto a edad&#44; sexo y antecedentes de tabaquismo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;095&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;308 y p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;499&#44; respectivamente&#41;&#46; No hubo diferencias significativas entre los grupos al comparar el n&#250;mero de tumores&#44; el tama&#241;o del tumor&#44; la presencia de muscular propia en las muestras patol&#243;gicas y la estratificaci&#243;n del grupo de riesgo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;816&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;196&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;822 y p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;859&#44; respectivamente&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">La frecuencia de la enfermedad recurrente no fue estad&#237;sticamente diferente entre los 2 grupos &#40;38&#44;8 vs&#46;31&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;064&#41;&#46; Del mismo modo&#44; no hubo diferencias entre los grupos al comparar la mediana de tiempo hasta la primera recidiva y la frecuencia de la recidiva dentro de los primeros 12 meses &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;671 y p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;145&#44; respectivamente&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Las caracter&#237;sticas patol&#243;gicas de la enfermedad recurrente en cada grupo se resumen en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">En los an&#225;lisis de subgrupos basados en los grupos de riesgo&#44; la frecuencia de recidiva de la enfermedad fue menor en el grupo RB-2 en comparaci&#243;n con el grupo RB-1 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;042&#41;&#46; No hubo diferencias entre los subgrupos de CVSIM de bajo riesgo cuando se compar&#243; la mediana de tiempo hasta la primera recidiva y la frecuencia de recidiva en los primeros 12 meses &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;139 y p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;070&#44; respectivamente&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4&#46;1</a>&#41;&#46; No se observaron diferencias entre los subgrupos de riesgo intermedio de CVSIM cuando se compar&#243; la frecuencia de la enfermedad recurrente&#44; la mediana del tiempo hasta la primera recurrencia y la frecuencia de la recurrencia dentro de los primeros 12 meses &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#44; para cada uno&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 4&#46;2</a>&#41;&#46; Aunque se observ&#243; una tasa m&#225;s alta de enfermedad recurrente en el grupo RB-1&#44; la inmensa mayor&#237;a de estas eran menores de 3<span class="elsevierStyleHsp" style=""></span>cm &#40;94&#44;3&#37;&#41;&#44; de bajo grado &#40;91&#44;4&#37;&#41; y tumores Ta &#40;88&#44;6&#37;&#41;&#46; Adem&#225;s&#44; no hubo diferencias significativas entre estos dos subgrupos en cuanto a las caracter&#237;sticas patol&#243;gicas de los tumores recurrentes como el n&#250;mero de tumores recurrentes&#44; el tama&#241;o&#44; el grado&#44; el estadio y la presencia de CIS &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#44; para cada uno&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabla 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">En el presente estudio&#44; se evalu&#243; el papel del LVCS cuando se utiliza como tratamiento &#250;nico en comparaci&#243;n con IQPI seguido de la administraci&#243;n de LVCS en pacientes con CVSIM primario de riesgo bajo o intermedio en t&#233;rminos de recurrencia del CV&#46; Los resultados de nuestro estudio sugieren que el uso de IQPI antes del LVCS no proporcion&#243; ning&#250;n beneficio en la prevenci&#243;n de la recidiva del CV en la poblaci&#243;n general de pacientes&#46; En el subgrupo de pacientes con CVSIM primario de bajo riesgo&#44; la tasa de recidiva fue menor cuando se les trat&#243; con LVCS despu&#233;s de la IQPI&#46; Sin embargo&#44; las recidivas observadas en esta poblaci&#243;n fueron en general lesiones peque&#241;as&#44; solitarias y de bajo grado&#46; Adem&#225;s&#44; no se observ&#243; ning&#250;n beneficio adicional de la combinaci&#243;n de IQPI y LVCS en la prevenci&#243;n de la recidiva del CV en pacientes con CVSIM de riesgo intermedio en comparaci&#243;n con el LVCS solo&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En un estudio prospectivo y aleatorizado&#44; Oosterlinck et al&#46; informaron de que la IQPI pod&#237;a disminuir la tasa de recidiva del CV en casi un 50&#37; en los tumores de vejiga Ta&#47;T1 &#250;nicos en comparaci&#243;n con el uso de 50<span class="elsevierStyleHsp" style=""></span>ml de agua est&#233;ril tras la RTU<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a>&#46; En 2004 se public&#243; un metaan&#225;lisis que presentaba los resultados de 7 ensayos aleatorizados que comparaban la RTU sola o la IQPI despu&#233;s de la RTU<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a>&#46; En este metaan&#225;lisis&#44; se inform&#243; de que la IQPI reduce significativamente el riesgo de recidiva del CV en pacientes con un estadio Ta&#47;T1&#44; con tumores &#250;nicos o m&#250;ltiples&#59; sin embargo&#44; las tasas de recidiva del CV despu&#233;s de la IQPI siguen siendo altas en pacientes con tumores m&#250;ltiples<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a>&#46; En 2013&#44; un metaan&#225;lisis actualizado confirm&#243; que la IQPI prolonga los intervalos libres de recidiva y la recidiva temprana de CVSIM cuando se administra inmediatamente despu&#233;s de la RTU<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a>&#46; Por &#250;ltimo&#44; en 2016&#44; Sylvester et al&#46; se propusieron identificar los pacientes con CVSIM que se benefician de la administraci&#243;n de IQPI mediante una revisi&#243;n sistem&#225;tica y un metaan&#225;lisis de datos de pacientes individuales<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a>&#46; Los autores informaron de que la IQPI reduc&#237;a el riesgo de recurrencia del CV&#44; excepto en los pacientes con una tasa de recurrencia previa de m&#225;s de una recurrencia al a&#241;o o una puntuaci&#243;n de recurrencia EORTC de &#8805;<span class="elsevierStyleHsp" style=""></span>5<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a>&#46; Este metaan&#225;lisis tambi&#233;n inform&#243; de una tasa de mortalidad significativamente mayor en los pacientes que recibieron IQPI<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a>&#46; Adem&#225;s&#44; en la mayor&#237;a de los estudios incluidos en estos metaan&#225;lisis&#44; no hab&#237;a ning&#250;n brazo que recibiera solo IQPI despu&#233;s de la RTU&#44; lo que impide identificar adecuadamente el papel de la IQPI<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">8&#44;10&#44;16</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Aunque el uso de IQPI dio lugar a una disminuci&#243;n de la recidiva tumoral&#44; este efecto parece estar limitado a los tumores de bajo impacto cl&#237;nico&#46; De forma similar a nuestros hallazgos&#44; un estudio aleatorizado multic&#233;ntrico inform&#243; de que el efecto de IQPI se limita a recidivas tumorales muy peque&#241;as&#44; solitarias y de bajo grado&#44; que podr&#237;an fulgurarse f&#225;cilmente con anestesia local en la cistoscopia de seguimiento<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a>&#46; Hay informes que indican que estas peque&#241;as recidivas pueden observarse incluso sin consecuencias adversas a largo plazo&#46; Soloway et al&#46; informaron por primera vez de los resultados del manejo vigilante en pacientes con tumores vesicales papilares Ta de bajo grado<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a>&#46; Treinta y dos pacientes con antecedentes de tumores Ta de bajo grado y con un nuevo tumor&#44; el cual era consistente endosc&#243;picamente con uno o m&#225;s tumores peque&#241;os Ta de bajo grado&#44; recibieron seguimiento durante un periodo medio de observaci&#243;n de 38 meses&#46; Solo 3 &#40;9&#37;&#41; progresaron en estadio o grado&#44; y ninguno progres&#243; al estadio T2 de la enfermedad&#44; lo que indica un curso altamente indolente para estos tumores<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">En un estudio prospectivo&#44; aleatorizado y multic&#233;ntrico&#44; Gudj&#243;nsson et al&#46; evaluaron los efectos de la IQPI tras la RTU en pacientes con CVSIM de riesgo bajo a intermedio<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a>&#46; En este estudio&#44; los pacientes fueron tratados con 80<span class="elsevierStyleHsp" style=""></span>mg de epirubicina en 50<span class="elsevierStyleHsp" style=""></span>ml de suero salino o sin ning&#250;n otro tratamiento tras la RTU&#46; Los autores informaron de que IQPI reduce la probabilidad de recurrencia del CV&#46; Uno de los hallazgos emergentes que deben considerarse cuidadosamente en este estudio es que la IQPI redujo las tasas de recurrencia del CV en pacientes con tumores primarios y solitarios&#44; mientras que no proporcion&#243; beneficios en pacientes con tumores recurrentes o m&#250;ltiples<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a>&#46; Del mismo modo&#44; observamos que la utilizaci&#243;n de la IQPI no proporcion&#243; ning&#250;n beneficio sobre el LVCS en la prevenci&#243;n de las recurrencias del CV en pacientes con CVSIM de riesgo intermedio&#46; El LVCS solo parece ser una medida eficaz para disminuir la tasa de recurrencia&#46; En el estudio multic&#233;ntrico de Berrum-Svennung et al&#46;&#44; el 79 &#40;51&#44;0&#37;&#41; de los pacientes con IQPI tuvieron una recidiva&#44; en comparaci&#243;n con 95 de 152 &#40;62&#44;5&#37;&#41; en el grupo de placebo<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a>&#46; Esta observaci&#243;n se ve respaldada por una comparaci&#243;n no aleatorizada de 1&#46;592 pacientes&#44; en el metaan&#225;lisis de Sylvester et al&#46;&#44; donde la irrigaci&#243;n postoperatoria redujo significativamente el riesgo de recidiva&#44; tanto de manera global&#44; como en los 2 grupos de tratamiento<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a>&#46; Al ajustar el tratamiento aleatorizado y la puntuaci&#243;n de riesgo de recidiva de la EORTC&#44; la irrigaci&#243;n postoperatoria redujo el riesgo relativo de recidiva en un 21&#37; &#40;CRI&#58; 0&#44;79&#59; IC del 95&#37;&#58; 0&#44;67-0&#44;93&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a>&#46; En un estudio multic&#233;ntrico de fase III aleatorizado&#44; doble ciego y controlado con placebo&#44; Bohle et al&#46; informaron de que la IQPI no era superior a la administraci&#243;n de 100<span class="elsevierStyleHsp" style=""></span>ml de suero salino en pacientes con CVSIM &#40;Ta&#47;T1&#44;G1-3&#41; primario o recurrente en t&#233;rminos de supervivencia libre de recidiva cuando se emple&#243; LVCS como parte del protocolo en ambos grupos<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a>&#46; Onishi et al&#46; evaluaron la eficacia y la seguridad del LVCS en pacientes con CVSIM de riesgo bajo a intermedio<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a>&#46; En este estudio prospectivo&#44; los pacientes fueron asignados aleatoriamente a LVCS o IQPI&#44; y los autores no informaron de diferencias significativas entre los grupos en cuanto a las tasas libres de recidiva a 5 a&#241;os&#46; Adem&#225;s&#44; la incidencia de acontecimientos adversos fue menor en el grupo de LVCS<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a>&#46; En un metaan&#225;lisis reciente en el que se compar&#243; la eficacia y la seguridad de LVCS e IQPI&#44; Zhou et al&#46; informaron de que no hab&#237;a diferencias entre los dos grupos en cuanto a la supervivencia libre de recidiva a uno y dos a&#241;os&#44; la mediana del tiempo hasta la primera recidiva&#44; la progresi&#243;n del tumor y el n&#250;mero de recidivas durante el seguimiento<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a>&#46; Adem&#225;s&#44; el LVCS mostr&#243; una mejor tolerancia en comparaci&#243;n con IQPI<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Este estudio tiene algunas limitaciones&#46; La principal limitaci&#243;n es su car&#225;cter retrospectivo&#44; que podr&#237;a haber introducido un sesgo de selecci&#243;n y recuerdo en la comparaci&#243;n de los grupos&#46; En segundo lugar&#44; la base de datos no recog&#237;a los efectos secundarios de cada modalidad&#46; Por lo tanto&#44; no pudimos evaluar cualquier posible diferencia presente en t&#233;rminos de eventos adversos entre los grupos&#46; Una de las fortalezas del presente estudio es que comparamos a los pacientes de riesgo bajo e intermedio de CVSIM por separado en t&#233;rminos de la recidiva del CV&#46; En consecuencia&#44; mostramos un papel limitado de IQPI cuando se combina con LVCS s&#243;lo en pacientes con CVSIM de bajo riesgo &#40;tumores Ta primarios&#44; &#250;nicos y de bajo grado&#41; para la prevenci&#243;n de la recidiva del CV&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusiones</span><p id="par0125" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el presente estudio sugiere que la adici&#243;n de IQPI al LVCS puede reducir a&#250;n m&#225;s las tasas de recidiva de CV en pacientes con CVSIM primario de bajo riesgo&#44; aunque las recidivas evitadas son tumores peque&#241;os&#44; de grado y estadio bajo&#44; y no parece alterar significativamente el curso de la enfermedad&#46; Por el contrario&#44; no se observ&#243; ning&#250;n beneficio en pacientes con CVSIM primario de riesgo intermedio en cuanto a la recidiva de la enfermedad&#46; Adem&#225;s&#44; la IQPI por s&#237; sola parece disminuir las recidivas en ambos grupos de riesgo en comparaci&#243;n con los controles hist&#243;ricos&#46; Dado que el beneficio cl&#237;nico de la IQPI es extremadamente limitado y existen algunas preocupaciones no resueltas en t&#233;rminos de su seguridad&#44; se requieren m&#225;s estudios prospectivos bien dise&#241;ados&#44; a gran escala&#44; multic&#233;ntricos&#44; con brazos de tratamiento que incluyan &#171;IQPI sola&#187;&#44; &#171;LVCS solo&#187;&#44; &#171;LVCS despu&#233;s de IQPI&#187; y &#171;ninguna terapia intravesical adicional despu&#233;s de la RTU&#187; para aclarar el papel exacto de la IQPI y el LVCS en el tratamiento de los pacientes con CVSIM&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Financiaci&#243;n</span><p id="par0150" class="elsevierStylePara elsevierViewall">Esta investigaci&#243;n no recibi&#243; ninguna subvenci&#243;n espec&#237;fica de agencias de financiaci&#243;n en los sectores p&#250;blico&#44; comercial o sin fines de lucro&#46;</p></span></span>"
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    "fechaRecibido" => "2021-10-24"
    "fechaAceptado" => "2021-11-25"
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          "clase" => "keyword"
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          "palabras" => array:5 [
            0 => "Lavado vesical continuo con suero"
            1 => "Instilaci&#243;n intravesical de quimioterapia en postoperatorio inmediato"
            2 => "Quimioterapia intravesical"
            3 => "C&#225;ncer vesical sin invasi&#243;n muscular"
            4 => "Resecci&#243;n transuretral de tumor vesical"
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            0 => "Continuous saline bladder irrigation"
            1 => "Immediate postoperative instillation of intravesical chemotherapy"
            2 => "Intravesical chemotherapy"
            3 => "non-muscle-invasive bladder cancer"
            4 => "Transurethral resection of bladder tumors"
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    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n y objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluar si existe alguna diferencia entre el efecto de la instilaci&#243;n intravesical de quimioterapia postoperatoria inmediata &#40;IQPI&#41; y el del lavado vesical continuo con suero salino &#40;LVCS&#41; en la recidiva del c&#225;ncer de vejiga &#40;CV&#41; en pacientes con CV primario de riesgo bajo o intermedio sin invasi&#243;n muscular &#40;CVSIM&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materiales y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se revisaron retrospectivamente las historias cl&#237;nicas de 1&#46;482 pacientes sometidos a resecci&#243;n transuretral de tumor de vejiga entre marzo de 1994 y agosto de 2020&#46; Los pacientes se dividieron en 2 grupos seg&#250;n el tratamiento administrado de IQPI y&#47;o LVCS &#40;Grupo 1&#58; solo LVCS&#59; Grupo 2&#58; LVCS tras IQPI&#41;&#46; Los pacientes con CVSIM de riesgo bajo e intermedio tambi&#233;n se dividieron en subgrupos seg&#250;n el tipo de tratamiento administrado&#58; IQPI y&#47;o LVCS&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 594 pacientes con CVSIM primario&#46; De los pacientes&#44; 86 &#40;14&#44;5&#37;&#41; eran mujeres y 508 &#40;85&#44;5&#37;&#41; eran varones&#44; con una edad media de 69 &#40;60-78&#41; a&#241;os&#46; La frecuencia de pacientes en el grupo 1 y el grupo 2 fue de 361 &#40;60&#44;8&#37;&#41; y 233 &#40;39&#44;2&#37;&#41;&#44; respectivamente&#46; Se observ&#243; enfermedad recurrente en 213 &#40;35&#44;9&#37;&#41; pacientes&#46; No hubo diferencias entre los grupos al comprar la frecuencia de la enfermedad recurrente&#44; la mediana de tiempo hasta la primera recidiva y la frecuencia de la recidiva en los primeros 12 meses &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;064&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;671 y p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;145&#44; respectivamente&#41;&#46; Las tasas de recidiva en los pacientes con CVSIM de bajo riesgo fueron menores cuando recibieron tratamiento con &#171;LVCS tras IQPI&#8221; en comparaci&#243;n con &#171;solo LVCS&#187; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;042&#41;&#46; Sin embargo&#44; no se observaron diferencias en los subgrupos de CVSIM de bajo riesgo al comparar las caracter&#237;sticas patol&#243;gicas de los tumores recurrentes como el n&#250;mero&#44; el tama&#241;o&#44; el grado&#44; el estadio y la presencia de carcinoma <span class="elsevierStyleItalic">in situ</span> &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#44; para cada una&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La combinaci&#243;n &#171;LVCS tras IQPI&#187; no fue superior al tratamiento &#250;nico con &#171;LVCS&#187; en la prevenci&#243;n de resultados patol&#243;gicos adversos en el CVSIM recurrente de riesgo bajo e intermedio&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Introducci&#243;n y objetivos"
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            "titulo" => "Materiales y m&#233;todos"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction and objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To evaluate whether there is any difference between immediate postoperative instillation of intravesical chemotherapy &#40;IPOIC&#41; and continuous saline bladder irrigation&#40;CSBI&#41; in terms of bladder cancer&#40;BC&#41; recurrence in patients with primary low- or intermediate-risk non-muscle-invasive BC &#40;NMIBC&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materials and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Medical records of 1482 patients who underwent transurethral resection of bladder tumor between March 1994 and August 2020 were reviewed retrospectively&#46; Patients were divided into two groups according to IPOIC and&#47;or CSBI administration status &#40;Group 1&#58; CSBI alone&#59; Group 2&#58; CSBI following IPOIC&#41;&#46; Low- and intermediate-risk NMIBC patients were also divided into subgroups according to IPOIC and&#47;or CSBI administration status&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 594 patients with primary NMIBC were included&#46; Of the patients&#44; 86 &#40;14&#46;5&#37;&#41; were female and 508 &#40;85&#46;5&#37;&#41; were male with a median age of 69 &#40;60-78&#41; years&#46; The frequency of patients in group 1 and group 2 were 361 &#40;60&#46;8&#37;&#41; and 233 &#40;39&#46;2&#37;&#41;&#44; respectively&#46; Recurrent disease was observed in 213 &#40;35&#46;9&#37;&#41; patients&#46; There was no difference between the groups when they were compared for recurrent disease frequency&#44; median time to first recurrence and frequency of recurrence within first 12 months &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;064&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;671&#44; and <span class="elsevierStyleItalic">P</span>&#61;&#46;145&#44; respectively&#41;&#46; Disease recurrence rates in low-risk NMIBC patients was lower when they were treated with &#8220;CSBI following IPOIC&#8221; when compared to &#8220;CSBI alone&#8221; &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;042&#41;&#46; However&#44; no difference was observed in low-risk NMIBC subgroups when they were compared for pathological features of recurrent tumors such as number&#44; size&#44; grade&#44; stage&#44; and presence of carcinoma <span class="elsevierStyleItalic">in situ</span> &#40;<span class="elsevierStyleItalic">P</span>&#62;&#46;05&#44; for each&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">&#8220;CSBI following IPOIC&#8221; combination was not superior to &#8220;CSBI alone&#8221; for preventing adverse pathological&#160;outcomes in recurrent low- and intermediate-risk NMIBC&#46;</p></span>"
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            "titulo" => "Introduction and objectives"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0130">Los miembros de Turkish Urooncology Association&#44; Bladder Cancer Study Group est&#225;n disponibles en el Anexo 1&#46;</p>"
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            "apendice" => "<p id="par0135" class="elsevierStylePara elsevierViewall">Los miembros de la Asociaci&#243;n Turca de Urooncolog&#237;a&#58; Dr&#46; Murat Bozlu&#44; Profesor del Departamento de Urolog&#237;a&#44; Universidad de Mersin&#44; Facultad de Medicina&#44; Mersin&#44; Turqu&#237;a&#46;</p>"
            "etiqueta" => "Appendix A"
            "identificador" => "sec0040"
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          1 => array:4 [
            "apendice" => "<p id="par0145" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Anexo A"
            "titulo" => "Material adicional"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">IQPI&#58; instilaci&#243;n intravesical de quimioterapia postoperatoria inmediata&#59; LVCS&#58; lavado vesical continuo con suero&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
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                  \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
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                  \t\t\t\t\ttable-entry\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">130 &#40;21&#44;9&#41;&nbsp;\t\t\t\t\t\t\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"><span class="elsevierStyleHsp" style=""></span>Entre 6 y 12<span class="elsevierStyleHsp" style=""></span>h&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">103 &#40;17&#44;3&#41;&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  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">LVCS</span></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"><span class="elsevierStyleHsp" style=""></span>No&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">0&nbsp;\t\t\t\t\t\t\n
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                  \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"><span class="elsevierStyleHsp" style=""></span>S&#237;&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">594 &#40;100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \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"><span class="elsevierStyleHsp" style=""></span>6-12<span class="elsevierStyleHsp" style=""></span>h&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">1 &#40;0&#44;2&#41;&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"><span class="elsevierStyleHsp" style=""></span>12-24<span class="elsevierStyleHsp" style=""></span>h&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">534 &#40;89&#44;9&#41;&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"><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h&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 &#40;0&#44;7&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Combinaci&#243;n de IQPI &#43; LVCS</span></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"><span class="elsevierStyleHsp" style=""></span>LVCS sola &#40;grupo 1&#41;&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">361 &#40;60&#44;8&#41;&nbsp;\t\t\t\t\t\t\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"><span class="elsevierStyleHsp" style=""></span>LVCS tras IQPI &#40;grupo 2&#41;&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">233 &#40;39&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">IQPI&#58; instilaci&#243;n intravesical de quimioterapia postoperatoria inmediata&#59; LVCS&#58; lavado vesical continuo con suero&#59; RIC&#58; rango intercuartil&#59; RTU&#58; resecci&#243;n transuretral del tumor vesical&#46;</p>"
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                  \t\t\t\t" scope="col">Variables&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" scope="col">Grupo 1&#40;LVCS sola&#41;&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>361&#59; 60&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Grupo 2&#40;LVCS tras IQPI&#41;&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>233&#59; 39&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;095<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Femenino&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
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                  \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">38 &#40;16&#44;3&#41;&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;308&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>Masculino&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">313 &#40;86&#44;7&#41;&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
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                  \t\t\t\t</td><td class="td" title="\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  " colspan="4" align="left" valign="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&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">70 &#40;19&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59 &#40;25&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;499<a class="elsevierStyleCrossRef" href="#tblfn0030">&#42;</a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">198 &#40;54&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">145 &#40;62&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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>Desconocido&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">93 &#40;25&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29 &#40;12&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Paquetes tabaco&#47;a&#241;o &#40;mediana &#91;RIC&#93;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;489<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">T&#233;cnica RTU primaria</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Resecci&#243;n en bloque&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;055<a class="elsevierStyleCrossRef" href="#tblfn0030">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \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>Resecci&#243;n est&#225;ndar&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">216 &#40;92&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Energ&#237;a RTU primaria</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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Laser&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0030">&#42;</a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">&#42;&#42;</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bipolar&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">105 &#40;29&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Monopolar&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">255 &#40;70&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Numero de tumores</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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Solitario&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">245 &#40;67&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">156 &#40;67&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;816<a class="elsevierStyleCrossRef" href="#tblfn0030">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \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>M&#250;ltiple&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">77 &#40;33&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tama&#241;o total tumor</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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">275 &#40;76&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">188 &#40;80&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;196<a class="elsevierStyleCrossRef" href="#tblfn0030">&#42;</a>&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;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">86 &#40;23&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">45 &#40;19&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Estratificaci&#243;n grupo de riego</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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Riesgo bajo&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">201 &#40;55&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">128 &#40;54&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;859<a class="elsevierStyleCrossRef" href="#tblfn0030">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \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>Riesgo intermedio&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">160 &#40;44&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">105 &#40;45&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Presencia de muscularis propria en muestra patol&#243;gica</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
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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
                  \t\t\t\t">102 &#40;43&#44;8&#41;&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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;822<a class="elsevierStyleCrossRef" href="#tblfn0030">&#42;</a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \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
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hidronefrosis preoperatoria</span></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"><span class="elsevierStyleHsp" style=""></span>No&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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">227 &#40;97&#44;4&#41;&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;167<a class="elsevierStyleCrossRef" href="#tblfn0030">&#42;</a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</span></a>&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&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">13 &#40;3&#44;6&#41;&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 &#40;1&#44;7&#41;&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="" 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></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"><span class="elsevierStyleHsp" style=""></span>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">10 &#40;2&#44;8&#41;&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 &#40;0&#44;9&#41;&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="" 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></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Variables&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
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                  \t\t\t\t" scope="col">Grupo 1&#40;LVCS sola&#41;&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>361&#59; 60&#44;8&#37;&#41;&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">Grupo 2&#40;LVCS tras IQPI&#41;&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>233&#59; 39&#44;2&#37;&#41;&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="" 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></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 &#40;&#37;&#41;&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 &#40;&#37;&#41;&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">Valor de 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="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Recidiva enfermedad</span></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"><span class="elsevierStyleHsp" style=""></span>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">221 &#40;61&#44;2&#41;&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">160 &#40;68&#44;7&#41;&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;064<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">a</span></a>&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"><span class="elsevierStyleHsp" style=""></span>S&#237;&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
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                  \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">73 &#40;31&#44;3&#41;&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="" 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></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"><span class="elsevierStyleItalic">Tiempo hasta la primera recidiva &#40;meses&#41; &#40;mediana &#91;RIC&#93;&#41;</span>&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 &#40;7-27&#41;&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 &#40;8-27&#41;&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;671<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">b</span></a>&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  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Recidiva durante los primeros 12 meses</span></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"><span class="elsevierStyleHsp" style=""></span>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">295 &#40;81&#44;7&#41;&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">201 &#40;86&#44;3&#41;&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;145<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">a</span></a>&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"><span class="elsevierStyleHsp" style=""></span>S&#237;&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">66 &#40;18&#44;3&#41;&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 &#40;13&#44;7&#41;&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="" 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></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Numero de tumores recurrentes</span></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"><span class="elsevierStyleHsp" style=""></span>Solitario&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">66 &#40;47&#44;1&#41;&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 &#40;58&#44;9&#41;&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;053<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0050">&#42;</a>&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"><span class="elsevierStyleHsp" style=""></span>M&#250;ltiple&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">69 &#40;49&#44;3&#41;&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 &#40;34&#44;2&#41;&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="" 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></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"><span class="elsevierStyleHsp" style=""></span>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">5 &#40;3&#44;6&#41;&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 &#40;6&#44;8&#41;&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="" 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></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tama&#241;o de los tumores recurrentes</span></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"><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm&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">121 &#40;86&#44;4&#41;&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 &#40;82&#44;2&#41;&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;724<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">&#42;&#42;</span></a>&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"><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm&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 &#40;7&#44;1&#41;&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 &#40;8&#44;2&#41;&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="" 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></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"><span class="elsevierStyleHsp" style=""></span>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">9 &#40;6&#44;4&#41;&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 &#40;9&#44;6&#41;&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="" 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></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Grado de los tumores recurrentes</span></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"><span class="elsevierStyleHsp" style=""></span>NUPBPM&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">2 &#40;2&#44;7&#41;&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;928<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&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"><span class="elsevierStyleHsp" style=""></span>Grado bajo&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">125 &#40;89&#44;3&#41;&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">65 &#40;89&#44;0&#41;&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="" 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></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"><span class="elsevierStyleHsp" style=""></span>Grado alto&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 &#40;7&#44;9&#41;&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 &#40;8&#44;2&#41;&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="" 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></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"><span class="elsevierStyleHsp" style=""></span>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 &#40;2&#44;9&#41;&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="" 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></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estadio tumoral de recidiva</span></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"><span class="elsevierStyleHsp" style=""></span>Ta&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">118 &#40;84&#44;3&#41;&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">65 &#40;89&#44;0&#41;&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;442<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0065"><span class="elsevierStyleSup">&#42;&#42;&#42;&#42;</span></a>&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"><span class="elsevierStyleHsp" style=""></span>T1&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 &#40;11&#44;4&#41;&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 &#40;8&#44;2&#41;&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="" 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></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"><span class="elsevierStyleHsp" style=""></span>T2&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 &#40;0&#44;7&#41;&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 &#40;2&#44;7&#41;&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="" 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></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"><span class="elsevierStyleHsp" style=""></span>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">5 &#40;3&#44;6&#41;&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="" 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></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Presencia de carcinoma in situ en la recidiva</span></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"><span class="elsevierStyleHsp" style=""></span>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">128 &#40;91&#44;4&#41;&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">67 &#40;91&#44;8&#41;&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;938<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">&#42;&#42;&#42;&#42;&#42;</span></a>&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"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Variables&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Grupo RB-1&#40;LVCS sola&#41;&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>201&#59; 61&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">97 &#40;75&#44;8&#41;&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">0&#44;042<a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0085">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">70 &#40;34&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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">0&#44;139<a class="elsevierStyleCrossRef" href="#tblfn0080"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">118 &#40;92&#44;2&#41;&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">0&#44;070<a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">a</span></a>&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">28 &#40;90&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;000<a class="elsevierStyleCrossRef" href="#tblfn0105"><span class="elsevierStyleSup">b</span></a>&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">0&#44;667<a class="elsevierStyleCrossRef" href="#tblfn0105"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0120"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \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>Grado bajo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">64 &#40;91&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28 &#40;90&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                            4 => "A&#46;H&#46; Mostafid"
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                    0 => array:2 [
                      "titulo" => "Tumor progression and survival of patients with high grade&#44; noninvasive papillary &#40;TaG3&#41; bladder tumors&#58; 15-year outcome"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables&#58; A combined analysis of 2596 patients from seven EORTC trials"
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                    0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Urothelial susceptibility to tumor cell implantation&#58; Influence of cauterization"
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                          "etal" => false
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                            0 => "M&#46;S&#46; Soloway"
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                        "tituloSerie" => "Cancer"
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                        "paginaFinal" => "1163"
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                          "autores" => array:6 [
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Información del artículo
ISSN: 02104806
Idioma original: Español
DOI:10.1016/j.acuro.2021.11.008
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