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.     

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%.     

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.     

Factors Affecting Survival of Cervical Cancer Patients Treated at the Radiation Unit of Srinagarind Hospital,Khon Kaen University,Thailand

This retrospective longitudinal study aimed to evaluate factors for survival of cervical cancer patients treatedwith radiation therapy. Information was retrieved from the medical records of 1,180 cervical cancer patientsand pathologic material was reviewed to confirm the diagnosis of those treated with radiation therapy atSrinagarind Hospital, Khon Kaen University between 1 January 1994 and 31 December 1999. The patientswere followed up until December 31, 2004, with current vital status determined through the hospital-basedregistry, the population-based cancer registry of Khon Kaen Province, the civil registration database, the Ministryof Interior and by mail. Data were analysed with the Kaplan-Meier, Log-rank test and Cox proportion hazardmodels. The mortality rate was 70 per 1,000 person-years with an overall 5-year survival of 62.5%. Mediansurvival was >10 years. From multivariate analyses, the factors that statistically affected survival of cervicalcancer patients included stage (p-value<0.001), hemoglobin level (p-value<0.001), interval between externaland intracavitary radiation (p-value<0.001) and fractionation (p-value=0.024). Stage III was associated with a1.65-fold mortality risk compared with stage I (95% CI=1.05-2.59). Patients with a low hemoglobin level (≤ 10g./dl.) demonstrated a 1.85-fold mortality risk compared with patients a value >12 g./dl. (95% CI=1.40-2.44). Aninterval between external and intracavitary radiation >28 days was associated with 2.28-fold mortality riskcompared with a duration of <1 day (95% CI= 1.40-2.44). The fractionation 2 faction was associated with 0.25-fold mortality risk compared with 1 fraction (95% CI=0.07-0.96). Future prospective trials should be undertakento confirm the validity of these factors and to elucidate their therapeutic implications.     

Hepatitis Viruses and Risk of Cholangiocarcinoma in Northeast Thailand

Liver cancer is the most common cancer in males in Thailand and the third in females. A high incidence of cholangiocarcinoma (CCA) is estimated in the northeast of Thailand. Chronic infection with Opisthorchis viverrini (OV) is the major risk factor for development of CCA. It has been demonstrated that HCV infection is a risk factor for CCA in non - endemic area of OV infection. We examined the association of HBV and HCV and risk of CCA in the northeast Thailand. All cases of CCA were recruited between 1999 and 2001 from Nakhon Phanom provincial hospital and all community hospitals in the province. One control per case was selected, matched by sex, age (±5 years) and residence. 106 case-control pairs were obtained. Anti-OV, HBsAg, and Anti HCV were determined by ELISA. Among 103 age-sex-place of residence matched case-control pairs, there were 7, 0, 0, 96 pairs for anti-HCV (+) case vs. (-) control, (+) case vs. (+) control, (-) case vs. (+) control and (-) case vs. (-) control combinations (OR=7/0). Among 106 matched pairs, there were 9, 2, 4, 91 pairs for the similar four combinations of HBsAg (OR=2.25 (95%CI: 0.63-10.00)). If the subject had anti-HCV and/or HBsAg, the OR for CCA was 4.00 (95%CI: 1.29-16.44). Even after adjustment for anti-OV, risk for HBsAg and/or anti-HCV positive was still marginally increased with an OR of 4.69 although not reaching statistical significance (95%CI: 0.98-22.47). Hepatitis B and C virus infection may also play role in the development of CCA in northeast Thailand.     

Risk Factors for Cholangiocarcinoma in the Lower Part of Northeast Thailand: a Hospital-based Case-control Study

Background: Cholangiocarcinoma (CCA) is the most common cancer in Northeast Thailand. It is also acrucial health problem for Thai people. Various risk factors for CCA have been identified in the upper partof Northeast Thailand, but no similar studies of risk factors have been conducted in the lower parts of theregion. This study aimed to investigate factors associated with CCA in the resident population. Materials andMethods: A hospital-based case-control study was conducted during 2009-2012 with the recruitment of 123 CCAcases and 123 non-CCA patient controls, matched for sex, age and residential area. Information was collectedby interview with a structured questionnaire. Blood samples were collected for assays of anti-OV antibodies.Associations between various personal factors, dietary habits, family history, the presence of anti-OV antibodiesand CCA were analyzed using multiple conditional logistic regression. Results: Patients who consumed rawmeat (beef, pork) and alcoholic beverages ≥3 times per week had a higher risk of CCA than non-consumers(ORadj=4.33; 95%CI=1.14-16.35 and ORadj=2.13; 95%CI=1.00-4.55, respectively). Patients who had a familyhistory of cancer had a higher risk than those who did not (ORadj=4.34; 95%CI=1.80-10.43). Also, patients whohad anti-OV antibodies (AU>23.337) had a higher risk than those whose anti-OV antibodies were below thecut-off (AU≤23.34) (ORadj=3.09; 95%CI=1.04-9.16). Conclusions: As is the case in the upper part of NortheastThailand, OV infection is a crucial risk factor for CCA in people who live in lower part of the region. Similarly,a family history of cancer and the consumption of alcohol are risk factors for CCA.     

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.     

Factors Associated with Demand for Medical Cannabis Use among Breast Cancer Patients in Northern Thailand: A Cross-Sectional Study

Objective: Breast cancer is the leading cause of death among women worldwide. Although modern treatments are recognized as effective, they often cause side effects. In Thailand, medical cannabis (MC) was legalized in 2019 with limited research on demand for its use. Therefore, this study aimed to identify factors associated with demand for MC among breast cancer patients in the North of Thailand as a target group. Methods: This cross-sectional analytical study administered multistage random sampling to recruit 432 breast cancer patients in northern Thailand. Ethical approval and signed written informed consents were obtained from the patients, prior to the study. A standardized, self-administered structured questionnaire was used to obtain the sociodemographic characteristics, clinical characteristics, social support, attitudes toward MC, knowledge about MC, health literacy about MC, and questions on demand for MC use. The scores from all questionnaires were converted to percentages before analysis. Result: A total of 173 (40%) of patients with breast cancer reported demand to use MC. The factors that were significantly associated with demand to use MC included had high levels of health literacy about MC (adj.OR = 4.96; 95% CI: 2.77 to 8.87), higher levels of social support (adj.OR =4.56; 95% CI: 2.20 to 9.42), higher monthly household income (adj.OR =4.02; 95% CI: 2.33 to 6.94), and positive attitudes toward MC use (adj.OR = 3.52; 95% CI: 1.91 to 6.52) when controlling for effects of other covariates. Conclusion: We found substantial demand for MC use among breast cancer patients. Health literacy, social support, monthly household income, and attitudes about MC were significantly associated with demand for MC use. Therefore, improving health literacy, social support, and attitudes about MC, especially among breast cancer patients, could help increase demand for MC as a complementary and alternative medicine alongside cancer treatment.     

Survival of Cholangiocarcinoma Patients in Northeastern Thailand after Supportive Treatment

Background: Cholangiocarcinoma (CCA) is a very common cancer in Northeastern Thailand. Most CCApatients see a physician at a late stage when curative surgery is not possible. After diagnosis, they generally aretreated by partial surgery/percutaneous drainage, chemotherapy and supportive treatment. Objective: Thisstudy aimed to assess the survival rates of CCA patients after supportive treatment. Methods: A retrospectivecohort design was applied in this study. Data for 746 CCA patients were extracted from the hospital-based cancerregistry of Srinagarind Hospital, Khon Kaen University. The patients were diagnosed (at least by ultrasonography)between 1 January, 2009 and 31 December, 2009 and then followed up for current status until 30 June, 2011.The cumulative survival rate was calculated by the Kaplan-Meier method, and independent prognostic factorswere investigated using Cox regression. Results: The total follow-up time was 5,878 person-months, and thetotal number of deaths was 637. The mortality rate was therefore 10.8 per 100 person-year (95%CI : 10.1-11.7).The cumulative 3, 6, 9, 12 and 24 month survival rates were 59%, 39%, 31%, 24% and 14%, respectively. Themedian survival time after supportive treatment was 4 months. After adjusting for gender, age, stage, distantmetastasis, histological grading and treatment, stage was a significant predictor of survival of CCA patients.Those in stage III and stage IV had a 6.78 fold higher mortality than the stage I and stage II cases (95% CI :1.6-28.7). Conclusion: It is very important to encourage patients to see health personnel at an early stage.     

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.     

Factors Affecting Survival in Neuroendocrine Tumors: A 15-Year Single Center Experience

Background: Neuroendocrine tumors are a heterogeneous group of tumors that can originate from all of theneuroendocrine cells in the body, mostly from the gastrointestinal tract. In addition to early diagnosis, streamingpatients into appropriate prognostic groups is an important component of treatment. In this study, we examined thefactors that affect survival in patients we followed in our center between 2000-2016. Methods: The demographic data,clinical and pathological features of patients were obtained from their medical files. TNM staging and tumor gradingwere performed according to AJCC and WHO 2010 classification. SPSS 15.0 for Windows programme was used forstatistical analysis. Results: 85 patients (32 male, 53 female) were included into the study. The median age of the patientswas 55,7 (27-83) years. Eighty percent of the tumors were of gastroenteropancreatic system, most commonly stomach(27.1%) origin. Nineteen patients (22.4%) died during follow-up. In univariate analysis; age (p<0,001), stage (p=0.002),primary tumor localization (p=0.005), grade (p<0.001), Ki-67 value (p<0.001), number of metastases (p=0.001) andtype of surgery (p<0.001) were found to be factors affecting survival. Age (p=0.024) and Ki67 (p <0.001) were theindependent prognostic factors for survival in multivariate analysis. For the cut-off value of 6%, Ki-67 had a sensitivityof 83.3% and specifity of 71.4% for survival determination. Conclusion: Ki-67 ratio and age were the most importantfactors affecting survival in neuroendocrine tumors in our study. Ki-67 ratio has a high sensitivity and specificity forpredicting survival, a cut-off value of 6% may be used to predict survival.     

Survival Time and Molecular Subtypes of Breast Cancer after Radiotherapy in Thailand

Background: Breast cancer is an important cause of death among women. One way of classifying differentforms of breast cancer is by molecular features, usually in terms of the four subtypes: luminal A, luminalB, HER2-enriched, and triple negative. Objectives: This study aimed to investigate the association betweenmolecular subtypes and survival among breast cancer patients treated with radiotherapy. Materials and Methods:A retrospective cohort study was conducted. The subjects were 272 breast cancer patients who had receivedtreatment in the radiotherapy unit at Srinagarind Hospital, Thailand, between 1 January, 1999, and 31 May,2009. The end of the study was 1 June, 2014. Overall survival was defined as the time elapsing between initialregistration at the radiotherapy unit and death or the end of the study. Survival curves were estimated by theKaplan-Meier method, and a multivariate analysis was performed using Cox’s proportional hazard regressionmodel. Results: The patient mean age was 47.5±10.4 at the time of diagnosis. Of the 272 patients, 146 (53.7%)were classified as luminal A, 12 (4.4%) as luminal B, 30 (11.0%) as HER2-enriched, and 84 (30.9%) as triplenegative. The overall survival rates at 1, 3 and 5 years were 87.1%, 68.4% and 59.2%, respectively. According tomolecular subtypes, HER2-enriched patients had the lowest 5-year survival rate (30.0 %, 95%CI: 15.02-46.55).The median follow-up time was 8.37 years. In the Cox model analysis a higher risk of death was found for patientswith HER2-enriched (HRadj=3.34, 95%CI:1.96-5.67), triple negative (HRadj=2.17, 95%CI: 1.44-3.27), and stageIIlB (HRadj=2.20, 95%CI: 1.16-4.17) cancers. Conclusions: The worst survival rates were among patients classifiedas HER2-enriched, triple negative and at stage IIIB. Early detection and an advanced treatment modality areneeded to help these patients.     

Factors Influencing Demand for Medical Cannabis Use among Cancer Patients in the North of Thailand

Objective: Cancer treatments often cause side effects. Cannabis is a plant that has been studied and used to treat and relieve side effects from modern medicine. Medical cannabis (MC) was legalized in Thailand in 2019 with limited research on demand for its use. Therefore, this study aimed to identify factors associated with demand for MC use among cancer patients in the North of Thailand. Methods: This analytical cross-sectional study administered a multistage random sampling to recruit 1,284 cancer patients in northern Thailand to response a self-administered structured questionnaire. Generalized Linear Mixed Model (GLMM) was used to identify the determinants of demand for MC use among the population, presented adjusted odds ratios (adj.OR), 95% confidence intervals (95% CI), and p-values. Result: Nearly half of the respondents reported demand to use MC (44.0%). The factors that were significantly associated with demand to use MC included had high levels of health literacy about MC (adj.OR = 5.70; 95% CI: 4.08 to 7.96), higher levels of social support (adj.OR =5.50; 95% CI: 3.60 to 8.39), positive attitudes toward MC use (adj.OR = 2.56; 95% CI: 1.83 to 3.56), aged less than 30 (adj.OR =1.89; 95% CI: 1.21 to 2.93), diagnosis with cancerfor more than 12 months ago (adj.OR =1.73; 95% CI: 1.19 to 2.52) when controlling effect of other covariates. Conclusion: We found substantial demand for MC use among cancer patients. Health literacy,social support, attitudes about MC, age, and duration of having cancer were significantly associated with demand for MC use. Therefore, improving health literacy and social support, especially among older cancer patients, could help increasing demand for MC as a complementary medicine to treat cancers.     

Risk Factors for Cholangiocarcinoma in Khon Kaen,Thailand: A Nested Case-Control Study

The present nested case-control study within the Khon Kaen cohort study was conducted to assess riskfactors for cholangiocarcinoma (CCA) development. Cases were 108 subjects with proven CCA by ultrasoundat least and controls also numbered 108, matched by sex, age (not more than 3 years difference) and period ofrecruitment to the cohort (not more than 3 months difference). A questionnaire was constructed based on thatemployed for the Khon Kaen cohort study recruitment. McNemar’s chi-square test and conditional logisticregression were used for crude analysis and multivariables analysis. Results revealed a sex ratio of 2:1 formales:females. The current study found a statistically significant association when adjusted for other potentialcovariate factors between cholangiocarcinoma and the consumption of total fruits 1.0-2.08 times per day (OR0.32; 95%CI: 0.12-0.88) and history of Opisthorchis viverrini (OV) eggs in stools at recruitment plus consumptionof meat < 0.45 times per day (OR 2.99; 95%CI: 1.04-8.62). The findings suggest that OV infestation is thestrongest risk factor for development of cholangiocarcinoma and also suggests decrease in risk among individualswho consume more fruit.     

Risk Factors for Cholangiocarcinoma in Thailand: A Systematic Review and Meta-Analysis

Background and objective: Cholangiocarcinoma remains a serious public health concern in Thailand. While manyof the risk factors for cholangiocarcinoma in western countries are well-recognized, it remains unclear whether theyare the same in Thailand. We set out to investigate the risk factors for cholangiocarcinoma in Thailand. Methods:Starting March 4, 2016, we reviewed studies found using pre-specified keywords on SCOPUS, Pro Quest ScienceDirect, PubMed, and online public access catalog of Khon Kaen University. Two review authors independently screenedstudies for inclusion criteria, extracted data, and assessed the studied Risk of Bias. The Newcastle-Ottawa Scale and theJoanna Briggs Institute Critical Appraisal Tools were used to assess the quality of included studies. The risk effects offactors were estimated as a pooled adjusted odds ratio with a 95% confidence interval. The heterogeneity of results wasconsidered using the I-square, Tau-square and Chi-square statistics. Results: A strong association was found betweencholangiocarcinoma and age, Opisthorchis viverrini infection, eating raw cyprinoid fish, family history of cancer, liquorconsumption, and taking praziquantel. There was only a mild association found between eating nitrite-containing foods,fresh vegetables, education, smoking behavior, and sex. No association was found between cholangiocarcinoma andeating fermented fish (Pla-ra), northeastern Thai or Chinese sausage, sticky rice, meat, chewing betel nut, or eatingfruit. There were two protective factors including fresh vegetables consumption and education attainment. Conclusion:There are unique risk factors of cholangiocarcinoma in Thailand, including age, Opisthorchis     

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.     

Re-examination of Opisthorchis viverrini Infection in Northeast Thailand

Background: Liver fluke infection caused by the parasite Opisthorchis viverrini (O. viverrini), a humancarcinogen, is endemic in north-eastern Thailand and remains a major health problem. Objectives: The objectivesof the study were to (1) resurvey the prevalence of O. viverrini infection in a field site from the Khon Kaen CohortStudy (in newly recruited subjects as well as previous cohort subjects surveyed in 1992); (2) investigate howsubjects’ lifestyle habits and their exposure to health promotion initiatives influence changes in prevalence ofO. viverrini infection. Materials and Methods: The prevalence of O. viverrini infection in the cohort subjects (aswell as new subjects) was investigated using faecal egg counts. Information on demographic factors, lifestyle andawareness of health promotion initiatives were obtained through questionnaires. Results: O. viverrini infectionrates in the same individuals of the cohort were lower in 2006 than in 1992. Also, by studying the period effect, thecurrent 35-44 year olds had a 12.4% (95% CI 3.9% to 20.9%) lower prevalence of O. viverrini infection than the35-44 year olds in 1992 (24.2% versus 11.8%). Lifestyle choices showed that smoking and alcohol consumptionwere associated with an increased chance of acquiring O. viverrini infection with adjusted odds ratios of 10.1(95%CI 2.4-41.6) and 5.3 (95%CI 1.2-23.0), respectively. Conclusions: Our study has demonstrated that althoughthe prevalence of O. viverrini infection over a 14-year period has decreased, unhealthy lifestyle was commonwith smoking and alcohol consumption being associated with increased chances of infection, emphasising thedouble burden of disease which developing countries are facing.     

影响喉癌生存率的单因素和多因素分析

[目的]探讨影响喉癌生存率的因素以及病理学切缘在上述诸多因素中的地位。[方法]回顾性分析253例喉癌临床资料 ,比较喉癌切缘阴阳性患者的生存率 ,Cox回归模型分析影响喉癌预后的诸因素。[结果]①病理学切缘阳性率是20.2% (51/253) ,相对阴性切缘而言 ,切缘阳性者的生存率低 (37.52 %vs64.37% ,P<0.05)。②单因素分析时年龄、肿瘤生长部位、病理学类型、临床分期、淋巴结有无转移、切缘阴阳性和手术方式均有统计学意义 (P值均<0.05) ;但多因素分析时只有年龄、临床分期、淋巴结有无转移、切缘阴阳性才有意义(P均<0.05)。[结论]切缘阳性者的生存率较阴性者差 ,病理学切缘和淋巴结、临床分期一样都是影响喉癌预后的重要因素。     

Factors Affecting Survival in Patients with Colorectal Cancer in Shiraz,Iran

Background: Colorectal cancer (CRC) is the third most common cancer in the world, and the fourth in Iran in both genders. The aim of this study was to find predictive factors for CRC survival. Materials and Methods: Medical records of 570 patients referred to the radiotherapy oncology department of Shiraz Namazi hospital from 2005 to 2010 were retrospectively analysed. Data were collected by reviewing medical records, and by telephone interviews with patients. Survival analysis was performed using the Cox’s regression model with survival probability estimated with Kaplan-Meier curve. The log-rank test was used to compare survival between strata. Data was analyzed with Stata 12. Results: The five-year survival rate and the mean survival time after cancer diagnosis were 58.5% and 67±1.4 months. On multivariate analysis, age of diagnosis, disease stage and primary tumor site‚ lymphovascular invasion and type of treatment (in colon cancer) were significant factors for survival. Conclusions: Age of diagnosis and type of treatment (adjuvant therapy in patients with colon cancer) were two modifiable factors related to survival of CRC patients. Therefore earlier diagnosis might help increase survival.     

Surprise Questions for Survival Prediction in Patients With Advanced Cancer: A Multicenter Prospective Cohort Study

Background.

Predicting the short-term survival in cancer patients is an important issue for patients, family, and oncologists. Although the prognostic accuracy of the surprise question has value in 1-year mortality for cancer patients, the prognostic value for short-term survival has not been formally assessed. The primary aim of the present study was to assess the prognostic value of the surprise question for 7-day and 30-day survival in patients with advanced cancer.

Patients and Methods.

The present multicenter prospective cohort study was conducted in Japan from September 2012 through April 2014, involving 16 palliative care units, 19 hospital-based palliative care teams, and 23 home-based palliative care services.

Results.

We recruited 2,425 patients and included 2,361 for analysis: 912 from hospital-based palliative care teams, 895 from hospital palliative care units, and 554 from home-based palliative care services. The sensitivity, specificity, positive predictive value, and negative predictive value of the 7-day survival surprise question were 84.7% (95% confidence interval [CI], 80.7%–88.0%), 68.0% (95% CI, 67.3%–68.5%), 30.3% (95% CI, 28.9%–31.5%), and 96.4% (95% CI, 95.5%–97.2%), respectively. The sensitivity, specificity, positive predictive value, and negative predictive value for the 30-day surprise question were 95.6% (95% CI, 94.4%–96.6%), 37.0% (95% CI, 35.9%–37.9%), 57.6% (95% CI, 56.8%–58.2%), and 90.4% (95% CI, 87.7%–92.6%), respectively.

Conclusion.

Surprise questions are useful for screening patients for short survival. However, the high false-positive rates do not allow clinicians to provide definitive prognosis prediction.

Implications for Practice:

The findings of this study indicate that clinicians can screen patients for 7- or 30-day survival using surprise questions with 90% or more sensitivity. Clinicians cannot provide accurate prognosis estimation, and all patients will not always die within the defined periods. The screened patients can be regarded as the subjects to be prepared for approaching death, and proactive discussion would be useful for such patients.