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  • SURVIVAL  (9)
  • carcinoma  (6)
  • 1
    Keywords: CANCER ; SURVIVAL ; THERAPY ; BREAST-CANCER ; TRIALS ; colorectal cancer ; chemotherapy ; COLON-CANCER ; QUESTIONNAIRE ; MANAGEMENT ; UPDATE ; quality of life ; SURVIVORS ; ADJUVANT CHEMOTHERAPY ; OLDER ; CANCER SURVIVORS ; Long term
    Abstract: Purpose. To investigate the age-specific pattern of administration of chemotherapy and its association with long-term survival and quality of life (QoL) in stage II and III colorectal cancer patients. Methods. Chemotherapy allocation according to disease and patient characteristics was investigated in a population-based cohort of 562 stage II and III colorectal cancer patients. Five years after diagnosis, survival was determined and QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 Items and a tumor specific module. The association among chemotherapy, survival, and QoL was examined while controlling for potential confounders. Results. Chemotherapy was administered in 71% of patients aged 〈60 years and in only 20% of patients aged 〉/=80 years. A significant association between chemotherapy and longer survival time was found for stage III cancer only. Chemotherapy was associated with higher symptom levels for trouble with taste, anxiety, and hair loss. In age-specific analyses, younger survivors (〈70 years at time of follow-up) with a history of chemotherapy reported significantly lower physical, role, and cognitive functioning and higher pain, appetite loss, hair loss, and trouble with taste symptom levels. In contrast, for older survivors (〉/=70 years), only two (hair loss and dry mouth) out of 38 QoL scores were significantly associated with chemotherapy. Discussion. Chemotherapy is associated with lower long-term QoL, especially in younger survivors. In cases of uncertain survival benefits of chemotherapy, consideration of its long-term effects on QoL should be incorporated into final decisions on treatment.
    Type of Publication: Journal article published
    PubMed ID: 22101506
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  • 2
    Keywords: CANCER ; SURVIVAL ; DIAGNOSIS ; DISEASE ; POPULATION ; AGE ; colorectal cancer ; COLON-CANCER ; MORPHOLOGY ; SUBSITE ; EUROPE ; PATIENT SURVIVAL ; PERIOD ANALYSIS ; colonoscopy ; EMPIRICAL-EVALUATION ; colorectal ; UP-TO-DATE ; EUROCARE-4
    Abstract: BACKGROUND: Colorectal cancer is the most common cancer in Germany and the second most common cause of cancer-related deaths in both men and women. The aim of this study is to provide detailed analysis of recent developments in survival of colorectal cancer patients using newly available data on a national basis. METHODS: We included data from 11 German cancer registries covering a population of 33 million inhabitants. Period analysis and modelled period analysis were used to provide most up-to-date estimates of 5-year relative survival in 2002-2006. RESULTS: The analysis was based on records of 164 996 colorectal cancer patients. Five-year relative survival was 63.0% overall, decreased with age and was significantly higher among women than among men in patients under 75 years. Overall age-adjusted 5-year relative survival increased from 60.6 to 65.0% over the period 2002-2006. Significant increase in survival was only observed in patients with localised or regional disease. Highest subsite-specific survival was observed in patients with cancer in descending (67.7%) and ascending (66.5%) colon. CONCLUSION: Survival of patients with colorectal cancer continued to increase in the early 21st century in Germany, with 5-year relative survival reaching 65% in 2006. However, lack of progress still persisted in patients with advanced disease.
    Type of Publication: Journal article published
    PubMed ID: 22555397
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  • 3
    Keywords: CELLS ; EXPRESSION ; carcinoma ; ACTIVATION ; CARCINOGENESIS ; METASTASIS ; BETA ; POOR-PROGNOSIS ; TUMORIGENESIS ; EPITHELIAL-MESENCHYMAL TRANSITION
    Abstract: Epithelial-to-mesenchymal transition (EMT) contributes significantly to tumor progression and metastasis. The assessment of EMT-associated transcription factors could be a promising approach to identify biomarkers and potential therapeutic targets in colorectal cancer. In our study, we focused on the transcription factor Sine oculis homeobox (SIX) 1, which is a member of the superfamily of the homeobox genes and has been described to promote EMT in different types of tumors. Immunohistochemistry against SIX1 was performed on colorectal mucosa, adenomas, carcinomas-in situ and primary adenocarcinomas. An expression score was developed and subsequently assessed for its prognostic value in two independent cohorts. Cohort 1 consisted of 128 patients with stage I-III colorectal cancer; cohort 2 included 817 patients with stage I-III colorectal cancer who had participated in the DACHS study. HCT-116 cells were transfected with SIX1 plasmids and subjected to migration and colony formation assays. The expression of SIX1 increases gradually from mucosa to colorectal adenocarcinomas (p〉0.0001). Univariate and multivariate analyses reveal that high expression of SIX1 is associated with decreased overall survival (cohort 1: HR: 4.01, CI: 1.20-14.07, p=0.025; cohort 2: HR: 1.43, CI: 1.014-2.02, p=0.047). Overexpression of SIX1 induces a more mesenchymal-like phenotype in HCT-116 cells and enhances tumor migration. High expression of SIX1 is an independent prognostic marker in colorectal cancer. It might be a promising biomarker to stratify patients into different risk groups. Moreover, targeting SIX1 might be a novel therapeutic approach in patients with colorectal cancer. What's new? Gains in stem cell-like properties by tumor cells may be linked to the epithelial-to-mesenchymal transition (EMT), suggesting that changes in the expression of EMT-associated transcription factors are predictive of tumor progression. This study shows that progression of colorectal mucosa from normal to adenomatous to cancerous is accompanied by gradually increasing expression of sine oculis homeobox 1 (SIX1), a transcription factor known to regulate EMT-related mechanisms. In two separate colorectal patient cohorts, elevated SIX1 expression was found to be associated with decreased overall survival. The results indicate that SIX1 is of prognostic value in colorectal cancer.
    Type of Publication: Journal article published
    PubMed ID: 25951369
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  • 4
    Keywords: SURVIVAL ; neoplasms ; COMMON ; PATTERNS ; COUNTRIES ; SWEDEN ; DATABASE ; STRATEGIES ; EUROPE ; FAMILY-HISTORY
    Abstract: We aimed at investigating the distribution and risk of all second discordant primary cancers (SDPCs) after a specific first primary cancer in Germany and Sweden to provide etiological understanding of SDPCs and insight into their incidence rates and recording practices. Among 1,537,004 survivors of first primary cancers in Germany and 588,103 in Sweden, overall 80,162 and 32,544 SDPCs were recorded, respectively. Standardized incidence ratios (SIRs) of all SDPCs were elevated at levels between 1.1 and 2.1 after 23 (out of overall 29) cancers in Germany and at levels between 1.1 and 1.6 after 24 cancers in Sweden, and among them, elevated SIRs were found after 19 cancers in both populations. Decreased SIRs at levels ranging from 0.5 to 0.9 were found for some cancers with poor prognosis in Germany only. We found elevated risk after 19 out of 29 cancers in both countries, suggesting common etiology of SDPCs after most of first cancers and registration similarity. Decreased risks after some fatal cancers were found only in Germany, which may be attributed to reporting practices or missed death data in Germany.
    Type of Publication: Journal article published
    PubMed ID: 26319898
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  • 5
    Keywords: carcinoma ; CLASSIFICATION ; MORTALITY ; TUMORS ; TRENDS ; EUROPE ; PERIOD ANALYSIS ; ENGLAND ; WALES ; EUROCARE-4
    Abstract: Introduction: The aim of this study was to provide detailed age-specific (5-year age groups) and histology-specific (histologic subtypes of seminoma and nonseminoma) relative survival estimates of testicular germ cell cancer patients in Germany and the United States (U.S.) for the years 2002-2006 and to compare these estimates between countries. Methods: We pooled data from 11 cancer registries of Germany and used data from the U.S. (SEER-13 database) including 11,508 and 10,774 newly diagnosed cases (1997-2006) in Germany and the U.S., respectively. We estimated 5-year relative survival (5-year-RS) by histology and age based on period analysis. Results: 5-year-RS for testicular germ cell tumors was 96.7% and 96.3% in Germany and the U.S., respectively. 5-Year-RS for spermatocytic seminoma was close to 100% in both countries. 5-Year-RS for nonseminoma was lower than for classical seminoma in Germany (93.3% versus 97.6%) and the U.S. (91.0% versus 98.2%). Among nonseminomas, choriocarcinomas provided the lowest 5-year-RS in both countries (Germany 80.1%, U.S. 79.6%). Age-specific 5-year-RS for seminoma showed only little variation by age. 5-Year-RS for nonseminomas tended to be lower at higher ages, especially for malignant teratoma. Discussion: This is the first study that provides up-to-date survival estimates for testicular cancer by histology and age in Germany and the U.S. Survival after a diagnosis of testicular cancer is very comparable between Germany and the U.S. 5-Year-RS for spermatocytic seminoma was close to 100% and the lowest 5-year-RS occurred among choriocarcinoma. Higher age at diagnosis is associated with a poorer prognosis among nonseminoma patients.
    Type of Publication: Journal article published
    PubMed ID: 23623488
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  • 6
    Keywords: CELLS ; SURVIVAL ; THERAPY ; COHORT ; BREAST-CANCER ; MELANOMA ; QUALITY-OF-LIFE ; NOREPINEPHRINE
    Abstract: Recent observational studies have suggested that the use of beta blockers might be associated with better prognosis after cancer. Because evidence is limited for colorectal cancer (CRC), the association of beta blocker use and prognosis was investigated in a large population-based cohort of patients with CRC. METHODS Between 2003 and 2007, information on beta blocker use at diagnosis and potential confounders was collected by personal interviews for 1975 patients with CRC. Vital status, cause of death, and recurrence status were assessed during a median follow-up time of 5.0 years. The associations of beta blocker use and overall, CRC-specific, and recurrence-free survival were estimated by Cox proportional hazard regression. In addition, beta blocker subgroup, site, and stage-specific analyses were performed. RESULTS After adjustment for covariates including sociodemographic, cancer-related, and lifestyle factors and comorbidity and medications, no significant association between beta blocker use at diagnosis and prognosis was observed for all stages combined. However, in stage-specific analyses, beta blocker use was associated with longer overall survival (hazard ratio = 0.50; 95% confidence interval = 0.33-0.78) and CRC-specific survival (hazard ratio = 0.47; 95% confidence interval = 0.30-0.75) in stage IV patients. For these patients, median overall survival was 18 months longer and CRC-specific survival was 17 months longer for beta blocker users than for nonusers (38 versus 20 months and 37 versus 20 months, respectively). CONCLUSIONS These results suggest that beta blocker use might be associated with longer survival in patients with stage IV CRC.
    Type of Publication: Journal article published
    PubMed ID: 24415516
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  • 7
    Keywords: SURVIVAL ; CLASSIFICATION ; SYSTEM ; IMPACT ; metastases ; ADENOCARCINOMAS ; rectum ; SPREAD ; PERICOLONIC TUMOR DEPOSITS ; OPTIMAL CATEGORIZATION
    Abstract: BACKGROUND: pN1c is a novel N-category introduced for colorectal cancer (CRC) in current TNM (Tumour, Node, Metastasis) classification. It represents cancers displaying tumour deposits (TDs) in the fat but no involvement of lymph nodes. pN1c is integrated into the UICC (International Union Against Cancer) staging system and shifts previous stage II cancers (6th edition) to stage III. We investigated the frequency of upstaging and TD prognostic significance. METHODS: 414 CRCs, consecutively collected during a population-based epidemiological study, TNM classified and UICC staged according to the 6th TNM edition were reinvestigated for TD presence. The association with survival was investigated after a median follow-up time of 5years in multivariate analyses among nodal negative and positive cases. RESULTS: TDs were found in 103 (24.9%) cancers and were strongly associated with T-, N- and M-stages (p〈0.0001, each). Upstaging of previous stage II cancers by the presence of TDs (pN1c) was found in six of 140 cases (4.3% of stage II, 1.4% of all tumours). For stage III CRC, strongly reduced overall, CRC-specific and recurrence-free survival were observed with the presence of TDs (hazard ratios (HR) 2.29, 95% confidence interval 1.27-4.10, HR 2.51, 1.27-4.98, and HR 2.43, 1.32-4.48, respectively). CONCLUSIONS: Upstaging of CRCs through the introduction of pN1c occurs in less than 5% of previous stage II and less than 2% of all cancers. Given the biologic relevance of TDs, integration into the UICC staging relevant N-category is justified. The high prognostic impact of TDs, however, is not reflected in nodal positive cancers in both the TNM and UICC staging systems.
    Type of Publication: Journal article published
    PubMed ID: 25281526
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  • 8
    Keywords: SURVIVAL ; RATES ; RESECTION ; CARCINOMAS ; III COLON-CANCER ; SPECIMENS ; PATHOLOGISTS ; LYMPHADENECTOMY ; STAGE-III ; MINIMUM NUMBER
    Abstract: Colorectal cancer guidelines recommend adjuvant chemotherapy in stage II disease when less than 12 lymph nodes are assessed. The recommendation bases on previous studies showing an association of a low lymph node count and adverse outcome. Compared to current standards, however, the quality of lymph node examination in the studies was low. We, therefore, investigated the prognostic role of 〈12 lymph nodes in cancers diagnosed adherent to current quality measures. Stage I-IV colorectal cancers from 1,899 patients enrolled into a population-based cohort study were investigated for the prognostic impact of a lymph node count 〈12. The stage specific share of patients diagnosed with 12 nodes (stage I-IV: 62, 85, 85, 78%, respectively) was used to compare lymph node examination quality to other studies. We found no impact of a lymph node count 〈12 on overall, cancer-specific or recurrence-free survival for any tumour stage. Compared to studies reporting an adverse prognostic impact of a low lymph node count in stages II and III the stage-specific shares of patients with 12 nodes were markedly higher in this study (85% vs. 24-58% in previous analyses) and this correlated with increased rates of stage III compared to stage II cancers. In conclusion our data indicate, that the previously reported effect of a low lymph node count on the patients' outcomes is eliminated by improved lymph node examination quality and thus question the general applicability of a 12 lymph node cut off for adjuvant chemotherapy decision making in stage II disease.
    Type of Publication: Journal article published
    PubMed ID: 25231924
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  • 9
    Keywords: CANCER ; SURVIVAL ; POPULATION ; ACCURACY ; epidemiologic methods ; REGISTRIES ; RATIOS
    Abstract: Background:Relative survival estimates cancer survival in the absence of other causes of death. Previous work has shown that standard errors of non-standardised relative survival may be substantially overestimated by the conventionally used method. However, evidence was restricted to non-standardised relative survival estimates using Hakulinen's method. Here, we provide a more comprehensive evaluation of the accuracy of standard errors including age-standardised survival and estimation by the Ederer II method.Methods:Five- and ten-year non-standardised and age-standardised relative survival was estimated for patients diagnosed with 25 common forms of cancer in Finland in 1989-1993, using data from the nationwide Finnish Cancer Registry. Standard errors of mutually comparable non-standardised and age-standardised relative survival were computed by the conventionally used method and compared with bootstrap standard errors.Results:When using Hakulinen's method, standard errors of non-standardised relative survival were overestimated by up to 28%. In contrast, standard errors of age-standardised relative survival were accurately estimated. When using the Ederer II method, deviations of the standard errors of non-standardised and age-standardised relative survival were generally small to negligible.Conclusion:In most cases, overestimations of standard errors are effectively overcome by age standardisation and by using Ederer II rather than Hakulinen's method.
    Type of Publication: Journal article published
    PubMed ID: 22173672
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  • 10
    Keywords: SURVIVAL ; THERAPY ; MORTALITY ; BREAST-CANCER ; prevention ; WOMEN ; smoking ; HYPERTENSION ; METAANALYSIS ; bias
    Abstract: BACKGROUND: Recently, it has been postulated that long-term use of beta blockers might decrease the risk of certain types of cancer because of weakening of norepinephrine signaling. Previous studies on colorectal cancer (CRC) yielded inconsistent results, but lacked information on covariates. Thus, the authors investigated the association of beta blocker use and CRC risk in a large population-based case-control study (DACHS study). METHODS: Between 2003 and 2007, information on beta blocker use and potential confounders was collected by personal interviews for 1762 CRC cases and 1708 control individuals from Germany. The association of CRC risk and beta blocker use and subclasses of beta blockers was estimated by multiple logistic regression. In addition, site- and stage-specific analyses were performed. RESULTS: After adjustment for covariates, no association was observed with beta blocker use (odds ratio [OR], 1.05; 95% confidence interval [CI], 0.86-1.29) or with duration of beta blocker use. Also, the analysis by subclasses of beta blockers (cardioselectivity) and active ingredients (metoprolol, bisoprolol, carvedilol, and atenolol) or by CRC subsite showed no associations. In stage-specific analyses, long-term beta blocker use (6+ years) was associated with a significantly higher risk of stage IV CRC (OR, 2.02; 95% CI, 1.25-3.27). CONCLUSIONS: Our adjusted results do not support the hypothesis that beta blocker use is associated with decreased risk of CRC. In contrast, we found a positive association of long-term beta blocker use and risk of stage IV CRC. The latter result should be further evaluated in future studies.
    Type of Publication: Journal article published
    PubMed ID: 22585669
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