Background and aimsMELD allocation system has changed the clinical consequences on waiting list (WL) for LT, but its impact on mortality has been seldom studied. We aimed to assess the ability of MELD and other prognostic scores to predict mortality after LT.Methods301 consecutive patients enlisted for LT were included, and prioritized within WL by using the MELD-score according to: hepatic insufficiency (HI), refractory ascites (RA) and hepatocellular carcinoma (HCC). The analysis was performed to predict early mortality after LT (8 weeks).ResultsPatients were enlisted as HI (44.9%), RA (19.3%) and HCC (35.9%). The major aetiologies of liver disease were HCV (45.5%). Ninety-four patients (31.3%) were excluded from WL, with no differences among the three groups (p = 0.23). The remaining 207 patients (68.7%) underwent LT, being HI the most frequent indication (42.5%). HI patients had the shortest length within WL (113.6 days vs 215.8 and 308.9 respectively; p<0.001), but the highest early post-LT mortality rates (18.2% vs 6.8% and 6.7% respectively; p<0.001). The independent predictors of early post-LT mortality in the HI group were higher bilirubin (OR = 1.08; p = 0.038), increased iMELD (OR = 1.06; p = 0.046) and non-alcoholic cirrhosis (OR = 4.13; p = 0.017). Among the prognostic scores the iMELD had the best predictive accuracy (AUC = 0.66), which was strengthened in non-alcoholic cirrhosis (AUC = 0.77).ConclusionPatients enlisted due to HI had the highest early post-LT mortality rates despite of the shortest length within WL. The iMELD had the best accuracy to predict early post-LT mortality in patients with HI, and thus it may benefit the WL management.

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Background: The treatment of localized stage lung cancer offers limited succes in terms of increase survival. This study aims to find out if there are differences in disease-free survival (DFS) between surgery and chemoradiotherapy in lung cancer Stage III. Method: A retrospective study was conducted on 96 patients with localized lung cancer treated in our center between from 2009 to and 2017, selecting only patients in Stage III. All the clinical medical histories were reviewed in order to analyze different parameters related to demography, histology and treatment. A statistical data analysis software (SPSS) was applied to search for relationships statistically significant among the variables. For the survival analysis, They used Kaplan-Meier curves and the Log-Rank test. Result: 39 cases of patients in Stage III were collected. The surgery group (with neoadjuvant or adjuvant chemotherapy) covers 21 patients (54%). The group treated with Chemo-Radiotherapy includes 18 patients (46%). For the surgery group, the mean for the DFS is estimated at 51 months (39.5-62.3 months), the median has not yet been reached.The mean DFS in the Chemo-Radiotherapy group is 40.2 months (22.6-57.8 months); the median being 18.2 months (15.75-20.65 months). These differences are statistically significant. The group treated with surgery: median age of 66.5 years, 94% male smokers. The adenocarcinoma represented the 61% of the group compared to the epidermoids, which account for 39%. In 44% of the tumors, signs of inflammatory infiltration were found. The Standard Uptake Value (SUV) average was . The group treated with Chemo-Radiotherapy: median age of 66 years, 95% male smokers, 57% epidermoid tumors versus 43% of adenocarcinomas. Only 14% had signs of histological inflammation. The average SUV was 15.94 (3-48 SUV). Conclusion: Patients candidates for surgery not only have optimal respiratory function tests. They seem to present less pulmonary pathology, a better immune response against tumors and a lower SUV value.

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