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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n y objetivos</span><p id="par0005" class="elsevierStylePara elsevierViewall">El c&#225;ncer de recto es una enfermedad altamente frecuente&#44; cuyo n&#250;mero de casos nuevos en el mundo para el 2018 se estim&#243; en 704&#44;376&#44; con tasas de incidencia de 10 por 100&#44;000 mujeres y 5&#46;6 por 100&#44;000 hombres&#46; En Suram&#233;rica&#44; las tasas estimadas fueron 7&#46;7 en mujeres y 5&#46;4 en hombres<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a>&#46; Seg&#250;n GLOBOCAN&#44; para el 2018 en Colombia el c&#225;ncer de recto era la d&#233;cima causa&#44; con 2&#44;922 casos nuevos<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Actualmente&#44; el tratamiento neoadyuvante es la indicaci&#243;n terap&#233;utica para pacientes con adenocarcinoma de recto que tengan tumores T3&#44; T4 o sospecha de compromiso ganglionar regional<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; Las gu&#237;as <span class="elsevierStyleItalic">National Institute for Clinical Excellence</span> &#40;NICE&#41; y <span class="elsevierStyleItalic">National Comprehensive Cancer Network</span> &#40;NCCN&#41; recomiendan ofrecer quimiorradioterapia preoperatoria con un intervalo antes de la cirug&#237;a para permitir una reducci&#243;n del tama&#241;o tumoral y obtener mejores resultados quir&#250;rgicos en pacientes con c&#225;ncer rectal operable de alto riesgo<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">4&#44;5</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La terapia neoadyuvante se asocia con una disminuci&#243;n significativa del tama&#241;o tumoral&#44; un descenso de la incidencia de recurrencia local&#44; un aumento de la probabilidad de preservar el esf&#237;nter anal y&#44; adem&#225;s&#44; con la posibilidad de lograr una respuesta patol&#243;gica completa &#40;pRC&#41;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Para conocer los resultados obtenidos con la neoadyuvancia existen en la actualidad 5 diferentes clasificaciones de valoraci&#243;n de la respuesta patol&#243;gica a la quimiorradioterapia y la clasificaci&#243;n del <span class="elsevierStyleItalic">American Joint Committee on Cancer</span> es la usada como est&#225;ndar<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">7&#8211;9</span></a>&#46; Esta se categoriza como&#58; &#40;0&#41; respuesta completa cuando no se ven c&#233;lulas tumorales&#59; &#40;1&#41; respuesta moderada cuando se observan solo peque&#241;os nidos tumorales o c&#233;lulas &#250;nicas&#59; &#40;2&#41; respuesta m&#237;nima cuando hay c&#225;ncer residual pero con fibrosis predominante&#44; y &#40;3&#41; pobre respuesta cuando la regresi&#243;n tumoral fue m&#237;nima o nula&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El objetivo de este estudio fue describir la respuesta patol&#243;gica y la supervivencia de los pacientes sometidos a tratamiento neoadyuvante para c&#225;ncer de recto&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materiales y m&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio retrospectivo de seguimiento&#46; Los datos se tomaron del Sistema de Informaci&#243;n para el Seguimiento de Pacientes con C&#225;ncer Colorrectal del Instituto de Cancerolog&#237;a &#40;IDC&#41; Las Am&#233;ricas&#46; Se incluyeron los pacientes atendidos en el periodo 2011-2017 por c&#225;ncer de recto&#44; estadio T3&#44; T4 y&#47;o compromiso ganglionar tumoral y&#47;o M1 con intenci&#243;n curativa&#44; que recibieron quimioterapia y&#47;o radioterapia neoadyuvante y que se operaron en el IDC&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se tuvieron en cuenta variables sociodemogr&#225;ficas como edad&#44; sexo&#44; tipo de aseguramiento en salud&#59; condiciones cl&#237;nicas&#44; como comorbilidades m&#233;dicas &#40;hipertensi&#243;n&#44; diabetes&#44; enfermedad pulmonar obstructiva cr&#243;nica&#44; enfermedad renal cr&#243;nica y enfermedades cardiacas&#41;&#44; diagn&#243;stico histol&#243;gico&#44; estadio cl&#237;nico&#59; de tratamiento&#44; como neoadyuvancia&#44; esquema de quimioterapia&#44; dosis de radioterapia&#44; tipo de cirug&#237;a&#44; meses entre diagn&#243;stico-neoadyuvancia&#44; tiempo entre neoadyuvancia-cirug&#237;a y complicaciones &#40;durante la neoadyuvancia se consideraron como graves aquellas donde se tuvo que suspender el tratamiento y las postoperatorias aquellas que requirieron reintervenci&#243;n&#41;&#46; Adem&#225;s&#44; se incluyeron variables de recurrencia como met&#225;stasis y&#47;o reca&#237;da&#44; meses entre cirug&#237;a-met&#225;stasis y estado vital&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se emple&#243; el sistema de estadificaci&#243;n del <span class="elsevierStyleItalic">American Joint Committee on Cancer</span>&#46; La estadificaci&#243;n cl&#237;nica se realiz&#243; con colonoscopia&#44; tomograf&#237;a contrastada de t&#243;rax y resonancia magn&#233;tica de abdomen y pelvis contrastada&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El protocolo de quimiorradioterapia se realiz&#243; con radioterapia conformada tridimensional&#46; El volumen grueso se defini&#243; como la enfermedad macrosc&#243;pica identificada por examen f&#237;sico y radiol&#243;gico como la tomograf&#237;a contrastada o la resonancia magn&#233;tica de pelvis&#46; El volumen cl&#237;nico cubre la totalidad del mesorrecto y los ganglios linf&#225;ticos iliacos internos derecho e izquierdo para los tumores T3&#44; y los ganglios iliacos externos derecho e izquierdo para los tumores T4&#46; La dosis total para las cadenas ganglionares fue de 45 a 1&#46;8<span class="elsevierStyleHsp" style=""></span>Gy&#44; y la del tumor fue de 50&#46;4 a 1&#46;8<span class="elsevierStyleHsp" style=""></span>Gy&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">El esquema de quimioterapia fue de 5<span class="elsevierStyleHsp" style=""></span>FU 350<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span> por v&#237;a intravenosa al d&#237;a&#44; m&#225;s leucovorina 20<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span> por v&#237;a intravenosa al d&#237;a&#44; por 5 d&#237;as la primera y la quinta semana de radioterapia&#59; en caso de desabastecimiento&#44; capecitabina 1&#44;650<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span>&#47;d&#237;a por v&#237;a oral cada 12<span class="elsevierStyleHsp" style=""></span>h todos los d&#237;as durante la radioterapia&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">La cirug&#237;a incluy&#243; escisi&#243;n mesorrectal total en la mayor&#237;a de los pacientes&#46; La preservaci&#243;n o no del esf&#237;nter anal dependi&#243; del nivel de resecci&#243;n de la masa&#46; Se plante&#243; resecci&#243;n anterior baja de recto bien por abordaje abierto&#44; bien por abordaje laparosc&#243;pico y resecci&#243;n abdominoperineal &#40;bien por abordaje abierto&#44; bien por abordaje laparosc&#243;pico&#41;&#46; En algunos pacientes que expresaron su negativa a la escisi&#243;n mesorrectal se les hizo resecci&#243;n local por abordaje transanal&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Todos los espec&#237;menes de resecci&#243;n fueron evaluados y estadificados por los pat&#243;logos del Laboratorio de Patolog&#237;a Las Am&#233;ricas&#44; teniendo en cuenta las gu&#237;as del <span class="elsevierStyleItalic">College of American Pathologists</span> y del <span class="elsevierStyleItalic">American Joint Committee on Cancer</span><a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">8&#44;9</span></a>&#46; De los espec&#237;menes con enfermedad macrosc&#243;picamente visible se procesaron partes representativas del tumor para la evaluaci&#243;n microsc&#243;pica&#46; En los casos en que no se observ&#243; tumor macrosc&#243;picamente&#44; el lecho tumoral&#44; las &#225;reas ulceradas&#44; fibr&#243;ticas o sospechosas de tumor se procesaron en su totalidad en cortes seriados con un espesor de 4<span class="elsevierStyleHsp" style=""></span>mm&#44; se incluyeron en bloques de parafina y posteriormente se evaluaron microsc&#243;picamente&#46; Los ganglios linf&#225;ticos se procesaron y evaluaron en su totalidad&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La pRC se defini&#243; como la ausencia de c&#233;lulas tumorales viables en el esp&#233;cimen quir&#250;rgico &#40;ypT0ypN0&#41; y no completa cuando se clasific&#243; como casi completa&#44; parcial&#44; pobre o sin respuesta&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">La supervivencia global &#40;SG&#41; se determin&#243; como el tiempo transcurrido desde el diagn&#243;stico hasta la muerte por cualquier causa&#44; y la supervivencia libre de enfermedad &#40;SLE&#41; se defini&#243; como el tiempo desde el diagn&#243;stico hasta la aparici&#243;n de signos y&#47;o s&#237;ntomas de la enfermedad o muerte&#46; La fecha de fallecimiento se obtuvo de la historia cl&#237;nica&#44; de la base de datos de la Registradur&#237;a Nacional del Estado Civil o de la Administradora de Recursos del Sistema&#46; Se estableci&#243; el 30 de agosto de 2018 como la fecha de cierre para obtener la informaci&#243;n necesaria para SG y SLE&#46; Los pacientes en los que no se pudo conocer su estado vital en las fuentes mencionadas se censuraron con la fecha del &#250;ltimo contacto en el IDC&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">An&#225;lisis estad&#237;stico</span><p id="par0075" class="elsevierStylePara elsevierViewall">Las variables cuantitativas se expresaron como media y desviaci&#243;n est&#225;ndar &#40;DE&#41; o mediana y rango intercuart&#237;lico &#40;RIC&#41;&#44; seg&#250;n fuera la simetr&#237;a de la variable&#46; Se us&#243; la prueba de Kolmogorov-Smirnov para comprobar la normalidad&#46; Las variables categ&#243;ricas se expresaron mediante frecuencias absolutas y porcentajes&#46; Para determinar la asociaci&#243;n entre 2 variables se utiliz&#243; la prueba de Chi-cuadrado de Pearson&#44; la t de Student o la U de Mann-Whitney&#44; seg&#250;n su naturaleza&#46; La supervivencia se calcul&#243; mediante el m&#233;todo de Kaplan-Meier y para comparar las curvas de supervivencia se emple&#243; el log-rank test&#46; Los datos se analizaron con el programa estad&#237;stico STATA v12&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Consideraciones &#233;ticas</span><p id="par0080" class="elsevierStylePara elsevierViewall">El protocolo se elabor&#243; seg&#250;n las normas &#233;ticas internacionales y la legislaci&#243;n colombiana&#44; y tanto este como la ejecuci&#243;n del estudio fueron aprobados y vigilados por el Comit&#233; de &#201;tica Independiente del IDC Las Am&#233;ricas&#44; el cual cumple con las normas de Buenas Pr&#225;cticas Cl&#237;nicas en todas sus actividades&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">El Comit&#233; de &#201;tica dispens&#243; al investigador de la obtenci&#243;n de consentimiento informado al ser una investigaci&#243;n clasificada como sin riesgo seg&#250;n la normatividad colombiana&#46; Los autores han seguido los protocolos sobre publicaci&#243;n de datos de pacientes y el anonimato de los mismos fue preservado en todo momento&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0090" class="elsevierStylePara elsevierViewall">De los 991 pacientes con c&#225;ncer de recto atendidos en el periodo&#44; 310 &#40;31&#46;3&#37;&#41; recibieron neoadyuvancia en el IDC&#44; de los que se incluyeron en el estudio 152 pacientes&#46; Las causas por las que no fueron operados 127 &#40;40&#46;9&#37;&#41; se muestran en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46; Nueve pacientes con respuesta completa por im&#225;genes se llevaron a junta multidisciplinaria a petici&#243;n de ellos y se decidi&#243; no operarlos&#59; de estos&#44; 2 presentaron met&#225;stasis&#44; uno falleci&#243; y 7 contin&#250;an con respuesta cl&#237;nica completa&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">El promedio de edad fue 59 a&#241;os &#40;DE 12&#46;8&#41;&#44; con un rango de 18 a 84 a&#241;os&#44; con predominio del sexo masculino&#58; 82 &#40;53&#46;9&#37;&#41;&#46; Los pacientes que reportaron comorbilidades m&#233;dicas fueron 74 &#40;48&#46;7&#37;&#41;&#46; El estadio cl&#237;nico fue IIIB en 89 &#40;58&#46;6&#37;&#41; pacientes&#46; La histolog&#237;a de todos los tumores fue adenocarcinoma y el sitio de met&#225;stasis de los 4 pacientes estadio <span class="elsevierStyleSmallCaps">iv</span> fue al h&#237;gado &#40;2&#41; y al pulm&#243;n &#40;2&#41;&#44; los cuales fueron tratados con cirug&#237;a y quimioterapia&#46; La pRC al tratamiento neoadyuvante se logr&#243; en 26 &#40;17&#37;&#41; pacientes&#44; con un promedio de edad de 56 a&#241;os &#40;DE 13&#46;8&#41; y predominio del sexo femenino&#58; 14 &#40;53&#46;9&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">El protocolo de quimiorradioterapia se dio a 146 &#40;96&#46;1&#37;&#41; pacientes&#44; con esquema Mayo en 122 &#40;83&#46;5&#37;&#41; y dosis de 50&#46;4<span class="elsevierStyleHsp" style=""></span>Gy en 146 &#40;96&#46;1&#37;&#41;&#46; A la mayor&#237;a de los pacientes se les practic&#243; resecci&#243;n anterior baja de recto &#40;83&#59; 54&#46;6&#37;&#41;&#46; El 62&#46;5&#37; de los pacientes se oper&#243; despu&#233;s de las 12 semanas debido a demoras administrativas&#44; como autorizaciones&#44; entrega de documentaci&#243;n y programaci&#243;n del procedimiento&#44; tratamiento concomitante de otra enfermedad o renuencia a la cirug&#237;a&#44; entre otros&#46; Los pacientes con pRC recibieron en su totalidad quimiorradioterapia&#59; el tiempo promedio entre el diagn&#243;stico y el inicio de la neoadyuvancia fue 1&#46;8 &#40;RIC 1&#46;5-3&#46;6&#41; meses&#44; inferior al reportado en quienes no tuvieron respuesta completa&#44; que fue de 2&#46;5 &#40;RIC 1&#46;7-3&#46;2&#41; meses &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">El 34&#46;2&#37; de los pacientes tuvieron progresi&#243;n de la enfermedad&#44; en 9 los cuales fue antes de la cirug&#237;a&#46; Entre los pacientes con pRC solo uno tuvo reca&#237;da&#44; con sitio p&#233;lvico&#46; Por otra parte&#44; el grupo sin respuesta a la neoadyuvancia tuvo como sitio de recurrencia de mayor frecuencia el sist&#233;mico &#40;39&#59; 76&#46;5&#37;&#41;&#46; La mediana de tiempo entre la cirug&#237;a y la met&#225;stasis y&#47;o la reca&#237;da fue 13&#46;5 semanas &#40;RIC 6-19&#41;&#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">A 30 de agosto de 2018&#44; de los 152 pacientes&#44; 45 &#40;29&#46;6&#37;&#41; hab&#237;an fallecido&#44; uno &#40;3&#46;9&#37;&#41; con pRC y 44 &#40;34&#46;9&#37;&#41; no completa&#46; La mediana de seguimiento de todos los pacientes fue de 33&#46;3 meses &#40;RIC 20-45&#41;&#44; con una SG de 79&#46;5&#37; &#40;IC 95&#37; 70&#46;9-85&#46;8&#41;&#46; La SG a 5 a&#241;os fue del 51&#46;2&#37; &#40;IC 95&#37; 38&#46;6-62&#46;4&#41;&#44; para quienes tuvieron pRC&#44; del 80&#46;0&#37; &#40;IC 95&#37; 20&#46;3-96&#46;9&#41; y no completa&#44; del 46&#46;1&#37; &#40;IC 95&#37; 33&#46;3-57&#46;8&#41;&#46; Las curvas de Kaplan-Meier muestran una mejor SG para quienes tuvieron pRC &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Al comparar por estadio se encontr&#243; una SG a 5 a&#241;os del 58&#46;6&#37; &#40;IC 95&#37; 33&#46;3-77&#46;2&#41;&#44; el 48&#46;3&#37; &#40;IC 95&#37; 33&#46;1-61&#46;9&#41; y el 50&#37; &#40;IC 95&#37; 0&#46;6-91&#46;0&#41; en estadios <span class="elsevierStyleSmallCaps">ii</span>&#44; <span class="elsevierStyleSmallCaps">iii</span> y <span class="elsevierStyleSmallCaps">iv&#44;</span> respectivamente&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">El tiempo entre la finalizaci&#243;n de la neoadyuvancia y la realizaci&#243;n de la cirug&#237;a no mostr&#243; diferencias en la SG a 5 a&#241;os de los pacientes&#59; quienes fueron operados antes de las 8 semanas tuvieron una SG del 51&#46;7&#37; &#40;IC 95&#37; 25&#46;9-72&#46;4&#41;&#44; entre 8 y 12 semanas&#44; del 58&#46;2&#37; &#40;IC 95&#37; 32&#46;1-77&#46;3&#41;&#44; y mayor de 12 semanas&#44; del 46&#46;5&#37; &#40;IC 95&#37; 27&#46;4-63&#46;5&#41;&#46; Tampoco hubo diferencias en la SG a 5 a&#241;os seg&#250;n el tiempo entre neoadyuvancia y cirug&#237;a&#44; tanto en los pacientes que tuvieron pRC como en los que no la tuvieron&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">La SLE fue del 71&#46;7&#37; &#40;IC 95&#37; 63&#46;2-78&#46;6&#41; y a los 5 a&#241;os&#44; del 38&#46;4&#37; &#40;IC 95&#37; 27&#46;1-49&#46;6&#41;&#46; Quienes tuvieron pRC mostraron una mayor SLE con respecto de quienes tuvieron respuesta parcial o no respuesta&#58; 94&#46;7&#37; &#40;IC 95&#37; 68&#46;1-99&#46;2&#41; y 30&#46;1&#37; &#40;IC 95&#37; 19&#46;4-41&#46;6&#41;&#44; respectivamente &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discusi&#243;n y conclusiones</span><p id="par0130" class="elsevierStylePara elsevierViewall">Varios estudios han descrito los resultados del tratamiento con quimiorradioterapia neoadyuvante en los pacientes con c&#225;ncer de recto localmente avanzado&#44; en cuanto a la pRC&#44; el control local&#44; el locorregional y la supervivencia&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En el presente estudio se pudo identificar que las caracter&#237;sticas sociodemogr&#225;ficas de la cohorte fueron muy similares a las referidas en otros estudios&#44; con una edad media que oscila entre los 58 y los 65 a&#241;os y mayor representaci&#243;n del g&#233;nero masculino<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">10&#8211;13</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">La frecuencia de pRC en nuestro estudio fue del 17&#37;&#44; lo que es concordante con lo publicado en otras series&#46; En el estudio de Banurra et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a>&#44; con un seguimiento de 13 a&#241;os y una cohorte muy similar&#44; se obtuvo una pRC del 12&#46;5&#37;&#46; En el estudio de Cienfuegos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a>&#44; que corresponde a la cohorte m&#225;s grande que se conozca con 500 pacientes seguidos&#44; se observ&#243; una pRC del 12&#37;&#46; Otros estudios&#44; como el de Codina-Cazador et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a>&#44; Esp&#237;nola et al&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a> y Omejec y Potisek<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a>&#44; con cohortes de 162&#44; 119 y 202 pacientes&#44; describieron pRC en el 11&#46;7&#44; 15&#46;1 y 14&#46;8&#37; de los pacientes&#44; respectivamente&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Por lo general&#44; el tratamiento del c&#225;ncer de recto en el estadio <span class="elsevierStyleSmallCaps">ii</span> &#40;T3-4&#44; enfermedad con ganglios negativos con penetraci&#243;n del tumor a trav&#233;s de la pared muscular&#41; o en el estadio <span class="elsevierStyleSmallCaps">iii</span> &#40;enfermedad con ganglios positivos sin met&#225;stasis a distancia&#41; incluye el tratamiento locorregional debido al riesgo relativamente alto de reaparici&#243;n&#46; Este riesgo est&#225; asociado con la proximidad del recto a las estructuras y &#243;rganos p&#233;lvicos&#44; la ausencia de una serosa alrededor del recto y las dificultades t&#233;cnicas asociadas con la obtenci&#243;n de amplios m&#225;rgenes quir&#250;rgicos en la resecci&#243;n<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a>&#46; Sauer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a> reportaron que la incidencia de reca&#237;da local a los 10 a&#241;os fue del 7&#46;1&#37;&#46; Por el contrario&#44; en otro estudio&#44; Cienfuegos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a> describieron una recidiva tumoral en el 28&#37; de los pacientes&#44; de los cuales el 25&#46;6&#37; corresponde a recurrencias a distancia&#46; En nuestra serie&#44; de igual manera se presenta una tasa de recurrencia alta del 34&#37;&#44; sin embargo&#44; en el grupo con respuesta completa solo se registr&#243; un caso con reca&#237;da p&#233;lvica&#46; Finalmente&#44; el resultado de un metaan&#225;lisis de 12 estudios<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">16</span></a> publicado en el 2012 inform&#243; una tasa de recurrencia local a 5 a&#241;os del 0&#37; entre los pacientes que ten&#237;an una pRC&#46; El promedio ponderado global de la tasa de recurrencia local entre todos los estudios fue del 7&#37;&#46; Aquellos con pRC ten&#237;an casi 4 veces menos probabilidades de desarrollar una reca&#237;da en comparaci&#243;n con quienes presentaron una respuesta parcial o no respuesta&#46; Las reca&#237;das a distancia o met&#225;stasis se observaron en el 8&#46;7&#37; de los pacientes que tuvieron una respuesta completa&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">La mayor&#237;a de los autores han descrito una correlaci&#243;n entre el grado de respuesta y la supervivencia&#59; el estudio retrospectivo comparativo institucional de Lee et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a> reporta que la tasa de SG a 5 a&#241;os fue del 76&#46;2&#37; y la de SLE a 5 a&#241;os fue del 72&#46;1&#37;&#46; Cienfuegos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a> reportaron una SG a 5 a&#241;os del 76&#46;9&#37; y de SLE del 66&#37;&#46; En el metaan&#225;lisis<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">16</span></a> se informa una tasa de SG a los 5 a&#241;os para los pacientes con una pRC del 90&#46;2&#37;&#59; estos pacientes ten&#237;an una ventaja de SG de 3&#46;3 veces en comparaci&#243;n con quienes no tuvieron respuesta completa&#46; La SLE a 5 a&#241;os fue del 87&#37; en aquellos con pRC&#46; Este grupo ten&#237;a 4&#46;3 veces m&#225;s probabilidades de estar libre de enfermedad a los 5 a&#241;os que los pacientes sin respuesta completa&#46; Otros estudios<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">11&#44;12&#44;14</span></a> describieron una SG a los 5 a&#241;os del 100&#37;&#46; En nuestro estudio se encontr&#243; que la SG a los 5 a&#241;os fue del 80&#37; y la SLE&#44; del 94&#46;7&#37;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Los investigadores han intentado identificar el intervalo de tiempo &#243;ptimo entre la neoadyuvancia y la cirug&#237;a para aumentar las tasas de respuesta completa&#44; pero los resultados han sido contradictorios e inconsistentes&#46; Adem&#225;s&#44; si los pacientes con una pRC deben someterse a quimioterapia adyuvante tambi&#233;n sigue siendo un tema de debate&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Este estudio tiene como fortaleza que es el primero que se conoce en Colombia&#59; sin embargo&#44; est&#225; limitado por el n&#250;mero de pacientes&#44; el poco tiempo de seguimiento y haber sido realizado en un solo centro de c&#225;ncer&#46; Se pudo evidenciar que los pacientes son similares a los presentados en otros estudios y se concluye que los pacientes que reciben tratamiento neoadyuvante con quimiorradioterapia y obtienen una pRC tienen un excelente control oncol&#243;gico a largo plazo&#44; al disminuir las tasas de reca&#237;da locorregional y a distancia&#44; adem&#225;s de mejorar la SLE y la SG&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Financiaci&#243;n</span><p id="par0165" class="elsevierStylePara elsevierViewall">La presente investigaci&#243;n no ha recibido becas espec&#237;ficas provenientes de agencias del sector p&#250;blico&#44; sector comercial o sin &#225;nimo de lucro&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicto de intereses</span><p id="par0170" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Discusi&#243;n y conclusiones"
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    "fechaRecibido" => "2019-08-16"
    "fechaAceptado" => "2019-11-29"
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          "palabras" => array:4 [
            0 => "C&#225;ncer de recto"
            1 => "Neoadyuvante"
            2 => "Respuesta patol&#243;gica"
            3 => "Supervivencia"
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            0 => "Rectal cancer"
            1 => "Neoadjuvant"
            2 => "Pathologic response"
            3 => "Survival"
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    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n y objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La terapia neoadyuvante en el c&#225;ncer de recto se asocia con una disminuci&#243;n del tama&#241;o tumoral y es la indicaci&#243;n terap&#233;utica para pacientes con tumores T3&#44; T4 o con compromiso ganglionar&#46; El objetivo de este trabajo fue describir la frecuencia de respuesta patol&#243;gica y la supervivencia de los pacientes sometidos a neoadyuvancia para c&#225;ncer de recto&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materiales y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio de seguimiento&#44; retrospectivo&#44; con an&#225;lisis de supervivencia&#46; Se incluyeron los pacientes con c&#225;ncer de recto localmente avanzado&#44; que recibieron tratamiento neoadyuvante y se operaron en el Instituto de Cancerolog&#237;a Las Am&#233;ricas &#40;Medell&#237;n&#44; Colombia&#41;&#46; La supervivencia se estim&#243; por el m&#233;todo de Kaplan-Meier&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 152 pacientes&#44; con un promedio de edad de 59 a&#241;os &#40;DE 12&#46;8&#41;&#44; 53&#46;9&#37; hombres&#44; 58&#46;6&#37; diagnosticados en estadio IIIB&#46; La respuesta patol&#243;gica completa &#40;pRC&#41; se logr&#243; en el 17&#37; de los pacientes&#46; El protocolo de quimiorradioterapia se dio a 146 &#40;96&#46;1&#37;&#41; pacientes&#59; presentaron met&#225;stasis y&#47;o reca&#237;da 52 &#40;34&#46;2&#37;&#41;&#44; de los cuales uno &#40;3&#46;8&#37;&#41; hab&#237;a tenido pRC&#46; La mediana de seguimiento fue de 33 meses &#40;Q1-Q3&#58; 20-45&#41;&#44; con una supervivencia global de 79&#46;5&#37; &#40;IC 95&#37; 70&#46;9-85&#46;8&#41;&#46; Para quienes tuvieron pRC&#44; la supervivencia a 5 a&#241;os fue del 80&#37; &#40;IC 95&#37; 20&#46;3-96&#46;9&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La frecuencia de pRC fue similar a la hallada en otros estudios publicados y su recidiva fue menor con respecto de quienes no tuvieron respuesta&#46; La supervivencia a 5 a&#241;os de los pacientes con pRC fue alta&#44; aunque inferior a lo publicado en otros estudios&#46;</p></span>"
        "secciones" => array:4 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction and aims</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Neoadjuvant therapy in rectal cancer is associated with a decrease in tumor size and is the therapeutic indication for patients with T3 or T4 tumors or lymph node involvement&#46; Our aim was to describe the frequency of pathologic response and the survival rate in patients that underwent neoadjuvant therapy for rectal cancer&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materials and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A retrospective follow-up study with a survival analysis was conducted&#46; Patients with locally advanced rectal cancer that received neoadjuvant treatment and were operated on at the <span class="elsevierStyleItalic">Instituto de Cancerolog&#237;a Las Am&#233;ricas</span> &#40;Medell&#237;n&#44; Colombia&#41; were analyzed&#46; Survival was calculated using the Kaplan-Meier method&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 152 patients were included&#46; Mean patient age was 59 years &#40;12&#46;8 SD&#41;&#44; 53&#46;9&#37; were men&#44; and 58&#46;6&#37; of the patients were diagnosed with stage IIIB disease&#46; The pathologic complete response &#40;pCR&#41; was achieved in 17&#37; of the patients&#46; A total of 146 &#40;96&#46;1&#37;&#41; patients received the chemoradiotherapy protocol&#46; Fifty-two &#40;34&#46;2&#37;&#41; patients developed metastasis and&#47;or relapse&#44; and one &#40;3&#46;8&#37;&#41; of those patients had presented with pCR&#46; The median follow-up period was 33 months &#40;Q1-Q3&#58; 20-45&#41;&#44; with an overall survival rate of 79&#46;5&#37; &#40;95&#37; CI 70&#46;9-85&#46;8&#41;&#46; The 5-year survival rate for the patients that had pCR was 80&#37; &#40;95&#37; CI 20&#46;3-96&#46;9&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The frequency of pCR was similar to that in other published studies and disease recurrence was lower&#44; compared with patients with no response&#46; The 5-year survival rate in patients with pCR was high&#44; albeit lower than that reported in other studies&#46;</p></span>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Edad &#40;a&#241;os&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Menor de 60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;61&#46;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">55 &#40;43&#46;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">71 &#40;46&#46;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&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Entre 60 y 75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;26&#46;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">60 &#40;47&#46;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">67 &#40;44&#46;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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mayor de 75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;11&#46;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;8&#46;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">14 &#40;9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" 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="elsevierStyleItalic">Sexo</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Femenino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;53&#46;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">56 &#40;44&#46;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">70 &#40;46&#46;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&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;46&#46;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">70 &#40;55&#46;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">82 &#40;53&#46;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" 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" 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="elsevierStyleItalic">Vinculaci&#243;n SGSSS</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Contributivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;100&#46;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">116 &#40;92&#46;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">142 &#40;93&#46;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&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Subsidiado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&#46;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">10 &#40;7&#46;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">10 &#40;6&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="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" 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="elsevierStyleItalic">Comorbilidades m&#233;dicas</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;46&#46;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">62 &#40;49&#46;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">74 &#40;48&#46;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&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;53&#46;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">64 &#40;50&#46;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">78 &#40;51&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" 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" 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="elsevierStyleItalic">Grado del tumor</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bien diferenciado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;38&#46;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">84 &#40;66&#46;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">94 &#40;61&#46;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-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderadamente diferenciado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;26&#46;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">28 &#40;22&#46;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">35 &#40;23&#46;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&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mal diferenciado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;7&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#46;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
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                  """
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">152&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" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">120 &#40;95&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">146 &#40;96&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Radioterapia&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">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">6 &#40;3&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\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="elsevierStyleHsp" style=""></span>Capecitabina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;13&#46;3&#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">23 &#40;15&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">122 &#40;83&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mayo-capecitabina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;3&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;7&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;92&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">122 &#40;96&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">146 &#40;96&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t  " rowspan="4" align="left" valign="\n
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                  \t\t\t\t">0&#46;05</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>RAB&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;57&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>RAP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;34&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">57 &#40;45&#46;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">66 &#40;43&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Resecci&#243;n local&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;7&#46;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 &#40;0&#46;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">3 &#40;2&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tiempo entre neoadyuvancia-cirug&#237;a &#40;semanas&#41;</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;45</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Menos de 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;7&#46;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">17 &#40;13&#46;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">19 &#40;12&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Entre 8-12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;19&#46;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">33 &#40;26&#46;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">38 &#40;25&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#225;s de 12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;73&#46;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">76 &#40;60&#46;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">95 &#40;62&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="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">Complicaciones neoadyuvancia</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">16 &#40;61&#46;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">77 &#40;61&#46;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">93 &#40;61&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Leves&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;93&#46;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">72 &#40;93&#46;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">87 &#40;93&#46;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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;97</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Graves&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;6&#46;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">5 &#40;6&#46;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">6 &#40;6&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Complicaciones postoperatorias</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;38</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;11&#46;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">20 &#40;15&#46;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">23 &#40;15&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;88&#46;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">106 &#40;84&#46;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">129 &#40;84&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Caracter&#237;sticas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Respuesta patol&#243;gica</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Completa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No completa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">26 &#40;17&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">126 &#40;82&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">152&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Met&#225;stasis y&#47;o reca&#237;da</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">1 &#40;3&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">52 &#40;34&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sist&#233;mica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;15&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Global cancer statistics 2018&#58; GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                  "contribucion" => array:1 [
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                      "titulo" => "Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer&#58; The M&#46; D&#46; Anderson Cancer Center experience"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N&#46;A&#46; Janjan"
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                    0 => array:2 [
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                        "volumen" => "44"
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                          "autores" => array:2 [
                            0 => "B&#46; Minsky"
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                        "volumen" => "106"
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                        "link" => array:1 [
                          0 => array:2 [
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                      "titulo" => "Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum &#91;Internet&#93;"
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                          "etal" => true
                          "autores" => array:3 [
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                            0 => "M&#46; Amin"
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                            2 => "C&#46; Pastor"
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