Impact of deprivation and rural residence on treatment of colorectal and lung cancer

For common cancers, survival is poorer for deprived and outlying, rural patients. This study investigated whether there were differences in treatment of colorectal and lung cancer in these groups. Case notes of 1314 patients in north and northeast Scotland who were diagnosed with lung or colorectal cancer in 1995 or 1996 were reviewed. On univariate analysis, the proportions of patients receiving surgery, chemotherapy and radiotherapy appeared similar in all socio-economic and rural categories. Adjusting for disease stage, age and other factors, there was less chemotherapy among deprived patients with lung cancer (odds ratio 0.39; 95% confidence intervals 0.16 to 0.96) and less radiotherapy among outlying patients with colorectal cancer (0.39; 0.19 to 0.82). The time between first referral and treatment also appeared similar in all socio-economic and rural groups. Adjusting for disease stage and other variables, times to lung cancer treatment remained similar, but colorectal cancer treatment was quicker for outlying patients (adjusted hazard ratio 1.30; 95% confidence intervals 1.03 to 1.64). These findings suggest that socio-economic status and rurality may have a minor impact on modalities of treatment for colorectal and lung cancer, but do not lead to delays between referral and treatment.     

Time and chemotherapy treatment trends in the treatment of elderly patients (age >/=70 years) with small cell lung cancer

Platinum-based treatment for small cell lung cancer (SCLC) has been established since 1995. This study investigates treatment outcome of elderly patients (age >/=70 years) with SCLC over the past 20 years in a large UK cancer centre. Comparison of all-cause survival was assessed in patients presenting between two predefined time periods: 1982-1994 and 1995-2003. All the survival analysis were adjusted for stage and performance status and age if appropriate. Survival between different chemotherapy treatment regimens was compared. A total of 322 elderly patients (31% of all) registered between 1982-2003 received chemotherapy for SCLC. Patients presenting in 1995-2003 had an overall better median survival (43 vs 25 weeks) and a 1-year survival (37 vs 14%) than patients presenting in 1982-1994 (P<0.001). This applied to patients with both limited and extensive stage disease and all age groups. There was a trend towards the use of more platinum-based treatments in the later cohort but the use of radiotherapy remained constant. Patients who received platinum combinations (Carboplatin or Cisplatin) had significantly improved survival over those who received single agents or other combinations (P<0.001) and there was no significant difference between carboplatin and cisplatin (P=0.7). The analysis demonstrates that there has been a significant improvement in survival for elderly patients with lung cancer treated by chemotherapy in the past 20 years despite more very elderly patients being treated with a poorer performance status. This change is probably multifactorial and may be due to the increased use of platinum-based treatment and improved supportive care.     

Survival from childhood cancer in Yorkshire, U.K.: effect of ethnicity and socio-economic status

The effect of ethnicity and socio-economic status on the survival of a population-based cohort of 1979 children diagnosed with cancer between 1974 and 1995 was investigated. Ethnicity was assigned by computer algorithms and visual inspection as south Asian (or not) for each child, based on their full name. Socio-economic status was measured using the Carstairs index, based on census areas of case residence at diagnosis. 15 children (0.8%) were lost to follow-up. Log-rank tests showed survival from all cancers did not differ between south Asians and other children and no increased risk was observed for south Asians in any diagnostic category, although numbers were small. Increasing levels of deprivation were associated with significant trends of poorer survival from all cancers, leukaemias and brain tumours. Risk of death was typically higher for children from the most deprived areas although differences were not statistically significant after accounting for other factors including ethnicity. Taking all children with malignant disease together, neither ethnicity nor socio-economic status appear to influence survival after taking other factors into consideration.     

Brain metastases in breast cancer: prognostic factors and management

Background The purpose of this retrospective study was to analyze the overall survival of patients with brain metastases due to breast cancer and to identify prognostic factors that affect clinical outcome. Methods Of the 7,872 breast cancer patients histologically diagnosed with breast cancer between January 1990 and July 2006 at the Asan Medical Center, 198 patients with solitary or multiple brain metastases were included in this retrospective study. Central nervous system (CNS) lesions were diagnosed by computed tomography (CT) or magnetic resonance imaging (MRI). Patients with leptomeningeal or dural metastases without co-existent parenchymal metastatic lesions were excluded in this study. We reviewed the medical records and pathologic data of these 198 patients to characterize the clinical features and outcomes. Results The median age of the patients at the diagnosis of brain metastases was 45 years (range 26–78 years). Fifty-five patients (28%) had a single brain metastasis, whereas 143 (72%) had more than two metastases. A total of 157 (79.2%) patients received whole-brain radiation therapy (WBRT). A total of 7 (3.6%) patients underwent resection of solitary brain metastases, 22 (11%) patients underwent gamma-knife surgery, three patients underwent intrathecal chemotherapy (1.5%) and 9 (4.6%) patients received no treatment. The overall median survival time was 5.6 months (95% confidence interval (CI), 4.7–6.5 months) and 23.1% of the patients survived for more than 1 year. The median overall survival time was 5.4 months for patients treated with WBRT, 14.9 months for patients treated with surgery or gamma-knife surgery only, and 2.1 months for patients who received no treatment (P < 0.001). Multivariate analysis demonstrated that Eastern Cooperative Oncology Group (ECOG) performance status (relative risk (RR) = 0.704, 95% CI 0.482–1.028, P = 0.069), number of brain metastases (RR = 0.682, 95% CI 0.459–1.014, P = 0.058), treatment modalities (RR = 1.686, 95% CI 1.022–2.781, P = 0.041), and systemic chemotherapy after brain metastases (RR = 1.871, 95% CI 1.353–2.586, P < 0.001) were independent factors associated with survival. Conclusion Although survival of breast cancer patients with brain metastases was generally short, the performance status, number of brain metastases, treatment modalities and systemic chemotherapy after brain metastases were significantly associated with survival. Patients with single-brain metastasis and good performance status deserve aggressive treatment. The characteristics of initial primary breast lesions did not affect survival after brain metastasis.     

Race,ethnicity, and socioeconomic status influence the survival of patients with hepatocellular carcinoma in the United States

BACKGROUND:

Racial, ethnic, and socioeconomic disparities in the survival of patients with hepatocellular carcinoma (HCC) continue to exist. The authors of this report hypothesized that these differences result from inequities in access to care and in response to therapy.

METHODS:

Patients with HCC (n = 20,920) were identified from the Surveillance, Epidemiology, and End Results (SEER) database, and patients who underwent liver transplantation for HCC (n = 4735) were identified from the United Network for Organ Sharing (UNOS) database. Clinical and pathologic factors were compared after patients were stratified by race and ethnicity.

RESULTS:

The survival of patients with HCC improved over time for all racial, ethnic, and income groups (P < .001). Black and low income individuals had the poorest long‐term survival (P < .001). On multivariate analysis, black race was predictive of the poorest survival (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.09‐1.22; P < .001), whereas Asian race was associated with the best survival (HR, 0.87; 95% CI, 0.83‐0.91; P < .001). After liver transplantation, black patients had the worst graft survival and overall survival (median survival [MS], 30.5 months and 39.7 months, respectively; P < .001), whereas Hispanics had the best survival (MS, 83.4 months and 86.6 months, respectively; P < .001). In a multivariate analysis of transplantation patients, race and ethnicity were associated significantly with outcome.

CONCLUSIONS:

Significant racial and ethnic disparities in the outcome of patients with HCC persist despite the receipt of comparable treatment. The authors concluded that further investigations are warranted to identify the reasons for the stark disparity in outcomes between black patients and Hispanic patients after liver transplantation for HCC. Cancer 2010. © 2010 American Cancer Society.     

Prognostic significance of several histological features in intermediate and high‐risk endometrial cancer patients treated with curative intent using surgery and adjuvant radiotherapy

The purpose of the present study was to explore the prognostic significance of several histological features with respect to lymph node metastasis, failure‐free survival (FFS), and overall survival (OS) in intermediate and high‐risk endometrial cancer patients treated with curative intent. One hundred and eighty patients with endometrial cancer were treated with hysterectomy with or without lymphadenectomy and received external beam radiotherapy (EBRT). The mean follow‐up period was 4.25 years (range 0.44–10.45 years). In multifactor analysis, fractional myometrial invasion (MI) (P = 0.047), histology (P < 0.001) and lymph‐vascular space invasion (LVSI) (P = 0.025) were significant predictors for FFS when nodal status was not included. When lymph node status was known, histology (P = 0.007) and LVSI (P = 0.014) remained significant factors for FFS. For OS, histology (P < 0.001) and fractional MI (P = 0.004) were the significant factors. Lymph node status could be predicted by tumour grading (P = 0.016) and absolute MI (P = 0.002). Histology type and the presence of LVSI were the most important prognostic factors in high‐risk endometrial cancer patients treated by surgery and postoperative radiotherapy. Absolute MI and tumour grading were useful predictors of nodal spread.     

Salvage stereotactic radiosurgery for breast cancer brain metastases: outcomes and prognostic factors

BACKGROUND:

Salvage stereotactic radiosurgery (SRS) is often considered in breast cancer patients previously treated for brain metastases. The goal of this study was to analyze clinical outcomes and prognostic factors for survival in the salvage setting.

METHODS:

The authors retrospectively examined 79 consecutive breast cancer patients who received salvage SRS (interval of >3 months after initial therapy), 76 of whom (96%) received prior whole‐brain radiation therapy. Overall survival (OS) and central nervous system (CNS) progression‐free survival rates were calculated from the date of SRS using the Kaplan‐Meier method. Prognostic factors were evaluated using the Cox proportional hazards model.

RESULTS:

Median age was 50.5 years. Fifty‐eight percent of this population was estrogen receptor positive, 62% was HER2 positive, and 10% was triple negative. At the time of SRS, 95% had extracranial metastases, with 81% of extracranial metastases at other visceral sites (lung/pleura/liver). Forty‐eight percent had stable extracranial disease. Median interval from initial brain metastases therapy to SRS was 8.4 months. Median CNS progression‐free survival after SRS was 5.7 months (interquartile range [IQR], 3.6‐11 months), and median OS was 9.8 months (IQR, 3.8‐18 months). Eighty‐two percent of evaluable patients received further systemic therapy after SRS. HER2 status (adjusted hazard ratio [HR], 2.4; P = .008) and extracranial disease status (adjusted HR, 2.7; P = .004) were significant prognostic factors for survival on multivariate analysis.

CONCLUSIONS:

In patients with good Karnofsky performance status, salvage SRS for breast cancer brain metastases is a reasonable treatment option, given an associated median survival in excess of 9 months. Furthermore, patients with HER2‐positive tumors at diagnosis or stable extracranial disease at the time of SRS have an improved clinical course, with median survival of >1 year. Cancer 2012. © 2011 American Cancer Society.     

Impact of race and ethnicity on features and outcome of ductal carcinoma in situ of the breast

BACKGROUND:

The impact of race and ethnicity on the biologic features and outcome variables of women who are diagnosed with preinvasive breast cancer—ductal carcinoma in situ (DCIS)—has not been addressed widely in the published literature.

METHODS:

Patient demographic, clinical, and pathologic features and outcome variables were analyzed with respect to the patient's initial self‐reported race/ethnicity among women who received treatment for a diagnosis of pure DCIS from 1996 to 2009.

RESULTS:

Of 1902 patients, 1411 were white (74.2%), 214 were African American (11.3%), 175 were Hispanic (9.1%), and 102 were Asian/Pacific Islander (5.4%). The majority of patients were between ages 41 and 70 years (83%). Patients of Hispanic and Asian/Pacific Islander descent were significantly younger than white and African American patients (P < .001). DCIS size and grade, the presence of necrosis, and the frequency of breast‐conserving surgery did not differ significantly between groups. African American patients aged >70 years and Hispanic patients aged <50 years were significantly more likely to have estrogen receptor‐positive DCIS than patients of other races in the same age categories (P < .001). Adjuvant radiotherapy and tamoxifen were received significantly less often by white women (P < .001). At a median follow‐up of 4.8 years (range, 1‐14 years), recurrence rates and the development of contralateral breast cancer did not differ significantly among racial/ethnic groups when stratified by treatments received.

CONCLUSIONS:

There was variation in age at presentation, biologic features, and treatment of DCIS among the different ethnic groups. Additional studies with larger numbers of ethnic minority patients are needed to confirm whether the consistent application of evidence‐based treatment practices presents an opportunity for reducing disparities in patients with DCIS. Cancer 2013. © 2012 American Cancer Society.     

The survival of patients with high grade glioma from different ethnic groups in South East England

Studies in the United States (US) have reported varying treatment and survival for patients with high grade glioma from different ethnic groups. This study investigates for the first time whether differences also exist in the United Kingdom (UK). This population-based cohort study used cancer registration data for 4,845 patients diagnosed in South East England between 2000 and 2009. Linked self-assigned ethnicity data within Hospital Episode Statistics were used to define White, Indian, Pakistani, Bangladeshi, Black Caribbean, Black African, Other and Not known groups. Logistic regression was used to generate odds ratios for a record of receipt of treatment (surgery, radiotherapy and chemotherapy), adjusting for sex, age, morphology, socioeconomic deprivation and comorbidity in each ethnic group. Hazard ratios were generated using Cox regression, adjusting for sex, age, morphology, socioeconomic deprivation, comorbidity and treatment. The overall one-year survival was 28.4 %. Ethnicity data was available for 3,793 (78 %) patients. Receipt of treatment was generally similar between different ethnic groups after adjustment for sex, age, morphology, socioeconomic deprivation and comorbidity. After adjustment for potential confounders, the Indian (HR 0.72, p = 0.037) and Other groups (HR 0.76, p = 0.003) had better survival, while the Not known group (HR 1.34, p < 0.0001) had worse survival than the White group. Patients from UK Indian groups have better survival than White patients while those from Black ethnic groups appear to have similar survival to White patients. These findings suggest the need to investigate possible contributing factors including the completeness of follow-up, clinical performance status and tumour biology.     

Breast cancer treatment and ethnicity in British Columbia,Canada

Background  

Racial and ethnic disparities in breast cancer incidence, stage at diagnosis, survival and mortality are well documented; but few studies have reported on disparities in breast cancer treatment. This paper compares the treatment received by breast cancer patients in British Columbia (BC) for three ethnic groups and three time periods. Values for breast cancer treatments received in the BC general population are provided for reference.     

Triple negative breast cancer compared to hormone receptor negative/HER2 positive breast cancer

The aim of this study is to reveal likely demographic, clinical, and pathological differences among hormone receptor negative breast cancer patients according to their HER-2 status. The medical records of hormone receptor negative breast cancer patients with known HER-2 status between January 1999 and December 2006 were reviewed, retrospectively. A total of 91 cases were included in the study (68 HER-2 negative cases and 23 HER-2 positive cases). The results obtained showed that median age, menarche age, childbearing age, number of children, menopause age, and body-mass indexes were similar in both groups. The HER-2 negative patients had more family history of breast cancer than HER-2 positive patients (13.2% and 0%, respectively, P = 0.091). Eighty-three patients received neoadjuvant/adjuvant chemotherapy. Recurrence occurred in 41 (46.6%) patients. Neither recurrence nor disease-free survival of those patients was associated with HER-2 status. Tumor size (P = 0.042) and number of involved lymph nodes (P = 0.001) were found to be independent prognostic factors for disease-free survival. A tendency for more frequent cerebral metastasis was found in HER-2 positive advanced stage patients (P = 0.052). HER-2 positive patients were less responsive to taxanes (P = 0.071). The number of involved lymph nodes (P = 0.004) and HER-2 status (P = 0.043) were found to be prognostic factors for overall survival. HER-2 positive and negative patients should be followed and treated with different strategies. HER-2 positive patients are at least as resistant to systemic therapies as the HER-2 negative patients. Genetic counseling should be routinely provided to triple negative patients and their families. HER-2 positive patients may be candidates for prophylactic treatment strategies concerning cerebral metastasis.     

Socio-economic inequalities in cancer survival: how do they translate into Number of Life-Years Lost?

Background We aimed to investigate the impact of socio-economic inequalities in cancer survival in England on the Number of Life-Years Lost (NLYL) due to cancer.Methods We analysed 1.2 million patients diagnosed with one of the 23 most common cancers (92.3% of all incident cancers in England) between 2010 and 2014. Socio-economic deprivation of patients was based on the income domain of the English Index of Deprivation. We estimated the NLYL due to cancer within 3 years since diagnosis for each cancer and stratified by sex, age and deprivation, using a non-parametric approach. The relative survival framework enables us to disentangle death from cancer and death from other causes without the information on the cause of death.Results The largest socio-economic inequalities were seen mostly in adults <45 years with poor-prognosis cancers. In this age group, the most deprived patients with lung, pancreatic and oesophageal cancer lost up to 6 additional months within 3 years since diagnosis than the least deprived. For most moderate/good prognosis cancers, the socio-economic inequalities widened with age.Conclusions More deprived patients and particularly the young with more lethal cancers, lose systematically more life-years than the less deprived. To reduce these inequalities, cancer policies should systematically encompass the inequities component.Subject terms: Cancer epidemiology, Health policy, Prognosis, Epidemiology, Cancer     

Lung cancer incidence and survival in different ethnic groups in South East England

Background:

This study aimed to examine the incidence and survival of lung cancer patients from several different ethnic groups in a large ethnically diverse population in the United Kingdom.

Methods:

Data on residents of South East England diagnosed with lung cancer between 1998 and 2003 were extracted from the Thames Cancer Registry database. Age- and socioeconomic deprivation-standardised incidence rate ratios were calculated for males and females in each ethnic group. Overall survival was examined using Cox regression, adjusted for age, socioeconomic deprivation, stage of disease and treatment. Results are presented for White, Indian, Pakistani, Bangladeshi, Black Caribbean, Black African and Chinese patients, apart from female survival results where only the White, South Asian and Black ethnic groups were analysed.

Results:

Compared with other ethnic groups of the same sex, Bangladeshi men, White men and White women had the highest incidence rates. Bangladeshi men had consistently higher survival estimates compared with White men (fully adjusted hazard ratio 0.46; P<0.001). Indian (0.84; P=0.048), Black Caribbean (0.87; P=0.47) and Black African (0.68; P=0.007) men also had higher survival estimates. South Asian (0.73; P=0.006) and Black (0.74; P=0.004) women had higher survival than White women.

Conclusion:

Smoking prevention messages need to be targeted for different ethnic groups to ensure no groups are excluded. The apparent better survival of South Asian and Black patients is surprising, and more detailed follow-up studies are needed to verify these results.     

Predictive and prognostic factors associated with survival outcomes in patients with stage I–III breast cancer: A report from a developing country

Background: There is a paucity of data on factors that predict relapse and survival for stages I to III breast cancer patients from developing countries. The primary purpose of our study is to correlate clinical outcomes with established prognostic and predictive factors in patients with stage I to III breast cancer. Methods: A total of 525 patients followed from January 1996 to December 2005 were analyzed for factors predicting relapse and mortality. These included their age, social strata, tumor size, number of positive lymph nodes, stage and histological grade, estrogen and progesterone receptor status and treatment profiles. Results: The patients' median age was 45 years. Only 6.7% patients presented with stage I disease. Factors that were predictive of relapse were a poor socioeconomic status P < 0.0001, T2/T3/T4 tumors P < 0.0001, N1/N2/N3 P < 0.0001, grade III P < 0.0001, initial stage II/III P < 0.0001, estrogen receptor negativity P 0.01. For overall survival significant predictive factors were poor socioeconomic status P < 0.009 T2/T3/T4 P < 0.0001, N1/N2/N3 P < 0.0001, grade III P < 0.001, initial stage II/III P < 0.0001, estrogen receptor (ER) negativity P < 0.002. Event free survival and overall survival for all patients at 5 and 10 years were 57 and 37%, and 72 and 61%, respectively. Conclusion: Poor prognostic markers for survival outcomes were large tumors, advanced disease, number of positive lymph nodes, grade III tumors, ER/progesterone receptor (PR) negative tumors, poor socioeconomic status and variable treatment profiles. Clinical outcomes and survival associated for each prognostic marker were inferior when compared to developed countries due to the larger tumor burden and less than optimal treatment. Early detection programs, improvements in technical expertise and quality of care, with economically feasible guidelines, need to be developed for countries with limited resources.     

Nanog,a novel prognostic marker for lung cancer

ObjectiveTo investigate the expression of the stem cell marker Nanog in lung cancer tissues and the correlations between Nanog expression and clinic-pathologic characteristics as well as prognosis of lung cancer.Methods163 patients with lung cancers enrolled in the study. The expression of Nanog in the cell lines and lung cancers were evaluated by RT-PCR, immunofluorescence and immunohistochemisty. Then, the correlations between Nanog expression status and clinic-pathologic characteristics and prognosis of lung cancer patients were analyzed.ResultsIt showed that Nanog are higher expressed in lung cancer tissues compared to their normal counterparts in both mRNA and protein levels, and Nanog expression was observed to be positively correlated with tumor differentiation and clinical stages of lung cancer patients (P = 0.001 and 0.001). Nanog were mainly localized at the cytoplasm in the brown color in the lung cancers. In addition, nuclear staining of Nanog was more observed in poorly differentiated lung cancers compared to others (P = 0.01). Furthermore, survival analyses showed that over-expression of Nanog protein predicted a worse prognosis for lung cancer patients (P = 0.001).ConclusionNanog can be an important prognostic marker for lung cancer, which may present a new therapeutic target for lung cancer patients in the future.     

Prognostic factors for renal cell carcinoma: Trakya University experience from Turkey

YURUT‐CALOGLU V., CALOGLU M., KAPLAN M., OZ‐PUYAN F., KARAGOL H., IBIS K., COSAR‐ALAS R, KOCAK Z. & INCI O. (2010) European Journal of Cancer Care 19 , 656–663 Prognostic factors for renal cell carcinoma: Trakya University experience from Turkey The purpose of the present study is to evaluate the prognostic factors of patients with renal cell carcinoma. The treatment results such as distant metastasis‐free survival and overall survival of 59 previously untreated patients were retrospectively analysed. Median follow‐up was 17.5 months (3.8–88.5 months). Overall survival was 22.4 months (3–87 months). Distant metastasis developed in 35 (59%) patients. The Eastern Cooperative Oncology Group (ECOG) performance status (P= 0.022), tumour size (P= 0.025) and lymphatic invasion (P < 0.0001) were significantly effective prognostic factors for distant metastasis‐free survival on multivariate analysis. Related to overall survival, gender (P= 0.025), ECOG performance status (P= 0.027), nuclear grade (P= 0.002), tumour size (P= 0.029), T stage (P= 0.044), nodal involvement (P= 0.003), surgical margin (P= 0.046), renal sinus invasion (P < 0.0001), perineural growth (P= 0.001) and lymphatic invasion (P < 0.0001) were significant prognostic factors on univariate analysis. Gender (P= 0.008), ECOG performance status (P= 0.027), tumour size (P= 0.025) and lymphatic invasion (P < 0.0001) retained their significance on multivariate analysis. We concluded that the most important prognostic factors for patients with renal cell carcinomas are ECOG performance status, tumour size and lymphatic invasion.     

Differences in breast cancer biological characteristics between ethnic groups in New Zealand

Objective To investigate differences in breast cancer biological characteristics between ethnic groups in Auckland, New Zealand. Design Prospective cohort study. Setting Auckland Breast Cancer Study Group. Participants All people diagnosed with breast cancer in the greater Auckland area between 2000 and 2005 who agreed to participate (1,577). Main outcome measures Size, grade, lymph node status, estrogen receptor (ER), progesterone receptor (PR), lymphovascular invasion (LVI), grade allowing for size, all compared with ethnicity. Results NZ Maori and Pacific Island participants had larger tumours (P < 0.0001), higher grade tumours (P < 0.0001) with more involved lymph nodes (P < 0.0001). When allowing for size, there was still an indication that NZ Maori people had higher grade tumours (P = 0.03). There was no difference in ER, PR and LVI between ethnic groups. Conclusion These data suggest differences in tumour biology related to ethnicity in the Auckland population and this has implications for breast cancer screening and management.     

Adjuvant chemoradiation for patients with adenocarcinoma of the pancreas: an expirence of single institute

Only a small percentage of patients with pancreatic cancer have limited disease suitable for curative resection. Even with surgery, patients often have poor long-term survival due to relapse of the disease. There are controversies about the adjuvant treatment of these patients. We reported the survival of resected pancreatic cancer from a single institute. About 128 consecutive patients who had complete resection of the pancreatic ductal adenocarcinoma were evaluated, retrospectively. Chemoradiotherapy (45 Gy plus 5-fluorouracil) was given to 63 patients. Fifty-five patients declined to take chemoradiotherapy or with poor performance status were observed without additional treatment. Eight patients took only chemotherapy and two patients took only radiotherapy. The median survival of chemoradiotherapy group was significantly higher than the observation group (13 months vs. 4 months, respectively; P < 0.001). In multivariate analyses the most important factors improving survival were the application of chemoradiation (P < 0.001), low-level serum LDH (P = 0.026), good performance status (P = 0.033) and low serum CA19-9 (P = 0.037). Although adjuvant chemoradiotherapy has a significant survival benefit when compared with the observation group, the survival data are still poor for pancreatic cancer. Therefore, we need more effective additional or adjuvant treatment modalities.     

Prognostic factors in patients with small cell lung carcinoma

Background The current prognosis in patients with small cell lung cancer (SCLC) is unsatisfactory, even though there have been considerable improvements in diagnosis and treatment. Methods We retrospectively analyzed all consecutive patients with small cell lung carcinoma between 1995 and 2007 in a Turkish chest hospital. A total of 116 SCLC patients initially presented with limited disease, while 92 small cell lung carcinoma patients were found to be extensive. Results The mean age of the patients (18 women and 190 men) was 56 years. The median survival was 74 weeks. Performance status, superior vena cava syndrome (SVCS), stage, elevated white blood cell count, elevated lactate dehidrogenase levels, short symptom duration (≤4 weeks) response to chemotherapy and bone metastasis were significant prognostic factors in univariate analysis. It was necessary for patients to receive at least three cycles of chemotherapy for a survival benefit. Cox proportional hazards model identified only stage, performance status and SVCS as independent prognostic factors. Conclusions Stage, performance status and SVCS were determined to be the most important prognostic factors for SCLC patients.     

Differences in Testis Cancer Survival by Race and Ethnicity: A Population-Based Study, 1973–1999 (United States)

Objective: We examined the relationship between race/ethnicity and testis cancer survival in a population-based setting. Methods: We analyzed 16,086 cases of primary testis cancer diagnosed during 1973–1999 and reported to 12 cancer registries participating in the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. We compared testis cancer-specific survival between patients from different racial/ethnic groups by use of the hazard ratio (HR) and 95% confidence intervals (CI) calculated from Cox proportional hazards models, adjusting for stage, histology, and period of diagnosis. Conclusion: These findings are consistent with previous reports of race/ethnic disparities in stage at diagnosis and survival in testis cancer patients as well as other cancer patients. Further research is needed to understand the reasons underlying these disparities.