| 1. |
- Ness-Jensen, Eivind, et al.
(författare)
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All-cause and cancer-specific mortality in GORD in a population-based cohort study (the HUNT study)
- 2018
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Ingår i: Gut. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 0017-5749 .- 1468-3288.
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Gastro-oesophageal reflux is a public health concern which could have associated oesophageal complications, including adenocarcinoma, and possibly also head-and-neck and lung cancers. The aim of this study was to test the hypothesis that reflux increases all-cause and cancer-specific mortalities in an unselected cohort. DESIGN: The Nord-Trondelag health study (HUNT), a Norwegian population-based cohort study, was used to identify individuals with and without reflux in 1995-1997 and 2006-2008, with follow-up until 2014. All-cause mortality and cancer-specific mortality were assessed from the Norwegian Cause of Death Registry and Cancer Registry. Multivariable Cox regression was used to calculate HRs with 95% CIs for mortality with adjustments for potential confounders. RESULTS: We included 4758 participants with severe reflux symptoms and 51 381 participants without reflux symptoms, contributing 60 323 and 747 239 person-years at risk, respectively. Severe reflux was not associated with all-cause mortality, overall cancer-specific mortality or mortality in cancer of the head-and-neck or lung. However, for men with severe reflux a sixfold increase in oesophageal adenocarcinoma-specific mortality was found (HR 6.09, 95% CI 2.33 to 15.93) and the mortality rate was 0.27 per 1000 person-years. For women, the corresponding mortality was not significantly increased (HR 3.68, 95% CI 0.88 to 15.27) and the mortality rate was 0.05 per 1000 person-years. CONCLUSIONS: Individuals with severe reflux symptoms do not seem to have increased all-cause mortality or overall cancer-specific mortality. Although the absolute risk is small, individuals with severe reflux symptoms have a clearly increased oesophageal adenocarcinoma-specific mortality.
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| 2. |
- Gottlieb-Vedi, Eivind, et al.
(författare)
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Extent of Lymphadenectomy and Long-Term Survival in Esophageal Cancer
- 2023
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Ingår i: Annals of Surgery. - : Wolters Kluwer. - 0003-4932 .- 1528-1140. ; 277:3, s. 429-436
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine the hypothesis that survival in esophageal cancer increases with more removed lymph nodes during esophagectomy up to a plateau, after which it levels out or even decreases with further lymphadenectomy.Summary of Background Data: There is uncertainty regarding the ideal extent of lymphadenectomy during esophagectomy to optimize long-term survival in esophageal cancer.Methods: This population-based cohort study included almost every patient who underwent esophagectomy for esophageal cancer in Sweden or Finland in 2000-2016 with follow-up through 2019. Degree of lymphadenectomy, divided into deciles, was analyzed in relation to all-cause 5-year mortality. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (95% CI) adjusted for all established prognostic factors.Results: Among 2,306 patients, the 2nd (4-8 nodes), 7th (21-24 nodes) and 8th decile (25-30 nodes) of lymphadenectomy showed the lowest all-cause 5-year mortality compared to the 1st decile (HR = 0.77, 95% CI 0.61-0.97, HR = 0.76, 95% CI 0.59-0.99, and HR = 0.73, 95% CI 0.57-0.93, respectively). In stratified analyses, the survival benefit was greatest in decile 7 for patients with pathological T-stage T3/T4 (HR = 0.56, 95% CI 0.40-0.78), although it was statistically improved in all deciles except decile 10. For patients without neoadjuvant chemotherapy, survival was greatest in decile 7 (HR = 0.60, 95% CI 0.41-0.86), although survival was also statistically significantly improved in deciles 2, 6, and 8.Conclusion: Survival in esophageal cancer was not improved by extensive lymphadenectomy, but resection of a moderate number (20-30) of nodes was prognostically beneficial for patients with advanced T-stages (T3/T4) and those not receiving neoadjuvant therapy.
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| 3. |
- Gottlieb-Vedi, Eivind
(författare)
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Improved surgical treatment of oesophageal cancer
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Oesophageal cancer is the 7thmost common cancer globally and the 5-year survival is poor (below 20%). Curative treatment usually involves surgical resection of the tumour (oesophagectomy), with or without neoadjuvant chemo(radio)therapy. The aim of the thesis was to identify surgery-related factors of importance for improved long-term survival in oesophageal cancer. Study I was a nationwide Swedish cohort study of patients who underwent oesophagectomy for oesophageal cancer between 1987 and 2010, with follow-up until 2016. The study included 1,384 patients who had undergone surgery by any of 36 surgeons. Risk adjusted cumulative sum analysis was used to create proficiency gain curves for “lower volume surgeons” (<4 cases per year) and “higher volume surgeons” (≥4 cases per year), as well as “younger surgeons” (<45 years) and “older surgeons” (≥45 years) regarding all-cause 1 to 5-year mortality (main outcome). The results were adjusted for confounders. “Higher volume surgeons” reached proficiency at 14 cases compared to 31 cases for “lower volume surgeons”. “Younger surgeons” reached proficiency at 13 cases compared to 48 cases for “older surgeons”. Study II was a systematic review and meta-analysis comparing long-term survival after minimally invasive oesophagectomy (MIO) with open oesophagectomy (OO) for oesophageal cancer in studies published up until 2018. Based on 55 relevant studies and 14,592 patients (7,358 MIO and 7,234 OO), random effects meta-analysis was used to produce hazard ratios (HR) with 95% confidence intervals (CI) for all-cause 5-year mortality (main outcome) with adjustment for confounders. MIO was associated with 18% lower risk of all-cause 5-year mortality compared to OO (HR 0.82, 95% CI 0.76-0.88). Study III was a population-based cohort study including almost all patients operated for oesophageal cancer in Sweden from 2011 until 2015 and in Finland from 2010 until 2016, with follow-up throughout 2019. Multivariable Cox regression was used to produce HRs with 95% CIs comparing MIO (n=459) with OO (n=771) for the main outcome all-cause 5-year mortality. The results were adjusted for confounders. MIO was associated with 18% lower risk of all-cause 5-year mortality compared to OO (HR 0.82, 95% CI 0.67-1.00 [P=0.048]). Study IV was a population-based cohort study including almost all patients who underwent surgery for oesophageal cancer from 2000 until 2015 in Sweden and from 2000 until 2016 in Finland, with follow-up throughout 2019. The 2,306 included patients were divided into deciles (10 about equal size group) by the level of lymphadenectomy during oesophagectomy. Multivariable Cox regression was used to produce HRs with 95% CIs for the main outcome all-cause 5-year mortality with adjustment for confounders. Compared to the 1st decile (0-3 nodes) the lowest risk for all-cause 5-year mortality was found in decile 8 (25-30 nodes). Upon stratification, this survival benefit was especially apparent for T3/T4 tumours and for patients who did not receive neoadjuvant therapy. In conclusion, this thesis indicates that intense training in oesophagectomy of younger surgeons, use of minimally invasive oesophagectomy and moderate extent of lymphadenectomy improve long-term survival in patients who undergo surgery for oesophageal cancer.
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| 4. |
- Holmberg, Dag, et al.
(författare)
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Aspirin or statin use in relation to survival after surgery for esophageal cancer : a population-based cohort study
- 2023
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Ingår i: BMC Cancer. - : BioMed Central (BMC). - 1471-2407. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Adjuvant postoperative treatment with aspirin and statins may improve survival in several solid tumors. This study aimed to assess whether these medications improve the survival after curatively intended treatment (including esophagectomy) for esophageal cancer in an unselected setting.Methods: This nationwide cohort study included nearly all patients who underwent esophagectomy for esophageal cancer in Sweden from 2006 to 2015, with complete follow-up throughout 2019. Risk of 5-year disease-specific mortality in users compared to non-users of aspirin and statins was analyzed using Cox regression, providing hazard ratios (HR) with 95% confidence intervals (CI). The HRs were adjusted for age, sex, education, calendar year, comorbidity, aspirin/statin use (mutual adjustment), tumor histology, pathological tumor stage, and neoadjuvant chemo(radio)therapy.Results: The cohort included 838 patients who survived at least 1 year after esophagectomy for esophageal cancer. Of these, 165 (19.7%) used aspirin and 187 (22.3%) used statins during the first postoperative year. Neither aspirin use (HR 0.92, 95% CI 0.67-1.28) nor statin use (HR 0.88, 95% CI 0.64-1.23) were associated with any statistically significant decreased 5-year disease-specific mortality. Analyses stratified by subgroups of age, sex, tumor stage, and tumor histology did not reveal any associations between aspirin or statin use and 5-year disease-specific mortality. Three years of preoperative use of aspirin (HR 1.26, 95% CI 0.98-1.65) or statins (HR 0.99, 95% CI 0.67-1.45) did not decrease the 5-year disease-specific mortality.Conclusions: Use of aspirin or statins might not improve the 5-year survival in surgically treated esophageal cancer patients.
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