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Reconstrucción inmediata mediante implante directo tras quimioterapia neoadyuvante. ¿Es una práctica segura?
Direct-to-implant breast reconstruction after neoadjuvant chemotherapy: A safe option?
Marta Allué Cabañuza,
Autor para correspondencia
martitaallue@hotmail.com

Autor para correspondencia.
, Maria Dolores Arribas del Amoa, Ismael Gil Romeaa, María Pilar Val-Carreres Riveraa, Ramón Sousa Domíngueza, Antonio Tomás Güemes Sáncheza,b
a Unidad de Mama, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
b Universidad de Zaragoza, Zaragoza, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El <span class="elsevierStyleItalic">gold standard</span> para el tratamiento quir&#250;rgico del c&#225;ncer de mama es la cirug&#237;a conservadora seguida de radioterapia&#46; Sin embargo&#44; y a pesar de los avances terap&#233;uticos&#44; hasta un 45&#37; de pacientes ser&#225;n intervenidas mediante mastectom&#237;a<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> y hasta un 20-40&#37; asociar&#225;n alguna t&#233;cnica reconstructiva con objeto de mejorar la calidad de vida y disminuir el impacto sociopsicol&#243;gico de la mastectom&#237;a<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">2&#44;3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">En la &#250;ltima d&#233;cada la mastectom&#237;a bilateral est&#225; experimentando un aumento y tambi&#233;n las tasas de reconstrucci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">4&#44;5</span></a>&#44; que puede ser diferida o inmediata &#40;RMI&#41; mediante reconstrucci&#243;n aut&#243;loga o heter&#243;loga colocando implantes directos&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Aunque varios estudios aseguran viable realizar la RMI tras mastectom&#237;as ahorradoras de piel en pacientes que previamente han recibido quimioterapia neoadyuvante &#40;QTNA&#41;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a>&#44; todav&#237;a resulta controvertido<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">7&#44;8</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El objetivo de este estudio retrospectivo de casos y controles es analizar y comparar las tasas de complicaciones&#44; secuelas y reintervenci&#243;n&#44; as&#237; como los resultados oncol&#243;gicos entre las pacientes sometidas a QTNA y mastectom&#237;a bilateral con reconstrucci&#243;n inmediata &#40;MBRMI&#41; y las que no la precisaron&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">No se dispone hasta la fecha de ning&#250;n estudio de casos y controles emparejados prospectivo sobre reconstrucci&#243;n mamaria tras tratamiento neoadyuvante&#44; por lo que el presente trabajo a pesar de contar con las limitaciones de ser un estudio retrospectivo puede aportar informaci&#243;n &#250;til&#44; que permita aumentar el n&#250;mero de indicaciones de RMI tras QTNA al demostrarse segura&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis observacional retrospectivo para identificar a las pacientes intervenidas de mastectom&#237;a bilateral como tratamiento de un c&#225;ncer de mama con RMI mediante pr&#243;tesis directa en nuestro centro durante el periodo 2000-2016&#46; De ellas se seleccionaron pacientes sometidas a MBRMI tras QTNA &#40;grupo QTNA&#41;&#44; que fueron emparejadas como m&#225;ximo 1&#58;5 respecto a las pacientes que no recibieron QTNA &#40;grupo control&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se recopilaron datos sobre variables demogr&#225;ficas &#40;edad&#44; comorbilidades como obesidad&#44; HTA&#44; DM&#44; y tabaquismo activo&#41;&#44; cl&#237;nico-patol&#243;gicas &#40;indicaci&#243;n&#44; estadio cl&#237;nico&#44; etc&#46;&#41;&#44; en relaci&#243;n con el tratamiento quir&#250;rgico incluyendo el tipo de intervenci&#243;n&#44; las t&#233;cnicas reconstructivas empleadas y la morbilidad postoperatoria&#46; Se evaluaron las complicaciones postoperatorias &#40;aquellas que aparecieron dentro de los 30 d&#237;as tras la intervenci&#243;n&#41; y secuelas &#40;pasados 30 d&#237;as&#41;&#46; Asimismo&#44; se eval&#250;an los resultados oncol&#243;gicos&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Este estudio se adhiere a los principios &#233;ticos de la Declaraci&#243;n de Helsinki y fue aprobado por el comit&#233; &#233;tico del centro y por el Comit&#233; &#201;tico de Investigaci&#243;n Cl&#237;nica de Arag&#243;n &#40;CEICA<span class="elsevierStyleBold">&#41;</span> con n&#250;mero de registro C&#46;P&#46;-C&#46;I&#46; PI16&#47;002&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Selecci&#243;n de pacientes</span><p id="par0045" class="elsevierStylePara elsevierViewall">Los criterios de inclusi&#243;n para realizar la MBRMI fueron&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8211;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Carcinoma multic&#233;ntrico o multifocal no susceptible de cirug&#237;a conservadora&#46; Multifocalidad&#58; 2 o m&#225;s focos tumorales en un mismo cuadrante y a menos de 5<span class="elsevierStyleHsp" style=""></span>cm del foco primario&#59; y multicentricidad&#58; 2 o m&#225;s focos tumorales en distintos cuadrantes de la misma mama o a m&#225;s de 5<span class="elsevierStyleHsp" style=""></span>cm del foco primario&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8211;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Gran componente in situ del tumor infiltrante&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8211;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Alto riesgo por historia familiar &#40;sin mutaci&#243;n conocida&#41;&#58; definido por 2 o m&#225;s familiares &#40;al menos uno de ellos de primer grado afectados de c&#225;ncer de mama u ovario a edades tempranas&#44; antes de los 50 a&#241;os&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8211;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Mutaci&#243;n conocida en genes BRCA1 y BRCA2&#46;</p></li></ul></p><p id="par0070" class="elsevierStylePara elsevierViewall">Se excluyeron las pacientes con carcinoma inflamatorio&#44; as&#237; como las MBRMI sin enfermedad oncol&#243;gica presente o pasada &#40;mastectom&#237;a profil&#225;ctica pura&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Los criterios para la administraci&#243;n de QTNA siguieron las gu&#237;as y recomendaciones actualizadas en el momento del tratamiento&#44; as&#237; como las pautas y duraciones de los mismos&#44; teniendo en cuenta que han variado durante los a&#241;os del estudio&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Se excluyeron pacientes con met&#225;stasis a distancia al diagn&#243;stico y progresi&#243;n de la enfermedad durante la QTNA puesto que no se les practic&#243; RMI tras la mastectom&#237;a&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Las pacientes con tumores mayores de 5<span class="elsevierStyleHsp" style=""></span>cm de di&#225;metro y&#47;o 4 o m&#225;s ganglios linf&#225;ticos axilares positivos recibieron adem&#225;s radioterapia adyuvante&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">T&#233;cnica quir&#250;rgica</span><p id="par0090" class="elsevierStylePara elsevierViewall">La t&#233;cnica quir&#250;rgica consiste en resecci&#243;n del tejido mamario&#44; dejando finos colgajos de piel&#44; variando en la incisi&#243;n cut&#225;nea y la preservaci&#243;n completa o un injerto libre de CAP&#46; Las incisiones var&#237;an seg&#250;n el tama&#241;o y configuraci&#243;n de la mama afecta y la contralateral&#44; del tama&#241;o y localizaci&#243;n del tumor&#44; de cicatrices previas y de la preferencia del cirujano&#46;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8211;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Mastectom&#237;a subcut&#225;nea por incisi&#243;n lateral externa&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8211;</span><p id="par0100" class="elsevierStylePara elsevierViewall">T&#233;cnica de Spira modificada&#58; pr&#243;tesis con doble cubierta mediante un colgajo desepitelizado unido al m&#250;sculo pectoral mayor e injerto libre del CAP tras biopsia intraoperatoria negativa de la base del pez&#243;n&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8211;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Mastectom&#237;a ahorradora de piel seg&#250;n patr&#243;n de Wise corto&#58; incisi&#243;n periareolar con prolongaci&#243;n vertical hacia el surco submamario y extensi&#243;n lateral y medial a lo largo del surco&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8211;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Mastectom&#237;a ahorradora de piel y pez&#243;n por incisi&#243;n radial externa&#46;</p></li></ul></p><p id="par0115" class="elsevierStylePara elsevierViewall">La RMI se realiz&#243; mediante implante directo de silicona de perfil anat&#243;mico&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Evaluaci&#243;n patol&#243;gica y resultados oncol&#243;gicos</span><p id="par0120" class="elsevierStylePara elsevierViewall">El estadio cl&#237;nico se establece seg&#250;n la clasificaci&#243;n de la s&#233;ptima edici&#243;n de la AJCC<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">La respuesta cl&#237;nica completa se defini&#243; como la ausencia de tumor palpable y&#47;o visible en RMN tras QTNA&#44; y la respuesta parcial&#44; como reducci&#243;n tumoral&#46; Cualquier aumento en el tama&#241;o del tumor se consider&#243; progresi&#243;n&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La recurrencia locorregional se defini&#243; como aparici&#243;n de nuevo tumor en la pared tor&#225;cica ipsilateral &#40;piel&#44; tejido subcut&#225;neo y m&#250;sculo pectoral&#41; o recurrencia en la axila ipsilateral&#44; ganglios linf&#225;ticos supraclaviculares&#44; en cadenas mamarias internas o infraclaviculares&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">La met&#225;stasis a distancia fue definida como cualquier recurrencia en todas las dem&#225;s &#225;reas no incluidas en la recurrencia locorregional&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">An&#225;lisis estad&#237;stico</span><p id="par0140" class="elsevierStylePara elsevierViewall">Para evaluar las diferencias entre los grupos a estudio&#44; se emplearon los test estad&#237;sticos de &#967;<span class="elsevierStyleSup">2</span> o test de Fisher en el caso de variables cualitativas&#59; los test de U de Mann-Whitney o t de Student fueron usados para variables cuantitativas seg&#250;n criterios de normalidad&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Para evaluar la supervivencia global &#40;SG&#41;&#44; supervivencia libre de enfermedad &#40;SLE&#41;&#44; supervivencia libre de met&#225;stasis a distancia &#40;SLMD&#41; y supervivencia libre de recurrencia locorregional &#40;SLRLR&#41; se utilizaron curvas de Kaplan-Meier y test de log-rank&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">El punto primario del estudio fue la SLE&#59; se ajustaron diferentes modelos de regresi&#243;n de Cox para evaluar el tiempo hasta el evento&#46; Un valor de p de 0&#44;05 se consider&#243; estad&#237;sticamente significativo&#46; Para toda la investigaci&#243;n se ha utilizado el programa SPSS 22&#46;0&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resultados</span><p id="par0155" class="elsevierStylePara elsevierViewall">Durante el periodo de estudio se realizaron 171 intervenciones de MBRMI como tratamiento de un c&#225;ncer de mama en nuestro centro&#58; 62 pacientes &#40;36&#44;3&#37;&#41; tras QTNA y 109 pacientes &#40;63&#44;7&#37;&#41; que no recibieron tratamiento neoadyuvante&#46;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados generales</span><p id="par0160" class="elsevierStylePara elsevierViewall">Las pacientes ten&#237;an una edad media de 48&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;8 a&#241;os &#40;rango 31-87&#41; al momento de la intervenci&#243;n quir&#250;rgica&#46; En el grupo de QTNA fue de 46&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;0 a&#241;os &#40;rango 31-61&#41;&#44; y en el grupo control fue de 49&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;0 a&#241;os &#40;rango 31-87&#41;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;183&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Los datos cl&#237;nico-patol&#243;gicos relativos al tumor y las comorbilidades que pudiesen afectar a la t&#233;cnica quir&#250;rgica y el desarrollo de complicaciones se exponen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; La distribuci&#243;n de estos factores entre los grupos del estudio fue homog&#233;nea&#44; &#250;nicamente se encuentran diferencias estad&#237;sticamente significativas para HTA&#44; siendo superior en el grupo control &#40;14&#44;7&#37; vs&#46; 3&#44;2&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;020&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">La indicaci&#243;n para practicar una MBRMI m&#225;s frecuente en ambos grupos es la elecci&#243;n de la paciente &#40;32&#44;7&#37;&#41;&#44; seguida de multifocalidad &#40;27&#44;5&#37;&#41;&#44; como se expone en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">La mediana de seguimiento fue de 52&#44;0 &#40;RIQ&#58; 23&#44;0-94&#44;0&#41; meses&#44; de 34&#44;5 &#40;RIQ&#58; 13&#44;0-77&#44;3&#41; meses para el grupo de QTNA y de 62&#44;0 &#40;RIQ&#58; 36&#44;5-110&#44;0&#41; para el grupo control&#44; respectivamente &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">T&#233;cnicas quir&#250;rgicas</span><p id="par0180" class="elsevierStylePara elsevierViewall">La distribuci&#243;n de los diferentes tipos de reconstrucci&#243;n en los dos grupos del estudio fue homog&#233;nea&#44; atendiendo a razones puramente t&#233;cnicas&#44; individualizando en cada paciente y eligiendo la t&#233;cnica m&#225;s id&#243;nea&#46; No se encontraron diferencias estad&#237;sticamente significativas&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Presentamos los resultados de las diferentes t&#233;cnicas utilizadas en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Complicaciones</span><p id="par0190" class="elsevierStylePara elsevierViewall">La tasa global de complicaciones fue del 29&#44;8&#37; para todo el grupo y no hubo diferencias estad&#237;sticamente significativas entre los dos grupos en cuanto a la tasa de complicaciones&#58; 32&#44;2&#37; en el grupo QTNA y 28&#44;4&#37; en el grupo control &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;44&#41;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">La complicaci&#243;n postoperatoria m&#225;s frecuente fue necrosis cut&#225;nea &#40;7&#44;6&#37;&#41;&#44; seguida de seroma mantenido &#40;7&#44;0&#37;&#41; y hematoma &#40;5&#44;8&#37;&#41;&#44; tal como se expone en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; La necrosis cut&#225;nea fue la m&#225;s frecuente en el grupo QTNA y el seroma mantenido fue la m&#225;s frecuente en el grupo control&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">La tasa de reintervenci&#243;n en el postoperatorio temprano fue del 1&#44;8&#37; para el grupo QTNA y del 2&#44;3&#37; para el grupo control &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;705&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Resultados oncol&#243;gicos</span><p id="par0205" class="elsevierStylePara elsevierViewall">Un 8&#44;2&#37; de las pacientes fallecieron a causa de c&#225;ncer de mama durante el estudio&#44; de las cuales 7 pacientes fallecieron en el grupo de QTNA &#40;11&#44;3&#37;&#41; y 7 en el grupo control &#40;6&#44;5&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0210" class="elsevierStylePara elsevierViewall">Las curvas de supervivencia de Kaplan-Meier para SG &#40;test de log-rank&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#41;&#44; SLE &#40;test de log-rank&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#44; SLMD &#40;test de log-rank&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41; y SLRLR &#40;test de log-rank&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;368&#41; se exponen en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0215" class="elsevierStylePara elsevierViewall">Grupo QTNA&#58;</p><p id="par0220" class="elsevierStylePara elsevierViewall">El tiempo medio de SG fue de 46&#44;1 &#40;IC 95&#37;&#58; 36&#44;2-55&#44;9&#41; meses&#44; el tiempo medio de SLE fue de 40&#44;6 meses &#40;IC 95&#37;&#58; 31&#44;7-49&#44;5&#41;&#44; el tiempo medio de SLMD fue de 39&#44;8 meses &#40;IC 95&#37;&#58; 31&#44;2-48&#44;5&#41; y el tiempo medio de SLRLR fue de 43&#44;0 meses &#40;IC 95&#37;&#58; 33&#44;5-52&#44;5&#41;&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Grupo control&#58;</p><p id="par0230" class="elsevierStylePara elsevierViewall">El tiempo medio de SG fue de 75&#44;9 &#40;IC 95&#37;&#58; 65&#44;8-86&#44;1&#41; meses&#44; el tiempo medio de SLE fue de 72&#44;5 meses &#40;IC 95&#37;&#58; 62&#44;4-82&#44;6&#41;&#44; el tiempo medio de SLMD fue de 70&#44;8 &#40;IC 95&#37;&#58; 60&#44;7-80&#44;9&#41; meses y el tiempo medio de SLRLR fue de 71&#44;3 &#40;IC 95&#37;&#58; 61&#44;4-81&#44;2&#41; meses&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Existen diferencias estad&#237;sticamente significativas entre los grupos para todas las variables excepto recidiva local&#46; Se observa en las curvas de supervivencia &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41; y el an&#225;lisis univariante muestra que las pacientes del grupo QTNA tienen 3 veces m&#225;s riesgo que las pacientes del grupo control de presentar recidiva en un momento determinado del tiempo 3&#44;009 &#40;1&#44;349-6&#44;713&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discusi&#243;n</span><p id="par0240" class="elsevierStylePara elsevierViewall">Como resultado de los recientes avances en los tratamientos quimioter&#225;picos y agentes dirigidos contra HER2&#44; el uso de QTNA ha aumentado<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a>&#44; vi&#233;ndose aumentado tambi&#233;n el n&#250;mero de pacientes intervenidas de RMI tras QTNA&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">La seguridad oncol&#243;gica de la RMI tras mastectom&#237;as ahorradoras de piel&#44; o de piel y pez&#243;n&#44; practicadas en pacientes con c&#225;ncer de mama en estadio avanzado&#44; a&#250;n es controvertida&#44; especialmente cuando se administra QTNA&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">En nuestro estudio&#44; encontramos diferencia en SG&#44; SLE&#44; SLMD y SLRLR entre los 2 grupos tras ser apareados por edad y estadio cl&#237;nico&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Muchos cirujanos dudan en realizar RMI tras QTNA porque podr&#237;a aumentar la tasa de complicaciones&#44; lo que se traducir&#237;a en un retraso en la administraci&#243;n de los tratamientos adyuvantes&#44; como la radioterapia o trastuzumab<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">11&#44;12</span></a>&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Aurilio et al&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">13</span></a> informaron tasas de recurrencia local significativamente altas en comparaci&#243;n con el grupo de mastectom&#237;a simple sin reconstrucci&#243;n en pacientes con receptores estrog&#233;nicos negativos&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Sin embargo&#44; muchos otros estudios no mostraron un aumento significativo en las complicaciones en pacientes intervenidas mediante RMI tras QTNA<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">14-17</span></a>&#46; Song et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a> informaron que un metaan&#225;lisis que incluy&#243; 11 estudios demostr&#243; que la QTNA no aumenta la tasa de complicaciones en pacientes con RMI&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">En un estudio prospectivo publicado por Donker et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a> no solo no se demostr&#243; aumento de las complicaciones a corto plazo&#44; sino que estas fueron significativamente inferiores &#40;15&#37; vs&#46; 29&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;042&#41; en las pacientes con RMI tras QTNA comparadas con las que recibieron QT adyuvante tras la RMI&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Los resultados de nuestro estudio est&#225;n en consonancia con estos datos ya que no encontramos diferencias estad&#237;sticamente significativas en cuanto a las tasas de complicaciones&#44; secuelas y&#47;o necesidad de reintervenci&#243;n entre los grupos de estudio&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">S&#237; se observan algunas diferencias como el mayor riesgo de presentar recidiva en las pacientes del grupo QTNA&#44; que nos hacen pensar que las pacientes que reciben QTNA a pesar de presentar un estadio tumoral m&#225;s desfavorable&#44; son discretamente m&#225;s j&#243;venes y con menor n&#250;mero de comorbilidades que pudieran afectar al desarrollo de complicaciones&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">Aunque un ensayo controlado aleatorizado prospectivo ser&#237;a el ideal&#44; existen muchas dificultades en cuanto a la realizaci&#243;n de la RMI&#44; no solo de &#237;ndole t&#233;cnica establecidas por el cirujano sino tambi&#233;n las preferencias de las pacientes&#59; y adem&#225;s&#44; es dif&#237;cil predecir con precisi&#243;n la respuesta cl&#237;nica a la QTNA&#44; lo que dificulta la planificaci&#243;n quir&#250;rgica&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">Existen pocos estudios de casos-controles pareados al respecto&#44; por ello estudios de este tipo pueden aportar informaci&#243;n &#250;til&#44; que permita aumentar el n&#250;mero de indicaciones de RMI tras la QTNA al demostrarse segura&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">No obstante&#44; existen varias limitaciones en este estudio que no permiten generalizar los resultados&#46; En primer lugar&#44; se trata de un estudio retrospectivo con un tiempo de seguimiento relativamente corto teniendo en cuenta la supervivencia actual del c&#225;ncer de mama&#46; En segundo lugar&#44; al tratarse de la experiencia de una &#250;nica instituci&#243;n el tama&#241;o de la muestra es peque&#241;o para establecer un an&#225;lisis preciso de los resultados oncol&#243;gicos&#46; Por otro lado&#44; la diferencia de seguimiento en ambos grupos constituye asimismo una limitaci&#243;n para la generalizaci&#243;n de resultados&#46; Ser&#237;a necesario llevar a cabo estudios multic&#233;ntricos con un tiempo de seguimiento mayor para poder generalizarlos&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusiones</span><p id="par0300" class="elsevierStylePara elsevierViewall">La RMI mediante pr&#243;tesis directa tras mastectom&#237;as ahorradoras de piel puede ser una opci&#243;n viable de tratamiento para pacientes con c&#225;ncer de mama que reciben QTNA&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">Estas pacientes presentan un aumento del riesgo de desarrollar recidiva local&#44; pero se necesitan datos de seguimiento a largo plazo para evaluar con precisi&#243;n los resultados oncol&#243;gicos&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Financiaci&#243;n</span><p id="par0310" class="elsevierStylePara elsevierViewall">El trabajo no ha recibido financiamiento&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicto de intereses</span><p id="par0315" class="elsevierStylePara elsevierViewall">No existe conflicto de intereses&#46;</p></span></span>"
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    "fechaRecibido" => "2019-06-18"
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            0 => "Mastectom&#237;a bilateral"
            1 => "Reconstrucci&#243;n inmediata"
            2 => "Implante directo"
            3 => "Quimioterapia neoadyuvante"
            4 => "Complicaciones"
            5 => "Reintervenci&#243;n"
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            0 => "Bilateral mastectomy"
            1 => "Immediate reconstruction"
            2 => "Direct-to-implant"
            3 => "Neoadjuvant chemotherapy"
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    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introducci&#243;n</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La reconstrucci&#243;n inmediata &#40;RMI&#41; tras mastectom&#237;a en pacientes que han recibido quimioterapia neoadyuvante &#40;QTNA&#41; sigue siendo controvertida&#46; El objetivo de este estudio es analizar y comparar resultados oncol&#243;gicos y las tasas de complicaciones y reintervenci&#243;n en pacientes sometidas a QTNA y un grupo control&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis observacional retrospectivo de casos-controles&#46; Pacientes con c&#225;ncer de mama intervenidas de mastectom&#237;a bilateral con RMI &#40;MBRMI&#41; mediante pr&#243;tesis directa durante el periodo 2000-2016&#46; Grupo que recibi&#243; QTNA emparejadas m&#225;ximo 1&#58;5 respecto a las pacientes sin QTNA &#40;grupo control&#41;&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Evaluamos diferencias entre grupos mediante test &#967;<span class="elsevierStyleSup">2</span> o Fisher &#40;variables cualitativas&#41;&#44; U de Mann-Whitney o t de Student &#40;variables cuantitativas&#41;&#46; An&#225;lisis de supervivencia mediante curvas de Kaplan-Meier y test de log-rank &#40;SPSS 22&#46;0&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Un total de 171 pacientes con MBRMI&#44; 62 pacientes &#40;36&#44;3&#37;&#41; tras QTNA y 109 pacientes &#40;63&#44;7&#37;&#41; en grupo control sin QTNA&#46; Mediana de seguimiento de 52&#44;0 &#40;RIQ&#58; 23&#44;0-94&#44;0&#41; meses&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La indicaci&#243;n para practicar una MBRMI m&#225;s frecuente en ambos grupos es la elecci&#243;n de la paciente &#40;32&#44;7&#37;&#41;&#46; No hay diferencias estad&#237;sticamente significativas entre los grupos en cuanto a tasa de complicaciones &#40;24&#44;2&#37; en el grupo QTNA y 19&#44;3&#37; en el grupo control &#91;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;44&#93;&#41;&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">S&#237; existen diferencias en resultados oncol&#243;gicos&#46; Las pacientes del grupo QTNA tienen 3 veces m&#225;s riesgo que las pacientes del grupo control de presentar recidiva en un momento determinado del tiempo &#40;3&#44;009 &#91;1&#44;349-6&#44;713&#93;&#41; seg&#250;n el an&#225;lisis univariante&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La RMI mediante pr&#243;tesis directa tras mastectom&#237;as ahorradoras de piel es una opci&#243;n viable de tratamiento para pacientes con c&#225;ncer de mama que reciben QTNA&#46;</p></span>"
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          0 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Introducci&#243;n"
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          1 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "M&#233;todos"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Immediate reconstruction &#40;IBR&#41; after mastectomy in patients who have received neoadjuvant chemotherapy &#40;NACT&#41; remains controversial&#46; The aim of this study is to analyze and compare oncological results as well as complication and reoperation rates in patients undergoing NACT and a control group&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Methods</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Retrospective observational case-control study of patients with breast cancer who underwent bilateral mastectomy and direct-to-implant IBR &#40;BMIBR&#41; from 2000-2016&#46; The group that received NACT was matched 1&#58;5 to patients without NACT &#40;Control group&#41;&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">We evaluated differences between groups using the &#967;<span class="elsevierStyleSup">2</span> or Fisher test &#40;qualitative variables&#41;&#44; Mann-Whitney U or Student&#39;s <span class="elsevierStyleItalic">t</span>-test &#40;quantitative variables&#41;&#46; The survival analysis was performed using Kaplan-Meier curves and log-rank test &#40;SPSS 22&#46;0&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The study included a total of 171 patients with BMIBR&#58; 62 patients &#40;36&#46;3&#37;&#41; after NACT and 109 patients &#40;63&#46;7&#37;&#41; in the control group without NACT&#46; Median follow-up was 52&#46;0 &#40;IQR&#58; 23&#46;0-94&#46;0&#41; months&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">In both groups&#44; the indication for BMIBR was patient choice &#40;32&#46;7&#37;&#41;&#46; There were no statistically significant differences between groups in terms of complication rate &#40;24&#46;2&#37; in the NACT group and 19&#46;3&#37; in the control group &#91;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;44&#93;&#41;&#44; but differences in oncological results were found&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Patients in the NACT Group had three times more risk of recurrence at a given time than patients in the control group &#40;3&#46;009 &#91;1&#46;349-6&#46;713&#93;&#41; according to the univariate analysis&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Direct-to-implant IBR after skin-sparing mastectomy is a viable option for breast cancer patients undergoing NACT&#46;</p></span>"
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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  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Variables de comorbilidad</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><span class="elsevierStyleItalic">DM tipo 2</span>&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">3 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;2&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Obesidad &#40;IMC</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#62;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">30&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;2&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;3&#44;7&#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;298<a class="elsevierStyleCrossRef" href="#tblfn0010"><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-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">HTA</span>&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">18 &#40;10&#44;5&#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">2 &#40;3&#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">16 &#40;14&#44;7&#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"><span class="elsevierStyleBold">0&#44;020</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><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-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Tabaquismo</span>&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">20 &#40;11&#44;7&#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">8 &#40;12&#44;9&#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">12 &#40;11&#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;806<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\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Variables asociadas al tumor</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Estadio tumoral TNM</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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>I&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">16 &#40;9&#44;4&#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">5 &#40;8&#44;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;10&#44;1&#41;&nbsp;\t\t\t\t\t\t\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\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><span class="elsevierStyleHsp" style=""></span>II&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">113 &#40;66&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">35 &#40;56&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">78 &#40;71&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;064<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\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><span class="elsevierStyleHsp" style=""></span>III&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">40 &#40;23&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22 &#40;35&#44;5&#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
                  \t\t\t\t">18 &#40;16&#44;5&#41;&nbsp;\t\t\t\t\t\t\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\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><span class="elsevierStyleHsp" style=""></span>IV&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;1&#44;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">0 &#40;0&#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">2 &#40;1&#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="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></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="elsevierStyleItalic">Tama&#241;o tumor media</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DE &#40;cm&#41;</span>&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">2&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;370<a class="elsevierStyleCrossRef" href="#tblfn0005"><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="elsevierStyleItalic">Multifocalidad</span>&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">47 &#40;27&#44;5&#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">18 &#40;29&#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">29 &#40;26&#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&#44;726<a class="elsevierStyleCrossRef" href="#tblfn0010"><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-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">RE positivo</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">99 &#40;57&#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">31 &#40;50&#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">68 &#40;62&#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;147<a class="elsevierStyleCrossRef" href="#tblfn0010"><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-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">HER2 positivo</span>&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">56 &#40;32&#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">21 &#40;33&#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">35 &#40;32&#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">0&#44;866<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2171086.png"
              ]
            ]
          ]
          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Test U de Mann-Whitney&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Test de Fisher&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Test de Fisher&#44; estadio tumoral II s&#237;&#47;no&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Variables demogr&#225;ficas y comorbilidades de las pacientes y datos cl&#237;nico-patol&#243;gicos del tumor</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Hay pacientes en las que coexisten m&#225;s de una indicaci&#243;n&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\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">Indicaciones MBRI&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>171&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo QTNA &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>62&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo control &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>109&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&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-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">C&#225;ncer bilateral</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">13 &#40;7&#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">2 &#40;3&#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">11 &#40;10&#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">0&#44;137&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">C&#225;ncer unilateral</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">158 &#40;92&#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;96&#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">98 &#40;89&#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><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">Multifocalidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;27&#44;5&#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">18 &#40;29&#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">29 &#40;26&#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&#44;726&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">Elecci&#243;n de la paciente&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">56 &#40;32&#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">22 &#40;35&#44;5&#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">34 &#40;31&#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;613&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">Carcinoma lobulillar infiltrante &#40;elecci&#243;n de la paciente&#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">24 &#40;14&#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">6 &#40;9&#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">18 &#40;16&#44;5&#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;258&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">Multicentricidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;11&#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">3 &#40;4&#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">17 &#40;15&#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"><span class="elsevierStyleBold">0&#44;046</span>&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">Carcinoma ductal in situ extenso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;7&#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">3 &#40;4&#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">10 &#40;9&#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;380&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">Elevado riesgo familiar sin mutaci&#243;n conocida&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;4&#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">0 &#40;0&#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">7 &#40;6&#44;&#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"><span class="elsevierStyleBold">0&#44;049</span>&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">Mutaciones de los genes BRCA1 y 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;3&#44;5&#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;6&#44;5&#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;1&#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;191&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2171083.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Test de Fisher&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Indicaciones MBRI</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Los datos se expresan como n &#40;&#37;&#41;&#46;</p>"
          "tablatextoimagen" => array:2 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\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">T&#233;cnica&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Serie completa &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>171&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo QTNA &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>62&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo control &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>109&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&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-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">Subcut&#225;nea incisi&#243;n lateral externa&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">77 &#40;45&#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">25 &#40;40&#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">52&#40;47&#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;750&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">T&#233;cnica Spira&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">71 &#40;41&#44;5&#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">27 &#40;43&#44;5&#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">44 &#40;40&#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;748&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">Patr&#243;n Wise corto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;12&#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">10 &#40;14&#44;5&#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">11 &#40;10&#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">0&#44;460&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">Incisi&#243;n radial externa&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;1&#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 &#40;0&#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">2 &#40;1&#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;535&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2171087.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\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">Complicaciones&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Serie completa &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>171&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo QTNA &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>62&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo control &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>109&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&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-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">Necrosis cut&#225;nea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;7&#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">6 &#40;3&#44;5&#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;4&#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">0&#44;550&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">Infecci&#243;n&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;5&#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">3 &#40;1&#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">6 &#40;3&#44;5&#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">1&#44;000&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">Seroma mantenido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;7&#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">4 &#40;2&#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">8 &#40;4&#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">1&#44;000&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">Hematoma&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;5&#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">4 &#40;2&#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">6 &#40;3&#44;5&#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">1&#44;000&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">Reintervenci&#243;n&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;4&#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">3 &#40;1&#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">4 &#40;2&#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;705&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2171085.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Test de Fisher&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">T&#233;cnica quir&#250;rgica y complicaciones durante el primer mes postoperatorio</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabla 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Los datos se expresan como n &#40;&#37;&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\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">Resultados oncol&#243;gicos&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Serie completa &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>171&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo QTNA &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>62&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo control &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>109&#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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">a</span></a>&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-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">Recurrencia locorregional&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;4&#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">3 &#40;4&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;102-2&#44;371&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">Estadio tumoral al diagn&#243;stico</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Ref&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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Información del artículo
ISSN: 0009739X
Idioma original: Español
DOI:10.1016/j.ciresp.2019.07.003
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