| 1. |
- Hemminki, Kari, et al.
(författare)
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Co-Morbidity between Early-Onset Leukemia and Type 1 Diabetes - Suggestive of a Shared Viral Etiology?
- 2012
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 7:6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) are common early-onset malignancies. Their causes are largely unknown but infectious etiology has been implicated. Type 1 diabetes (T1D) is an autoimmune disease for which infectious triggers of disease onset have been sought and increasing pointing to enteroviruses. Based on our previous results on co-morbidity between leukemia and T1D, we updated the Swedish dataset and focused on early onset leukemias in patients who had been hospitalized for T1D, comparing to those not hospitalized for T1D. Methods and Findings: Standardized incidence ratios (SIRs) were calculated for leukemia in 24,052 patients hospitalized for T1D covering years 1964 through 2008. T1D patients were included if hospitalized before age 21 years. Practically all Swedish children and adolescents with T1D are hospitalized at the start of insulin treatment. SIR for ALL was 8.30 (N = 18, 95% confidence interval 4.91-13.14) when diagnosed at age 10 to 20 years after hospitalization for T1D and it was 3.51 (13, 1.86-6.02) before hospitalization for T1D. The SIR for ALL was 19.85 (N = 33, 13.74-27.76) and that for AML was 25.28 (8, 10.80-50.06) when the leukemias were diagnosed within the year of T1D hospitalization. The SIRs increased to 38.97 (26, 25.43-57.18) and 40.11 (8, 17.13-79.42) when T1D was diagnosed between ages 10 to 20 years. No consistent time-dependent changes were found in leukemia risk. Conclusion: A shared infectious etiology could be a plausible explanation to the observed co-morbidity. Other possible contributing factors could be insulin therapy or T1D related metabolic disturbances.
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| 2. |
- Hemminki, Kari, et al.
(författare)
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Familial risks in cancer of unknown primary: tracking the primary sites.
- 2011
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Ingår i: Journal of Clinical Oncology. - 1527-7755. ; 29:4, s. 435-440
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE Cancer of unknown primary (CUP) is diagnosed at the metastatic stage, and despite extensive diagnostic work-up, the primary tumor often remains unidentified. No data are available on familial clustering of CUP. We hypothesize that familial clustering of CUP with other cancers may be informative of the primary sites. PATIENTS AND METHODS A total of 35,168 patients with CUP were identified in the Swedish Family-Cancer Database, and risks between family members were calculated for concordant (CUP-CUP) and discordant (CUP-any other cancer) cancers using standardized incidence ratio (SIR). Results Familial cases of CUP accounted for 2.8% of all CUP cases in the offspring generation. Familial SIR for CUP was 1.69 when a sibling was diagnosed with CUP. As to discordant associations between siblings, CUP was associated with lung (SIR, 1.87), kidney (SIR, 1.82), liver (SIR, 1.67), ovarian (SIR, 1.45), colorectal (SIR, 1.26), and breast (SIR, 1.15) cancers and melanoma (SIR, 1.26). Upper aerodigestive tract, bladder, pancreatic, and prostate cancers were additionally associated with CUP. Notably, CUP was associated with families of kidney, lung, and colorectal cancers. CONCLUSION The present data show that CUP is not a disease of random metastatic cancers but, instead, a disease of a defined set of cancers. The association of CUP with families of kidney, lung, and colorectal cancers suggests a marked genetic basis and shared metastatic mechanisms by many cancer types. Familial sites shared by CUP generally match those arising in tissue-of-origin determinations and, hence, suggest sites of origin for CUP. Mechanistic exploration of CUP may provide insight into defense against primary tumors and the metastatic process.
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| 3. |
- Shu, Xiaochen, et al.
(författare)
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Cancer risk among patients hospitalized for Type 1 diabetes mellitus: a population-based cohort study in Sweden
- 2010
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Ingår i: Diabetic Medicine. - : Wiley. - 1464-5491 .- 0742-3071. ; 27:7, s. 791-797
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Tidskriftsartikel (refereegranskat)abstract
- P>Aims Type 1 diabetes mellitus (T1DM) is an autoimmune disease with potential mechanistic links to immune-related cancers. We aimed at examining the overall and specific cancer risks among hospitalized T1DM patients from the national registers in Sweden. Methods A T1DM research cohort was created by identifying T1DM patients from the Hospital Discharge Register and linking them with the Cancer Registry. Standardized incidence ratios (SIRs) for subsequent cancers were calculated among patients with T1DM compared with those without T1DM. Results Two hundred and fifty-eight cases were ascertained with subsequent cancers during the follow-up duration from 1964 to 2006, with an increased overall SIR of 1.17 (95% CI 1.04-1.33) among 24 052 T1DM patients identified at baseline. Significant excess was noted for gastric and skin (squamous cell carcinoma) cancers and for leukaemia. Increased risk of acute lymphatic leukaemia accounted for most of the variation of leukaemia risk (SIR = 5.31, 95% CI 3.32-8.05). Cancer risk varied with sex, age at first hospitalization and numbers of hospitalizations. The risk was higher in women compared with men and in those hospitalized for T1DM at age over 10 years compared with the younger patients. Higher risks were also found among those with more hospital visits. Conclusion By quantifying the variations of overall and site-specific cancer risks after T1DM, the current study provides novel associations between T1DM and subsequent cancers, the mechanisms of which remain to be established.
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| 4. |
- Shu, Xiaochen, et al.
(författare)
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Cancer risk in patients hospitalised for Graves' disease: a population-based cohort study in Sweden
- 2010
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Ingår i: British Journal of Cancer. - : Springer Science and Business Media LLC. - 1532-1827 .- 0007-0920. ; 102:9, s. 1397-1399
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The possibility of an association of Graves' disease (GD) with subsequent cancers raised by certain studies. METHODS: Using a database on 18 156 hospitalised GD patients, subsequent cancers were ascertained. RESULTS: Increased risks of thyroid and parathyroid tumours were limited to the early follow-up period, which is probably a surveillance bias. Cancer sites with observed excess included the mouth and breast, in contrast to decreased risks of colon cancer, melanoma and non-Hodgkin's lymphoma. CONCLUSION: Increased subsequent cancers in GD patients appeared to be balanced by decreased risks at other sites; chance cannot be excluded. British Journal of Cancer (2010) 102, 1397-1399. doi:10.1038/sj.bjc.6605624 www.bjcancer.com Published online 30 March 2010 (C) 2010 Cancer Research UK
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| 5. |
- Shu, Xiaochen, et al.
(författare)
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Risk of cancer of unknown primary among immigrants to Sweden.
- 2012
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Ingår i: European Journal of Cancer Prevention. - 1473-5709. ; 21:1, s. 10-14
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Tidskriftsartikel (refereegranskat)abstract
- Incidence of cancer of unknown primary (CUP) varies globally, and environmental factors are suspected to be related to its development. Immigrant studies offer insights into disease etiology, but no studies have been published on CUP. We investigated CUP risk in immigrants to Sweden to search for etiological clues. The nationwide Swedish Family Cancer Database was used to calculate standardized incidence ratios for CUP in the first-generation immigrants compared with native Swedes from 1958 to 2008. A total of 2340 patients with CUP were identified among immigrants during a follow-up of 23 million person-years compared with 30 507 patients with CUP identified in native Swedes who were followed for 260 million person-years, showing an overall standardized incidence ratio of 0.88 (95% confidence interval: 0.85-0.93). The median age at immigration was 28 years for men and 27 for women. Significantly lower CUP risks, ranging from 0.18 to 0.89, were mainly observed among Finnish, German, and Asian immigrants. The decreased risks tended to be lower for women compared with men. Danes of both sexes had an increased risk. The increased or decreased CUP risks observed in this novel study suggested that early life environmental risk factors or genetic factors influence the development of CUP. The risk patterns were modified by sex. The observed differences may give clues about incidence rates in countries of origin for which incidence data are lacking.
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| 6. |
- Shu, Xiaochen, et al.
(författare)
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Subsequent cancers in patients diagnosed with cancer of unknown primary (CUP): etiological insights?
- 2012
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Ingår i: Annals of Oncology. - : Elsevier BV. - 1569-8041 .- 0923-7534. ; 23, s. 269-275
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patterns of subsequent malignancies in patients with cancer of unknown primary (CUP) may provide etiological insight into the primary tumor. The objective of the present study is to quantify risks of the subsequent cancers in CUP patients since such studies are lacking. PATIENTS AND METHODS: A population-based cohort of CUP was identified from the Swedish Family-Cancer Database of year 2008. Standardized incidence ratios (SIRs) were calculated for developing the following malignancies in 31 357 CUP patients from 1975 to 2008. RESULTS: A total of 755 CUP patients developed subsequent cancers, showing a significantly increased overall SIR of 1.69 (95% confidence interval 1.57-1.81). Among the most common 32 malignancies, increased SIRs were noted for 16 sites. Over 10-fold increases were observed for squamous cell carcinoma at four sites, possibly as a result of uncontrolled human papillomavirus infection due to faltering immune surveillance. The highest SIRs were observed among CUP patients diagnosed at a younger age and during the first follow-up year. CONCLUSIONS: Swedish CUP survivors had a higher risk of developing many subsequent cancers. Different patterns of risk excess may be suggestive of possible roles for disease- and therapy-related immunosuppression, reappearance of hidden primary tumors, or genetic predisposition.
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| 7. |
- Shu, Xiaochen, et al.
(författare)
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Survival in cancer patients hospitalized for inflammatory bowel disease in Sweden.
- 2011
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Ingår i: Inflammatory Bowel Diseases. - : Oxford University Press (OUP). - 1536-4844 .- 1078-0998. ; 17, s. 816-822
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:: The increased cancer risk among patients diagnosed with inflammatory bowel disease (IBD) is well reported, whereas studies regarding the cancer prognosis with IBD have shown conflicting results. We aimed at assessing and quantifying the cause-specific and overall mortality among cancer patients with IBD compared to those without IBD. METHODS:: The population-based Swedish registers were used to identify cancer patients diagnosed with or without IBD. We used a Cox regression model to estimate hazard ratios (HRs) for cause-specific and overall mortality, showing the probability of death in the study group compared to the reference. RESULTS:: A total of 2462 cancer patients with IBD and 1,011,894 cancer patients without IBD were ascertained from 1964 to 2006, showing a significant survival disparity (overall HR, 1.26; 95% confidence interval [CI]: 1.20-1.33 versus cause-specific HR, 1.22; 95% CI: 1.15-1.29). Although worse overall cancer mortality with IBD was widely observed, the worse cause-specific mortality was only confined to colorectal cancer (CRC). There was no difference in TNM staging among cancer patients with or without IBD. Stratified analyses showed that a worse prognosis was more pronounced in younger patients (<60 years) and in men. Discordant malignant neoplasms and cardiovascular diseases were noted to be associated with increased mortality in the study group. CONCLUSIONS:: Previously diagnosed IBD worsens the prognosis of cancers, especially for CRC. The more pronounced effect was noted among younger patients and in men. The underlying mechanisms warrant further investigation. (Inflamm Bowel Dis 2010).
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| 8. |
- Shu, Xiaochen, et al.
(författare)
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Survival in cancer patients hospitalized for psoriasis: a population-based cohort study in Sweden.
- 2011
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Ingår i: British Journal of Dermatology. - : Oxford University Press (OUP). - 1365-2133 .- 0007-0963. ; 165, s. 129-136
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Tidskriftsartikel (refereegranskat)abstract
- Background Increased cancer risk after psoriasis has been observed in previous studies, whereas little is known about the prognosis in cancer patients with previously diagnosed psoriasis. Objectives We aimed at examining the cancer-specific and overall mortality among psoriatic cancer patients compared with the reference population. Methods The population-based Swedish registers were used to identify psoriatic cancer patients and cancer patients without psoriasis. We estimated hazard ratios (HRs) showing the probability of death in the two groups. Results In total, 1746 psoriatic cancer patients and 1 011 757 other cancer patients were identified from 1964 to 2006, showing a significant survival disparity [overall HR 1·27, 95% confidence interval (CI) 1·20-1·35 and cancer-specific HR 1·26, 95% CI 1·18-1·35]. An overall mortality excess after psoriasis was observed for nine cancer sites and a cancer-specific mortality excess for seven cancer sites. Stratified analyses showed that the prognosis was worse for psoriatic cancer patients diagnosed below age 65 years and for those who had been treated for alcohol-related diseases. Those with more than one hospitalization for psoriasis were more likely to be associated with an increased risk of cancer-specific mortality. Conclusions A previous diagnosis of psoriasis worsens the prognosis of many cancers. A worse prognosis was more pronounced in psoriatic cancer patients diagnosed at an earlier age, previously hospitalized for alcohol-related diseases, or with severe symptoms. Our study provides clinicians and patients with information about mortality risk and prognostic factors for psoriatic cancer patients. The mechanisms underlying this disparity warrant further studies.
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| 9. |
- Shu, Xiaochen, et al.
(författare)
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Survival in cancer patients with previous hospitalization for sarcoidosis: a Swedish population-based cohort study during 1964-2006.
- 2011
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Ingår i: Annals of Oncology. - : Elsevier BV. - 1569-8041 .- 0923-7534. ; 22, s. 1427-1434
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Sarcoidosis has been reported to be associated with an increased risk of cancer; however, little information is available about the prognosis for sarcoidosis patients diagnosed with cancer. PATIENTS AND METHODS: A population-based cohort of sarcoidosis patients was identified from Swedish registers. Cause-specific and overall hazard ratios (HRs) were estimated by using Cox regression model to show the probability of death in the study group compared with the control population. RESULTS: A total of 1167 sarcoidosis patients were identified with subsequent cancer compared with 1 023 725 cancer patients without sarcoidosis from 1964 to 2006, showing a significant survival disparity [overall HR 1.21, 95% confidence interval (CI) 1.13-1.30 and cause-specific HR 1.16, 95% CI 1.08-1.27]. Site-specific analyses revealed that an overall mortality excess in sarcoidosis patients was observed for six cancers in comparison with a cancer-specific mortality excess for four cancers. Notably, stratified analyses showed that the prognosis was worse for cancer patients diagnosed below age 65 years. Cancer sites with significant mortality excess after sarcoidosis were mutually exclusive for men and women. CONCLUSIONS: A previously diagnosed sarcoidosis worsens the prognosis of cancer, preferentially for those diagnosed at a relatively younger age. The underlying mechanisms and more prognostic factors warrant further investigation.
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| 10. |
- Shu, Xiaochen, et al.
(författare)
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Time trends in incidence, causes of death, and survival of cancer of unknown primary in Sweden.
- 2012
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Ingår i: European Journal of Cancer Prevention. - 1473-5709. ; 21, s. 281-288
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Tidskriftsartikel (refereegranskat)abstract
- Time trends in incidence, causes of death, and prognosis of cancer of unknown primary (CUP) could provide important clues for occult primary sites and thus result in effective organ-specific treatment, although such studies are seldom reported. We aimed at examining time trends in percentage and incidence rates, causes of death, and survival of CUP. A total of 50 545 patients with CUP were identified in the Swedish Cancer Registry from 1960 to 2008. We used direct standardization to standardize age-adjusted incidence rate to the Segi world population. Consistent increase before the late 1990s and dramatic decrease afterward was observed for both percentage and incidence of CUP in Swedes regardless of sex. Comparable time trends were noted in Norwegian and Finnish populations, but with several years earlier peaking times. For most anatomic sites, CUP and lung cancer were the two most common causes of death for patients with CUP irrespective of nodal involvement. Survival probability at 12 months after CUP was approximately 20% and then leveled off at approximately 10%. Adenocarcinoma accounted for most of this incidence variation and experienced the worst prognosis. High incidence rates and comparable time trends for CUP were observed in Sweden, Norway, and Finland. The increasing time trends may partially reflect the change of autopsy rates in these countries. The decreased incidence in the last decade could be due to an increasing identification of unknown primary caused by improving diagnostic methods. Histological types were significantly associated with survival in patients with CUP.
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