| 11. |
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| 12. |
- Jokinen, Jussi, et al.
(författare)
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Suicide attempt and future risk of cancer : a nationwide cohort study in Sweden
- 2015
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Ingår i: Cancer Causes and Control. - : Springer Nature. - 0957-5243 .- 1573-7225. ; 44, s. 11-12
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Little is known about cancer incidence among patients with a history of suicide attempt. Suicide attempters have lower levels of oxytocin, a hormone related to lactation, stress, social functioning, and well-being, and recent research indicates influence on carcinogenesis. We hypothesized that the low oxytocin levels among suicide attempters results in an increased risk of cancer in general and in organs with oxytocin receptors in particular.Methods: A nationwide cohort study of patients aged 15 years or older with hospitalization for self-inflicted injury or attempted suicide was identified from the Swedish patient register in 1968–2011. The cancer outcomes were identified from the Swedish cancer register. Cancer risk in suicide attempters was compared with the risk in the background population of the corresponding age, sex, and calendar period by calculating standardized incidence ratios (SIRs) with 95 % confidence intervals (95 % CI).Results: The 186,627 patients (83,637 men and 102,990 women) hospitalized for self-inflicted injury or attempted suicide contributed with 2.6 million person-years at risk. The SIR for all cancer was 1.3 (95 % CI 1.27–1.33) in men and 1.25 (1.22–1.28) in women. For cancers in organs rich in oxytocin receptors (uterus, breast, and brain), the corresponding SIRs were 1.02 (0.87–1.19) and 1.13 (1.09–1.17), respectively. There was a particularly increased risk of cancers related to alcohol and tobacco in both sexes.Conclusion: Patients attempting suicide have an increased risk of cancer. However, this increase does not seem to be associated with low oxytocin levels, but rather to exposures like tobacco smoking and alcohol consumption.
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| 13. |
- Kauppila, Joonas H, et al.
(författare)
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Neoadjuvant therapy in relation to lymphadenectomy and resection margins during surgery for oesophageal cancer
- 2018
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Ingår i: Scientific Reports. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 2045-2322.
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Tidskriftsartikel (refereegranskat)abstract
- It is unclear whether gastrectomy or oesophagectomy offer better outcomes for gastro-oesophageal junction (GOJ) cancer. A total of 240 patients undergoing total gastrectomy (n = 85) or oesophagectomy (n = 155) for Siewert II-III GOJ adenocarcinoma were identified from a Swedish prospective population-based nationwide cohort. The surgical approaches were compared in relation to non-radical resection margins (main outcome) using multivariable logistic regression, providing odds ratios (ORs) and 95% confidence intervals (CIs), mean number of removed lymph nodes with standard deviation (SD) using ANCOVA, assessing mean differences and 95% CIs, and 5-year mortality using Cox regression estimating hazard ratios (HRs) and 95% CIs. The models were adjusted for age, sex, comorbidity, tumour stage, and surgeon volume. The non-radical resection rate was 15% for gastrectomy and 14% for oesophagectomy, and the adjusted OR was 1.61 (95% CI 0.68-3.83). The mean number of lymph nodes removed was 14.2 (SD +/- 9.6) for gastrectomy and 14.2 (SD +/- 10.4) for oesophagectomy, with adjusted mean difference of 2.4 (95% CI-0.2-5.0). The 5-year mortality was 76% following gastrectomy and 75% following oesophagectomy, with adjusted HR = 1.07 (95% CI 0.78-1.47). Gastrectomy and oesophagectomy for Siewert II or III GOJ cancer seem comparable regarding tumour-free resection margins, lymph nodes removal, and 5-year survival.
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| 14. |
- Lagergren, Jesper, et al.
(författare)
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Clinical implementation of a new antibiotic prophylaxis regimen for percutaneous endoscopic gastrostomy
- 2013
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Ingår i: BMJ Open. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 2044-6055.
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: This study was undertaken to test the extent to which a new antibiotic prophylaxis regimen for percutaneous endoscopic gastrostomy (PEG), identified as a justified and simpler alternative to conventional regimen in a randomised clinical trial, has been adopted in clinical practice. DESIGN: A Swedish nationwide implementation survey, conducted in February 2013, assessed the level of clinical implementation of a 20 ml dose of oral solution of sulfamethoxazole and trimethoprim deposited in the PEG catheter immediately after insertion. All hospitals inserting at least five PEGs annually were identified from the Swedish Patient Registry. A clinician involved in the PEG insertions at each hospital participated in a structured telephone interview addressing their routine use of antibiotic prophylaxis. SETTING: All Swedish hospitals inserting PEGs (n=60). PARTICIPANTS: Representatives of PEG insertions at each of the 60 eligible hospitals participated (100% participation). MAIN OUTCOME MEASURES: Use of routine antibiotic prophylaxis for PEG. RESULTS: A total of 32 (53%) of the 60 hospitals had adopted the new regimen. It was more frequently adopted in university hospitals (67%) than in community hospitals (41%). An annual total of 1813 (70%) of 2573 patients received the new regimen. Higher annual hospital volume was associated with a higher level of adoption of the new regimen (80% in the highest vs 31% in the lowest). CONCLUSIONS: The clinical implementation of the new antibiotic prophylaxis regimen for PEG was high and rapid (70% of all patients within 3 years), particularly in large hospitals.
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| 15. |
- Lagergren, Jesper, et al.
(författare)
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Extent of lymphadenectomy and prognosis after esophageal cancer surgery
- 2015
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Ingår i: JAMA Surgery. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 2168-6254 .- 2168-6262.
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Tidskriftsartikel (refereegranskat)abstract
- Importance: The prognostic role of the extent of lymphadenectomy during surgery for esophageal cancer is uncertain and requires clarification. Objective: To clarify whether the number of removed lymph nodes influences mortality following surgery for esophageal cancer. Design, Setting, and Participants: Conducted from January 1, 2000, to January 31, 2014, this was a cohort study of patients who underwent esophagectomy for cancer in 2000-2012 at a high-volume hospital for esophageal cancer surgery, with follow-up until 2014. Exposures: The main exposure was the number of resected lymph nodes. Secondary exposures were the number of metastatic lymph nodes and positive to negative lymph node ratio. Main Outcomes and Measures: The independent role of the extent of lymphadenectomy in relation to all-cause and disease-specific 5-year mortality was analyzed using Cox proportional hazard regression models, providing hazard ratios (HRs) with 95% CIs. The HRs were adjusted for age, pathological T category, tumor differentiation, margin status, calendar period of surgery, and response to preoperative chemotherapy. Results: Among 606 included patients, 506 (83.5%) had adenocarcinoma of the esophagus, 323 (53%) died within 5 years of surgery, and 235 (39%) died of tumor recurrence. The extent of lymphadenectomy was not statistically significantly associated with all-cause or disease-specific mortality, independent of the categorization of lymphadenectomy or stratification for T category, calendar period, or chemotherapy. Patients in the fourth quartile of the number of removed nodes (21-52 nodes) did not demonstrate a statistically significant reduction in all-cause 5-year mortality compared with those in the lowest quartile (0-10 nodes) (HR, 0.86; 95% CI, 0.63-1.17), particularly not in the most recent calendar period (HR, 0.98; 95% CI, 0.57-1.66 for years 2007-2012). A greater number of metastatic nodes and a higher positive to negative node ratio was associated with increased mortality rates, and these associations showed dose-response associations. Conclusions and Relevance: This study indicated that the extent of lymphadenectomy during surgery for esophageal cancer might not influence 5-year all-cause or disease-specific survival. These results challenge current clinical guidelines. This cohort study indicates that the extent of lymphadenectomy during surgery for esophageal cancer might not influence the 5-year all-cause or disease-specific survival. These results challenge current clinical guidelines.
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| 16. |
- Lagergren, Jesper, et al.
(författare)
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Prognosis following cancer surgery during holiday periods
- 2017
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Ingår i: International Journal of Cancer. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 0020-7136 .- 1097-0215.
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Tidskriftsartikel (refereegranskat)abstract
- Surgery is the mainstay curative treatment in most cancer. We aimed to test the new hypothesis that cancer surgery performed during holiday periods is associated with worse long-term prognosis than for non-holiday periods. This nationwide Swedish population- based cohort study included 228,927 patients during 1997-2014 who underwent elective resectional surgery for a cancer where the annual number of resections was over 100. The 16 eligible cancer sites were grouped into 10 cancer groups. The exposure, holiday periods, was classified as wide (14-weeks) or narrow (7-weeks). Surgery conducted inside versus outside holiday periods was compared regarding overall disease-specific (main outcome) and overall all-cause (secondary outcome) mortality. Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, sex, comorbidity, hospital volume, calendar period, and tumor stage. Surgery conducted during wide and narrow holiday periods were associated with increased HRs of disease-specific mortality for cancer of the breast (HR 1.08, 95% CI 1.03-1.13 and HR 1.06, 95% CI 1.01-1.12) and possibly of cancer of the liver-pancreas-bile ducts (HR 1.09, 95% CI 0.99-1.20 and HR 1.12, 95% CI 0.99-1.26). Sub- groups with cancer of the colon-rectum, head-and-neck, prostate, kidney-urine bladder, and thyroid also experienced statistically significantly worse prognosis following surgery conducted during holiday periods. No influence of surgery during holiday was detected for cancer of the esophagus-stomach, lung, or ovary-uterus. All-cause HRs were similar to the disease-specific HRs. The prognosis following cancer surgery might not be fully maintained during holiday periods for all cancer sites.
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| 17. |
- Lagergren, Jesper, et al.
(författare)
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Weekday of cancer surgery in relation to prognosis
- 2017
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Ingår i: British Journal of Surgery. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 0007-1323 .- 1365-2168.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Later weekday of surgery seems to affect the prognosis adversely in oesophageal cancer, whereas any such influence on other cancer sites is unknown. This study aimed to test whether weekday of surgery influenced prognosis following commonly performed cancer operations. METHODS: This nationwide Swedish population-based cohort study from 1997 to 2014 analysed weekday of elective surgery for ten major cancers in relation to disease-specific and all-cause mortality. Cox regression provided hazard ratios with 95 per cent confidence intervals, adjusted for the co-variables age, sex, co-morbidity, hospital volume, calendar year and tumour stage. RESULTS: A total of 228 927 patients were included. Later weekday of surgery (Thursdays and, even more so, Fridays) was associated with increased mortality rates for gastrointestinal cancers. Adjusted hazard ratios for disease-specific mortality, comparing surgery on Friday with that on Monday, were 1·57 (95 per cent c.i. 1·31 to 1·88) for oesophagogastric cancer, 1·49 (1·17 to 1·88) for liver/pancreatic/biliary cancer and 1·53 (1·44 to 1·63) for colorectal cancer. Excluding mortality during the initial 90 days of surgery made little difference to these findings, and all-cause mortality was similar to disease-specific mortality. The associations were similar in analyses stratified for co-variables. No consistent associations were found between weekday of surgery and prognosis for cancer of the head and neck, lung, thyroid, breast, kidney/bladder, prostate or ovary/uterus.
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| 18. |
- Lagergren, Jesper, et al.
(författare)
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Weekday of esophageal cancer surgery and its relation to prognosis
- 2015
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Ingår i: Annals of Surgery. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 0003-4932. ; 263:6, s. 1133-1137
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Tidskriftsartikel (refereegranskat)abstract
- In this nationwide Swedish study, later weekday of esophageal cancer surgery entailed increased long-term mortality, particularly for earlier tumor stages. The increase in 5-year mortality for each later weekday was 7% for all tumor stages, 24% for stages 0-I, 13% for stage II, but was not increased for stages III-IV. Objective: To assess whether weekday of surgery influences long-term survival in esophageal cancer. Summary Background Data: Increased 30-day mortality rates have been reported in patients undergoing elective surgery later compared to earlier in the week Methods: This population-based cohort study included 98% of all esophageal cancer patients who underwent elective surgery in Sweden in 1987-2010, with follow-up until 2014. The association between weekday of surgery and 5-year all-cause and disease-specific mortality was analyzed using a multivariable Cox proportional hazards model, providing hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for age, co-morbidity, tumor stage, histology, neoadjuvant therapy, and surgeon volume. Results: Among 1,748 included patients, surgery conducted Wednesday-Friday entailed 13% increased all-cause 5-year mortality compared to surgery Monday-Tuesday (HR=1.13, 95% CI 1.01-1.26). The corresponding association was strong for early tumor stages (0-I) (HR=1.59, 95% CI 1.17-2.16), moderate for intermediate tumor stage (II) (HR=1.28, 95% CI 1.07-1.53), and absent in advanced tumor stages (III-IV) (HR=0.93, 95%CI 0.79-1.09). The increase in 5-year mortality for each later weekday (discrete variable) was 7% for all tumor stages (HR=1.07, 95% CI 1.02-1.12), 24% for early tumor stages (HR=1.24, 95% CI 1.09-1.41), 13% for intermediate stage (HR=1.13, 95% CI 1.05-1.22), while no increase was found for advanced stages (HR=0.98, 95% CI 0.92-1.05). The disease-specific 5-year mortality was similar to the all-cause mortality. Conclusions: The increased 5-year mortality of potentially curable esophageal cancer following surgery later in the week suggests that this surgery is better performed earlier in the week.
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| 19. |
- Lagergren, Jesper, et al.
(författare)
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Weekday of oesophageal cancer surgery in relation to early postoperative outcomes in a nationwide Swedish cohort study
- 2016
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Ingår i: BMJ Open. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 2044-6055.
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Later weekday of surgery for oesophageal cancer seems to increase 5-year mortality, but the mechanisms are unclear. We hypothesised that early postoperative reoperations and mortality might explain this association, since reoperation after oesophagectomy decreases long-term prognosis, and later weekday of elective surgery increases 30-day mortality. Design: This was a population-based cohort study during the study period 1987–2014. Setting: All Swedish hospitals conducting elective surgery for oesophageal cancer in Sweden. Participants: Included were 1748 patients, representing almost all (98%) patients who underwent elective surgery for oesophageal cancer in Sweden during 1987–2010, with follow-up until 2014. Primary and secondary outcome measures: The risk of reoperation or mortality within 30 days of oesophageal cancer surgery was assessed in relation to weekday of surgery by calculating ORs with 95% CIs using multivariable logistic regression. ORs were adjusted for age, comorbidity, tumour stage, histology, neoadjuvant therapy and surgeon volume. Results: Surgery Wednesday to Friday did not increase the risk of reoperation or mortality compared with surgery Monday to Tuesday (OR=0.99, 95% CI 0.75 to 1.31). A decreased point estimate of reoperation (OR=0.88, 95% CI 0.64 to 1.21) was counteracted by an increased point estimate of mortality (OR=1.28, 95% CI 0.83 to 1.99). ORs did not increase from Monday to Friday when each weekday was analysed separately. There was no association between weekday of surgery and reoperation specifically for anastomotic leak, laparotomy or wound infection. Stratification for surgeon volume did not reveal any clear associations between weekday of surgery and risk of 30-day reoperation or mortality. Conclusions: Weekday of oesophageal cancer surgery does not seem to influence the risk of reoperation or mortality within 30 days of surgery, and thus cannot explain the association between weekday of surgery and long-term prognosis.
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| 20. |
- Lagergren, Katarina, et al.
(författare)
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Abdominal fat and male excess of esophageal adenocarcinoma
- 2013
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Ingår i: Epidemiology. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 1531-5487.
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Tidskriftsartikel (refereegranskat)abstract
- The 7-to-1 male-to-female ratio in esophageal and gastroesophageal junctional adenocarcinoma (EAC) might be explained by abdominal adiposity, typical for males. If true, a stronger male predominance in higher BMI categories is expected. We conducted a nationwide Swedish population-based case-control study in 1995-1997 and collected data on BMI and other variables at face-to-face interviews. Age-adjusted relative risk (RR) and 95% confidence intervals (CI) levels were calculated using Poisson regression. Among 451 EAC cases and 820 controls, RR of EAC in males compared to females did not increase with higher BMI as assessed 20 years before interview, at 20 years of age, or at maximum or minimum adult BMI. For BMI 20 years before interview, RR in males compared to females were 7.4 (95%CI:3.9-14.1), 5.3 (95%CI:3.5-8.1), and 5.8 (95%CI:3.9-8.8) in the BMI categories <22, 22-<25, and ≥25, respectively. Conclusions: Abdominal adiposity might not explain the male predominance in esophageal adenocarcinoma.
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