Better survival in patients with metastasised kidney cancer after nephrectomy: a population-based study in the Netherlands

Aim

Cytoreductive nephrectomy is considered beneficial in patients with metastasised kidney cancer but only a minority of these patients undergo cytoreductive surgery. Factors associated with nephrectomy and the independent effect of nephrectomy on survival were evaluated in this study.

Methods

Patients were selected from the population-based cancer registry and detailed data were retrieved from clinical files. Factors associated with nephrectomy were evaluated by logistic regression analyses. Cox proportional hazard regression analysis was performed to evaluate factors associated with survival; a propensity score reflecting the probability of being treated surgically was included in order to adjust for confounding by indication.

Results

37.5% of 328 patients diagnosed with metastatic kidney cancer between 1999 and 2005 underwent nephrectomy. Patients with a low performance score, high age, ?2 comorbid conditions, ?2 metastases, low or high BMI, weight loss, elevated lactate dehydrogenase, elevated alkaline phosphatase, female gender and liver or bone metastases were less likely to be treated surgically. Three year survival was 25% and 4% for patients with and without nephrectomy, respectively (p < 0.001). After adjustment for other prognostic factors including the propensity score, nephrectomy remained significantly associated with better survival (Hazard ratio: 0.52, 95% Confidence interval: 0.37-0.73).

Conclusions

Even after accounting for prognostic profile, patients still benefit from a nephrectomy; an approximately 50% reduction in mortality was observed. It is, therefore, recommended that patients with metastasised disease receive cytoreductive surgery when there is no contraindication. Trial results on cytoreductive surgery combined with targeted molecular therapeutics are awaited for.     

Treatment of metachronous colorectal cancer metastases in the Netherlands: A population-based study

BackgroundThis study aimed to describe the treatment of metachronous colorectal cancer metastases in a recent population-based cohort.MethodPatients with stage I-III colorectal cancer (CRC), diagnosed between January 1st and June 30th^, 2015 who were surgically treated with curative intent were selected from the Netherlands Cancer Registry. Follow-up was at least 3 years after diagnosis of the primary tumour. Treatment of metachronous metastases was categorized into local treatment, systemic treatment, and best supportive care. Overall survival was estimated using Kaplan-Meier method.ResultsOut of 5412 patients, 782 (14%) developed metachronous metastases, of whom 393 (50%) underwent local treatment (LT) with or without systemic therapy, 30% of patients underwent only systemic therapy (ST) and 19% only best supportive care (BSC). The most common metastatic site was the liver (51%) followed by lungs (33%) and peritoneum (22%). LT rates were 69%, 66%, and 44% for liver-only, lung-only and, peritoneal-only metastases respectively. Patients receiving LT and ST were significantly younger than patients receiving LT alone, while patients receiving BSC were significantly older than the other groups (p < 0.001). Patients with liver-only or lung-only metastases had a 3-year OS of 50.2% (43.3–56.7 95% CI) and 61.5% (50.7–70.6 95% CI) respectively. Patients with peritoneal-only disease had a lower 3-year OS, 18.1% (10.1–28.0 95% CI).ConclusionPatients with metastases confined to the liver and lung have the highest rates of local treatment for metachronous metastatic colorectal cancer. The number of patients who underwent local treatment is higher than reported in previous Dutch and international studies.     

The impact of surgery delay on survival of resectable pancreatic cancer: A systematic review of observational studies

BackgroundPancreatic cancer is considered a lethal disease and the only potentially curative option is R0 excision. The aim of this study was to investigate whether the waiting time interval from diagnosis to surgical treatment affects overall survival in patients who undergo curative-intent surgery for pancreatic cancer.MethodsSearch in Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar databases was conducted from inception until April 2022.ResultsOverall, 10 studies were included that enrolled 181,344 patients. The dominating cut-off time point was 4 weeks in studies which utilized a biphasic waiting time pattern. In addition, prolonged waiting time interval was associated with decreased overall survival in 3 studies, whereas it demonstrated a favorable effect on overall survival in 2 studies and no impact on survival in 5 studies.ConclusionThe great diversity that was observed regarding the impact of surgery delay on survival underlines the lack of knowledge about biologic pathways of pancreatic cancer. Novel imaging studies and molecular “fingerprints” in combination to time-to-treatment standardization in the design of future randomized trials could lead to the recognition of patients that could benefit from a timely resection.     

肿瘤相关贫血、肿瘤病理状况与胃癌患者生存预后的相关性研究

目的：研究胃癌患者肿瘤相关贫血对胃癌患者生存时间的影响。方法：选取2001～2005年病理确诊的术前胃癌患者，通过检索患者住院病历和随访来获取研究资料，应用SPSS软件处理和分析影响胃癌患者预后的因素。结果：669例获生存随访等资料的胃癌患者，术前有无贫血，其生存时间存在显著差异[（23．9±1．7）个月摊．（35．1±2．2）个月，P〈0．01]；按胃癌TNM分期计算有无贫血患者的生存时间，在I期胃癌患者中，无贫血和有贫血患者的生存期分别是（79．9±2．0）个月和（63．5±7．1）个月（P〈0．01），但是在Ⅱ期、Ⅲ期和Ⅳ期患者中，未见生存时间存在显著差异（P〉0．05）。Cox回归分析表明，有无贫血和胃癌患者预后无显著相关性，而胃癌的肿瘤直径（P=0．009）、肿瘤分化程度（P=0．004）和TNM分期（P〈0．001）与胃癌患者预后显著相关。结论：有肿瘤相关性贫血的胃癌患者生存期短于无贫血患者；影响胃癌患者生存期的独立预后因素为肿瘤分期、肿瘤分化程度和肿瘤直径。     

The impact of radiotherapy on survival in resectable gastric carcinoma: a meta-analysis of literature data

BACKGROUND: The benefit of external radiotherapy for gastric carcinoma has been extensively studied, but data on survival are still equivocal. OBJECTIVE: To assess the effectiveness of surgery combined with preoperative radiotherapy or postoperative chemoradiotherapy in the reduction of all-cause mortality in patients with resectable gastric carcinoma. METHODS: Computerised bibliographic searches of MEDLINE and CANCERLIT (1970-2006) were supplemented with hand searches of reference lists. STUDY SELECTION: Studies were included if they were randomised controlled trials (RCTs) comparing mortality of surgery combined with preoperative radiotherapy or postoperative chemoradiotherapy to surgery alone, and if they included patients with histologically-proven gastric adenocarcinoma without metastases. Nine eligible RCTs, 4 of preoperative radiotherapy (832 patients) and 5 of postoperative chemoradiotherapy (869 patients), were identified and included in the meta-analysis. DATA EXTRACTION: Data on study populations, interventions, and outcomes were extracted from each RCT according to the intention to treat method by three independent observers and combined using the DerSimonian and Laird method. RESULTS: Surgery combined with preoperative radiotherapy compared to surgery alone significantly reduced the 3-year (OR 0.57; 95% CI 0.43-0.76: p=0.0001) and 5-year (OR 0.62; 95% CI 0.46-0.84; p=0.002) mortality rate. A significant reduction of the 5-year (OR 0.45; 95% CI 0.32-0.64; p<0.00001) mortality rate was observed when surgery followed by chemoradiotherapy was compared to surgery alone. CONCLUSIONS: In patients with resectable gastric carcinoma, adjuvant radiotherapy significantly reduces 3-year and 5-year all-cause mortality, but the magnitude of the benefit is relatively small. Available evidence is inadequate to determine whether postoperative chemoradiotherapy is superior to preoperative radiotherapy.     

North European comparison of treatment strategy and survival in older patients with resectable gastric cancer: A EURECCA upper gastrointestinal group analysis

Background

As older gastric cancer patients are often excluded from randomized clinical trials, the most appropriate treatment strategy for these patients remains unclear. The current study aimed to gain more insight in treatment strategies and relative survival of older patients with resectable gastric cancer across Europe.

管状胃与全胃代食管术治疗食管癌的疗效比较

目的 比较管状胃代食管术与全胃代食管术治疗食管癌的临床疗效。方法 回顾性分析2007年1月至2012年1月在我院接受食管癌手术患者的病例资料;比较管状胃组（n=53）和全胃代食管组(n=48)患者在术中吻合口位置、术中出血量、手术时间、术后胃肠减压时间、胃肠减压量、胸腔闭式引流管拔除时间、胸腔引流液量、术后并发症发生情况及术后1个月的肺功能等临床指标上的差异。结果 管状胃组患者术后反流性食管炎的发生率为5.7％（3／53）,低于全胃组的25.0％（12／48）,差异具有统计学意义（P=0.01）;管状胃组无术后胸胃综合征,全胃组的发生率为8.3％（4／48）;管状胃组术后1个月的肺活量占预计值的百分比、最大通气量占预计值的百分比及第一秒用力呼气容积占预计值的百分比均显著高于全胃组,差异均有统计学意义（P＜0.01）。结论 管状胃代食管术较全胃代食管术可降低术后反流、胸胃综合征的发生率,且对患者术后呼吸功能影响较小。     

Estimation of Cancer Incidences in Aichi Prefecture: Use of a Model Area with Good Quality Registry Data

In Japan, local government is responsible for organization of population-based cancer registries and the quality ‍of the registration remains modest, mainly due to dependence on voluntary-based operations without legal obligations. ‍Aichi Prefecture cancer registry covers a large population, estimated at 7 million, and its quality has yet to reach the ‍level required internationally. The derived cancer incidences for Aichi Prefecture therefore tend to be underestimated. ‍In the present study we set up a model area, located in the central part of Aichi Prefecture, with a good quality of ‍registry data, covering a reasonable population, including both urban and rural areas. Our model area has typical ‍demographic features of Aichi Prefecture. ‍The materials were data on cancer incidence and deaths during the period of 1996-2000 in this model area of ‍Aichi prefecture, with a population of approximately one million, under the jurisdiction of three public health ‍centers, covering nine municipalities. The percentage of death certificated notified (DCN) cases for all sites was ‍around 14% and the incidence/death ratio was around 1.9. Estimated age-adjusted incidence rates were found to be ‍256.0 (per 100,000) for males and 177.6 for females, these values being 10~15 % higher than those generated using ‍data for the whole prefecture, and quite close to incidence rates in Japan estimated from the highest quality of data ‍available. It is suggested that the cancer incidence in the Aichi prefecture is indeed being underestimated and that ‍the actual figures may be closer to the estimates provided here. ‍     

Textbook outcome and survival after gastric cancer resection with curative intent: A population-based analysis

BackgroundThe concept of textbook outcome (TO) has been proposed for analyzing quality of surgical care. This study assessed the incidence of TO among patients undergoing curative gastric cancer resection, predictors for TO achievement, and the association of TO with survival.MethodAll patients with gastric and gastroesophageal junction cancers undergoing curative gastrectomy between January 2014–December 2017 were identified from a population-based database (Spanish EURECCA Registry). TO included: macroscopically complete resection at the time of operation, R0 resection, ≥15 lymph nodes removed and examined, no serious postoperative complications (Clavien-Dindo ≥II), no re-intervention, hospital stay ≤14 days, no 30-day readmissions and no 90-day mortality. Logistic regression was used to assess the adjusted achievement of TO. Cox survival regression was used to compare conditional adjusted survival across groups.ResultsIn total, 1293 patients were included, and TO was achieved in 541 patients (41.1%). Among the criteria, “macroscopically complete resection” had the highest compliance (96.5%) while “no serious complications” had the lowest compliance (63.7%). Age (OR 0.53 for the 65–74 years and OR 0.34 for the ≥75 years age group), Charlson comorbidity index ≥3 (OR 0.53, 95%CI 0.34–0.82), neoadjuvant chemoradiotherapy (OR 0.24, 95%CI 0.08–0.70), multivisceral resection (OR 0.55, 95%CI 0.33–0.91), and surgery performed in a community hospital (OR 0.65, CI95% 0.46–0.91) were independently associated with not achieving TO. TO was independently associated with conditional survival (HR 0.67, 95%CI 0.55–0.83).ConclusionTO was achieved in 41.1% of patients who underwent gastric cancer resection with curative intent and was associated with longer survival.     

Enhanced recovery after surgery (ERAS) versus standard recovery for gastric cancer patients: The evidences and the issues

The significant advances that have been reached, in the last decades, in the treatment of gastric cancer, contributed to the concept of enhanced recovery after surgery (ERAS) with the aim to reduce the surgical stress, accelerate postoperative recovery, and reduce the length of hospital stay. The most important items included in the ERAS protocols are the pre-operative patient education, early mobilization and immediate oral intake from the first postoperative day. The aim of this narrative review is to focus the attention on the possible advantages of ERAS program on perioperative functional recovery outcomes after gastrectomy for gastric cancer.     

Impact of prior cancer history on survival of patients with gastric cancer

BackgroundPatients with prior cancer history are commonly excluded from clinical trial. However, the impact of prior cancer on survival of patients with gastric cancer remains largely unknown. The aim of this study was to evaluate the prevalence of prior cancer and assess its impact on survival of patients diagnosed with gastric cancer.MethodsPatients with gastric cancer as the primary or second primary malignancies diagnosed from 2004 to 2010 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was conducted to balance baseline characteristics. Kaplan-Meier method, multivariate Cox proportional hazard model, and multivariate competing risk model were performed for survival analysis.ResultsA total of 28,795 eligible patients with gastric cancer were included, of whom 2695 (9.35%) had a history of prior cancer. Prostate (35%), breast (12%), colon (8%), and urinary bladder (7%) malignancies were the most common prior cancer types. Patients with prior cancer history had slightly inferior overall survival (AHR = 1.06; 95% CI [1.00–1.12]; P = 0.043) but superior gastric cancer-specific survival (AHR = 0.82; 95% CI [0.76–0.88]; P < 0.001) compared with those without prior cancer. The subgroup analysis determined that a prior cancer history did not adversely affect gastric patients’ clinical outcomes, except in those with prior cancer diagnosed within one year, at distant stage, or originating from lung and bronchus.ConclusionA substantial proportion of gastric cancer patients with a history of prior cancer had non-inferior clinical outcome to those without prior cancer. These patients should be considered in clinical trials.     

Cancer survival in European adolescents and young adults

Survival of patients aged 15–24 years, diagnosed with cancer during the period of 1990–1994, is described within Europe. Data on 15 101 patients, extracted from the files of the 56 adult cancer registries included in the EUROCARE-3 database, representing 20 European countries, were analysed and compared. Five-year survival for ‘all cancers combined’ was 75% in males (ranging from 59% in Estonia to 89% in Iceland), and 78% in females (ranging from 59% in Estonia to 89% in Norway). The Northern European countries (except Denmark) and Austria had the highest survival figures, while survival in the Eastern European countries was lower than the European average. Denmark, UK, and the pool of the central European countries, had intermediate survival figures. Haemopoietic tumours were the most common malignancies: 5-year survival was high for Hodgkin's disease (89%), intermediate for non-Hodgkin's lymphoma (68%) and lower for acute lymphoblastic leukaemia (ALL) (47%) and acute myeloblastic leukaemia (AML) (39%). Five-year survival for gonadal germ cell cancers, the second most common malignancy in young adults, was 90%. Five-year survival for the other cancers under consideration was as follows: 89% for skin melanoma, 66% for all Central Nervous System (CNS) tumours, 57% for bone tumours, 58% for osteosarcoma, 42% for Ewing's sarcoma, 57% for soft-tissue sarcomas, 99% for thyroid carcinoma, 82% for uterine cervical carcinoma, and 83% for ovarian carcinoma. For more ‘adult-specific tumours’, 5-year survival was good for colon (77%) and lung (60%) cancers, and less favourable, compared with adults, for breast cancer (68%). Adolescents (15–19 years) had significantly worse survival than young adults (20–24 years) for all malignancies combined. Survival for Hodgkin's lymphoma, CNS tumours, melanoma and colon cancer showed marked regional variability. Since many of the tumours occurring in young adults are curable, these results should encourage, without delay, efforts to identify obstacles to improving outcome and reducing geographical inequalities in survival for this group of patients.     

Improving outcomes in gastric cancer over 20 years

Background Gastric cancer has in the past proven to be a difficult disease to cure. Surgery is the most effective treatment, although the extent of lymphadenectomy undertaken is controversial. This paper examines trends in the detection and treatment of gastric cancer, the move toward targeted surgery, and their impact on survival.Methods From 1982 to 2001, 430 patients with gastric cancer were under the care of a single surgeon at the same institution. Copies of the operation records, discharge summaries, and histology reports were retained and subsequently reviewed.Results Thirty-six patients were excluded from the analysis. Two hundred and five patients (52%) had potentially curative surgery for adenocarcinoma and 189 had incurable disease. During the 20-year period, overall 5-year survival increased significantly, from 15% to 41% (P < 0.01). The number of curative procedures also increased significantly, from 33% to 73% (P1 < 0.001) as disease was detected earlier, and 5-year survival in these patients increased from 26% to 46%. Eighty-seven D1, 92 D2, and 26 targeted procedures were performed, with 30-day mortalities of 5%, 9%, and 5%, respectively. The 5-year survival was 47% for D1, 42% for D2, and 66% for targeted surgery.Conclusion This paper demonstrates an improvement in the stage at which disease was detected and improvement in long-term survival for patients with gastric cancer. The development of targeted surgery has shown promising early results.     

Comparison of cancer registry and clinical data as predictors for breast cancer survival

Background  In spite of the increasing amount of clinically relevant information for survival from breast cancer, the amount of data recorded in a population-based cancer registry is limited and the registry-based survival predictions are routinely made without clinical details. Objective  To find out how important is the role of screening and clinical tumor characteristics in addition to cancer registry information in describing the breast cancer survival. Methods  A representative clinical database on 483 breast cancer patients diagnosed during 1996–1997 in Tampere University Hospital Area was linked with Finnish Cancer Registry data and a survival model including the available registry variables was compared to models including screen-detection information and clinical tumor characteristics also. Results and conclusion  Estimates of registry stage and age act as surrogates for clinical variables and mammography-detection. The surrogacy was found to be almost complete indicating that clinical variables are not necessarily needed when making breast cancer mortality predictions based on a population-based cancer registry. In cases with dissimilar staging cancer registry stage gave a better picture of the breast cancer survival than the clinical stage. This work was performed in Finnish Cancer Registry, Helsinki, Finland.     

Improved regional control and survival with “low Maruyama Index” surgery in gastric cancer: autopsy findings from the Dutch D1-D2 Trial

Based on more than 11 years of follow-up, autopsy-based analysis of recurrence in the Dutch D1-D2 Trial permits meaningful assessment of patterns of failure with respect to the Maruyama Index (MI). We previously reported that a low Maruyama Index was an independent predictor of both overall and disease-specific survival. Autopsy results are available for 441 deaths on study. Distant-only failure (15% vs 13%) was no different between the MI categories, but isolated “regional” failure (8% for MI < 5 group vs 21%) and “regional + distant” failure (19% for MI < 5 group vs 36%) occurred less frequently in the MI < 5 group (P < 0.001). We conclude that “low Maruyama Index” surgery enhances regional control and survival but does not alter the occurrence of isolated distant metastases unassociated with regional failure. Our results speak to the substantial survival value of local-regional control in this disease. Presented at the 79th Annual Meeting of the Japanese Gastric Cancer Association, held in Nagoya, Japan, March 1–3, 2007     

Procedure volume of gastric cancer resections versus 5-year survival

Aim

We used nationwide, population-based data to examine associations between hospital and surgeon volumes of gastric cancer resections and their patients’ short-term and long-term survival likelihood.

Methods

The study uses 1997–1999 inpatient claims data from Taiwan's National Health Insurance linked to “cause of death” data for 1997–2004. The total cohort of 6909 gastric cancer resection patients were categorized by their surgeon's/hospital's procedure volume, and examined for differences in 6-month mortality and 5-year mortality (post 6 months), by procedure volume, using Cox proportional hazard regressions, adjusting for surgeon, hospital and patient characteristics. We hypothesized that surgeons’ case volume and age but not hospital volume will predict short-term and long-term survival.

Results

Adjusted estimates show that increasing surgeon volume predicts better 6-month survival (adjusted mortality hazard ratio = 1.3 for low-volume surgeons relative to very high-volume surgeons; p < 0.01) and 5-year survival (adjusted mortality hazard ratios = 1.3; p < 0.001 for low-volume; 1.2 with p < 0.01 for medium volume) and increasing surgeon's age (adjusted hazards ratio = 1.4 for age < 41 years relative to 41–50 years; p ≤ 0.001; 0.8 for ≥51 years relative to 41–50 years; p < 0.05). In hospital volume regressions, surgeon's age is a consistent and significant predictor, not hospital volume. Findings suggest a key role of experience in surgical skill and sensitivity for early stage diagnosis in gastric cancer survival.

Conclusions

Although a key study limitation is the lack of cancer stage data, the pattern of findings suggests that experienced surgeons have relatively better survival outcomes among gastric cancer patients.     

Human papillomavirus genotype and oropharynx cancer survival in the United States of America

BackgroundThe presence of human papillomavirus (HPV) DNA in oropharyngeal squamous cell cancer (OPSCC) tissue appears to be a strong predictor of improved prognosis, but this observation has not been explored in a population-based sample with generalisable findings.MethodsFollow-up data from a large sample of OPSCC patients identified through six population-based cancer registries in the United States of America (USA) were used to characterise the association of tumour HPV status with survival.ResultsHPV DNA was detected in tumour tissue from 71% (378 in 529) of the OPSCC patients. A total of 65% of patients with HPV16-associated tumours survived 5 years compared to 46% of patients with other HPV types and 28% of patients with HPV-negative tumours (p log-rank test <0.0001). The OPSCC patients with detectable HPV16 DNA had a 62% reduced hazard of death at 5 years, and patients with other HPV types had a 42% reduced hazard of death at 5 years compared to HPV-negative patients. Compared to non-Hispanic Whites, Blacks with OPSCC had a 2.6-fold greater risk of death at 5 years after adjustment for HPV status and other prognostic variables. Both surgery and radiation therapy were associated with a reduced 5-year risk of death, but no evidence was found for an interaction between HPV status and radiotherapy or surgery on survival time.ConclusionsData from this US study suggest that HPV16-positive OPSCC patients survive longer than HPV-negative patients regardless of treatment, highlighting the prognostic importance of HPV status for this malignancy. Optimal treatment regimens for OPSCC could be tailored to each patient’s HPV status and prognostic profile.