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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Mycosis fungoides &#40;MF&#41; and S&#233;zary syndrome &#40;SS&#41; are the most common subtypes of cutaneous T-cell lymphomas &#40;CTCL&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">1&#44;2</span></a> MF usually has an indolent course with prolonged survival and a good clinical response to skin-directed therapies&#46; However&#44; 20&#37; up to 25&#37; of patients progress to advanced tumor stages&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a> These advanced forms of MF and SS are aggressive diseases of difficult treatment and a grim prognosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">1&#44;2</span></a> The factors involved in the progression and the survival of these lymphomas is still to be elucidated&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">This study describes the progression-free survival &#40;PFS&#41; and disease-specific survival &#40;DSS&#41; of a cohort of patients with MF&#47;SS and aims to evaluate which prognostic factors have an adverse impact on the survival of these lymphomas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">We analyzed all consecutive cases diagnosed with MF and SS from January 2008 through December 2022 at the Cutaneous Lymphoma Unit of Hospital Universitari de Bellvitge&#44; Barcelona&#44; Spain&#46; Diagnosis was achieved based on the criteria established by the World Health Organization &#40;WHO&#41;-European Organization of Research and Treatment of Cancer &#40;EORTC&#41;2&#46; Demographic data such as age&#44; sex&#44; diagnostic subtype&#44; status at last follow-up&#44; stage at diagnosis and at progression &#40;TNMB staging was used based on the recommendation proposed by the International Society for Cutaneous Lymphoma &#91;ISCL&#93; &#8211; EORTC&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a> histological parameters &#40;large cell transformation &#91;LCT&#93;&#44; folliculotropism &#91;FT&#93;&#44; percentage of CD30<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>cells&#44; Ki-67&#44; clonal T-cell receptor &#91;TCR&#93; in the skin&#41; and hematological parameters &#40;LDH&#44; beta2-microglobulin &#91;B2<span class="elsevierStyleHsp" style=""></span>M&#93;&#44; leukocytes&#44; lymphocytes&#44; clonal TCR in blood&#41; were collected&#46; Ki-67 staining was considered intense in biopsies showing a Ki-67 proliferation index &#62; 30&#37; and mild if<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30&#37;&#46; LDH and B2<span class="elsevierStyleHsp" style=""></span>M were considered elevated if values were &#62; 213 U&#47;L and 2&#46;4<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#44; respectively&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">LCT was defined when the presence of large lymphocytes &#62; 25&#37; of the dermal infiltrate or following the formation of large cell nodules&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">PFS was defined as the time from the first objective response to treatment until relapse&#44; progression&#44; or death &#40;in patients who progress&#41; or until the date of the last follow-up &#40;in patients who don&#8217;t&#41;&#59; overall survival &#40;OS&#41; was defined as the time elapsed from the starting date of treatment to the all-cause mortality date&#59; and DSS as the time elapsed from the starting date of treatment to the date of lymphoma-related death&#46; Progression was defined as the change from one stage to a higher one&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using SPSS Statistics software&#46; A descriptive frequency analysis was conducted for categorical variables&#44; and the normality of numerical variables was evaluated&#46; Contingency tables and statistical tests were used to analyze relationships between variables&#46; Fisher&#39;s exact test or the chi-square test were used&#44; when appropriate&#44; depending on the size of expected frequencies&#46; The Mann-Whitney U test was used to compare numerical and categorical variables&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">DSS and survival rates throughout years were estimated using the Kaplan-Meier method&#46; The log-rank test was used for group comparison&#46; Multivariate analyses were performed using Cox proportional hazards regression model&#44; including significant variables from previous analyses&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">A total of 148 cases were included&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the main characteristics of patients with MF and SS&#46; The median age was 62 years &#91;49-70 years&#93;&#44; and 63&#37; of patients were men&#46; A total of 121 cases &#40;82&#37;&#41; were diagnosed with MF&#44; and 27 with SS&#46; At diagnosis&#44; the initial stages &#40;&#60; IIA&#41; accounted for 65&#37; of cases&#46; A total of 37 patients &#40;25&#37;&#41; progressed at some point during the course of their disease&#46; The median PFS was 127 months &#40;129 months for MF and 95 months for SS&#41;&#46; At the last follow-up&#44; 53&#37; of patients were alive with lesions&#44; 24&#37; in complete remission&#44; and 23&#37; had already died &#40;16&#37; due to lymphoma and 7&#37; for other reasons&#41;&#46; In 10&#37; of MF cases&#44; death was lymphoma-related vs 41&#37; of the cases of SS&#46; The median DSS for the entire cohort was 135 months&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> also shows the results of the univariate Kaplan-Meier&#47;log-rank survival analysis for the cohort for each of the variables detailed below&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">In the univariate analysis&#44; age &#62; 60 years &#40;52&#37; of cases&#41; was associated with poorer DSS with a mean survival of 121 months&#46; No differences were found based on sex&#46; Regarding diagnosis&#44; SS had worse outcomes with a mean survival of 86&#46;6 months and a 5-year survival rate of 50&#37; vs 88&#37; in the MF group &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A&#41;&#46; However&#44; no survival differences were found when comparing SS patients to the advanced MF group&#46; Regarding stage at diagnosis&#44; <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B indicates the mean DSS and the 1-&#44; 3-&#44; and 5-year survival rates for each stage&#46; No statistically significant differences were seen either between stages I and III&#44; yet differences were seen compared to stages IIB and IVA&#46; Regarding IVA stage&#8212;which includes IVA1 with peripheral blood involvement B2 &#40;median DSS&#44; 55 months&#41; and IVA2 with nodal involvement N3 &#40;median DSS&#44; 14 months&#41;&#8212;no differences were found between the 2 groups&#46; However&#44; when comparing survival of N3 and&#47;or Nx &#40;abnormal peripheral nodes without histological confirmation&#41; with N1 and&#47;or N2&#44; differences became evident&#46; Differences in survival were also found between patients with B2 involvement &#40;IVA&#41;&#8212;who had a worse prognosis &#40;62&#46;6 vs 146&#46;5 months&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#8212;compared to those with B0 or B1&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Regarding histological parameters&#44; LCT was reported in 19&#37; of patients during the course of their disease&#44; and 43&#37; of these cases were reported at diagnosis&#46; The presence of LCT at diagnosis had a significant adverse effect on these patients&#8217; survival &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>C&#41;&#46; The presence of FT &#40;27&#37; of cases&#41; was not associated with poorer survival across the entire cohort&#44; but when analyzed in the population that started in early stages &#60;<span class="elsevierStyleHsp" style=""></span>IIB&#44; patients with FT had significantly lower survival rates vs those without FT &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>D&#41;&#46; Conversely&#44; the analysis of the population with stages &#62; IIB showed that those without FT had even lower survival rates&#46; Intense Ki-67 staining&#44; found in 28&#37; of the 108 cases studied&#44; was also associated with poorer survival&#44; with a mean of 85&#46;2 months and a 5-year survival rate of 50&#46;6&#37; vs 92&#46;4&#37; in the group with mild Ki-67 &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#59; no such association was found with CD30 expression&#46; The predominant phenotype in the series was CD4<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;83&#37; of cases&#41;&#44; while CD8<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>and double negative CD4-&#47;CD8- cases accounted for 13&#37; and 5&#37;&#44; respectively&#46; No differences were found between the different phenotypes&#46; Regarding clonality studies&#44; skin clonality documented in 80&#37; of cases was not associated with unfavorable outcomes&#44; while patients with positive blood clonality &#40;39&#37; of cases&#41; had poorer DSS vs those without it &#40;88&#46;7 vs 143&#46;6 months&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Regarding analytical data&#44; elevated LDH &#40;22&#37;&#41; and B2<span class="elsevierStyleHsp" style=""></span>M &#40;30&#37;&#41; were also associated with worse survival rates in the cohort &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the multivariate analysis&#44; LCT at diagnosis &#40;Hazard ratio &#91;HR&#93;&#44; 10&#46;41&#41; and the IVA stage &#40;HR&#44; 6&#46;29&#41; were the variables that showed an independently significant effect on DSS &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">For years&#44; efforts have been made to elucidate factors or markers of poor prognosis associated with high mortality rates&#44; low survival&#44; or a higher risk of lymphoma progression&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">6&#44;7</span></a> In 2013&#44; the CLIPI &#40;Cutaneous Lymphoma International Prognostic Index&#41; was proposed&#8212;the first prognostic index for cutaneous lymphoma&#8212;which included factors associated with poor prognosis in the early &#40;male sex&#44; age &#62; 60 years&#44; plaques&#44; FT&#44; N1&#47;X&#41; and advanced stages &#40;male sex&#44; age &#62; 60 years&#44; stages B1&#47;B2&#44; N2&#47;N3&#44; visceral involvement&#41;&#44; attributing low&#44; intermediate&#44; or high risk based on the score&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a> In 2015&#44; the CLIC &#40;Cutaneous Lymphoma International Consortium&#41; embarked on a large-scale project called ProCLIPI &#40;Prospective Cutaneous Lymphoma International Prognostic Index&#41; which was designed to create an international CTCL database with the long-term goal of developing a prognostic index to identify patients with unfavorable outcomes&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">9&#44;10</span></a> Some prospective studies have already been published&#44; such as the one conducted by Scarisbrick et al&#46;&#44; which included advanced cases of MF&#47;SS&#44; developing a prognostic index model with the variables stage IV&#44; age &#62; 60 years&#44; LCT&#44; and elevated LDH6&#46; Most of these factors&#44; and these prognostic indices&#44; have not yet been validated in clinical practice&#44; and so far&#44; stage &#40;TNM&#41; has been the prognostic marker with the most predictive value&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">4&#44;11</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">This study aims to evaluate which factors are associated with poorer prognosis and a higher risk of progression in a series of 148 patients with MF&#47;SS from a reference center on the management of cutaneous lymphoma&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Advanced age &#40;&#62; 60 years&#41; had already been associated with poorer prognosis&#44; especially in advanced stages of the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">3&#44;6&#44;12</span></a> However&#44; in this cohort&#44; other factors such as comorbidities and limited treatment options could not be evaluated&#46; Despite the predominance of male patients in the study&#44; no significant survival differences were found between sexes&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The diagnosis of SS was associated with a worse course of the disease compared with MF&#46; However&#44; no differences in DSS were found between advanced MF and SS&#44; suggesting that initial stage impacts prognosis more than the type of diagnosis&#46; In line with these data&#44; <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B shows that statistically significant differences in survival were seen when comparing early stages with stage IIB and IVA&#46; These differences resemble previously published data in which clear dissimilarities are observed between the median OS of early stages &#40;IA-IIA&#41; and more advanced stages of the disease &#40;&#62; IIB&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Among patients with erythroderma&#44; no differences in survival were seen between patients with low-level blood involvement &#40;IIIB&#41; vs those without it &#40;IIIA&#41;&#46; In contrast&#44; and consistent with previously published data&#44;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">3&#44;6&#44;13</span></a> patients with B2 involvement &#40;IVA&#41; showed a worse prognosis &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; vs those with B0 or B1&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Furthermore&#44; no survival differences were seen in patients without nodal involvement and those with N1 and N2 involvement&#46; However&#44; patients with partial or total disappearance of nodal architecture &#40;N3&#41; showed a worse outcome&#46; We also saw that cases with pathological nodes without staging &#40;Nx&#41; had a higher mortality risk&#8212;which is similar to the risk of N3&#8212;thus confirming recently published data showing that the increased size of the lymph node confirmed only by clinical evaluation &#40;Nx&#41; was associated with a higher risk of progression&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a> highlighting the importance of performing biopsies of palpable nodes for proper staging&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The presence of LCT at diagnosis turned out to be an independent histological marker of poor prognosis&#44; with an even worse survival than that reported by other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">3&#44;6&#44;13&#44;14</span></a> Additionally&#44; as previously described&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a> LCT was more prevalent in advanced stages&#44; predominantly among patients with stage IIIB&#44; specifically those with tumor-form skin involvement&#46; Although FT phenomenon did not show any significant survival differences in the cohort studied&#44; its effect seems to vary based on the stage of the disease&#44; which is consistent with previously published data that showed FT acted as a predictor of poor outcome in early stages<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">8&#44;16</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Ki-67 and CD30 values were also evaluated&#44; with intense Ki-67 being associated with poorer prognosis&#44; while CD30 did not show any significant effects&#46; Conversely&#44; Scarisbrick et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a> found that CD30 positivity was associated with poorer DSS in patients with a T3 tumor phase&#44; which is closely associated with LCT&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">T-cell clonality in the skin did not have a prognostic effect on survival&#59; however&#44; it was indeed associated with poorer prognosis when clonal TCR was found in blood &#40;median survival&#44; 68 months&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Similarly&#44; Scarisbrick et al&#46;6 observed a 49&#37; clonal match in their cohort of advanced MF&#47;SS and a non-significant statistical trend towards poorer survival in patients with blood clones &#40;49&#46;8 months&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Elevated levels of LDH and B2<span class="elsevierStyleHsp" style=""></span>M were associated with poorer prognosis across the entire cohort&#46; In MF&#44; several studies have found that LDH levels are associated with poor prognosis in advanced stages&#59;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">6&#44;13&#44;17&#44;18</span></a> however&#44; predictive value in the early stages of the disease remains unclear&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a> In our cohort&#44; no significant differences regarding survival were found between CD4<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#44; CD8<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#44; or double-negative phenotypes&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0110" class="elsevierStylePara elsevierViewall">In conclusion&#44; this study reviewed 148 cases diagnosed with MF&#47;SS and found that age &#62; 60 years&#44; SS diagnosis&#44; presence of LCT at diagnosis&#44; FT in early stages&#44; intense Ki-67&#44; clonal TCR in blood&#44; elevated LDH and B2<span class="elsevierStyleHsp" style=""></span>M&#44; and stages IIB&#44; IVA&#44; T3&#44; T4&#44; and N3&#47;Nx were all factors associated with poorer disease prognosis&#46; Stage IVA and the histological presence of initial LCT were the 2 independent predictive factors of adverse prognosis for MF&#47;SS&#46; Additionally&#44; LCT was the variable that most significantly reduced patient survival and was closely associated with tumor skin involvement and stage IIB&#46; However&#44; further research is still needed to better understand the impact of these factors on patient survival&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Limitations</span><p id="par0115" class="elsevierStylePara elsevierViewall">This was a single-center&#44; retrospective study&#44; and results may lack generalizability and not even be applicable to other populations or geographic regions due to potential differences in demographics and health care&#46; Additionally&#44; MF and SS are rare diseases&#44; which makes it difficult to obtain a representative sample&#44; which could eventually impact the representativeness of the results&#46; The lack of consideration for variability in treatment regimens is another significant limitation&#44; as these treatments can affect disease progression and patient survival&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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          "identificador" => "xres2231421"
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              "identificador" => "abst0005"
              "titulo" => "Background and Objective"
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              "titulo" => "Antecedentes y objetivo"
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              "titulo" => "Material y m&#233;todos"
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          "titulo" => "Introduction"
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          "titulo" => "Materials and Methods"
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    "fechaRecibido" => "2023-10-17"
    "fechaAceptado" => "2023-12-04"
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          "clase" => "keyword"
          "titulo" => "Keywords"
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          "palabras" => array:6 [
            0 => "Cutaneous T-cell lymphomas"
            1 => "Mycosis fungoides"
            2 => "S&#233;zary syndrome"
            3 => "Large cell transformation"
            4 => "Disease-specific survival"
            5 => "Prognostic factors"
          ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1868504"
          "palabras" => array:6 [
            0 => "Linfomas cut&#225;neos de c&#233;lulas T"
            1 => "Micosis fungoide"
            2 => "S&#237;ndrome S&#233;zary"
            3 => "Transformaci&#243;n a c&#233;lula grande"
            4 => "Supervivencia espec&#237;fica de la enfermedad"
            5 => "Factores pron&#243;sticos"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cutaneous T-cell lymphomas &#40;CTCL&#41; such as mycosis fungoides &#40;MF&#41; and S&#233;zary syndrome &#40;SS&#41; are rare lymphomas with varying prognoses&#46; The aim of the study was to describe the survival of a cohort of patients with MF&#47;SS and evaluate the prognostic factors impacting disease survival&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">All cases of MF&#47;SS diagnosed from 2008 through 2022 were retrospectively analyzed&#46; The demographic variables&#44; histological parameters&#44; and analytical data were analyzed too&#46; Progression-free survival &#40;PFS&#41; and disease-specific survival &#40;DSS&#41; were calculated&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 148 cases were included&#46; A total of 121 &#40;82&#37;&#41; and 27 cases were diagnosed with MF&#44; and SS&#44; respectively&#46; A total of 37 patients &#40;25&#37;&#41; experienced progression at some point disease progression&#46; The median PFS and median DSS were 127 and 135 months&#44; respectively&#46; Age &#62;<span class="elsevierStyleHsp" style=""></span>60 years&#44; diagnosis of SS&#44; the presence of large cell transformation &#40;LCT&#41; at diagnosis&#44; folliculotropism in early stages&#44; high Ki-67 expression&#44; the presence of the clonal T-cell receptor &#40;TCR&#41; in blood&#44; elevated LDH and B2M levels&#44; and advanced stages &#40;IIB&#44; IVA&#44; T3&#44; T4&#44; N3&#47;Nx&#41; were associated with worse prognosis across the entire cohort&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Stage IVA and the presence of LCT at diagnosis stood out as independent factors of unfavorable prognosis&#46; LCT was the variable that most significantly impacted the patients&#8217; survival and was closely associated with tumor skin involvement and stage IIB&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materials and Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los linfomas cut&#225;neos de c&#233;lulas T &#40;LCCT&#41; como la micosis fungoide &#40;MF&#41; y el s&#237;ndrome de S&#233;zary &#40;SS&#41; son linfomas poco comunes con pron&#243;sticos variables&#46; El objetivo del estudio fue describir la supervivencia de una cohorte de pacientes con MF&#47;SS y evaluar aquellos factores pron&#243;sticos con impacto en la supervivencia de la enfermedad&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se analizaron retrospectivamente todos los casos diagnosticados de MF&#47;SS entre 2008 y 2022&#46; Se evaluaron variables demogr&#225;ficas&#44; par&#225;metros histol&#243;gicos&#44; y datos anal&#237;ticos&#46; Se calcularon la supervivencia libre de progresi&#243;n &#40;PFS&#41; y la supervivencia espec&#237;fica de la enfermedad &#40;DSS&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron un total de 148 casos&#46; Ciento veinti&#250;n casos &#40;82&#37;&#41; fueron diagnosticados de MF y 27 casos de SS&#46; Treinta y siete pacientes &#40;25&#37;&#41; progresaron en alg&#250;n momento de la evoluci&#243;n&#46; La mediana de PFS fue de 127 meses y la mediana de DSS de 135 meses&#46; La edad &#62;<span class="elsevierStyleHsp" style=""></span>60 a&#241;os&#44; el diagn&#243;stico de SS&#44; la presencia de transformaci&#243;n a c&#233;lula grande &#40;TCG&#41; al diagn&#243;stico&#44; el foliculotropismo en estadios iniciales&#44; la elevaci&#243;n de Ki-67&#44; la presencia de TCR clonal en sangre&#44; niveles elevados de LDH y B2M&#44; y estadios avanzados &#40;IIB&#44; IVA&#44; T3&#44; T4&#44; N3&#47;Nx&#41; se asociaron con un peor pron&#243;stico en la cohorte&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El estadio IVA y la presencia de TCG al diagn&#243;stico destacaron como factores independientes de pron&#243;stico desfavorable&#46; La TCG fue la variable que produjo una disminuci&#243;n m&#225;s acentuada de la supervivencia de los pacientes estando estrechamente relacionada con la afectaci&#243;n cut&#225;nea tumoral y el estadio IIB&#46;</p></span>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Disease-specific survival &#40;DSS&#41; curves and tables for the cohort of patients with MF&#47;SS comparing&#58;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A&#41; DSS between patients with mycosis fungoides &#40;MF&#41; and patients with S&#233;zary syndrome &#40;SS&#41;&#46; B&#41; DSS across different stages&#46; C&#41; DSS between patients with large cell transformation &#40;LCT&#41; at diagnosis and those without it&#46; D&#41; DSS for the variable folliculotropism &#40;FT&#41; among patients with stages &#60; IIB&#46;</p>"
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      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">B2<span class="elsevierStyleHsp" style=""></span>M&#44; beta-2-microglobulin&#59; cTCR&#44; clonal T-cell receptor&#59; Dx&#44; diagnosis&#59; FT&#44; folliculotropism&#59; LCT&#44; large cell transformation&#59; LDH&#44; lactate dehydrogenase&#59; MF&#44; mycosis fungoides&#59; SS&#44; S&#233;zary syndrome&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 60 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;728&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Present&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">FT</span><span class="elsevierStyleItalic">&#40;</span>&#41;&nbsp;\t\t\t\t\t\t\n
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