| 1. |
- Holmberg, Marcus, et al.
(författare)
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Outcome after surgery for invasive intraductal papillary mucinous neoplasia compared to conventional pancreatic ductal adenocarcinoma : a swedish nationwide register-based study
- 2022
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Ingår i: Pancreatology (Print). - : Elsevier. - 1424-3903 .- 1424-3911. ; 23:1, s. 90-97
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Tidskriftsartikel (refereegranskat)abstract
- Background: The clinical importance of intraductal papillary mucinous neoplasm (IPMN) have increased last decades. Long-term survival after resection for invasive IPMN (inv-IPMN) compared to conventional pancreatic ductal adenocarcinoma (PDAC) is not thoroughly delineated.Objective: This study, based on the Swedish national pancreatic and periampullary cancer registry aims to elucidate the outcome after resection of inv-IPMN compared to PDAC.Methods: All patients ≥18 years of age resected for inv-IPMN and PDAC in Sweden between 2010 and 2019 were included. Clinicopathological variables were retrieved from the national registry. The effect on death was assessed in two multivariable Cox regression models, one for patients resected 2010–2015, one for patients resected 2016–2019. Median overall survival (OS) was estimated using the Kaplan-Meier method.Results: We included 1909 patients, 293 inv-IPMN and 1616 PDAC. The most important independent predictors of death in multivariable Cox regressions were CA19-9 levels, venous resection, tumour differentiation, as well as T-, N-, M-stage and surgical margin. Tumour type was an independent predictor for death in the 2016–2019 cohort, but not in the 2010–2015 cohort. In Kaplan-Meier survival analysis, inv-IPMN was associated with longer median OS in stage N0-1 and in stage M0 compared to PDAC. However, in stage T2-4 and stage N2 median OS was similar, and in stage M1 even shorter for inv-IPMN compared to PDAC.Conclusion: In this population-based nationwide study, outcome after resected inv-IPMN compared to PDAC is more favourable in lower stages, and similar to worse in higher.
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| 2. |
- Emilsson, Louise, 1982-, et al.
(författare)
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Gall Bladder Disease and the Risk of Small Bowel Cancer : Results from a Nationwide Swedish Cohort Study
- 2022
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Ingår i: Cancers. - : MDPI. - 2072-6694. ; 14:3
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: Small bowel cancer is a rare but rising malignancy. The etiology is poorly understood and there is a need for large-scale studies. Gallbladder disease (GBD), inducing localized inflammation, has been suggested to increase small bowel cancer risk.METHODS: We retrieved nationwide data from Sweden's 28 pathology departments on all adults (age 20-79) with pathology-confirmed GBD diagnosed in 1965-2017. In total 156,390 GBD patients were matched with up to 5 matched comparators from the general population and follow-up started one year after GBD diagnosis. We used stratified Cox regression to calculate hazard ratios (HRs) for small bowel adenocarcinoma, adenomas, and carcinoids.RESULTS: During a median follow-up of 12 years, we identified 92 small bowel adenocarcinomas, 132 adenomas, and 81 carcinoid tumors in the GBD cohort. Corresponding incidence rates were 4.8, 6.9, and 4.2 per 100,000 person-years (PY), compared to 3.2, 3.2, and 1.8 in matched comparators. The adjusted HR was 1.42 (95% CI = 1.08-1.87) for small bowel adenocarcinoma, 1.79 (95% CI = 1.41-2.27) for adenoma, and 2.07 (95% CI = 1.52-2.81) for carcinoid. The excess cancer risk was most pronounced during the first year of follow-up for adenocarcinomas and during the first six years for adenomas while for carcinoids the HR peaked 10-15 years after start of follow-up.CONCLUSIONS: In this nationwide cohort study, GBD was associated with an increased risk of small bowel cancer. The excess risk of small bowel adenocarcinoma was mainly seen during the first years of follow-up while small bowel carcinoid risk peaked 11-16 years after GBD diagnosis.
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| 3. |
- Radkiewicz, Cecilia
(författare)
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Sex differences in cancer risk and survival
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The objective of study I was to delineate and quantify sex differences in cancer risk and survival together with assessing the potential gain achieved by eliminating the excess cancer risk in men. Study II and III aimed to in detail characterize the superior non-small cell lung cancer survival and the inferior urinary bladder cancer survival, in women, with the underlying objective to identify underlying drivers to these two phenomena. In study IV we wanted to explore to what extent taller body stature can explain the excess cancer risk in men. Methods: All of the studies are Swedish population-based cohort studies. Study I included all incident cancer cases (n=872,397) recorded in the Swedish Cancer Register in 1970-2014 at age 15-84. The association between sex and cancer risk and sex and cancer survival was assessed by estimating male-to-female incidence rate ratios (IRRs) and excess mortality ratios (EMRs), respectively, using Poisson regression models adjusted for age and calendar year. All incident lung squamous cell carcinoma (n=10,325) and adenocarcinoma (n=23,465) cases recorded in the Swedish Lung Cancer Register in 2002-2016 formed the basis in Study II. Flexible parametric models were applied to compute adjusted female-to-male hazard ratios (HRs) and standardized survival proportions over follow-up, including; age, year, education, marital status, birth country, health care region, ECOG performance status, smoking history, comorbidity, TNM stage, and tumor location, in the final model. A subgroup analysis of lung adenocarcinoma, additionally adjusting for EGFR mutational status, was additionally performed. In study III we included all records of urothelial bladder cancer diagnosed in 1997-2014 at age 18-89 in the Swedish Urinary Bladder Cancer Register (n=36,344). We estimated empirical survival proportions and mortality rates in men and women as well as female-to-male adjusted HRs and standardized survival proportions, using flexible parametric models including; age, year, WHO grade, TNM stage, marital status, education, health care region, birth country, and comorbidity, in the fully-adjusted models. In study IV individual-level information on height from the Swedish Passport Register, the Conscription Register, and the Medical Birth Register (n=6,156,659) was linked to the Swedish Cancer Register where 285,778 cancer cases were identified. Contemporary mediation analysis was applied to assess the effect of male sex, explained by height, on cancer risk. Results: In study I we found that men are at a higher risk of 34 of 39 malignancies, and have a poorer survival in 27 of 39. Except for smoking-associated malignancies, the excess risk in men is stable over calendar time. In male predominant sites, IRRs range from 1.05; 95% CI, 1.02-1.1 (lung adenocarcinoma) to 8.0; 95% CI, 7.5-85 (laryngeal cancer). Women with non-small cell lung cancer (study II) are younger, smoke less, and present better performance status, compared to men. Women with lung adenocarcinoma additionally present lower comorbidity burden, less advanced stage, and more often harbor activating EGFR mutations. Women with non-small cell lung cancer have a superior survival that is most consistent in lung adenocarcinoma where female-to-male HRs ranged from 0.69; 95% CI 0.63-0.76 (stage IA-IIB) to 0.94; 95% CI 0.88-0.99 (stage IIIB-IV). HR estimates remain largely unchanged after meticulous adjustments. Except for an unfavorable stage distribution in women, we found sparse evidence of sex differences in clinical management or tumor aggressiveness, in urothelial bladder cancer (study III). Women, overall, have a poorer bladder cancer survival (adjusted HR 1.15; 95% CI 1.08-1.23) which is driven by muscle invasive tumors (adjusted HR 1.24; 95% CI 1.14-1.34) and restricted to the first two years from diagnosis. Study IV confirmed that a majority of investigated cancers are associated with male sex (here, 33 of 39) and body height (27 of 39). A fair proportion of the excess male cancer risk is explained by taller body stature, and ranges from 0.5% (laryngeal) to 100% (salivary, colon, melanoma, and AML). The effect of body height and the mediated Conclusion: In Study I we found that male sex is a consistent risk as well as a negative prognostic factor for a majority of cancers. Identifying and eliminating underlying factors to the excess cancer risk in men could substantially reduce the global cancer burden. Men with lung adenocarcinoma have a consistently poorer survival that remained largely unchanged after adjustments for a range of prognostic factors, indicating sex differences in tumor biology (study II). The excess bladder cancer mortality in women is limited to muscle-invasive tumors, only noticeable within the first two years from diagnosis, and cannot be explained by the examined clinicopathological factors (study III). This warrants further investigation of sex differences in outcomes and complications to radical cystectomy. A large proportion of the excess cancer risk in men is explainable by height (study IV). This finding corroborate that a considerable proportion of cancer cases are a result of random processes during DNA replication (i.e., bad luck) rather than underlying hereditary and/or environmental factors.
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| 4. |
- Radkiewicz, Cecilia, et al.
(författare)
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Sex Differences in Urothelial Bladder Cancer Survival
- 2020
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Ingår i: Clinical Genitourinary Cancer. - : Elsevier. - 1558-7673 .- 1938-0682. ; 18:1, s. 26-34
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Tidskriftsartikel (refereegranskat)abstract
- It is well known that women with urinary bladder cancer have poorer prognosis than men. We had complete clinical and sociodemographic data on close to 40,000 bladder cancer patients. The female survival disadvantage was limited to locally advanced tumors and was not explained by tumor nor patient characteristics. This indicates different management of locally advanced bladder cancer in men and women.Background: While urinary bladder cancer is consistently more common in men worldwide, women have poorer prognosis. The aim of this study was to outline sex differences in prognostic factors and clinical management and to explore whether these can explain the poorer urinary bladder cancer outcome in women.Patients and Methods: We performed a population-based cohort study including all patients diagnosed with urothelial bladder cancer between 1997 and 2014 at age 18 to 89 who had data recorded in the Swedish Urinary Bladder Cancer Register (n = 36,344). Female-to-male odds ratios for clinical management parameters were estimated by logistic regression. To quantify sex differences in bladder cancer-specific survival, we estimated empirical survival proportions and mortality rates as well as applied flexible parametric models to estimate female-to-male hazard ratios and survival proportions over follow-up. Adjusted models included age, year, World Health Organization grade, stage, marital status, education, health care region, birth country, and comorbidity.Results: Except for an adverse stage distribution in women, we found no evidence of unequal clinical management. Among those diagnosed with bladder cancer, women had a higher bladder cancer mortality (adjusted hazard ratio, 1.15; 95% confidence interval, 1.08-1.23) driven by muscle-invasive tumors (adjusted hazard ratio, 1.24; 95% confidence interval, 1.14-1.34). The female survival disadvantage was confined to the first 2 years after diagnosis.Conclusion: The excess bladder cancer mortality in women is limited to those diagnosed with muscle-invasive tumors and cannot be explained by the examined clinicopathologic factors. Further investigations of sex differences in therapeutic procedures and outcomes, including complications, of muscle-invasive bladder cancer, must be performed.
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