Survival Rate of Extrahepatic Cholangiocarcinoma Patients after Surgical Treatment in Thailand

Background: Intra- and extrahepatic cholangiocarcinoma (CCA) is the most common cancer in Thailand,especially in the northeast region. Most extrahepatic CCA patients consult a doctor at a late stage. Surgery isstill the best treatment. Objectives: The aim of this study was to evaluate survival rates and factors affectingsurvival in extrahepatic CCA patients following surgery at Srinagarind Hospital, Khon Kaen University, Thailand.Materials and Methods: A retrospective cohort study was conducted with 58 patients who were diagnosed andtreated by surgical resection by the same surgeon at Srinagarind Hospital between 2005 and 2009. The patientswere followed up until death or the end of the study (31 December, 2011). Survival rates were calculated by theKaplan-Meier method, and the Cox proportional hazard model was used to identify independent prognosticfactors. Results: The total follow-up time was 1,215 person-months, and the mortality rate was 50 per 100person-years. The cumulative 1-, 3-, and 5-year survival rates were 62.1%, 21.7% and 10.8%, respectively. Themedian survival time after resection was 15 months. After adjusting for age, gender, lymph node metastasis andhistological type, resection margin remained as a statistically significant prognostic factor for survival followingsurgery. A positive resection margin was associated with a 2.3-fold higher mortality rate than a negative margin.Conclusions: Resection margins are important prognostic factors affecting survival of extrahepatic CCA patientsafter surgery. A negative resection margin can reduce the mortality rate by 56%.     

Cholangiocarcinoma Patient Outcome in Northeastern Thailand: Single-Center Prospective Study

Background: Cholangiocarcinoma is relatively rare worldwide. Most previous reports collected only patients with pathological diagnosis. In fact, however, many patients coming to hospital are diagnosed by clinical suspicion with radiologic imaging and receive treatment without histological confirmation. Real survival data and outcome of each treatment, especially for patients that do not have histologic confirmation, are lacking. In this study, therefore, we aimed to analyze the survival rates of CCA patients and the proportions of patients receiving different treatments. Materials and Methods: A total of 270 patients clinically suspected of CCA and visiting Srinagarind Hospital in May-July 2010, were prospectively followed until December 2014. After checking their clinical records, 163 of 270 patients were finally diagnosed as having CCA, and the data of this group were analyzed for survival rate and received treatments. Results: Of the 163 patients, 96 (58.9%) had intrahepatic, 56 (34.4%) had perihilar and 11 (6.7%) had distal CCA. The majority [107 (65.6%, 95%CI, 57.8-73.0)] received only supportive care. Overall median survival was 4 months (95%CI, 3.3-4.7), and 2-years survival was only 8.1% (95%CI,4.5-12.9). However, the 4 year survival of the R0 resection group was 100%. Conclusions: The present results show that the prognosis of CCA is very poor in North-east Thailand. Most CCA patients receive only treatment to alleviate symptoms due to their advanced stage of disease. Complete surgical resection at the early stage is the only treatment that significantly improves patient survival.     

经匹配后放化疗与手术治疗局限期小细胞肺癌预后比较

目的 比较手术与放化疗治疗局限期小细胞肺癌(SCLC)患者的总生存(OS)、无进展生存(PFS)、颅内无进展生存(BMFS)预后差异。方法 收集2000-2016年在浙江省肿瘤医院经手术治疗的局限期SCLC患者 69例,在 503例经根治性放化疗的局限期SCLC数据库中,按照T、N分期,治疗年份,年龄,性别,是否预防性脑照射(PCI)等进行1∶1匹配 69例患者为放化疗组。结果 共纳入 138例患者,手术组 69例(Ⅰ期 24例、Ⅱ期 14例、Ⅲ期 31例),放化疗组 69例(Ⅰ期 24例、Ⅱ期 14例、Ⅲ期 31例)。手术组与放化疗组的中位OS期分别为37.1个月(95%CI为 24.1~50.2个月)和45.0个月(95%CI为 15.8~74.2个月),2、5年OS率分别为60%、45%和64%、45%(P=0.846);中位PFS期分别为27.1个月(95%CI为 0.00~60.3个月)和36.2个月(95%CI为 20.9~51.4个月),2、5年PFS率分别为52%、38%和56%、40%(P=0.610)。2、5年BMFS率分别为80%、76%和84%、80%(P=0.774)。Ⅰ期手术组、放疗组 5年OS率分别为62%、40%(P=0.038),PFS率分别为80%、40%(P=0.048),BMFS率分别为92%、95%(P=0.816)。Ⅱ期手术组、放化疗组 5年OS率分别为41%、51%(P=0.946),PFS率分别为65%、42%(P=0.280),BMFS率分别为75%、78%(P=0.720)。Ⅲ期手术组、放化疗组 5年OS率分别为25%、48%(P=0.220),5年PFS率分别为28%、36%(P=0.333),5年BMFS率分别为76%、74%(P=0.842)。结论 手术治疗可为Ⅰ期患者带来生存获益,Ⅱ期患者两组生存相当,Ⅲ期患者放化疗组有更好生存趋势。最终结论需要更大样本或开展前瞻性研究得出。     

Survival Rate of Intrahepatic Cholangiocarcinoma Patientsafter Surgical Treatment in Thailand

Intrahepatic cholangiocarcinoma (ICC), one of the primary liver cancers, is frequent in the northeasternpart of Thailand. Surgical resection remains the best method of treatment, but patients suffering from ICCusually present at a late stage of the disease. Studies of survival and prognostic factors after surgery remain rare.The aim here was to evaluate the survival rate and factors affecting the survival of patients with intrahepaticcholangiocarcinoma after surgery. The study used a retrospective cohort design. The subjects were 73 consecutivepatients with ICC, who were admitted for surgery to Srinagarind Hospital, Khon Kaen University, during theperiod 2005-2009. The censoring date was 31 December, 2011, data being evaluated using uni- and multivariateanalyses. Postoperative survival analysis was performed by the Kaplan-Meier method, and the Cox proportionalhazard model was used to identify independent prognostic factors. The total follow-up time was 99 person-years.The total number of deaths was 59, giving a mortality rate of 59 per 100 person-years. The cumulative 1-, 3-,and 5-year survival rates were 52.1%, 21.7%, and 11.2%, respectively. The median duration of survival afterresection was 12.4 months. Univariate analysis revealed stage of disease, lymph node metastasis, histologicaltype, histological grade and macroscopic classification to be statistically significant (p-value<0.05) prognosticfactors. In the multivariate analysis, only macroscopic classification was statistically significant (p-value<0.05).In conclusion, macroscopic classification was the only independent factor found to be significantly associatedwith survival following surgical treatment of ICC.     

Racial disparities and survival for nonsmall‐cell lung cancer in a large cohort of black and white elderly patients

BACKGROUND:

This study aimed to examine disparities in survival and associated factors for patients with nonsmall‐cell lung cancer (NSCLC) and to determine whether racial disparities varied over time (1991‐1995, 1996‐1999, and 2000‐2002).

METHODS:

The authors studied 70,901 patients aged ≥65 years with stage I‐IV NSCLC identified from Surveillance, Epidemiology, and End Results/Medicare data. Multivariate time‐to‐event survival analyses were completed using Cox proportional regression modeling.

RESULTS:

The 5‐year observed lung cancer‐specific survival rates were 52.7% for whites and 47.5% for blacks with stage I‐II disease, and 17.7% and 19.6% for whites and blacks, respectively at stages III‐IV. After controlling for standard treatment, socioeconomic status (SES), and other factors, there were no significant differences in all‐cause mortality, or lung cancer‐specific mortality between black and white patients with stage I‐II or III‐IV lung cancer. However, blacks had an increased risk for overall all‐cause mortality at stage I‐IV (hazard ratio [HR], 1.24; 95% confidence interval, 1.13‐1.35), and during 2000‐2002 at stage III‐IV for all‐cause mortality (HR, 1.22; 95% CI, 1.02‐1.47) and lung cancer‐specific mortality (HR, 1.24; 95% CI,1.01‐1.53). Standard treatment was significantly associated with increased survival, whereas poor SES was associated with increased mortality.

CONCLUSIONS:

There were no significant differences in survival between blacks and whites with NSCLC within stage stratifications after adjusting for covariates, except for black patients at overall stage for all‐cause mortality and at stage III‐IV diagnosed in 2000‐2002. Receiving stage‐specific evidence‐based standard therapy was associated with significantly increased survival. Cancer 2009. © 2009 American Cancer Society.     

Survival after Diagnosis of Cervical Cancer Patients at a Tertiary Referral Hospital in Northeast Thailand

Background: Cervical cancer (CC) is the third most common cancer in women globally, including Thailand, where the incidence rate was 16.2 cases per 100,000 individuals in 2018. Survival rates for patients with this condition have not improved over recent years. This study evaluated the survival rate and median survival time after diagnosis among CC patients, and investigated factors associated with survival in Northeast Thailand. Methods: This study included CC patients admitted to the gynecological ward at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand from 2010 to 2019. Survival rates and median survival time since the date of diagnosis and 95% confidence intervals (CIs) were calculated. Multiple cox regression was performed to investigate factors associated with survival which were quantified by adjusted hazard ratios (AHR) and their 95% CIs. Results: Of 2,027 CC patients, the overall mortality incidence rate was 12.44 per 100 person-years (95% CI: 11.7 - 13.22), median survival time was 4.82 years (95% CI: 3.92 - 5.72), and 10-year survival rate was 43.16% (95% CI: 40.71 - 45.59). The highest 10-year survival rate was 87.85% (95% CI: 82.23 - 91.78) found among those with stage I CC, followed by those who received surgical treatment, which was 81.22% (95% CI: 74.47 - 86.35). Factors that were associated with decreased survival included age ≥60 years (AHR = 1.25; 95% CI: 1.07 - 1.46), health insurance with the Universal Health Coverage Scheme (UCS) (AHR = 6.26; 95% CI: 5.13 - 7.64), malignant neoplasms histopathology (AHR = 1.36; 95% CI: 1.07 - 1.74), and treatment with supportive care (AHR = 7.48; 95% CI: 5.22 - 10.71). Conclusion: Among patients diagnosed with CC, those with stage I had the highest 10-year survival rate. CC patients with older age, UCS, malignant neoplasms histopathology, and received supportive care showed the highest survival association.     

Trends in oral cavity cancer incidence,mortality, survival and treatment in the Netherlands

Information on epidemiology is essential to evaluate care for the growing group of oral cancer patients. We investigated trends in incidence, mortality and relative survival rates for oral cavity cancer (OCC) and its subsites in the Netherlands from 1991 to 2010, and relate these to changes in stage and treatment. Patient (age, sex), tumour (subsite, stage) and treatment characteristics of patients diagnosed with OCC (ICD‐O‐3: C02‐C06) in 1991–2010 were extracted from the Netherlands Cancer Registry. Incidence, mortality and 5‐year relative survival rates over time are presented, as well as trends in type of treatment. The incidence of OCC increased with +1.2% (95%CI: +0.9%;+1.6%) per year: more strongly in women, stage I and IV disease, and in cancers of the tongue and gum. The mortality rate slightly rose (+0.8%, 95%CI: +0.3%;+1.3% per year), but differed by subsite. The 5‐year relative survival improved from 57% in 1991–1995 to 62% in 2006–2010. The 5‐year relative survival was better for women compared with men (64% and 55%, respectively), decreased with increasing stage, was the best for tongue cancer (63%) and the worst for cancer of the gum (56%) and floor of mouth cancer (55%). The relative excess risk of dying was higher for non‐surgery‐based treatments. Surgery was the main treatment option and the proportion of “surgery only” rose in stage I and III disease. The incidence and, to a lesser extent, mortality of OCC are increasing and therefore, even with slightly improving survival rates, OCC is an increasingly important health problem.     

'Debulking' surgery is unnecessary in advanced abdominal Burkitt lymphoma in Iraq

In a previous study (Burkitt lymphoma study I, BL I) between 1982 and 1984, we used a multidrug rotating chemotherapy schedule, now known as 'GRAB', to treat 24 Iraqi children with non-localised BL (Murphy stages II, III and IV). At the time of reporting, actuarial survival was 50% (current actual survival 42%) and the major morbidity and mortality was not from resistant or relapsed lymphoma, but from complications of the tumour lysis syndrome, sepsis and early abdominal surgery. The study (BL II) reported here was carried out between 1984 and 1986; we used GRAB to treat 24 newly and consecutively diagnosed children with advanced Burkitt lymphoma but discouraged early 'debulking' surgery and paid special attention to supportive care during the first two weeks of treatment. As in BL I, no radiotherapy was used. Twenty patients (83.8%) attained complete remission: 17 (71%), including three of the seven stage IV patients, survive continuously disease-free at a median of 26 months (range 18-36 months) from diagnosis. We have previously pointed out that GRAB, without radiotherapy, may be especially suited for use in some developing countries. From this study we conclude that, with appropriate supportive care and minimal surgery, survival rates over 50% may be achieved. Our next studies are aimed at defining a 'good risk' group of patients, who may be curable without alkylating agents and a 'poor risk' group, who need more intensive therapy.     

Epidermal growth factor receptor overexpression correlates with a poor prognosis in completely resected non-small-cell lung cancer.

BACKGROUND: We designed a prospective study to test epidermal growth factor receptor (EGFR) expression by immunohistochemistry (IHC) in resected stage I-IIIA non-small-cell lung cancer (NSCLC) and to correlate overexpression with survival. PATIENTS AND METHODS: EGFR expression was evaluated in 130 consecutive NSCLC patients after radical surgery (60 squamous cell carcinomas, 48 adenocarcinomas, 22 large cell carcinomas: stage I, 41 (31%); stage II, 37 (29%) and stage IIIA, 52 (40%). RESULTS: Overall, 101 of 130 (78%) specimens expressed EGFR, and with a cut-off value of 10% positive cells 48 cases (37%) were classified as positive. At univariate analysis, EGFR was significantly more expressed in stage III (50%) than stage I (20%) and stage II (25%) (P <0.03). No correlation with histotype was found. After a median follow-up of 84 months, both median survival time (18 versus 50 months), 2-year (43% versus 70%) and 5-year (31% versus 46%) survival rates of positive cases were significantly lower than negative ones [P <0.001; hazard ratio 1.96; 95% confidence interval (CI) 1.16-3.30]. At the multivariate analysis, EGFR overexpression and stage emerged as independent factors for cancer-related mortality. CONCLUSION: In patients with radically resected stage I-IIIA NSCLC, EGFR overexpression predicts shorter survival, thus representing a valuable prognostic factor.     

Factors Affecting Survival Time of CholangiocarcinomaPatients: A Prospective Study in Northeast Thailand

Cholangiocarcinoma (CCA) is a major health problem and cause of death among people in NortheasternThailand. In this prospective study 171 patients newly diagnosed with CCA by physicians in 5 tertiary hospitalsin four provinces of northeastern of Thailand between February and July 2011 were followed up to January2012. The outcome was survival time from diagnosis to death. A total of 758.4 person-months of follow-up wereavailable. The mortality rate was 16.9 per 100 person-months (95%CI: 14.1-20.1). The median survival timeamong CCA patients was 4.3 months (95%CI: 3.3-5.1). Cox’s proportional hazard model was used to study theindependent effects of factors affecting survival time among patients. Statistically significant factors includedadvanced stage at diagnosis (HR: 2.5, 95%CI: 1.7-3.8), presentation with jaundice (HR: 1.7, 95%CI: 1.1-2.4)or ascites (HR: 2.8, 95%CI: 1.8-4.4), and positive serum carcinoembryonic antigen (HR: 2.3, 95%CI: 1.2-4.3).Patients who had received standard treatment had a better prognosis that those who did not (HR: 0.5, 95%CI:0.3-0.7).     

Outcome of curative resection for perihilar cholangiocarcinoma in Northeast Thailand

AIM: To examine survival outcomes of perihilar cholangiocarcinoma (PCCA) resection including mortality, morbidity and prognostic factors.METHODS: Multivariate analyses were carried out based on the survival data of all patients with histologically confirmed PCCA who underwent curative resection at Srinagarind Hospital from January 2006 to December 2011.RESULTS: There were 29 (19%) cases of intrahepatic CCA that involved hilar and 124 (81%) with hilar bile-duct cancer. R0 resection was carried out on 66 (43.1%) patients of whom 50 (32.7%) also had lymph node metastasis. The other patients underwent R1 resection. The overall 5-year survival rate was 20.6% (95%CI: 13.8-28.4) and median survival time was 19.9 mo. Postoperative mortality was 2%, and 30% of patients had complications. Patients without lymph node metastasis were 60% less likely to die than those with metastasis. Achieving R0 led to a 58% reduction in the chance of mortality as compared to R1.CONCLUSION: To achieve a better survival outcome, focus should center on performing radical surgery and detection of patients with early stage cancer.     

Effects of health insurance and race on breast carcinoma treatments and outcomes

BACKGROUND: The authors hypothesized that insurance payer and race would influence the care and outcomes for patients with breast carcinoma. METHODS: The authors examined treatments and adjusted risk of death (through 1997) for all incident cases of breast carcinoma occurring in Florida in 1994 (n = 11,113) by using state tumor registry data. RESULTS: Patients lacking health insurance were less likely to receive breast-conserving surgery (BCS) compared with patients who had private health insurance. Among patients insured by Medicare, those belonging to a health maintenance organization (HMO) were more likely to receive BCS but less likely to receive radiation therapy after BCS. Non-Hispanic African Americans had higher mortality rates even when stage at diagnosis, insurance payer, and treatment modalities used were adjusted in multivariate models (adjusted risk ratio [RR], 1.35; 95% confidence interval [CI], 1.12-1.61; P = 0.001). Patients who had HMO insurance had similar survival rates compared with those with fee-for-service (FFS) insurance. Among non-Medicare patients, mortality rates were higher for patients who had Medicaid insurance (RR, 1.58, 95% CI, 1.18-2.11; P = 0.002) and those who lacked health insurance (RR, 1.31; 95% CI, 1.03-1.68; P = 0.03) compared with patients who had commercial FFS insurance. There were no insurance-related differences in survival rates, however, once stage at diagnosis was controlled. CONCLUSIONS: As a result of later stage at diagnosis, patients with breast carcinoma who were uninsured, or insured by Medicaid, had higher mortality rates. Mortality rates were also higher among non-Hispanic African Americans, a finding that was not fully explained by differences in stage at diagnosis, treatment modalities used, or insurance payer.     

Incidence,Mortality and Survival Analysis of Epithelial Ovarian Cancer in Brunei Darussalam

Background: This study provides population-based study of cancer incidence, mortality and survival rates for women diagnosed with epithelial ovarian cancer (EOC), and evaluate the prognostic factors of EOC patients survival in Brunei Darussalam. Methods: This is a retrospective  study of patients diagnosed with EOC between 1st January 2007 and 31st December 2017 in Brunei Darussalam. Crude, age-specific, age-standardized incidence and mortality rates per 100,000 women were calculated. Kaplan-Meier method was used to determine the overall 5-years survival rate. Log-rank test was used to examine the differences in survival between groups. The multivariable Cox Proportional Hazard regression models were used to estimate the hazard ratio for overall survival and to identify the prognostic factors. Results: A total of 207 patients were included in the study. The crude incidence and mortality rates were 9.7 and 3.6 per 100,000 respectively while the age-standardized incidence and mortality rates were 11.3 (95% CI: 9.7,12.9) and 4.5 (95% CI: 3.4,5.6) per 100,000 respectively in the period 2007-2017. The overall mean age at diagnosis was 48.4 (standard deviation=15.3) years. The overall survival rates at 1, 3, and 5 years for EOC patients were 79.7%, 69.7%, and 61.4% respectively. Age at diagnosis, cancer stage, and histology were significant prognostic factors for patients’ survival. Older age at diagnosis (≥70 years vs <40 years), regional or advanced stage (vs localized stage) and having undifferentiated or other epithelial ovarian (vs serous carcinoma) were associated with having higher hazard of death. Conclusion: Early detection of disease should be emphasized through public education and  raising awareness to improve survival rates of patients with EOC.     

Survival of Patients with Cholangiocarcinoma Receiving Surgical Treatment in an O. viverrini Endemic Area in Thailand: A Retrospective Cohort Study

Objective: To investigate risk factors associated with mortality in cholangiocarcinoma patients receiving surgical treatment in Thailand’s endemic area and their survival rate. Materials and Methods: Medical records of patients with histologically confirmed cholangiocarcinoma, who underwent surgical treatment at Sanpasitthiprasong Regional Hospital from  October 1, 2013 to  October, 31 2015, were retrospectively included. Patients’ vital status (death/alive) and date of death were obtained from the Interior Ministry’s death certificate. Cox proportional hazard regression was used to examine factors associated with mortality. Results: Out of 295 patients with cholangiocarcinoma (CCA), 180(58%) were intrahepatic CCA, 86(28%) were perihilar CCA, and 29 (9%) were distal CCA. Three groups were homogenous in terms of age and gender. Most of our patients referred with abdominal pain (63%), especially those who were intrahepatic CCA (77%). However, almost 80% of the perihilar CCA and distal CCA patients came with jaundice. Tumor markers (CEA and CA19-9) were not different between groups p=0.74 and p=0.43 respectively. Median survival of patients with intrahepatic CCA, perihilar CCA, and distal CCA patients was 14.6, 14.2, and 14.0 months, respectively. Factors independently associated with mortality in intrahepatic CCA patients were number and size of tumors and presence of perineural invasion (Hazard ratio (HR) 1.09[1.03 - 1.15], 1.07[1.02 - 1.13], and 2.09 [1.28 - 3.39], respectively). In perihilar CCA patients, having positive lymph nodes and resection status were independently associated with mortality. Compared to R0 resection, R1, R2, and no resection of perihilar CCA were associated with a 2-, 8- and 4-fold increase in the risk of mortality (HR 2.17 (0.99 – 4.78), 7.97 (3.22 – 19.71), and 4.21 (0.51 – 34.82), respectively). Conclusion: CCA patients in this endemic area had fairly poor survival. Factors associated with mortality in intrahepatic CCA were number and size of tumors and perineural invasion. However, risk factors for perihilar CCA included positive lymph nodes and resection status.     

Survival in stage I–III breast cancer patients by surgical treatment in a publicly funded health care system

BackgroundRecent investigations of breast cancer survival in the United States suggest that patients who receive mastectomy have poorer survival than those who receive breast-conserving surgery (BCS) plus radiotherapy, despite clinically established equivalence. This study investigates breast cancer survival in the publicly funded health care system present in Alberta, Canada.Patients and methodsSurgically treated stage I–III breast cancer cases diagnosed in Alberta from 2002 to 2010 were included. Demographic, treatment and mortality information were collected from the Alberta Cancer Registry. Unadjusted overall and breast cancer-specific mortality was assessed using Kaplan–Meier and cumulative incidence curves, respectively. Cox proportional hazards models were used to calculate stage-specific mortality hazard estimates associated with surgical treatment received.ResultsA total of 14 939 cases of breast cancer (14 633 patients) were included in this study. The unadjusted 5-year all-cause survival probabilities for patients treated with BCS plus radiotherapy, mastectomy, and BCS alone were 94% (95% CI 93% to 95%), 83% (95% CI 82% to 84%) and 74% (95% CI 70% to 78%), respectively. Stage II and III patients who received mastectomy had a higher all-cause (stage II HR = 1.36, 95% CI 1.13–1.48; stage III HR = 1.74, 95% CI 1.24–2.45) and breast cancer-specific (stage II HR = 1.39, 95% CI 1.09–1.76; stage III HR = 1.79, 95% CI 1.21–2.65) mortality hazard compared with those who received BCS plus radiotherapy, adjusting for patient and clinical characteristics. BCS alone was consistently associated with poor survival.ConclusionsStage II and III breast cancer patients diagnosed in Alberta, Canada, who received mastectomy had a significantly higher all-cause and breast cancer-specific mortality hazard compared with those who received BCS plus radiotherapy. We suggest greater efforts toward educating and encouraging patients to receive BCS plus radiotherapy rather than mastectomy when it is medically feasible and appropriate.     

Survival of Stomach Cancer Cases in Khon Kaen,Thailand 2000-2012

Background: Stomach cancer is an aggressive malignancy that is difficult to detect at an early stage and therefore is characterized by poor survival rates. Over the last two decades, there has been no report of gastric cancer survival in Khon Kaen province, Thailand. The aim of this retrospective cohort study was to provide up-to-date information about the survival of gastric cancer patients in this province. Materials and Methods: Data from Khon Kaen population-based cancer registry, Faculty of Medicine, Khon Kaen University were newly obtained on 650 patients who were diagnosed with stomach cancer during the period 1 January, 2000 to 31 December, 2012. These were then followed up until death or the end of the study (31 December 2014). We calculated the observed survival with the actuarial life table method, and relative survival, defined as the ratio of observed survival in the group of the stomach cancer patients to the expected survival in the entire Thai population from the estimated generation life tables for Thailand of five-year birth cohorts from 1900 - 2000. Results: The 5 year observed and 5 year relative survival rates were 17.2 % (95% CI: 13.54-21.14) and 18.2 % (95% CI: 14.3-22.4), respectively. The highest 5 year relative survival rates were demonstrated among patients aged 45-65, with stage I or II lesions, with adenocarcinomas, with a body of stomach location, well differentiated and receiving surgery and/or chemotherapy. Conclusions: The observed and relative survival rates were close to each other. Our findings provide basic information beneficial to development of an effective treatment system and appropriately improved population-based cancer registration.     

Localized squamous-cell cancer of the esophagus: retrospective analysis of three treatment schedules.

BACKGROUND AND PURPOSE: A retrospective study comparing chemotherapy and radiation, esophagectomy alone versus preoperative radiochemotherapy and surgery in localized squamous-cell esophageal carcinoma. MATERIALS AND METHODS: Between 1989 and 1995, 139 patients (40 stage I, 77 stage IIA and 22 stage IIB according to the UICC 78 TNM classification) were treated in two different institutions. They were divided into three groups according to the treatment proposed: E group (treatment by esophagectomy; n = 30), RCT+E group (treatment by preoperative radiochemotherapy and esophagectomy; n = 46), RCT group (treatment by radiochemotherapy; n = 63). Factors like age, tumor localization and stage were similar in all groups. An intention to treat analysis was made. RESULTS: The E group showed no postoperative mortality, while in the RCT+E group, the surgery mortality was 12.8%. The mortality after RCT was 1.7%. After preoperative radiochemotherapy, a pathological complete response was observed in 25% of cases and the curative resection rate was higher (82% after RCT + E versus 60% after E). The 5-year survival difference between the three groups was not relevant (E group, 12.6%; RCT group, 25.8%; RCT + E group, 38.7%). The median survival was 29, 24 and 28.5 months, respectively. The event-free survival was identical for the E group and the RCT group. For patients treated by radiochemotherapy, local and/or distant relapses were significantly reduced by esophagectomy (relapses occurred in 51% of patients in the RCT + E group versus 75% in the RCT group, P = 0.017). Palliative care (dilatations, prosthesis, gastrostomy or jejunostomy) to improve dysphagia was necessary for 38% of patients treated by exclusive radiochemotherapy versus 11% of patients treated by surgery (P = 0.001). CONCLUSIONS: Treatments by esophagectomy or radiochemotherapy were not significantly different. Preoperative radiochemotherapy and surgery lead to a higher survival rate than exclusive radiochemotherapy, however, with a high postoperative mortality rate. This study suggests the relevance of a prospective randomized trial to compare RCT+E and RCT alone.     

Outcomes of patients with stage III nonsmall cell lung cancer treated with chemotherapy and radiation with and without surgery

BACKGROUND:

The objective of this study was to identify the factors associated with improved outcome after treatment for stage III nonsmall cell lung cancer (NSCLC).

METHODS:

A retrospective review of stage III NSCLC patients treated at who were treated at the Dana‐Farber Cancer Institute/Brigham and Women's Cancer Center was done with institutional review board approval. Patients were followed for toxicity, local and distant failure, and overall survival. Multivariate Cox logistic regression analysis was used to determine the factors associated with treatment outcome.

RESULTS:

Between August 2000 and November 2006, 144 patients received concurrent chemoradiation (CRT) for stage III NSCLC. Eighty of 144 patients were men (56%), and the median age was 61 years (range, 33‐81 years). Sixty‐two patients (43%) had stage IIIA NSCLC, and 82 patients (57%) had stage IIIB NSCLC. Radiotherapy (RT) was given concurrently with chemotherapy to all patients; 100 patients (69%) received CRT without surgery, and 44 patients (31%) received with neoadjuvant CRT followed by surgical resection. The median RT dose was 60 grays (Gy) (range, 46‐70 Gy). The median follow‐up was 15 months (range, 3‐64 months), the median potential follow‐up was 37 months (range, 12‐84 months), and the median overall survival was 22 months (95% confidence interval, 15‐28 months). The 1‐year and 2‐year survival rates were 68% and 47%, respectively. Among the 44 patients who underwent resection, the median survival was 61 months, and the 2‐year survival rate was 73%. On multivariate analysis, stage at the time of treatment (stage IIIA vs stage IIIB) and use of surgery were the only factors associated with improved outcome (P = .01 and P = .001, respectively).

CONCLUSIONS:

In this retrospective series, those patients who were able to undergo resection appeared to have improved outcome after induction CRT. Cancer 2009. © 2009 American Cancer Society.     

450 例老年原发性支气管肺癌生存评价及影响预后因素分析

目的:肺癌的发病率及死亡率全球最高，老年肺癌的发病人数亦在增加。本文旨在评价老年原发性支气管肺癌的生存情况及探讨影响老年肺癌生存和预后的因素。方法:回顾性总结新疆医科大学第一附属医院2002年1 月至2007年1 月间收治的450 例年龄≥70岁的老年肺癌患者的病例资料，评价其1、3 年生存率并进行影响生存和预后的单因素及多因素分析。结果:老年肺癌患者总的1、3 年生存率分别为52.12% 、15.57% ，接受治疗的患者1、3 年生存率均明显高于未经治疗者（P<0.05，分别为52.8 %:10.18% ；17.26%:0），其中不同治疗模式中，手术组1、3 年生存率均高于化疗组及支持对症组（P<0.05），其余各组未发现有差异。单因素分析中民族、付费方式、治疗前的一般状况评分（PS）、体重减轻，有无转移、病理类型、分期和治疗模式与预后有统计学意义（P<0.05）。 而性别、吸烟指数、有无合并症、血红蛋白水平、白蛋白水平等均未发现与长期生存率相关；多因素分析显示治疗前的一般状况（PS）评分、分期、体重减轻是影响老年肺癌预后的独立因素。结论:老年肺癌患者接受治疗能够提高其1、3 年生存率。对于早期患者手术治疗仍为最有效的治疗方法之一。治疗前的一般状况（PS）评分、临床分期、体重减轻是影响老年肺癌预后的独立因素。