| 11. |
- Ringborg, Cecilia, et al.
(författare)
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Health‑related quality of life after gastrectomy, esophagectomy, and combined esophagogastrectomy for gastroesophageal junction adenocarcinoma
- 2017
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Ingår i: Gastric Cancer. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 1436-3291 .- 1436-3305.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The postoperative health-related quality of life (HRQOL) outcomes in patients with gastroesophageal junction (GEJ) adenocarcinoma after gastrectomy and esophagectomy are unclear. The aim was to evaluate HRQOL outcomes 6 months after extended total gastrectomy, subtotal esophagectomy, and combined esophagogastrectomy. METHODS: Patients who underwent surgery for GEJ adenocarcinoma of Siewert type 2 or 3 in 2001-2005 were identified from a nationwide Swedish prospective and population-based cohort. Three surgical strategies, i.e., gastrectomy, esophagectomy, or esophagogastrectomy, were analyzed in relationship to HRQOL measured at 6 months after surgery (main outcome). HRQOL was assessed using well-validated questionnaires for general (EORTC QLQ-C30) and esophageal cancer-specific (EORTC QLQ-OES18) symptoms. Mean score differences (MSD) and 95% confidence intervals (CI) were analyzed using ANCOVA and adjusted for age, sex, tumor stage, comorbidity, education level, hospital volume, and postoperative complications. MSDs > 10 were regarded as clinically relevant. RESULTS: Among 176 patients with complete information on HRQOL and covariates, none of the MSDs for HRQOL among the three surgery groups were clinically and statistically significant. MSDs comparing esophagectomy and gastrectomy showed no major differences in global quality of life (MSD, +8, 95% CI, 0 to +16), physical function (MSD, +2, 95% CI, -5 to +9), pain (MSD, -3, 95% CI, -12 to +7), or reflux (MSD, +5, 95% CI, -4 to +14). Also, complication rates and 5-year survival rates were similar comparing esophagectomy and gastrectomy. CONCLUSIONS: Extended total gastrectomy, subtotal esophagectomy, and combined esophagogastrectomy seemed to yield similar 6-month postoperative HRQOL outcomes for patients with GEJ adenocarcinoma.
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| 12. |
- Rutegård, Martin, et al.
(författare)
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The prognostic role of coeliac node metastasis after resection for distal oesophageal cancer
- 2017
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- It is uncertain whether coeliac node metastasis precludes long-term survival in distal oesophageal cancer. This nationwide population-based cohort study included patients who underwent surgical resection for stage III or IV distal oesophageal cancer in 1987-2010 with follow-up until 2014. A minority (17.0%) had neoadjuvant therapy. The prognosis in patients with coeliac node metastasis was compared with patients with no such metastasis and patients with more distant metastasis. Multivariable Cox proportional-hazards regression models provided hazard ratios (HRs) with 95% confidence intervals (CIs) of disease-specific and overall mortality. Among 446 patients, 346 (77.6%) had no coeliac node metastasis, 56 (12.6%) had coeliac node metastasis, and 44 (9.9%) had more distant metastasis. Compared to coeliac node negative patients, coeliac node positive patients were at a 52% increased risk of disease-specific mortality (HR = 1.52, 95% CI 1.10-2.10), while patients with more distant metastasis had a 27% statistically non-significant increase (HR = 1.27, 95% CI 0.88-1.83). Patients with distant metastasis had no increase in disease-specific mortality compared to those with coeliac node metastasis (HR 0.71, 95% CI 0.40-1.27). Thus, patients with distal oesophageal cancer with coeliac node metastasis seem to have a similarly poor survival as patients with more distant metastasis, and thus may not benefit from surgery.
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| 13. |
- Rutegård, Martin, et al.
(författare)
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Time Shift in Early Postoperative Mortality After Oesophagectomy for Cancer
- 2015
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Ingår i: Annals of Surgical Oncology. - : Springer Science and Business Media LLC. - 1068-9265 .- 1534-4681. ; 22:9, s. 3144-3149
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPostoperative mortality is traditionally defined as death within 30 days of surgery. We hypothesised that the declining 30-day mortality after oesophageal cancer resection is, at least partly, explained by a shift towards increased 90-day mortality.MethodsThis population-based cohort study included 95 % of all patients who underwent surgical resection for oesophageal cancer in Sweden in 1987–2010. Cox proportional-hazards regression models were used to calculate hazard ratios (HRs) with 95 % confidence intervals (CIs) of 30-day and 31–90 days postoperative mortality in three calendar periods (1987–1994, 1995–2002, and 2003–2010). Adjustments were made for age, sex, comorbidity, tumour stage, tumour histology, surgical radicality, neoadjuvant therapy, and hospital volume of oesophagectomy.ResultsAmong 1,822 patients, the 30-day postoperative mortality decreased from 9.3 % in 1987–1994 to 3.0 % in 2003–2010, while the corresponding 31–90 days mortality decreased from 8.4 to 4.6 %. The adjusted HR of 30-day mortality in the earliest period was markedly increased compared to the latest period (HR 3.26; 95 % CI 1.96–5.45), whereas the corresponding HR of 31–90 days mortality was weaker (HR 2.16; 95 % CI 1.34–3.46). Among patients who died within 90 days of surgery, the proportion of 31–90 days mortality increased from 47 to 61 % during the study period.ConclusionsThis population-based study indicates a shift of postoperative mortality following surgery for oesophageal cancer from 30 days to 31–90 days with more recent calendar periods. Reporting of 90-day mortality rates might replace 30-day mortality rates in assessing early postoperative mortality in oesophageal cancer patients.
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| 14. |
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| 15. |
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| 16. |
- Brusselaers, Nele, et al.
(författare)
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Menopausal hormone therapy and the risk of esophageal and gastric cancer
- 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
- A protective effect of female sex hormones has been suggested to explain the male predominance in esophageal and gastric adenocarcinoma, but evidence is lacking. We aimed to test whether menopausal hormone therapy (MHT) decreases the risk of these tumors. For comparison, esophageal squamous cell carcinoma was also assessed. This population-based matched cohort study included all women who had ever used systemic MHT in Sweden in 2005-2012. A comparison cohort of non-users of MHT was matched to the MHT-users regarding age, parity, thrombotic events, hysterectomy, diabetes, obesity, smoking-related diseases, and alcohol-related diseases. Individuals with any previous cancer were excluded. Data on MHT use, cancer, comorbidity, and mortality were collected from well-established Swedish nationwide registers. Odds ratios (OR) with 95% confidence intervals (CI) were calculated using conditional logistic regression. Different MHT regimens and age groups were compared in sub-group analyses. We identified 290,186 ever-users and 870,165 non-users of MHT. Ever-users had decreased ORs of esophageal adenocarcinoma (OR=0.62, 95% CI 0.45-0.85, n=46), gastric adenocarcinoma (OR=0.61, 95% CI 0.50-0.74, n=123), and esophageal squamous cell carcinoma (OR=0.57, 95% CI 0.39-0.83, n=33). The ORs were decreased for both estrogen-only MHT and estrogen and progestin combined MHT, and in all age groups. The lowest OR was found for esophageal adenocarcinoma in MHT-users younger than 60 years (OR=0.20, 95% CI 0.06-0.65). Our study suggests that MHT-users are at a decreased risk of esophageal and gastric adenocarcinoma, and also of esophageal squamous cell carcinoma. The mechanisms behind these associations remain to be elucidated.
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| 17. |
- Brusselaers, Nele, et al.
(författare)
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Tumour staging of oesophageal cancer in the Swedish Cancer Registry : a nationwide validation study
- 2015
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Ingår i: Acta Oncologica. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 1651-226X.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Tumour stage was introduced to the Swedish Cancer Registry in 2004, but this key variable for prognostic research has not yet been validated. We validated the tumour stage data in surgically treated oesophageal cancer patients. Material and Methods: Completeness and accuracy of tumour stage according to the TNM system (“Tumour Node Metastasis”) in the Cancer Registry were compared with a cohort study including comprehensive tumour stage data based on the pathological TNM of almost all patients operated for oesophageal cancer in 2006-2010 in Sweden. Results: Of the 397 patients with pathological TNM data in the comparison cohort, the Cancer Registry reported an overall TNM stage in 390 patients (98.2%), which was based on the pathological TNM of 104 patients (26.2%), the clinical TNM of 183 patients (46.1%), and the pathological or clinical TNM (undefined) of 110 patients (27.7%). The completeness for the separate T, N, and M components was 89.4%, 90.9%, and 85.1%, respectively. The concordance with tumour stage was 98.2%, while it was 51.1%, 70.5%, and 80.4% for the separate T, N, and M components, respectively. While the concordance with tumour stage was high for all TNM assessment groups (98.1-98.4%), the concordance of the T and N components was highest when using pathological TNM (82.7% and 95.2%, respectively), and the concordance of the M component was highest when using clinical TNM (88.5%). Conclusion: Although the overall completeness of tumour stage is high, the recording of pathological TNM stage and individual components could be improved within the Swedish Cancer Registry.
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| 18. |
- Buhre, Torsten, et al.
(författare)
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A Child´s perspective in football coach education : an action research project
- 2017
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: This action-research project was initiated by a Regional Football association in Sweden. The region encompasses, 380 clubs, 2.500 youth teams and approximately 25.000 players between the age of 6 and 12 years. 150 football-coaching courses are completed yearly and a total 2.710 coaches have completed these courses, since 2010. A board decision was made (10/1/2016): To make a shift down-sizing the importance of winning that exists at the youth-level to focusing on the individual soccer-development of all participants. This decision was made because the drop-out rate has increased in the age-group around the age of 10, and reports of both physical and verbal abuse has increased during the later years. The Association contacted Malmö University with an initial request to enforce the board decision: What research is available on positive youth development in sports and children´s development over time? Initial actions: The process started with 10 two hour meetings, discussing definitions and perspectives to gain a common ground of understand both the problem at hand and the interpretations of possible mechanisms creating the problem. The collective view on what needed to be done after these initial meetings, was a change in perspective away from a focus on sports to a see the world from a child´s perspective. Thus, a major culture change is needed on all levels in order to alleviate the problem at hand. Consequences of actions: The greatest leverage for a cultural change is the coach education. Coaches are the “keeper” of values and belief systems on the grass-root level. The initial collective analysis revealed a gap between the research and the material distributed by the National Football Federation, based on the UEFA standards. The gap was between “what to do in organized football” and “how to do it, from a child´s perspective”. In the material, the sport transpose it´s importance and the child gets lost in translation. Further actions: The next step is in progress and it entails participation in coach education courses, analyzing course evaluations and further discussions to the identified the incongruences between the child´s perspective and the focus on football. Initial analysis has identified three problematic factors: The lack of participation of youth soccer players, the focus on ball-movement in all videos and the constant use of a grown-up terminology in analyzing the game of football. To alleviate this problem the use of authentic learning is suggested, by the research team.
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| 19. |
- Doorakkers, Eva, et al.
(författare)
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Early complications following oesophagectomy for cancer in relation to long-term healthcare utilisation: a prospective population-based cohort study
- 2015
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Ingår i: Plos One. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 1932-6203.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Little is known about how early postoperative complications after oesophagectomy for cancer influence healthcare utilisation in the long-term. We hypothesised that these complications also increase healthcare utilisation long after the recovery period. METHODS: This was a prospective, nationwide Swedish population-based cohort study of patients who underwent curatively intended oesophagectomy for cancer in 2001-2005 and survived at least 1 year postoperatively (n = 390). Total days of in-hospitalisation, number of hospitalisations and number of visits to the outpatient clinic within 5 years of surgery were analysed using quasi-Poisson models with adjustment for patient, tumour and treatment characteristics and are expressed as incidence rate ratios (IRR) and 95% confidence intervals (CI). RESULTS: There was an increased in-hospitalisation period 1-5 years after surgery in patients with more than 1 complication (IRR 1.5, 95% CI 1.0-2.4). The IRR for the number of hospitalisations by number of complications was 1.1 (95% CI 0.7-1.6), and 1.2 (95% CI 0.9-1.6) for number of outpatient visits in patients with more than 1 complication. The IRR for in-hospitalisation period 1-5 years following oesophagectomy was 1.8 (95% CI 1.0-3.0) for patients with anastomotic insufficiency and 1.5 (95% CI 0.9-2.5) for patients with cardiovascular or cerebrovascular complications. We found no association with number of hospitalisations (IRR 1.2, 95% CI 0.7-2.0) or number of outpatient visits (IRR 1.3, 95% CI 0.9-1.7) after anastomotic insufficiency, or after cardiovascular or cerebrovascular complications (IRR 1.2, 95% CI 0.7-1.9) and (IRR 1.1, 95% CI 0.8-1.5) respectively. CONCLUSION: This study showed an increased total in-hospitalisation period 1-5 years after oesophagectomy for cancer in patients with postoperative complications, particularly following anastomotic insufficiency.
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| 20. |
- Doorakkers, Eva, et al.
(författare)
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Eradication of Helicobacter pylori and gastric and oesophageal cancer : a systematic review and meta-analysis of cohort studies
- 2016
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Ingår i: Journal of the National Cancer Institute. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 0027-8874 .- 1460-2105.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Helicobacter pylori (H. pylori) is associated with an increased risk of gastric adenocarcinoma and gastric mucosa associated lymphoid tissue (MALT) lymphoma, and a seemingly decreased risk of oesophageal adenocarcinoma. We aimed to assess how eradication therapy for H. pylori influences the risk of developing these cancers. Methods: This was a systematic review and meta-analysis. We searched PubMed, Web of Science, Embase and the Cochrane Library and selected articles that examined the risk of gastric cancer, MALT lymphoma or oesophageal cancer following eradication therapy, compared to a non-eradicated control group. Results: Among 3629 articles that were considered, 9 met the inclusion criteria. Of these, 8 cohort studies assessed gastric cancer, while 1 randomized trial assessed oesophageal cancer. Out of 12,899 successfully eradicated patients, 119 (0.9%) developed gastric cancer, compared to 208 (1.1%) out of 18,654 non-eradicated patients. The pooled relative risk of gastric cancer in all 8 studies was 0.46 (95% confidence interval 0.32-0.66, I2 32.3%) favouring eradication therapy. The 4 studies adjusting for time of follow-up and confounders showed a relative risk of 0.46 (95% confidence interval 0.29-0.72, I2 44.4%). Conclusion: This systematic review and meta-analysis indicates that eradication therapy for H. pylori prevents gastric cancer. There was insufficient literature for meta-analysis of MALT lymphoma or oesophageal cancer.
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