| 1. |
- Babaei, Masoud, et al.
(författare)
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Administration of adjuvant chemotherapy for stage II-III colon cancer patients : An European population-based study
- 2018
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Ingår i: International Journal of Cancer. - : WILEY. - 0020-7136 .- 1097-0215. ; 142:7, s. 1480-1489
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Tidskriftsartikel (refereegranskat)abstract
- The advantage of adjuvant chemotherapy (ACT) for treating Stage III colon cancer patients is well established and widely accepted. However, many patients with Stage III colon cancer do not receive ACT. Moreover, there are controversies around the effectiveness of ACT for Stage II patients. We investigated the administration of ACT and its association with overall survival in resected Stage II (overall and stratified by low-/high-risk) and Stage III colon cancer patients in three European countries including The Netherlands (2009-2014), Belgium (2009-2013) and Sweden (2009-2014). Hazard ratios (HR) for death were obtained by Cox regression models adjusted for potential confounders. A total of 60244 resected colon cancer patients with pathological Stages II and III were analyzed. A small proportion (range 9-24%) of Stage II and over half (range 55-68%) of Stage III patients received ACT. Administration of ACT in Stages II and III tumors decreased with higher age of patients. Administration of ACT was significantly associated with higher overall survival in high-risk Stage II patients (in The Netherlands (HR; 95%CI = 0.82 (0.67-0.99), Belgium (0.73; 0.59-0.90) and Sweden (0.58; 0.44-0.75)), and in Stage III patients (in The Netherlands (0.47; 0.43-0.50), Belgium (0.46; 0.41-0.50) and Sweden (0.48; 0.43-0.54)). In Stage III, results were consistent across subgroups including elderly patients. Our results show an association of ACT with higher survival among Stage III and high-risk Stage II colon cancer patients. Further investigations are needed on the selection criteria of Stages II and III colon cancer patients for ACT.
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| 2. |
- Bergh, Christina, 1953, et al.
(författare)
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Regionalt HTA-arbete kan ge bra genomslag i vården. Goda exempel från Västra Götaland : [Regional HTA work can have a good impact on health care. Good examples form Vastra Gotaland].
- 2010
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Ingår i: Läkartidningen. - 0023-7205. ; 107:29-31, s. 1780-1783
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Tidskriftsartikel (refereegranskat)abstract
- HTA (health technology assessment) innebär en systematisk granskning av det vetenskapliga underlaget för en viss teknik. Ett väl definierat PICO (patients, intervention, comparison, outcome) är en grundförutsättning för att få fram den dokumentation som ska granskas. En fokuserad fråga är central i HTA-processen. En teknik granskas med avseende på effektivitet och risker, etiska och organisatoriska aspekter samt kostnader. I en systematisk litteraturöversikt granskas vetenskapliga artiklar med avseende på kvalitet och relevans. Slutsatserna evidensgraderas enligt GRADE. I Västra Götalandsregionen har inrättats ett HTA-centrum som arbetar med regional medicinsk utvärdering. Regionalt HTA-arbete har flera fördelar; en är att den praktiska omsättningen av de nyvunna kunskaperna troligen kan ske snabbare.
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| 3. |
- Egenvall, Monika, et al.
(författare)
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Management of colon cancer in the elderly : a population-based study
- 2014
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 16:6, s. 433-441
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Tidskriftsartikel (refereegranskat)abstract
- AIM: although the median age of patients diagnosed with colon cancer is above 70 years, little is known about specific characteristics and management in the elderly. The aim of the study was to define characteristics of colon cancer in elderly patients and compare the quality of preoperative assessment and surgery with that of younger patients undergoing surgery for colon cancer.METHOD: data on 15.255 patients diagnosed with colon cancer between 2007 and 2010 were retrieved from the Swedish National Colon Cancer Register. Of these, 12.959 underwent surgical resection, 6.141 were 75 years or older while 6.818 were younger. The χ(2) test, Mann-Whitney U test and uni- and multivariable logistic regression analyses were used for comparison between groups.RESULTS: older patients were more likely to be female (54% older/48% younger) and have right-sided cancer (60% older/49% younger). Among patients who underwent resection, the elderly were less often evaluated regarding tumour stage prior to surgery (59% older/65% younger) and they were less often evaluated at a multidisciplinary team conference (26% older/34% younger). Elderly patients more frequently underwent emergency surgery (22% older/19% younger) despite having an earlier cancer stage. When adjusted for stage, fewer elderly patients underwent a radical curative procedure (OR for non-curative resection 1.19; 95% CI 1.06-1.33)CONCLUSION: routine management of patients with colon cancer is age-dependent. Patients 75 years and older are less often completely staged and less often evaluated at a multi-disciplinary team conference prior to surgery. Adjusted for stage, fewer elderly patients undergo curative resection.
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| 4. |
- Maringe, Camille, et al.
(författare)
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Stage at diagnosis and colorectal cancer survival in six high-income countries : A population-based study of patients diagnosed during 2000-2007
- 2013
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Ingår i: Acta Oncologica. - 0284-186X .- 1651-226X. ; 52:5, s. 919-932
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundLarge international differences in colorectal cancer survival exist, even between countries with similar healthcare. We investigate the extent to which stage at diagnosis explains these differences.MethodsData from population-based cancer registries in Australia, Canada, Denmark, Norway, Sweden and the UK were analysed for 313 852 patients diagnosed with colon or rectal cancer during 2000-2007. We compared the distributions of stage at diagnosis. We estimated both stage-specific net survival and the excess hazard of death up to three years after diagnosis, using flexible parametric models on the log-cumulative excess hazard scale.ResultsInternational differences in colon and rectal cancer stage distributions were wide: Denmark showed a distribution skewed towards later-stage disease, while Australia, Norway and the UK showed high proportions of 'regional' disease. One-year colon cancer survival was 67% in the UK and ranged between 71% (Denmark) and 80% (Australia and Sweden) elsewhere. For rectal cancer, one-year survival was also low in the UK (75%), compared to 79% in Denmark and 82-84% elsewhere. International survival differences were also evident for each stage of disease, with the UK showing consistently lowest survival at one and three years.ConclusionDifferences in stage at diagnosis partly explain international differences in colorectal cancer survival, with a more adverse stage distribution contributing to comparatively low survival in Denmark. Differences in stage distribution could arise because of differences in diagnostic delay and awareness of symptoms, or in the thoroughness of staging procedures. Nevertheless, survival differences also exist for each stage of disease, suggesting unequal access to optimal treatment, particularly in the UK.
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| 5. |
- Nemlander, Elinor, et al.
(författare)
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Validation of a diagnostic prediction tool for colorectal cancer : a case–control replication study
- 2023
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Ingår i: Family Practice. - : Oxford University Press. - 0263-2136 .- 1460-2229.
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundEarly detection of colorectal cancer (CRC) is crucial for survival. Primary care, the first point of contact in most cases, needs supportive risk assessment tools. We aimed to replicate the Swedish Colorectal Cancer Risk Assessment Tool (SCCRAT) for non-metastatic CRC in primary care and examine if risk factor patterns depend on sex and age.Methods2,920 adults diagnosed with non-metastatic CRC during the years 2015–2019 after having visited a general practitioner the year before the diagnosis were selected from the Swedish Cancer Register and matched with 11,628 controls, using the same inclusion criteria except for the CRC diagnosis. Diagnostic codes from primary care consultations were collected from a regional health care database. Positive predictive values (PPVs) were estimated for the same 5 symptoms and combinations thereof as in the baseline study.ResultsThe results for patients aged ≥50 years old in the present study were consistent with the results of the SCCRAT study. All symptoms and combinations thereof with a PPV >5% in the present study had a PPV >5% in the baseline study. The combination of bleeding with abdominal pain (PPV 9.9%) and bleeding with change in bowel habit (PPV 7.8%) were the highest observed PPVs in both studies. Similar risk patterns were seen for all ages and when men and women were studied separately.ConclusionThis external validation of the SCCRAT for non-metastatic CRC in primary care replicated the baseline study successfully and identified patients at high risk for CRC.
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| 6. |
- Olsson, Ulf, et al.
(författare)
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In vivo and in vitro studies of Bacillus subtilis ferrochelatase mutants suggest substrate channeling in the heme biosynthesis pathway.
- 2002
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Ingår i: Journal of Bacteriology. - 0021-9193. ; 184:14, s. 4018-4024
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Tidskriftsartikel (refereegranskat)abstract
- Ferrochelatase (EC 4.99.1.1) catalyzes the last reaction in the heme biosynthetic pathway. The enzyme was studied in the bacterium Bacillus subtilis, for which the ferrochelatase three-dimensional structure is known. Two conserved amino acid residues, S54 and Q63, were changed to alanine by site-directed mutagenesis in order to detect any function they might have. The effects of these changes were studied in vivo and in vitro. S54 and Q63 are both located at helix alpha3. The functional group of S54 points out from the enzyme, while Q63 is located in the interior of the structure. None of these residues interact with any other amino acid residues in the ferrochelatase and their function is not understood from the three-dimensional structure. The exchange S54A, but not Q63A, reduced the growth rate of B. subtilis and resulted in the accumulation of coproporphyrin III in the growth medium. This was in contrast to the in vitro activity measurements with the purified enzymes. The ferrochelatase with the exchange S54A was as active as wild-type ferrochelatase, whereas the exchange Q63A caused a 16-fold reduction in V(max). The function of Q63 remains unclear, but it is suggested that S54 is involved in substrate reception or delivery of the enzymatic product.
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| 7. |
- Reims, Annika, 1962, et al.
(författare)
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Cysteinyl leukotrienes are secretagogues in atrophic coeliac and in normal duodenal mucosa of children
- 2005
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Ingår i: Scand J Gastroenterol. - : Informa UK Limited. - 0036-5521. ; 40:2, s. 160-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The pathophysiology of intestinal inflammation and diarrhoea is complex and involves the arachidonic acid cascade. Prostaglandins induce chloride secretion in healthy subjects and in patients with coeliac disease. Leukotrienes (LTs) are also known inflammatory mediators which have been shown to stimulate ion secretion in ileum and colon of rats and rabbits. The aim of this study was to determine the effects of leukotrienes C(4) (LTC(4)) and D(4) (LTD(4)) in normal and atrophic intestinal mucosa in children. MATERIAL AND METHODS: Routine paediatric intestinal biopsies were obtained from 109 children. Sixty-seven control biopsies and 42 biopsies from children with different stages of coeliac disease were mounted in a modified Ussing chamber. Potential difference (Pd) was measured continuously and tissue resistance (R(t)) and the generated current (I(m)) were calculated. RESULTS: In morphologically normal mucosa of duodenum, LTC(4) and LTD(4) increased Pd and I(m) in a dose-dependent manner. The increase was more pronounced in the distal than in the proximal part, similar to the response to prostaglandin E(2). The induced current was chloride-mediated, since replacement of Cl(-) with SO(4)(2-) in the bathing solution eliminated the response to the LTs. The LTC(4)-induced secretion was significantly decreased in atrophic mucosa, but the response was partially restored after preincubation with the cyclooxygenase inhibitor indomethacin. CONCLUSIONS: The results showed that LTC(4) and LTD(4) are secretagogues in the duodenal mucosa from healthy children by inducing a net chloride secretion. Restoration of the response in coeliac disease by cyclooxygenase inhibition suggests interactions between the different pathways of the arachidonic cascade in the intestinal mucosa.
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| 8. |
- Reims, Annika, 1962, et al.
(författare)
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Epithelial electrical resistance as a measure of permeability changes in pediatric duodenal biopsies
- 2006
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Ingår i: J Pediatr Gastroenterol Nutr. - 1536-4801. ; 43:5, s. 619-23
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Intestinal permeability measured with medium-sized oral probes is increased in cystic fibrosis (CF) and celiac disease (CD), probably reflecting reduced tight junction resistance. The aim of this study was to evaluate whether square-pulse analysis of duodenal biopsies from children can be used to determine electrical tight junction resistance. METHODS: Intestinal biopsies from children with different stages of CD and from patients with CF were studied in a modified Ussing chamber. The epithelium was assumed to act as an electrical circuit consisting of a current generator parallel with a resistance and a capacitance. Subepithelial and epithelial resistances were determined by square-pulse analysis, and the generated current was calculated. RESULTS: Confirming data using permeability probes, reduced epithelial electrical resistance was found both in patients with CF and CD. Only the CF patients had reduced resting current as well. The secretagogues prostaglandin E2, cyclic adenosine monophosphate and acetylcholine increased the current in both control biopsies and biopsies with villous atrophy but had no significant effect on epithelial resistance. CONCLUSIONS: Measurement of electrical resistance in duodenal biopsies can be used as an alternative method of quantifying permeability in pediatric biopsies.
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| 9. |
- Robertson, Stephanie, et al.
(författare)
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Waiting times for cancer patients in Sweden : A nationwide population-based study
- 2017
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Ingår i: Scandinavian Journal of Public Health. - : SAGE PUBLICATIONS LTD. - 1403-4948 .- 1651-1905. ; 45:3, s. 230-237
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The reported long waiting times for cancer patients have mostly been related to prognostic outcome and less to patient-related experience to outcome. We assessed waiting times for patients with cancer of the breast, prostate, colon or rectum in Sweden.Methods: The median time from referral to start of treatment was assessed using data from clinical cancer registers for patients who received curative treatment during 2011, 2012 and 2013.Results: The median overall waiting time in different counties ranged from 7 to 28 days for breast cancer, from 117 to 280 days for prostate cancer, from 27 to 64 days for colon cancer and from 48 to 80 days for rectal cancer. For the entire nation, the median time from referral to start of treatment remained unchanged from 2011 to 2013 for each cancer diagnosis.Conclusions: Large variations were found in waiting times between different counties in Sweden and between different types of cancer. The long waiting times identified in this study emphasize the need to improve national programmes for more rapid diagnosis and treatment.
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| 10. |
- Sjövall, Annika
(författare)
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Colon cancer : management and outcome in a Swedish population
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Colon cancer is common in Sweden, with about 3500 new cases every year. Tumours of the colon and rectum are usually addressed as an entity. Great effort has been made to improve the outcome after rectal cancer treatment with subsequent improvement of survival. Only few studies have addressed the specific issue of colon cancer and how to improve the outcome for this large group of patients. As a consequence, the 5-year survival after colon cancer treatment in Sweden is now poorer than after rectal cancer treatment. Since 1996, the Stockholm-Gotland region has a common management protocol for patients with colon cancer. As part of this protocol, data on all patients with newly diagnosed colon cancer in the region are prospectively collected in a database at the Oncologic Centre in Stockholm. The database includes information on age, sex, tumour location and stage, emergency or elective surgery, type of surgery performed, postoperative mortality, histopathology of the tumour and follow-up data on recurrence and survival. The database is continuously validated and updated through comparison to other registers with information on healthcare consumption, diagnoses according to the international classification of diseases (ICD) and causes of death. This thesis is based on information from the Oncologic Centre database and includes all patients diagnosed with colon cancer in the Stockholm-Gotland region during 1996-2000, followed until January 2005. The aim of the thesis was to achieve knowledge on how patients with colon cancer have been managed in the region during these years and to assess the outcome in terms of postoperative mortality, loco-regional and distant recurrence and survival. Another aim was to identify risk factors for death and recurrence. During the study period, 2855 patients were diagnosed with colon cancer. After the exclusion of 80 patients diagnosed at autopsy, 2775 were eligible for follow-up. The crude 5-year survival for all patients was 46 per cent. Nine hospitals managed these patients, and differences in overall survival and risk for local recurrence between the hospitals were present despite the common management protocol. The cumulative risk for loco-regional recurrence was 11 per cent. Tumour location in the right flexure and sigmoid colon, more advanced T-stage and N-stage, bowel perforation, emergent surgery and poor tumour differentiation were identified as risk factors for loco-regional recurrence. After complete resection of loco-regional recurrences, the estimated 5-year survival was 43 per cent, while there were no 5-year survivors among patients where a complete resection of the recurrence could not be accomplished. Liver metastases were detected in 24 per cent of the patients during follow-up. The hepatic resection rate was four per cent, which is remarkably low. A retrospective evaluation of radiological images of the liver showed that ten per cent of the patients might have been candidates for liver surgery. An evaluation of tumour volume as a prognostic factor showed that an increased tumour volume was associated with poorer survival even after adjusting for other postoperatively known factors. Some areas of possible improvement were identified. A multidisciplinary approach to improve preoperative staging, surgery, histopathologic staging and selection of patients for medical oncologic treatment could probably improve the outcome for patients with colon cancer.
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