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y por la tendencia a evolucionar desde una fase cr&#243;nica prolongada a fases m&#225;s avanzadas &#40;fase acelerada&#44; crisis bl&#225;stica&#41; de comportamiento agresivo y alta mortalidad<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">2</span></a>&#46; Los datos epidemiol&#243;gicos sobre la enfermedad en Espa&#241;a y en Europa son escasos&#44; y se basan en estudios mayormente retrospectivos y metodol&#243;gicamente limitados<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">3&#8211;12</span></a>&#44; por lo que la incidencia real no es conocida&#46; Adem&#225;s&#44; las caracter&#237;sticas de presentaci&#243;n parecen haber ido cambiando desde las descripciones cl&#225;sicas a las series m&#225;s recientes<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">13&#8211;15</span></a>&#46; Por estos motivos es de gran inter&#233;s disponer de un estudio que aporte informaci&#243;n fiable sobre la incidencia actual de la enfermedad y sus caracter&#237;sticas de presentaci&#243;n&#46; Estas razones justificaron la realizaci&#243;n de un gran estudio epidemiol&#243;gico sobre la LMC en Europa &#40;registro poblacional del proyecto <span class="elsevierStyleItalic">European Treatment and Outcome Study for Chronic Myeloid Leukemia</span> &#91;EUTOS&#93;&#41;&#44; en el que participaron 20 pa&#237;ses incluyendo Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a>&#46; En este art&#237;culo presentamos un an&#225;lisis detallado de la secci&#243;n espa&#241;ola&#44; que aporta datos epidemiol&#243;gicos de la enfermedad m&#225;s representativos y fiables que los actualmente disponibles en nuestro pa&#237;s&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Pacientes y m&#233;todos</span><p id="par0010" class="elsevierStylePara elsevierViewall">El proyecto EUTOS se enmarca dentro de las actividades de la red europea de investigaci&#243;n en leucemia&#58; <span class="elsevierStyleItalic">European LeukemiaNet</span>&#46; Incluye un registro poblacional de casos nuevos de LMC&#44; incluyendo 22 &#225;reas en 20 pa&#237;ses europeos&#44; con un m&#225;ximo de 10 millones de habitantes por &#225;rea&#46; En cada una de estas &#225;reas se deb&#237;an incluir consecutivamente todos los casos nuevos de LMC en pacientes<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#46; El diagn&#243;stico se bas&#243; en la detecci&#243;n de <span class="elsevierStyleItalic">BCR-ABL</span> o del cromosoma Ph1&#46; La secci&#243;n espa&#241;ola incluy&#243; las comunidades aut&#243;nomas &#40;CC&#46; AA&#46;&#41; de Madrid&#44; Castilla-La Mancha y Arag&#243;n en un plazo de selecci&#243;n de 35 meses &#40;del 1-2-2010 al 31-12-2012&#41;&#46; Para detectar los casos se realiz&#243; un listado exhaustivo de todos los centros p&#250;blicos y privados con potencial para diagnosticarlos o tratarlos&#44; utilizando la informaci&#243;n disponible en las p&#225;ginas web de los servicios de salud de dichas comunidades y los listados de centros privados&#46; Se contact&#243; con todos los centros y se incluyeron en el estudio aquellos que confirmaron su capacidad de diagnosticar o tratar casos&#46; Adem&#225;s&#44; se incluyeron los laboratorios centrales p&#250;blicos y privados capaces de diagnosticar casos por incluir en su cartera de servicios la realizaci&#243;n de citogen&#233;tica convencional y&#47;o <span class="elsevierStyleItalic">BCR-ABL</span>&#46; Todos los centros seleccionados accedieron a participar&#46; Finalmente&#44; el n&#250;mero de hospitales y laboratorios centrales incluidos&#44; respectivamente&#44; fue&#58; Madrid 39 y 6&#44; Castilla-La Mancha 14 y 3&#44; Arag&#243;n 9 y 3&#46; El tama&#241;o de los centros incluidos fue muy variable&#44; con una dotaci&#243;n m&#237;nima de camas de 69 &#40;Hospital Sur IDC Salud&#44; Madrid&#41;&#44; hasta un m&#225;ximo de 1&#46;671 &#40;Hospital Gregorio Mara&#241;&#243;n&#44; Madrid&#41;&#46; Un listado completo de los centros colaboradores&#44; con el n&#250;mero de camas y de casos incluidos por centro&#44; se aporta en el <a class="elsevierStyleCrossRef" href="#sec0060">anexo 1</a>&#46; Se establecieron colaboradores en cada centro&#44; que fueron comunicando los casos prospectivamente&#46; Peri&#243;dicamente se contact&#243; con dichos investigadores para evitar casos sin notificar&#46; Las unidades que mostraron un alto grado de colaboraci&#243;n recogieron y enviaron sus propios datos&#44; mientras que el resto contaron con la colaboraci&#243;n de un administrador de datos <span class="elsevierStyleItalic">&#40;data manager&#41;</span>&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">An&#225;lisis estad&#237;stico</span><p id="par0015" class="elsevierStylePara elsevierViewall">Se analizaron las caracter&#237;sticas del conjunto de casos registrados&#46; Las variables num&#233;ricas como la edad y las cifras hematol&#243;gicas al diagn&#243;stico se caracterizaron mediante medidas de dispersi&#243;n sencillas&#44; como media&#44; mediana y percentil 75 o rango&#46; Las variables categ&#243;ricas se expresaron como frecuencias absolutas y porcentajes&#46; Con el n&#250;mero de casos registrados y las cifras poblacionales se calcularon las incidencias&#44; expresadas como n&#250;mero de casos por 100&#46;000 habitantes&#46; Las cifras poblacionales se obtuvieron del Instituto Nacional de Estad&#237;stica &#40;<a id="intr0005" class="elsevierStyleInterRef" href="http://www.ine.es/">www&#46;ine&#46;es</a>&#41;&#46; Al incluirse solo pacientes<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#44; para el c&#225;lculo de incidencias se utiliz&#243; en el denominador las poblaciones de m&#225;s de 18 a&#241;os &#40;en concreto&#44; las cifras poblacionales de habitantes entre 20 y 99 a&#241;os&#41;&#46; Para calcular la incidencia anual del a&#241;o 2010&#44; dado que el periodo de selecci&#243;n ese a&#241;o fue de 11 meses&#44; se realiz&#243; una extrapolaci&#243;n estad&#237;stica sum&#225;ndose al n&#250;mero de casos observados la media mensual de casos en dicho a&#241;o&#46; Adicionalmente a las incidencias brutas&#44; se calcul&#243; la incidencia estandarizada por edad&#44; usando la poblaci&#243;n estandarizada escandinava de Doll y Cook aceptada por la WHO como patr&#243;n de poblaci&#243;n estandarizada europea&#46; Este ajuste de tasas se realiz&#243; por el m&#233;todo directo utilizando el programa EPIDAT 4&#46;1 &#40;<a id="intr0010" class="elsevierStyleInterRef" href="http://www.sergas.es/Saude-publica/EPIDAT">http&#58;&#47;&#47;www&#46;sergas&#46;es&#47;Saude-publica&#47;EPIDAT</a>&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El estudio se desarroll&#243; seg&#250;n las directrices centrales de la <span class="elsevierStyleItalic">European LeukemiaNet</span>&#44; respetando los principios &#233;ticos de la Declaraci&#243;n de Helsinki y tras la aprobaci&#243;n por el Comit&#233; &#201;tico del Hospital de La Princesa de Madrid&#46;</p></span></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se registraron 250 casos en 35 meses&#44; con la siguiente distribuci&#243;n geogr&#225;fica&#58; Madrid 174&#44; Castilla-La Mancha 40 y Arag&#243;n 36&#46; Se incluyeron 146 hombres &#40;H&#41; &#40;58&#37;&#41; y 104 mujeres &#40;M&#41; &#40;42&#37;&#41; &#40;relaci&#243;n H&#47;M de 1&#44;40&#41;&#44; con una edad mediana de 54 a&#241;os &#40;rango&#58; 21-99&#44; percentil 75&#58; 71 a&#241;os&#41;&#44; similar en las 3 CC&#46; AA&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Incidencias</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se calcularon las incidencias por 100&#46;000 habitantes-a&#241;o&#44; global&#44; por sexo&#44; edad&#44; comunidad aut&#243;noma y a&#241;o&#46; La incidencia global&#44; incluyendo las 3 CC&#46; AA&#46; y los 3 a&#241;os del estudio&#44; fue de 1&#44;08 casos&#47;10<span class="elsevierStyleSup">5</span> habitantes-a&#241;o &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 1</a>&#41;&#46; La incidencia estandarizada por edad &#40;IEE&#41; fue parecida &#40;1&#44;04&#41;&#46; La incidencia fue inferior en Castilla-La Mancha &#40;0&#44;82&#41;&#44; y muy similar en Madrid &#40;1&#44;16&#41; y Arag&#243;n &#40;1&#44;12&#41;&#46; Las IEE para las 3 CC&#46; AA&#46; fueron 0&#44;78 &#40;Castilla-La Mancha&#41;&#44; 1&#44;10 &#40;Madrid&#41; y 1&#44;11 &#40;Arag&#243;n&#41;&#46; Dada la menor incidencia encontrada en Castilla-La Mancha&#44; se realiz&#243; una nueva revisi&#243;n que descart&#243; que existiesen casos no comunicados&#46; Se produjo una tendencia a la disminuci&#243;n de la incidencia en los a&#241;os 2011 y 2012 respecto a 2010&#44; muy similar en las 3 CC&#46; AA&#46; Respecto al sexo&#44; la incidencia fue superior en varones&#58; 1&#44;31 vs&#46; 0&#44;87 &#40;IEE 1&#44;31 y 0&#44;81&#41;&#46; En este aspecto&#44; hubo importantes diferencias entre CC&#46; AA&#46;&#44; observ&#225;ndose un predominio masculino en Arag&#243;n &#40;1&#44;90 vs&#46; 0&#44;37&#41;&#44; algo menos marcado en Madrid &#40;1&#44;4 vs&#46; 0&#44;95&#41;&#44; y un predominio femenino en Castilla-La Mancha &#40;0&#44;69 vs&#46; 0&#44;94&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 1</a>&#41;&#46; En cuanto a la distribuci&#243;n por edad&#44; aunque la mediana de presentaci&#243;n fue de 54 a&#241;os&#44; la incidencia aument&#243; con ella&#44; siendo mayor a partir de 65 a&#241;os&#46; Aun as&#237;&#44; el porcentaje de j&#243;venes fue apreciable&#58; 31&#44;7&#37; de casos entre 20 y 44 a&#241;os &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Presentaci&#243;n cl&#237;nica</span><p id="par0035" class="elsevierStylePara elsevierViewall">En 245 enfermos se dispuso de datos sobre la fase de la enfermedad&#59; de ellos&#44; 235 &#40;96&#37;&#41; se diagnosticaron en fase cr&#243;nica&#44; 6 &#40;2&#44;4&#37;&#41; en fase acelerada y 3 &#40;1&#44;6&#37;&#41; en crisis bl&#225;stica&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se obtuvo informaci&#243;n cl&#237;nica en 240 pacientes&#46; Solo el 44&#37; &#40;105&#41; estaban sintom&#225;ticos&#44; siendo los s&#237;ntomas m&#225;s frecuentes&#58; astenia &#40;21&#37;&#41;&#44; s&#237;ndrome constitucional &#40;14&#37;&#41;&#44; molestias abdominales &#40;9&#44;6&#37;&#41; y fiebre &#40;6&#37;&#41;&#46; El 38&#37; ten&#237;an esplenomegalia &#40;media desde el reborde costal de 4&#44;5<span class="elsevierStyleHsp" style=""></span>cm&#44; rango 1-22<span class="elsevierStyleHsp" style=""></span>cm&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Valores hematol&#243;gicos iniciales y distribuci&#243;n por sistemas de puntuaci&#243;n pron&#243;sticos</span><p id="par0045" class="elsevierStylePara elsevierViewall">Los par&#225;metros hematol&#243;gicos iniciales y la distribuci&#243;n seg&#250;n los sistemas de puntuaci&#243;n pron&#243;sticos de Sokal y Hasford se presentan en la <a class="elsevierStyleCrossRef" href="#tbl0025">tabla 2</a>&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Caracter&#237;sticas citogen&#233;ticas y moleculares</span><p id="par0050" class="elsevierStylePara elsevierViewall">El 4&#37; de los casos no presentaron cromosoma Ph1&#44; el 92&#44;5&#37; mostraron la traslocaci&#243;n t&#40;9&#59;22&#41;&#40;q34&#59;q11&#41; convencional&#44; el 3&#44;5&#37; traslocaciones variantes&#44; y el 6&#44;5&#37; alteraciones citogen&#233;ticas adicionales&#46; Un 49&#37; de los pacientes presentaron el tr&#225;nscrito b2a2 &#40;e13a2&#41;&#44; el 42&#37; el b3a2 &#40;e14a2&#41;&#44; y el 8&#37;&#44; transcritos at&#237;picos&#46; El 66&#37; de los pacientes ten&#237;an ratios de <span class="elsevierStyleItalic">BCR-ABL</span> medidos en escala internacional&#46; La media de ratio de <span class="elsevierStyleItalic">BCR-ABL</span> al diagn&#243;stico fue del 83&#37; &#40;0&#44;05-423&#37;&#41;&#46; Si incluimos solo casos con resultados en la escala internacional la media fue del 79&#37; &#40;0&#44;28-401&#37;&#41;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discusi&#243;n</span><p id="par0055" class="elsevierStylePara elsevierViewall">Este estudio aporta posiblemente la informaci&#243;n epidemiol&#243;gica m&#225;s completa y fiable de la LMC en Espa&#241;a disponible hasta la fecha&#46; Disponemos de diversos estudios epidemiol&#243;gicos nacionales<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">3&#8211;7</span></a>&#44; europeos<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">8&#8211;12&#44;16</span></a> y americanos<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">17&#8211;19</span></a> con los que hemos comparado nuestros datos &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabla 3</a>&#41;&#46; En este estudio la incidencia global de LMC fue de 1&#44;08 casos&#47;10<span class="elsevierStyleSup">5</span> habitantes-a&#241;o&#46; En Espa&#241;a las incidencias globales brutas y estandarizadas de los estudios publicados oscilan entre los 0&#44;35 y 1&#44;9 casos&#47;10<span class="elsevierStyleSup">5</span> habitantes-a&#241;o<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">3&#8211;7</span></a>&#46; Existen diferencias entre ellos que dificultan realizar comparaciones directas&#58; los resultados se expresan de forma variable con incidencias brutas&#44; estandarizadas o acumuladas&#44; y algunos incluyen enfermos solo en fase cr&#243;nica<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">7</span></a>&#46; Adem&#225;s&#44; la mayor&#237;a incluyen casos y poblaciones de todas las edades&#44; cuya informaci&#243;n se obtuvo de forma retrospectiva&#44; mientras que el estudio EUTOS se llev&#243; a cabo de forma prospectiva y solo incluy&#243; enfermos<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os y poblaci&#243;n con edad<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>20 a&#241;os&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">En el &#225;mbito internacional la informaci&#243;n epidemiol&#243;gica m&#225;s relevante procede del registro de tumores del programa <span class="elsevierStyleItalic">National Cancer Institute&#39;s Surveillance&#44; Epidemiology&#44; and End Results</span>&#44; que incluy&#243; al 28&#37; de la poblaci&#243;n de Estados Unidos&#44; de edades comprendidas entre los 25 y los 84 a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">17&#8211;19</span></a>&#46; La IEE de LMC en el per&#237;odo 1992-2009 fue de 2&#44;93 casos&#47;10<span class="elsevierStyleSup">5</span> habitantes-a&#241;o en hombres y de 1&#44;69 casos&#47;10<span class="elsevierStyleSup">5</span> habitantes-a&#241;o en mujeres<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">17</span></a>&#46; Esta incidencia claramente aument&#243; con la edad&#44; siendo unas 10 veces mayor a los 80 a&#241;os que a los 30&#46; Comparativamente con las nuestras&#44; las incidencias de dicho estudio son altas&#44; posiblemente debido a criterios diagn&#243;sticos m&#225;s imprecisos&#44; con inclusi&#243;n de casos sin confirmaci&#243;n molecular o citogen&#233;tica y de otras enfermedades&#44; como la leucemia mielomonoc&#237;tica cr&#243;nica&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En Europa los 2 estudios m&#225;s importantes son el registro nacional sueco<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">8</span></a> y el estudio EUTOS&#44; del que forma parte el presente trabajo<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a>&#46; El primero objetiv&#243; una incidencia bruta de 0&#44;9 casos&#47;10<span class="elsevierStyleSup">5</span> habitantes-a&#241;o&#44; mientras que la del estudio global EUTOS fue de 0&#44;99 casos&#47;10<span class="elsevierStyleSup">5</span> habitantes-a&#241;o &#40;variando desde 0&#44;69 en Polonia a 1&#44;38 en Italia&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">La edad de presentaci&#243;n en nuestro estudio &#40;media 55 a&#241;os&#44; mediana 54 a&#241;os&#41; coincide con la registrada en otros &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabla 3</a>&#41;&#46; Sin embargo&#44; en estudios m&#225;s antiguos &#40;a&#241;os 1910 a 1948&#41; se describen presentaciones m&#225;s tempranas&#44; entre los 39 y los 43 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">20</span></a>&#46; Adem&#225;s&#44; hemos observado un marcado aumento de la incidencia con la edad&#44; con cifras que oscilan desde los 0&#44;7 casos&#47;10<span class="elsevierStyleSup">5</span> habitantes-a&#241;o entre los 20 y los 44 a&#241;os hasta 1&#44;81 en mayores de 65 a&#241;os&#44; de manera similar a lo descrito en la literatura&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">En cuanto al sexo&#44; nuestro estudio muestra un predominio masculino &#40;relaci&#243;n hombre&#47;mujer de 1&#44;40&#41;&#44; lo que coincide con estudios previos &#40;predominio masculino entre 1&#44;17 y 1&#44;44&#41;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">3&#44;5&#44;6&#44;8&#8211;10&#44;12&#44;16</span></a>&#46; Son notables las diferencias regionales en relaci&#243;n con el sexo&#44; para lo que no tenemos una explicaci&#243;n adecuada&#46; En el global del estudio EUTOS-Europa tambi&#233;n existen diferencias regionales con proporciones de varones que oscilan entre un m&#225;ximo de 74&#44;2&#37; en Estonia y un m&#237;nimo de 38&#44;8&#37; en Francia<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a>&#46; Respecto a las caracter&#237;sticas de la presentaci&#243;n cl&#237;nica&#44; a diferencia de las descripciones cl&#225;sicas<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">13&#44;21</span></a>&#44; nuestro estudio pone de manifiesto que actualmente la LMC se diagnostica de forma mucho m&#225;s precoz debido a la realizaci&#243;n de anal&#237;ticas rutinarias en individuos asintom&#225;ticos&#46; Otras series m&#225;s recientes ya apuntaban esta tendencia<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">14&#44;15</span></a>&#46; Asimismo&#44; la cifra de leucocitos en el momento del diagn&#243;stico en nuestro estudio fue muy inferior a la observada en trabajos previos&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">En relaci&#243;n con la distribuci&#243;n por grupos de clasificaci&#243;n pron&#243;stica&#44; destaca la incidencia menor de casos con <span class="elsevierStyleItalic">scores</span> de alto riesgo en nuestra serie&#44; respecto al global del registro EUTOS-Europa<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a> y a otras<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">8&#44;14&#44;22</span></a>&#46; En cuanto al porcentaje de enfermos que se presentan en las distintas fases de la enfermedad&#44; nuestras cifras coinciden con las de estudios europeos recientes<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">8&#44;16</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Las conclusiones de nuestro estudio son muy superponibles al global de la serie europea&#46; La incidencia &#40;1&#44;08 vs&#46; 0&#44;99&#41;&#44; la mediana de edad &#40;54 vs&#46; 56 a&#241;os&#41;&#44; la distribuci&#243;n por sexo &#40;58&#37; de varones vs&#46; 53&#37;&#41;&#44; y la tendencia al incremento de la incidencia con la edad son similares&#44; al igual que las caracter&#237;sticas de presentaci&#243;n &#40;fase cr&#243;nica 96 vs&#46; 94&#37;&#44; pacientes asintom&#225;ticos 56 vs&#46; 57&#37;&#44; y enfermos con esplenomegalia 38 vs&#46; 46&#44;5&#37;&#41;&#46; El &#250;nico punto donde se aprecia una diferencia importante es en la distribuci&#243;n por <span class="elsevierStyleItalic">scores</span> pron&#243;sticos&#44; siendo menor la cifra de enfermos de alto riesgo en nuestra serie &#40;11 vs&#46; 24&#44;7&#37;&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La principal limitaci&#243;n de este estudio es la posibilidad de que haya casos de LMC no comunicados&#44; ya que&#44; por una parte&#44; la participaci&#243;n fue voluntaria&#44; y por otra&#44; algunos pacientes de edad avanzada y con comorbilidades pueden haber sido atendidos por otras especialidades como Medicina Interna o en el &#225;mbito de la atenci&#243;n primaria&#46; No obstante&#44; consideramos que estos casos &#171;perdidos&#187; ser&#237;an escasos&#46; El hecho de que las cifras obtenidas sean muy parecidas a las del global del estudio europeo<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a> y a las del registro sueco<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">8</span></a>&#44; donde la comunicaci&#243;n de casos es obligatoria por ley&#44; avala nuestros datos&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; la secci&#243;n espa&#241;ola del estudio EUTOS aporta la informaci&#243;n epidemiol&#243;gica m&#225;s fiable de la LMC en Espa&#241;a&#44; con cifras de incidencia generalmente superiores a las previamente descritas y un mayor n&#250;mero de casos diagnosticados en estadios evolutivos m&#225;s precoces de la enfermedad&#46; No obstante&#44; conviene rese&#241;ar que sigue existiendo un 4&#37; de enfermos que se presentan en fases avanzadas&#44; un 11&#37; con un &#237;ndice Sokal de alto riesgo y un 6&#44;5&#37; con alteraciones citogen&#233;ticas adicionales&#44; lo que constituir&#237;a una situaci&#243;n de alarma seg&#250;n los criterios de la <span class="elsevierStyleItalic">European LeukemiaNet</span><a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a>&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Financiaci&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">El proyecto EUTOS a nivel europeo ha contado con financiaci&#243;n de la compa&#241;&#237;a farmac&#233;utica Novartis&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicto de intereses</span><p id="par0105" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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    "fechaRecibido" => "2015-11-15"
    "fechaAceptado" => "2016-03-02"
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            0 => "Leucemia mieloide cr&#243;nica"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pretendemos aportar datos m&#225;s fiables sobre la epidemiolog&#237;a de la leucemia mieloide cr&#243;nica &#40;LMC&#41; en Espa&#241;a que los disponibles hasta la fecha&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El registro poblacional EUTOS&#44; de la <span class="elsevierStyleItalic">European LeukemiaNet</span>&#44; es un registro de casos nuevos de LMC en pacientes<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>de 18 a&#241;os de 22 &#225;reas europeas&#46; La secci&#243;n espa&#241;ola incluy&#243; las comunidades aut&#243;nomas de Madrid&#44; Castilla-La Mancha y Arag&#243;n&#44; en el periodo comprendido entre el 1-2-2010 y el 31-12-2012&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se registraron 250 casos en 35 meses&#46; La incidencia global fue de 1&#44;08 casos&#47;10<span class="elsevierStyleSup">5</span> habitantes-a&#241;o&#44; con predominio masculino &#40;58&#37; de varones&#41; y claras diferencias entre comunidades aut&#243;nomas&#46; La incidencia estandarizada por edad fue similar &#40;global 1&#44;04&#44; varones 1&#44;31&#44; mujeres 0&#44;81&#41;&#46; La mediana de edad fue de 54 a&#241;os&#46; La incidencia aument&#243; con la edad&#44; siendo m&#225;xima en<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os&#44; aunque un 31&#44;7&#37; de los casos aparecieron entre los 20 y los 44 a&#241;os&#46; Un 4&#37; se diagnosticaron en fases avanzadas &#40;2&#44;4&#37; en fase acelerada&#44; 1&#44;6&#37; en crisis bl&#225;stica&#41;&#44; el 56&#37; estaban asintom&#225;ticos&#44; el 38&#37; ten&#237;an esplenomegalia&#44; y el <span class="elsevierStyleItalic">score</span> Sokal era alto en el 11&#37; &#40;inferior a lo previamente reflejado en la literatura&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La incidencia actual de LMC en Espa&#241;a es superior a la previamente descrita y similar a la de los estudios europeos&#46; A diferencia de las descripciones cl&#225;sicas&#44; la LMC se presenta mayoritariamente de forma asintom&#225;tica&#44; sin esplenomegalia&#44; con menor leucocitosis y en estadios con mejor pron&#243;stico&#46;</p></span>"
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            "titulo" => "Material y m&#233;todos"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To provide more reliable data on the epidemiology of chronic myeloid leukaemia &#40;CML&#41; in Spain than are currently available&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The EUTOS population-based project of European LeukemiaNet is a population registry of new CML cases in patients 18 years of age or older from 22 European areas&#46; The Spanish section included the autonomous communities of Madrid&#44; Castilla-La Mancha and Aragon&#44; from 1-2-2010 to 31-12-2012&#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 250 cases were recorded in 35 months&#46; The overall incidence was 1&#46;08 cases&#47;10<span class="elsevierStyleSup">5</span> inhabitants-year&#44; with a predominance of men &#40;58&#37;&#41; and clear differences among the communities&#46; The incidence standardised by age was similar &#40;overall&#44; 1&#46;04&#59; men&#44; 1&#46;31&#59; women&#44; 0&#46;81&#41;&#46; The median age was 54 years&#46; The incidence increased with age&#44; reaching a peak at<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>65 years&#44; although 31&#46;7&#37; of cases appeared between the ages of 20 and 44 years&#46; Four percent of cases were diagnosed in advanced stages &#40;2&#46;4&#37; in accelerated phase&#44; 1&#46;6&#37; in blast crisis&#41;&#44; 56&#37; were asymptomatic&#44; 38&#37; had splenomegaly&#44; and the Sokal score was high in 11&#37; &#40;lower than what was previously reflected in the literature&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The current incidence of CML in Spain is higher than previously reported and similar to that of the European studies&#46; Unlike the classical descriptions&#44; CML presented mostly in asymptomatic form&#44; with no splenomegaly&#44; less leucocytosis and in stages with better prognosis&#46;</p></span>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="char" valign="top" scope="col">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="char" valign="top" scope="col">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="char" valign="top" scope="col">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total 3 a&#241;os</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="char" valign="top" scope="col" style="border-bottom: 2px solid black">IB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="char" valign="top" scope="col" style="border-bottom: 2px solid black">IE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arag&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Castilla-La Mancha&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">En las 3 regiones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;04&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IE&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hombre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mujere&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">20-44 a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">45-65 a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>65 a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Incidencias anuales de leucemia mieloide cr&#243;nica &#40;&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">5</span> habitantes-a&#241;o&#41;</p>"
        ]
      ]
      1 => array:8 [
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          "tablatextoimagen" => array:1 [
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              "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="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Rango</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hemoglobina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13<span class="elsevierStyleHsp" style=""></span>g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">6&#44;3-18<span class="elsevierStyleHsp" style=""></span>g&#47;dl</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Leucocitos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85&#46;400<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span>&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">2&#46;800-791&#46;000<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span>&#47;l</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Plaquetas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">458&#46;000<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span>&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">19&#46;000-2&#46;068&#46;000<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span>&#47;</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Porcentaje de blastos en sangre perif&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="left" valign="top">0-41</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sokal &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>240&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alto 11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Intermedio 41&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bajo 48&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hasford &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>221&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alto 5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Intermedio 34&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bajo 61&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Valores hematol&#243;gicos al diagn&#243;stico y distribuci&#243;n por escalas pron&#243;sticas</p>"
        ]
      ]
      2 => array:8 [
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        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at3"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">H&#58; hombres&#59; IB&#58; incidencia bruta&#59; IE&#58; incidencia estandarizada&#59; M&#58; mujeres&#59; ND&#58; no disponible&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#193;rea geogr&#225;fica&#44; n&#250;mero de pacientes&#44; periodo de estudio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Incidencia en casos&#47;10<span class="elsevierStyleSup">5</span> habitantes-a&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Edad de presentaci&#243;n&#44; a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relaci&#243;n H&#47;M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Fuente de datos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gerona<br>N&#58; 102<br>1994-2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IB global&#58; 1&#44;15<br>IE global&#58; 0&#44;96<br>H&#58; 1&#44;13&#44; M&#58; 0&#44;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mediana<br>H&#58; 64&#44; M&#58; 60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Registro poblacional de c&#225;ncer de Gerona<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Espa&#241;a<br>N&#58; 226<br>2002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">H&#58; 0&#44;9&#44; M&#58; 0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Media 55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Registros poblacionales de c&#225;ncer en Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tarragona<br>N&#58; 122<br>1980-1994&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IE&#58; 1&#44;3 a 1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Media 60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Predominio masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Registro poblacional de c&#225;ncer en Tarragona<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">6</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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Asturias<br>N&#58; 108<br>1972-1986&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IB global&#58; 0&#44;64<br>H&#58; 0&#44;8&#44; M&#58; 0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mediana 51 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Predominio masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Registro retrospectivo en Servicio de Hematolog&#237;a<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">7</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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;35 a 0&#44;98 seg&#250;n regiones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">EUTOS espa&#241;ol &#40;presente estudio&#41;<br>N&#58; 250<br>2010-2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IB global&#58; 1&#44;08 &#40;H&#58; 1&#44;31&#44; M&#58; 0&#44;87&#41;&#46;<br>IE global&#58; 1&#44;04 &#40;H&#58; 1&#44;31&#44; M&#58; 0&#44;81&#41; en<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mediana&#58; 54<br>H&#58; 52&#44; M&#58; 57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Registro poblacional prospectivo&#44; hospitales y laboratorios centrales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Suecia<br>N&#58; 779<br>2002-2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IB&#58; 0&#44;9 &#40;&#62;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mediana 60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Registro poblacional de c&#225;ncer sueco<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</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="table-entry ; entry_with_role_rowhead " align="left" valign="top">EUTOS Europa&#44; N&#58; 2&#46;957<br>2008-2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IB&#58; 0&#44;99 &#40;H&#58; 1&#44;12&#44; M&#58; 0&#44;88&#41;<br>IE&#58; 0&#44;96<br>&#62;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mediana 55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Registro poblacional prospectivo&#44; hospitales y laboratorios centrales<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dinamarca<br>N&#58; ND<br>1973-1976&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IB&#58; 1&#44;5 &#40;todas las edades&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Media 66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Registro dan&#233;s de c&#225;ncer<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Reino Unido<br>N&#58; ND<br>1987-2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IB&#58; 0&#44;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Predominio masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Base de datos de medicina general<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Escocia<br>N&#58; 64<br>1999-2000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IB&#58; 0&#44;64 &#40;todas las edades&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Registro escoc&#233;s de leucemias<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alemania<br>N&#58; 218<br>1998-2000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IB&#58; 0&#44;72 &#40;todas las edades&#41;<br>H&#58; 0&#44;79&#44; M&#58; 0&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Media 56&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Registro prospectivo en centros sanitarios<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Poblaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&#46;<span class="elsevierStyleSup">o</span> de camas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Casos incluidos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario Fundaci&#243;n Alcorc&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alcorc&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">409&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Cl&#237;nico San Carlos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">964&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Central de la Cruz Roja&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">156&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario 12 de Octubre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;314&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; El Escorial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">El Escorial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario de Fuenlabrada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fuenlabrada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">406&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fundaci&#243;n Jim&#233;nez D&#237;az&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">665&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario de Getafe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Getafe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">589&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Central de la Defensa G&#243;mez Ulla&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">498&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; General Universitario Gregorio Mara&#241;&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;671&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario del Henares&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Coslada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">210&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario Infanta Cristina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Parla&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">188&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario Infanta Elena&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Valdemoro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">117&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario Infanta Leonor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">269&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario Infanta Sof&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">San Sebasti&#225;n de los Reyes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">283&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital Universitario la Paz&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;308&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario Madrid Montepr&#237;ncipe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">183&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Madrid Norte San Chinarro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Madrid Torrelodones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Torrelodones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Sur IDC Salud&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; MD Anderson Cancer Center Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario Moncloa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">230&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario Sanitas La Moraleja&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital Universitario de M&#243;stoles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#243;stoles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">349&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Vithas Nuestra Se&#241;ora de Am&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario de La Princesa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">564&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario Pr&#237;ncipe de Asturias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alcal&#225; de Henares&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">594&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario Puerta de Hierro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Majadahonda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">613&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario Quir&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pozuelo de Alarc&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">190&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario Ram&#243;n y Cajal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">947&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario Rey Juan Carlos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#243;stoles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">260&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital Ruber Internacional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cl&#237;nica Ruber&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario Severo Ochoa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Legan&#233;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">412&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario del Sureste&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Arganda del Rey&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">133&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario del Tajo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aranjuez&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario de Torrej&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Torrej&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">250&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario Sanitas La Zarzuela&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aravaca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Poblaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&#46;<span class="elsevierStyleSup">o</span> de camas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Casos incluidos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; de Alca&#241;iz&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alca&#241;iz&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; de Barbastro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Barbastro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">161&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; de Calatayud&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Calatayud&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">122&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HUC Lozano Blesa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Zaragoza&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">802&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Militar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Zaragoza&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Obispo Polanco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Teruel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">215&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Royo Villanova&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Zaragoza&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">235&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; General San Jorge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Huesca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">312&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario Miguel Servet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Zaragoza&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;311&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
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                  <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="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hospital&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Casos incluidos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Valdepe&#241;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">103&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; de Hell&#237;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hell&#237;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">136&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Gral&#46; de Almansa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Almansa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Gral&#46; de Villarrobledo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Villarrobledo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">114&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Virgen de Altagracia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Manzanares&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">118&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Gral&#46; de Albacete&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Albacete&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Santa B&#225;rbara&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Puertollano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">173&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Gral&#46; de Tomelloso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tomelloso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Nuestra Se&#241;ora del Prado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Talavera de la Reina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">338&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Gral&#46; de Ciudad Real&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ciudad Real&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">564&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Gral&#46; La Mancha Centro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alcazar de San Juan&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">339&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Virgen de la Luz&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cuenca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">411&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Universitario de Guadalajara&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Guadalajara&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">414&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#46; Virgen de la Salud&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Toledo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">635&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                      "titulo" => "Datos epidemiol&#243;gicos de la leucemia mieloide cr&#243;nica en Espa&#241;a"
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                      "titulo" => "Tyrosine kinase inhibitor usage&#44; treatment outcome&#44; and prognostic scores in CML&#58; Report from the population-based Swedish CML registry"
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                          "etal" => true
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                          "autores" => array:5 [
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                      "doi" => "10.1186/1471-2407-9-252"
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                        "tituloSerie" => "Clin Haematol&#46;"
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Vol. 216. Núm. 6.
Páginas 293-300 (agosto - septiembre 2016)
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Vol. 216. Núm. 6.
Páginas 293-300 (agosto - septiembre 2016)
ORIGINAL
Leucemia mieloide crónica en España: sus características de presentación han cambiado. Sección española del registro poblacional EUTOS
Chronic myeloid leukaemia in Spain: Its presentation characteristics have changed. Spanish section of the EUTOS population-based registry
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S. Osorioa,
Autor para correspondencia
, L.F. Casadob, P. Giraldoc, B. Maestrod, M. Andradee, S. Redondoa, V. García-Gutiérrezf, R. Ayalag, N. Garciab, J.L. Steegmannd
a Servicio de Hematología, Hospital Gregorio Marañón, Madrid, España
b Servicio de Hematología, Hospital Virgen de la Salud, Toledo, España
c Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Zaragoza, España
d Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa (IIS-IP), Madrid, España
e Servicio de Hematología, Hospital Miguel Servet, Zaragoza, España
f Servicio de Hematología, Hospital Ramón y Cajal, Madrid, España
g Servicio de Hematología, Hospital 12 de Octubre, Madrid, España
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J. García-Suárez, J.J. Gil-Fernández
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Estadísticas
Tablas (6)
Tabla 1. Incidencias anuales de leucemia mieloide crónica (×105 habitantes-año)
Tabla 2. Valores hematológicos al diagnóstico y distribución por escalas pronósticas
Tabla 3. Estudios epidemiológicos sobre leucemia mileoide crónica españoles y europeos
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Resumen
Objetivos

Pretendemos aportar datos más fiables sobre la epidemiología de la leucemia mieloide crónica (LMC) en España que los disponibles hasta la fecha.

Material y métodos

El registro poblacional EUTOS, de la European LeukemiaNet, es un registro de casos nuevos de LMC en pacientesde 18 años de 22 áreas europeas. La sección española incluyó las comunidades autónomas de Madrid, Castilla-La Mancha y Aragón, en el periodo comprendido entre el 1-2-2010 y el 31-12-2012.

Resultados

Se registraron 250 casos en 35 meses. La incidencia global fue de 1,08 casos/105 habitantes-año, con predominio masculino (58% de varones) y claras diferencias entre comunidades autónomas. La incidencia estandarizada por edad fue similar (global 1,04, varones 1,31, mujeres 0,81). La mediana de edad fue de 54 años. La incidencia aumentó con la edad, siendo máxima en>65 años, aunque un 31,7% de los casos aparecieron entre los 20 y los 44 años. Un 4% se diagnosticaron en fases avanzadas (2,4% en fase acelerada, 1,6% en crisis blástica), el 56% estaban asintomáticos, el 38% tenían esplenomegalia, y el score Sokal era alto en el 11% (inferior a lo previamente reflejado en la literatura).

Conclusiones

La incidencia actual de LMC en España es superior a la previamente descrita y similar a la de los estudios europeos. A diferencia de las descripciones clásicas, la LMC se presenta mayoritariamente de forma asintomática, sin esplenomegalia, con menor leucocitosis y en estadios con mejor pronóstico.

Palabras clave:
Leucemia mieloide crónica
Epidemiología
España
Abstract
Objectives

To provide more reliable data on the epidemiology of chronic myeloid leukaemia (CML) in Spain than are currently available.

Material and methods

The EUTOS population-based project of European LeukemiaNet is a population registry of new CML cases in patients 18 years of age or older from 22 European areas. The Spanish section included the autonomous communities of Madrid, Castilla-La Mancha and Aragon, from 1-2-2010 to 31-12-2012.

Results

A total of 250 cases were recorded in 35 months. The overall incidence was 1.08 cases/105 inhabitants-year, with a predominance of men (58%) and clear differences among the communities. The incidence standardised by age was similar (overall, 1.04; men, 1.31; women, 0.81). The median age was 54 years. The incidence increased with age, reaching a peak at>65 years, although 31.7% of cases appeared between the ages of 20 and 44 years. Four percent of cases were diagnosed in advanced stages (2.4% in accelerated phase, 1.6% in blast crisis), 56% were asymptomatic, 38% had splenomegaly, and the Sokal score was high in 11% (lower than what was previously reflected in the literature).

Conclusions

The current incidence of CML in Spain is higher than previously reported and similar to that of the European studies. Unlike the classical descriptions, CML presented mostly in asymptomatic form, with no splenomegaly, less leucocytosis and in stages with better prognosis.

Keywords:
Chronic myeloid leukaemia
Epidemiology
Spain

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