Prognoses and improvement for head and neck cancers diagnosed in Europe in early 2000s: The EUROCARE-5 population-based study

BackgroundHead and neck (H&N) cancers are a heterogeneous group of malignancies, affecting various sites, with different prognoses. The aims of this study are to analyse survival for patients with H&N cancers in relation to tumour location, to assess the change in survival between European countries, and to investigate whether survival improved over time.MethodsWe analysed about 250,000 H&N cancer cases from 86 cancer registries (CRs). Relative survival (RS) was estimated by sex, age, country and stage. We described survival time trends over 1999–2007, using the period approach. Model based survival estimates of relative excess risks (RERs) of death were also provided by country, after adjusting for sex, age and sub-site.ResultsFive-year RS was the poorest for hypopharynx (25%) and the highest for larynx (59%). Outcome was significantly better in female than in male patients. In Europe, age-standardised 5-year survival remained stable from 1999–2001 to 2005–2007 for laryngeal cancer, while it increased for all the other H&N cancers. Five-year age-standardised RS was low in Eastern countries, 47% for larynx and 28% for all the other H&N cancers combined, and high in Ireland and the United Kingdom (UK), and Northern Europe (62% and 46%). Adjustment for sub-site narrowed the difference between countries. Fifty-four percent of patients was diagnosed at advanced stage (regional or metastatic). Five-year RS for localised cases ranged between 42% (hypopharynx) and 74% (larynx).ConclusionsThis study shows survival progresses during the study period. However, slightly more than half of patients were diagnosed with regional or metastatic disease at diagnosis. Early diagnosis and timely start of treatment are crucial to reduce the European gap to further improve H&N cancers outcome.     

青年人肺癌切除术的治疗结果

目的：总结青年人肺癌的治疗结果,探讨其临床特点及影响预后的因素。方法：采用ＳＴＡＴＡＴ５０统计软件,建立１１１例≤中４０岁手术切除的青年人肺癌的病例资料数据库并进行统计分析。生存率用寿命表法计算,生存率差异的显著性检验用Ｌｏｇｒａｎｋ检验。结果：本组并发症发生率为１０．８１％,无术后３０天死亡。     

French version of FACT-G: validation and comparison with other cancer-specific instruments

The aim of this study was to assess the validity of the French version of the Functional Assessment of Cancer Therapy - General (FACT-G), and to compare its psychometric properties with those of two other cancer-specific quality of life questionnaires, European Organisation for Research and Treatment of Cancer Quality of Life - Core 30 (EORTC QLQ-C30) and Functional Living Index - Cancer (FLIC). Two hundred and twenty three patients with breast or colorectal cancer completed the FACT-G questionnaire in French followed by (in random order) the QLQ-C30 and FLIC. An additional 87 patients with head and neck (H&N) cancer completed the FACT-H&N followed by the QLQ-C30 and H&N-Besan?on. The French version of FACT-G was internally consistent, and its reproducibility was excellent. FACT-G Physical Well-Being and global scores correlated with all QLQ-C30 subscales. There was evidence of discriminant validity. Compared with the other tools, FACT-G included a statistically significantly higher proportion of items patients considered to be confusing or upsetting. Patients with breast or colorectal cancer expressed a preference for QLQ-C30. Use of the specific H&N additional items increased the responsiveness to change of FACT-G. The French version of FACT-G is valid and has psychometric properties similar to those of FLIC and QLQ-C30.     

Smoking cessation among patients with head and neck cancer: cancer as a 'teachable moment'

Many cancer patients continue to smoke past diagnosis and treatment, even though smoking in some cases may cause more side effects and increase the risk of treatment failure. We developed and evaluated a nurse-led smoking cessation programme on 50 patients with head and neck (H&N) cancer undergoing radiotherapy (RT) with 1-year follow-up. To evaluate the effectiveness of the programme (proportion of smoke-free patients), smoking status was tested by measuring carbon monoxide in expired air.
Thirty-seven patients (74%) were tested smoke-free weekly during the RT period. At the 1-year follow-up visit, 28 patients (68%) were tested smoke-free. The results indicated that even H&N cancer patients with a heavy smoking history and multiple abuses could quit smoking with systematic support but a more sophisticated evaluation including larger study populations and control groups are needed.     

N1站淋巴结检出数目对pT1～3N0M0非小细胞肺癌患者预后的影响

目的探讨N1站淋巴结检出数目与pT1～3N0M0非小细胞肺癌(NSCLC)患者临床病理特征及预后的关系。方法选择2013年1月至2015年3月在安徽医科大学附属省立医院接受肺癌根治术的pT1～3N0M0 NSCLC患者337例, 采用受试者工作特征(ROC)曲线的分析确定以N1站淋巴结检出数目预测pT1～3N0M0 NSCLC患者5年生存的最佳界值, 根据最佳界值分组, 分析N1站淋巴结检出数目与pT1～3N0M0 NSCLC患者临床病理特征及预后的关系。结果 337例患者共检出N1站淋巴结1 321枚, 每例患者平均3.9枚。中位生存时间为42.0个月, 1、3、5年生存率分别为82.2%、57.1%和24.9%。ROC曲线分析显示, 以N1站淋巴结检出数目预测pT1～3N0M0 NSCLC患者5年生存的最佳界值4.5枚, 取整数后, 以N1站淋巴结检出数目为5枚作为界值, 将患者分为检出淋巴结<5枚组(212例)和检出淋巴结≥5枚组(125例)。检出淋巴结≥5枚组接受辅助化疗的患者比例为19.2%, 高于检出淋巴结<5枚组(9.0%, P=0.007), 两组患者其他临...     

Modeling the impact of the decline in distant stage disease on prostate carcinoma mortality rates

BACKGROUND: The incidence of distant stage prostate carcinoma was relatively flat until 1991 and then started declining rapidly. This decline probably was caused by the shift to earlier stage disease associated with the rapid dissemination of prostate specific antigen (PSA) screening. Prostate carcinoma mortality rates started falling at approximately the same time. In this article, the authors model the potential impact of this stage shift on prostate carcinoma mortality rates given various assumptions concerning the survival of patients with screen-detected local-regional disease. METHODS: The authors used the CAN*TROL 2 computer model to shift each deficit in the number of patients with distant stage disease to local-regional stage disease and modeled the implications on mortality using a set of base, optimistic, and pessimistic survival assumptions. A base survival assumes that a patient with screen-detected local-regional disease of a certain histologic grade has the same prognosis as a patient with clinically detected local-regional disease of same grade (i.e., an assumption of no length bias for patients with screen-detected disease), whereas the optimistic and pessimistic scenarios assume that survival is better or worse, respectively, than the base survival (i.e., complete cure for patients with favorable grade for the optimistic scenario and no improvements in survival for patients with unfavorable grade for the pessimistic scenario). RESULTS: Model results were compared with observed mortality trends. Rising age-adjusted mortality rates peaked in 1991 for white males and in 1993 for black males and then fell 21% and 13% for white males and black males, respectively, from 1990 through 1999. Under the modeled stage-shift intervention, mortality rates would fall 18%, 8%, and 19% for both white males and black males under the base, pessimistic, and optimistic assumptions, respectively. CONCLUSIONS: It is impossible to know what the mortality trends would have been in the absence of the introduction of PSA screening. However, under the base assumption, it appears that the decline in distant stage disease can have a fairly sizable and rapid impact on population mortality. The optimistic scenario is not much improved over the base scenario, which is indicative of the facts that the survival of patients diagnosed with clinical local-regional prostate carcinoma is quite good and that further survival improvements can have only a marginal impact. Under the pessimistic scenario, it appears that something else must be responsible for much of the decline in mortality. Screening trial results from the United States and Europe may verify and isolate the size of any mortality benefit associated with PSA screening. Trial results eventually can be put back into these population models to help quantify the impact of screening, treatment, and other factors on population trends.     

The surgical prognosis of pIIIA/N2 non-small-cell lung cancers

Objective

The aim of the study was to identify prognostic factors in non-small-cell lung cancer (NSCLC) with N2 nodal involvement.

Methods

A retrospective analysis of disease free survival and 5-year survival for NSCLC patients who underwent primary surgical resection without neoadjuvant chemotherapy were performed. Between January 1998 and May 2004, 133 patients were enrolled. Several factors such as age, sex, skip metastasis, number of N2 lymph node stations, type of resection, histology, adjuvant therapy etc., were recorded and analyzed. SPSS 16.0 software was used.

Results

Overall 5-year survival for 133 patients was 32.33%, 5-year survival for single N2 station and multiple N2 stations sub-groups were 39.62% and 27.50% respectively, and 5-year survival for cN0?C1 and cN2 sub-groups were 37.78% and 20.93% respectively. COX regression analysis revealed that number of N2 station (P = 0.013, OR: 0.490, 95% CI: 0.427?C0.781) and cN status (P = 0.009, OR: 0.607, 95% CI: 0.372?C0.992) were two favorable prognostic factors of survival.

Conclusion

Number of N2 station and cN status were two favorable prognostic factors of survival. In restrict enrolled circumstances, after combined therapy made up of surgery and postoperative adjuvant therapy have been performed, satisfied survival could be achieved.     

Clinical characteristics of patients with epidermoid carcinoma of the upper aerodigestive tract who develop second malignant tumors.

A total of 1294 patients with primary head and neck (H&N) cancer of a single site was diagnosed during the years 1970 to 1979 at the Memorial Sloan-Kettering Cancer Center, 163 subsequently developed a second malignant tumor (SMT). In 50% of the cases, the second tumor was in the H&N, and in 30% in the lung and esophagus; 41 patients developed a third tumor. Again, in 50% of these cases, the tumor was in the H&N and in 17% in the lung and esophagus. The stage of disease of all the second primary tumors was more advanced at diagnosis, mainly as a result of the large number of patients with lung and esophagus cancer. Patients who had a second tumor in the H&N were diagnosed in an earlier stage of disease than patients with a single H&N tumor. The survival of patients with localized second H&N cancer was worse than for those with a primary, localized single tumor.     

Stage at diagnosis is a key explanation of differences in breast cancer survival across Europe

We used multiple regression models to assess the influence of disease stage at diagnosis on the 5‐year relative survival of 4,478 patients diagnosed with breast cancer in 1990–1992. The cases were representative samples from 17 population‐based cancer registries in 6 European countries (Estonia, France, Italy, Netherlands, Spain and UK) that were combined into 9 regional groups based on similar survival. Five‐year relative survival was 79% overall, varying from 98% for early, node‐negative (T1N0M0) tumours; 87% for large, node‐negative (T2‐3N0M0) tumours; 76% for node‐positive (T1‐3N+M0) tumours and 55% for locally advanced (T4NxM0) tumours to 18% for metastatic (M1) tumours and 69% for tumours of unspecified stage. There was considerable variation across Europe in relative survival within each disease stage, but this was least marked for early node‐negative tumours. Overall 5‐year relative survival was highest in the French group of Bas‐Rhin, Côte d'Or, Hérault and Isère (86%), and lowest in Estonia (66%). These geographic groups were characterised by the highest and lowest percentages of women with early stage disease (T1N0M0: 39% and 9%, respectively). The French, Dutch and Italian groups had the highest percentage of operated cases. The number of axillary nodes examined, a factor influencing nodal status, was highest in Italy and Spain. After adjusting for TNM stage and the number of nodes examined, survival differences were greatly reduced, indicating that for these women, diagnosed with breast cancer in Europe during 1990–1992, the survival differences were mainly due to differences in stage at diagnosis. However, in 3 regional groups, the relative risks of death remained high even after these adjustments, suggesting less than optimal treatment. Screening for breast cancer did not seem to affect the survival patterns once stage had been taken into account. © 2003 Wiley‐Liss, Inc.     

Estimates of long-term survival for newly diagnosed cancer patients: a projection approach

BACKGROUND: Patients with newly diagnosed cancer may request an estimate of their prospects for long-term survival. Unfortunately, standard estimates of survival may be outdated, because they do not reflect recent advances. The authors present a projection method that incorporates trends in survival and provides more up-to-date estimates of long-term survival for newly diagnosed patients. METHODS: The projection method fits a regression model to interval relative survival and includes a parameter associated with a trend on diagnosis year. The cumulative relative survival rate (CRS) in a target year is calculated by multiplying the projected interval survival rates for that year. To investigate the predictive ability of the projection approach and to develop model-selection rules, data from the Surveillance, Epidemiology, and End Results Program and the Connecticut tumor registry were used to recreate data that were available at a particular time in the past, and those data were used to project survival for specified target years. RESULTS: The projection method was better at predicting the survival of recently diagnosed patients than current methods, especially long-term survival for patients who had disease sites with an increasing and stable trend in survival. The authors predicted that the 15-year CRS for patients who were diagnosed in 2003 will be 61% for all cancer sites combined, 57% for colorectal cancer, 82% for female breast cancer, 53% for ovarian cancer, and 97% for prostate cancer. CONCLUSIONS: Although the projection method was more speculative than other methods that are aligned more closely with current observed data, it offered the possibility of providing improved estimates of long-term survival for recently diagnosed patients. Caution should be used when applying these methods for cancer sites where there has been a dramatic uptake of screening, e.g., prostate cancer, for which the projected results may be overly optimistic.     

袖式切除治疗82例肺癌患者的临床分析

背景与目的:支气管袖式切除和/或肺血管袖式切除在切除肿瘤的同时能最大限度地保留健康肺组织,为肺癌外科治疗提供了一种手术方式。本研究旨在探讨肺癌袖式切除的技术问题、手术结果、术后并发症及患者术后生存情况。方法:选择2001年6月至2006年12月,在浙江省肿瘤医院行袖式切除的82例中央型肺癌患者,其中23例同时行肺动脉血管袖式切除,2例单独行肺血管袖式切除。所有患者术中行系统淋巴结清扫。观察淋巴结清扫情况以及术后并发症的发生情况,用Kaplan-Meier法对患者的生存情况进行分析。结果:82例患者清扫9～57个淋巴结,平均20个,中位数19个。淋巴结N1转移49例,占59.8%;N2转移21例,占25.6%。2例(2.4%)患者在围手术期死亡,无支气管吻合口瘘发生。全组中位生存期26个月。1、2、3、5年生存率分别为78.4%、52.5%、39.1%、23.4%。男性和女性、<60岁与≥60岁患者的1、3、5年生存率均无显著性差异(P>0.05)。而N1(-)N2(-)、N1( )N2(-)、N2( )患者的1、3、5年生存率差异有显著性(P<0.01);Ⅰ期、Ⅱ期、ⅢA期、ⅢB期患者的1、3、5年生存率差异也有显著性(P<0.01)。结论:肺癌袖式切除手术死亡率以及与吻合相关并发症发生率低,可在掌握适应证的情况下代替全肺切除。系统淋巴结清扫不增加手术并发症和死亡率。袖式切除术后患者的生存与淋巴结转移状况以及临床分期有关,而与性别、年龄无关。     

Rare cancers of the head and neck area in Europe

The RARECARE project has proposed a different and more detailed grouping of cancers, based on localisation and histological type, in order to identify rare entities with clinical meaning. RARECARE gathered data on cancer patients diagnosed from 1978 to 2002 and archived in 76 population-based cancer registries, all of which had vital status information available up to at least 31st December 2003. This study provides incidence, prevalence and survival rates for rare head and neck epithelial (H&N) cancers. Among the rare H&N cancers, those of oral cavity had the highest annual crude incidence rate of 48 per million, followed by oropharynx and 'major salivary glands and salivary gland type tumours' (28 and 13 per million, respectively). Incidence rates of epithelial tumours of nasal cavities, nasopharynx, eye and adnexa and middle ears were all lower than 5 per million. The prevalence for all investigated entities was lower than 35 per 100,000. The 5-year relative survival rates ranged from 40% for epithelial cancer of oropharynx to 85% for epithelial cancer of eye and adnexa. Survival rates were lower for men and for patients aged ≥65 years. With few exceptions, the lowest and highest survival figures were observed for Eastern Europe and Northern Europe, respectively. According to the definition for rare tumours by RARECARE (incidence<6 per 100,000), as well as according to the definition for rare diseases by the European Commission (prevalence<50 per 100,000) the H&N cancers described in this paper should be considered rare and diagnosis and treatment of these cancers should therefore be centralised.     

Long-term survival in node-positive breast cancer treated by locoregional therapy alone.

To investigate the long-term survival rate of node-positive (pN+) breast cancer treated by locoregional therapy alone, we made an attempt to identify all such patients followed up for at least 15 years after treatment in a defined geographical area (city of Turku, Southwestern Finland) and time period (1945-79) using the files of the local hospitals and the Finnish Cancer Registry. The clinical and autopsy records and histological slides of 1172 women diagnosed with breast cancer in the city were reviewed. From this cohort we identified 339 women with unilateral node-positive breast cancer treated with locoregional therapy without systemic adjuvant therapy. The relative survival rate of the cohort compared with the general female population matched for age and year of follow-up was calculated. The 15- and 30-year survival rates corrected for known intercurrent deaths were 26% (95% CI, 21-31%) and 21% (16-26%) respectively, and the relative survival rates 23% and 21% respectively. None of the patients with pN2 disease survived for 15 years, whereas the 30-year corrected survival rate in pN1 disease was 24% (18-30%). Women with pT1N1M0 cancer had as high as 59% (43-75%) 15-year survival rate corrected for intercurrent deaths. A trend for improving survival was found by the decade of diagnosis. The results indicate that a considerable proportion of women with pN1 breast carcinoma treated with locoregional therapy alone become 30-year survivors and are probably cured. Adequate locoregional treatment is mandatory in the care of node-positive breast cancer.     

Is adjuvant chemotherapy necessary for early gastric cancer?

Objective:To quantify the potential benefit of adjuvant chemotherapy (ACT) with respect to survival, and to identify factors for predicting prognoses in early gastric cancer patients.Methods:Patients with pT1 gastric cancer (GC) who underwent radical resection with D2 lymphadenectomy were retrospectively analyzed. Based on lymph node metastasis (LNM) status and treatment regimens, patients were classified into groups, and clinicopathological variables, overall survival (OS), and disease-specific survival (DSS) were compared.Results:Of 1,050 enrolled patients, 151 patients (14.4%) had a positive LNM status. Submucosal invasion, undifferentiated state, tumor size > 2 cm, ulceration, and lymphovascular invasion were independent risk factors for LNM using multivariate analyses. The 5-year OS of all patients was 96.4%. HER2 positive, perineural invasion, and LNM were independent factors for worse survival. Patients with pT1N3 GC had a worse 5-year OS and DSS than pT1N0, pT1N1, and pT1N2 patients (P < 0.001). The 5-year OS and DSS for pT1N1 patients showed no significant difference between ACT and surgery only patients. For pT1N2 patients, the 5-year OS and DSS showed no significant difference between S-1 and Xelox treatments. For pT1N3 patients, 7 (36.8%) received S-1, while 12 (63.2%) received Xelox treatment. Patients receiving Xelox treatment showed a better 5-year OS (75.0% vs. 14.3%) and DSS (81.8% vs. 20.0%) than patients receiving S-1 (P < 0.05).Conclusions:Curative surgery only was adequate for patients with pT1N0 and pT1N1. Xelox showed no survival benefits for pT1N2 patients. Therefore, S-1 is the optimal choice for pT1N2 patients, when considering adverse effects. Xelox is recommended for pT1N3 patients.     

The clinicopathological significance of inferior mesenteric lymph node metastasis in colorectal cancer.

AIMS: There are few studies reporting survival or recurrence patterns in colorectal cancer patients with inferior mesenteric lymph node metastasis (IMLN+). The present study evaluated the prognostic significance of patients being IMLN+ or IMLN- in colorectal cancer. METHODS: Survival, recurrence pattern and treatment protocols were compared between 63 IMLN+ patients and 108 IMLN- patients with stage III and IV rectal and sigmoid cancer undergoing curative surgery. Lymph node sampling was routinely performed prior to inferior mesenteric artery ligation and excision flush with aorta. Limited principal node dissection including IMLN was performed in cases of identified node metastasis. RESULTS: The 5-year disease-free survival rates were 50% in IMLN- and 31% in IMLN+ patients (P=0.004). The 5-year disease-free survival rate was greater in the N1 group than the N2 group (P=0.038). Cox regression analysis showed IMLN+, lymphovascular tumour invasion, T4, M1, and pre-operative serum CEA level over 6 ng/ml were independently associated with unfavorable disease-free survival. The prognostic significance of M category was greater when the IMLN+ was included in the M1 as opposed to the N category. In patients undergoing absolute curative surgery, post-operative recurrence rates were 34% for IMLN- and 57% for IMLN+ patients (P=0.009; OR, 2.611; 95% CI, 1.313-5.194). For IMLN+ patients, post-operative adjuvant treatment independently correlated with disease-free survival (P=0.029). CONCLUSIONS: IMLN+ is an independent survival factor enhancing the prognostic significance of the M category in the AJCC staging. Curative radical surgery and post-operative chemoradiotherapy appears to be warranted for IMLN+ colorectal cancer patients as it resulted in 5-year disease-free survival rates of up to 31% compared to 50% in IMLN- patients.     

Optimism and survival in lung carcinoma patients

BACKGROUND: It is popular belief that the psychologic response to a diagnosis of cancer influences survival in patients with cancer; however, research has produced contradictory results. In this prospective study, the authors investigated the relation between pretreatment levels of optimism and survival in patients with nonsmall cell lung carcinoma (NSCLC). METHODS: Two hundred four patients who were participating in a randomized trial that compared accelerated and conventional radiotherapy with and without carboplatin chemotherapy were asked to complete two questionnaires assessing optimism. The first assessment was just prior to commencing treatment and the second assessment took place after completing treatment. Survival was measured from the date of randomization to the date of death. Surviving patients were followed until February 8, 2001. RESULTS: The pretreatment questionnaire was completed by 179 patients, and 148 of those patients completed the posttreatment questionnaire. There was a small but significant reduction in optimism scores after treatment (P = 0.005). There was no association noted between pretreatment optimism and progression-free survival (P = 0.52, unadjusted; P = 0.22, adjusted for Eastern Cooperative Oncology Group performance status and patient age), nor was there an association noted between pretreatment optimism and overall survival (P = 0.36, unadjusted; P = 0.19, adjusted for disease stage). CONCLUSIONS: There was no evidence that a high level of optimism prior to treatment enhanced survival in patients with NSCLC. Encouraging patients to "be positive" only may add to the burden of having cancer while providing little benefit, at least in patients with NSCLC.     

Can the new American Joint Committee on Cancer staging system predict survival in rectal cancer patients treated with curative surgery following preoperative chemoradiotherapy?

BACKGROUND:

Although ypStage has been known as a strong prognosticator of recurrence and survival, the detailed interaction of ypT and ypN classification on a survival rate has never been evaluated.

METHODS:

Between October 2001 and December 2007, in total, 960 patients with locally advanced rectal cancer were enrolled retrospectively at 3 centers. Five‐year overall survival (OS) and disease‐free survival (DFS) rate were calculated for each ypTN classification.

RESULTS:

The ypT classification interacted with ypN classification to affect survival in most categories. Patients with ypStage 0 and I cancers showed a >90% 5‐year OS (ypStage 0, 96.5%; ypStage I, 92.9%; P = .346) and 5‐year DFS (ypStage 0, 90.2%; ypStage I, 90.7%; P = .879). Among ypStage III subgroups, large differences in 5‐year OS (ypStage IIIA, 90.1%; ypStage IIIB, 68.3%; ypStage IIIC, 40.5%; P < .001) and 5‐year DFS (ypStage IIIA, 74.8%; ypStage IIIB, 55.1%; ypStage IIIC, 12.3%; P < .001) were observed. OS and DFS in patients with ypStage IIIA disease were similar to or greater than those in patients with ypStage IIA or IIB/IIC disease. Four patient risk groups were defined: 1) low (ypT0‐isN0, ypT1N0, ypT2N0), 2) intermediate (ypT0‐2N1, ypT3N0), 3) moderately high (ypT0‐2N2, ypT3N1, ypT4N0), and 4) high risk (ypT3N2, ypT4N1‐2). Risk grouping showed a narrower range of survival rate compared with ypStage grouping.

CONCLUSIONS:

ypStage in rectal cancer, defined according to the 7th edition of the American Joint Committee on Cancer staging system, predicts survival for most ypNT classifications. However, patients with ypStage I rectal cancer have a similar prognosis to those with ypStage 0 cancer, and risk grouping reflects more precise survival outcomes than ypStage. Cancer 2012. © 2012 American Cancer Society.     

Immunohistochemical expression of epidermal growth factor receptor (EGFR) in oral squamous cell carcinoma in relation to proliferation,apoptosis, angiogenesis and lymphangiogenesis

Background

With 16,005 new cases and 5,406 related deaths in 2005, France is particularly concerned by Head and Neck (H&N) cancers. In addition to tobacco and alcohol, Human Papillomavirus (HPV) has been reported as a risk factor for H&N cancers. The literature on the burden of these cancers in Europe is scarce. This study was performed to assess the medical and economical burden of hospitalisations for H&N cancers in France.

Methods

The French national hospital database (PMSI), in which admissions to public and private hospitals are recorded, was retrospectively analysed to assess the annual number of patients hospitalised for H&N cancers and associated hospital costs from the healthcare payer perspective. ICD-10 codes (16 codes classified as oral cavity, oropharynx, pharynx, salivary glands and larynx) were used to extract admissions for these cancers. Hospital stays, chemotherapy and radiotherapy sessions were extracted to assess patients' management. Costs of admissions were obtained from French official tariffs.

Results

In 2007, there were 36 268 patients hospitalised for H&N cancers, of whom 81% were men, corresponding to 60 200 hospital stays and 287 846 sessions of chemo- or radio-therapy. Oropharynx cancer was the most frequent (28% of patients), followed by oral cavity cancer (25% of patients). The peak of frequency was observed in the 55-59 years age group. Patients were mainly treated in medicine (48%) and surgery (23%) units. Mean annual cost per patient ranged from €2 764 to €7 673 leading to a total hospital cost of €323 millions in 2007 (including hospitalization and expensive drugs). With 26% of H&N cancers attributable to HPV infections, 9 430 patients were hospitalized due to HPV-related H&N cancers, representing €138 million in 2007.

Conclusion

Even without taking into account the rehabilitation costs, the hospital burden of H&N cancers is considerable.     

Prognostic stratification of patients with T3N1M0 non-small cell lung cancer: which phase should it be?

In the 1997 revision of the TNM staging system for lung cancer, patients with T3N0M0 disease were moved from stage IIIA to stage IIB since these patients have a better prognosis. Despite this modification, the local lymph node metastasis remained the most important prognostic factor in patients with lung cancer. The present study aimed to evaluate the prognosis of patients with T3N1 disease as compared with that of patients with stages IIIA and IIB disease. During 7-year period, 313 patients with non-small cell lung cancer (297 men, 16 women) who had resection were enrolled. The patients were staged according the 2007 revision of Lung Cancer Staging by American Joint Committee on Cancer. The Kaplan–Meier statistics was used for survival analysis, and comparisons were made using Cox proportional hazard method. The 5-year survival of patients with stage IIIA disease excluding T3N1 patients was 40%, whereas the survival of the patients with stage IIB disease was 66% at 5 years. The 5-year survival rates of stage III T3N1 patients (single-station N1) was found to be higher than those of patients with stage IIIA disease (excluding pT3N1 patients, P = 0.04), while those were found to be similar with those of patients with stage IIB disease (P = 0.4). Survival of the present cohort of patients with T3N1M0 disease represented the survival of IIB disease rather than IIIA non-small cell lung cancer. Further studies are needed to suggest further revisions in the recent staging system regarding T3N1MO disease.     

Postoperative adjuvant chemotherapy with mitomycin C and UFT for curatively resected rectal cancer. Results from the Cooperative Project No.7 Group of the Japanese Foundation for Multidisciplinary Treatment of Cancer

Background. This study was conducted to evaluate the significance of postoperative adjuvant chemotherapy using mitomycin C (MMC) and UFT (tegafur; uracil at 1:4 molar ratio) in combination for rectal cancer. Methods. The Japanese Foundation for Multidisciplinary Treatment of Cancer conducted a prospective randomized controlled trial in 834 patients who had undergone curative resection for rectal cancer (T3 or T4 and/or Nl, N2, or N3 according to TNM classification) from February 1986 to December 1988. The patients were randomly allocated to a treatment group (MMC/UFT, 416 patients) and a control group (surgery alone, 418 patients). For the patients in the treatment group, 20 mg of MMC was sprinkled on the operating field upon completion of surgery. MMC was injected intravenously (6 mg/m²) on day 7, and then once a month for months 1–6 after surgery. UFT was administered at 400mg/day, orally, for 1 year, beginning 3 weeks after surgery. Results. There was no difference, in the 5-year survival rate between the two groups, but the 5-year disease-free survival rate in the MMC/UFT group (68.9%) was significantly higher than that (59.3%) in the control group (P = 0.006). The 5-year cumulative local recurrence rate was significantly lower in the MMC/UFT group (11.6%) than in the control group (19.0%) (P = 0.007). Conclusion. We conclude that the adjuvant use of longterm oral UFT and intermittent MMC (i.v.) improves the disease-free survival rate of patients with curatively resected rectal cancer (T3 or T4 and/or N1, N2, or N3).