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Symptoms of Women With High-Risk Early-Stage Ovarian Cancer. Obstet Gynecol 2022; 139:157-162. [PMID: 34991145 PMCID: PMC9126568 DOI: 10.1097/aog.0000000000004642] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/21/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the presentation, characteristics, and prognostic significance of symptoms in patients with high-risk early-stage epithelial ovarian cancer. METHODS A retrospective chart review was performed on all patients enrolled in a phase III clinical trial (GOG 157). All patients had surgically staged, high-risk early-stage epithelial ovarian cancer (stage IA-IB and grade 3, any clear cell, stage IC or II). Chi-square and Kaplan-Meier estimates and Cox proportional hazards models were used for statistical analyses. RESULTS Of 419 patients evaluated for symptoms, 301 (72%) presented with one or more symptoms, and 118 (28%) were asymptomatic but had a mass found on examination. Forty percent had only one symptom, and 32% had more than one symptom. Among those with at least one symptom, the most common were abdominal and pelvic pain (31%), and increased girth or fullness (26%). Overall, 23% of patients with tumors 10 cm or smaller, 27% of patients with tumors larger than 10 cm to 15 cm, and 46% of patients with tumors larger than 15 cm had multiple symptoms (P<.001). There was no significant difference in presentation of symptoms based on age, stage, or histologic subtype. Symptoms at diagnosis were not associated with recurrence or survival. CONCLUSION More than 70% of patients with high-risk early-stage, epithelial ovarian cancer present with one or more symptoms, with the most common being abdominal or pelvic pain. The proportion of women with symptoms and the number of symptoms increase with enlarging tumor size.
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Nadaraja S, Jørgensen TL, Matzen LE, Herrstedt J. Impact of Age, Comorbidity, and FIGO Stage on Treatment Choice and Mortality in Older Danish Patients with Gynecological Cancer: A Retrospective Register-Based Cohort Study. Drugs Real World Outcomes 2018; 5:225-235. [PMID: 30460662 PMCID: PMC6265233 DOI: 10.1007/s40801-018-0145-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The number of older patients with cancer is increasing in general, and ovarian and endometrial cancer are to a large extent cancers of the elderly. Older patients with cancer have a high prevalence of comorbidity. Comorbidity and age may be predictive of treatment choice and mortality in older patients with cancer along with stage and performance status. Objectives The aim of this study was to describe comorbidity in a population of older Danish patients with gynecological cancer, and to evaluate the predictive value of comorbidity and age on treatment choice and cancer-specific and all-cause mortality. Materials and methods In this retrospective study, we included 459 patients aged ≥ 70 years. Patients were diagnosed with cervical, endometrial, or ovarian cancer from 1 January, 2007 to 31 December, 2011 and were evaluated and/or treated at Odense University Hospital. Comorbidity was assessed using the Charlson Comorbidity Index. Treatment was classified as curative intended, palliative intended, or no treatment. Results Age, International Federation of Gynecology and Obstetrics (FIGO) stage, and performance status were found to be significant predictors of treatment choice, while comorbidity was not. Multivariate analyses showed that both cancer-specific and all-cause mortality were significantly associated with treatment choice, FIGO stage, and performance status. Age was not associated with mortality, with the exception of ovarian cancer, where age was associated with all-cause mortality. Comorbidity was not an independent predictor of treatment choice or mortality. Conclusions In our population of older Danish patients with gynecological cancer, age, FIGO stage, and performance status were predictors of treatment choice, while comorbidity was not. Treatment choice, FIGO stage, and performance status were significantly associated with both cancer-specific and all-cause mortality. Age was only associated with mortality in ovarian cancer, while comorbidity was not associated with mortality.
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Affiliation(s)
- Sambavy Nadaraja
- Department of Oncology, Odense University Hospital, Onkologisk afdeling R, Sdr. Boulevard 29, Indgang 109, 5000, Odense C, Denmark. .,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Trine Lembrecht Jørgensen
- Department of Oncology, Odense University Hospital, Onkologisk afdeling R, Sdr. Boulevard 29, Indgang 109, 5000, Odense C, Denmark
| | - Lars-Erik Matzen
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Jørn Herrstedt
- Department of Oncology, Odense University Hospital, Onkologisk afdeling R, Sdr. Boulevard 29, Indgang 109, 5000, Odense C, Denmark.,Department of Clinical Oncology, Zealand University Hospital, Roskilde, Denmark
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Wang JW, Sun L, Li J, Cong XH, Chen XF, Tang Z, Yu DH, Zhang TR, Luo ZN, Yuan ZP, Yu JM. Comorbid chronic diseases and their associations with quality of life among gynecological cancer survivors. BMC Public Health 2015; 15:965. [PMID: 26408314 PMCID: PMC4582736 DOI: 10.1186/s12889-015-2240-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 09/07/2015] [Indexed: 11/12/2022] Open
Abstract
Background Many gynecological cancer survivors (GCS) have comorbid chronic diseases (CCD). This study was to estimate the impacts of CCD on quality of life (QOL) in GCS. Methods We collected cross-sectional self-reported survey data from 598 GCS between April and July 2013, in Shanghai, China. All the subjects were asked to complete a questionnaire containing the European Organization for Research and Treatment quality of life version 3 questionnaire (EORTC QLQ-C30) and questions on socio-demographic characteristics and CCD. In order to mitigate the bias caused by confounding factors, multiple linear models were employed to calculate adjusted means of QOL scores. Results Approximately three-quarters of subjects reported at least one CCD. The highest overall prevalence of all CCD was found in endometrial cancer survivors. Subjects with CCD generally reported lower scores for most EORTC QLQ-C30 scales when compared to subjects without CCD, indicating poorer QOL, particularly for cardiovascular diseases, respiratory diseases, digestive diseases, and musculoskeletal disease. Conclusions The CCD are common health problems among GCS. CCD have significantly negative influence on QOL, and GCS with CCD generally reported lower QOL scores. These findings suggested comprehensive cares for GCS.
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Affiliation(s)
- Ji-Wei Wang
- School of public health and Key Laboratory of Public Health Safety, Fudan University, 30 Dong-An Road, Shanghai, 200032, China
| | - Li Sun
- School of public health and Key Laboratory of Public Health Safety, Fudan University, 30 Dong-An Road, Shanghai, 200032, China
| | - Jiang Li
- Jonathan and Karin Fielding School of Public Health, University of California, 650 Charles Young Drive South, Los Angeles, CA, 90095, USA
| | - Xiao-Huan Cong
- School of public health and Key Laboratory of Public Health Safety, Fudan University, 30 Dong-An Road, Shanghai, 200032, China
| | - Xue-Fen Chen
- School of public health and Key Laboratory of Public Health Safety, Fudan University, 30 Dong-An Road, Shanghai, 200032, China
| | - Zheng Tang
- School of public health and Key Laboratory of Public Health Safety, Fudan University, 30 Dong-An Road, Shanghai, 200032, China
| | - Dong-Hui Yu
- College of Clinical Medicine, Anhui Medical University, Hefei, Anhui Province, China
| | - Tian-Rui Zhang
- School of public health and Key Laboratory of Public Health Safety, Fudan University, 30 Dong-An Road, Shanghai, 200032, China
| | - Zheng-Nian Luo
- Shanghai Health Education Association, 122 Shan-Xi-Nan Road, 200040, Shanghai, China
| | - Zheng-Ping Yuan
- Shanghai Cancer Rehabilitation Club, 2795 Yang-Gao-Zhong Road, Shanghai, 200135, China
| | - Jin-Ming Yu
- School of public health and Key Laboratory of Public Health Safety, Fudan University, 30 Dong-An Road, Shanghai, 200032, China.
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Jiao YS, Gong TT, Wang YL, Wu QJ. Comorbidity and survival among women with ovarian cancer: evidence from prospective studies. Sci Rep 2015; 5:11720. [PMID: 26118971 PMCID: PMC4484350 DOI: 10.1038/srep11720] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 06/03/2015] [Indexed: 01/15/2023] Open
Abstract
The relationship between comorbidity and ovarian cancer survival has been controversial so far. Therefore, we conducted a meta-analysis to summarize the existing evidence from prospective studies on this issue. Relevant studies were identified by searching the PubMed, EMBASE, and ISI Web of Science databases through the end of January 2015. Two authors independently performed the eligibility evaluation and data abstraction. Random-effects models were used to estimate summary hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival. Eight prospective studies involving 12,681 ovarian cancer cases were included in the present study. The summarized HR for presence versus absence of comorbidity was 1.20 (95% CI = 1.11–1.30, n = 8), with moderate heterogeneity (I2 = 31.2%, P = 0.179). In addition, the summarized HR for the highest compared with the lowest category of the Charlson’s comorbidity index was 1.68 (95% CI = 1.50–1.87, n = 2), without heterogeneity (I2 = 0%, P = 0.476). Notably, a significant negative impact of comorbidity on ovarian cancer survival was observed in most subgroup analyses stratified by the study characteristics and whether there was adjustment for potential confounders. In conclusion, the findings of this meta-analysis suggest that underlying comorbidity is consistently associated with decreased survival in patients with ovarian cancer. Comorbidity should be taken into account when managing these patients.
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Affiliation(s)
- Yi-Sheng Jiao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ting-Ting Gong
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yong-Lai Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qi-Jun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
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Joslin CE, Brewer KC, Davis FG, Hoskins K, Peterson CE, Pauls HA. The effect of neighborhood-level socioeconomic status on racial differences in ovarian cancer treatment in a population-based analysis in Chicago. Gynecol Oncol 2014; 135:285-91. [PMID: 25173584 PMCID: PMC4443897 DOI: 10.1016/j.ygyno.2014.08.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 08/20/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Less than half of women with ovarian cancer and blacks specifically receive therapy adherent to National Comprehensive Cancer Network (NCCN) guidelines. The purpose is to assess the effect of neighborhood-level socioeconomic status (SES) on black-white treatment differences in a population-based analysis in a highly-segregated community. METHODS Illinois State Cancer Registry data for invasive epithelial ovarian cancer cases diagnosed in Cook County, IL in non-Hispanic white (NHW) or black (NHB) women from 1998 to 2009 was analyzed. As few women receive NCCN-adherent care, variables were constructed to assess extent of treatment, including receipt of: 1) debulking surgery; 2) any surgery; 3) multi-agent chemotherapy; and 4) any chemotherapy. Two measures (concentrated affluence and disadvantage) were used to estimate neighborhood-level SES. Multivariable logistic regression was used to compute odds ratios (OR) and 95% confidence intervals (95% CI), with generalized linear mixed models to account for hierarchical data. RESULTS 2766 (81.0%) NHW and 647 (19.0%) NHB women were diagnosed. Adjusting for covariates, NHB were less likely to receive debulking surgery (OR: 0.39; 95% CI: 0.30-0.50), any surgery (OR: 0.38; 95%CI: 0.29-0.49), multi-agent chemotherapy (OR: 0.56; 95% CI: 0.45-0.71) and any chemotherapy (OR: 0.58; 95% CI: 0.45-0.74). Concentrated affluence but not disadvantage was significant in final models for multi-agent and any chemotherapy, but not debulking or any surgery. CONCLUSIONS Results identify black-white differences consistent across treatments that persist despite adjustment for neighborhood-level SES. IMPACT Results advance inequality awareness beyond "ideal" NCCN-adherent care, indicating inequality exists in delivery of even the most basic oncologic care.
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Affiliation(s)
- Charlotte E Joslin
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, United States; Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, United States; University of Illinois at Chicago Cancer Center, Cancer Control and Population Science Research Program, United States.
| | - Katherine C Brewer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, United States
| | - Faith G Davis
- School of Public Health, University of Alberta, Canada
| | - Kent Hoskins
- University of Illinois at Chicago Cancer Center, Cancer Control and Population Science Research Program, United States; Department of Hematology/Oncology, University of Illinois at Chicago, United States
| | - Caryn E Peterson
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, United States
| | - Heather A Pauls
- Institute for Health Research and Policy (IHRP), University of Illinois at Chicago, United States
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Shinn EH, Lenihan DJ, Urbauer DL, Basen-Engquist KM, Valentine A, Palmero L, Woods ML, Patel P, Nick AM, Shahzad MMK, Stone RL, Golden A, Atkinson E, Lutgendorf SK, Sood AK. Impact of cardiovascular comorbidity on ovarian cancer mortality. Cancer Epidemiol Biomarkers Prev 2013; 22:2102-9. [PMID: 24045927 DOI: 10.1158/1055-9965.epi-13-0625] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND A retrospective cohort study utilizing prospectively collected data was conducted from August 2003 until March 2008 at M.D. Anderson Cancer Center. It is unknown whether cardiovascular comorbidity and chronic stress impact ovarian cancer outcome, which remains poor despite advances in therapy. The purpose of this study was to determine whether cardiovascular disease and markers that may be associated with stress are also associated with survival in patients with ovarian cancer. METHODS Participants with newly diagnosed epithelial ovarian cancer were followed until time of death or truncation of study period (median follow-up = 4.2 years; n = 271). Tumor characteristics (stage, tumor grade, histology, debulking status), demographic variables, and cardiovascular comorbidity were documented and compared to overall survival. RESULTS Of the nine cardiovascular events tracked during follow-up, venous thromboembolism [VTE; HR, 3.2; 95% confidence interval (CI), 1.8-5.5] and pulmonary hypertension (HR, 8.5; 95% CI, 3.9-18.7) were associated with shorter survival in multivariate analysis. In addition, high tumor grade, suboptimal cytoreduction, and baseline heart rate (HR, 1.02; 95% CI, 1.01-1.04) were related to decreased survival. CONCLUSION Careful management of certain cardiovascular comorbidities may extend survival in patients with ovarian cancer. Our findings suggest that increased baseline heart rate and the development of VTE and pulmonary hypertension after cancer diagnosis may be significant predictors of survival in women with ovarian cancer. IMPACT Our study emphasizes the importance of identifying and optimally treating tachycardia, VTE, and pulmonary hypertension in conjunction with cancer therapy.
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Affiliation(s)
- Eileen H Shinn
- Authors' Affiliations: University of Texas M.D. Anderson Cancer Center, Houston, Texas; Vanderbilt University Medical Center, Nashville, Tennessee; IDDI Corp., Houston, Texas; University of Texas Medical Branch at Galveston, Galveston, Texas; Moffitt Cancer Center, Tampa, Florida; University of Arkansas for Medical Sciences, Little Rock, Arkansas; St. Luke's Roosevelt Hospital Center, New York, New York; and University of Iowa, Iowa City, Iowa
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Sperling C, Noer MC, Christensen IJ, Nielsen MLS, Lidegaard Ø, Høgdall C. Comorbidity is an independent prognostic factor for the survival of ovarian cancer: a Danish register-based cohort study from a clinical database. Gynecol Oncol 2013; 129:97-102. [PMID: 23290990 DOI: 10.1016/j.ygyno.2012.12.039] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 12/18/2012] [Accepted: 12/24/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of the study was to examine whether comorbidity is an independent prognostic factor for 3129 women diagnosed with ovarian cancer from 2005 to 2011. As Performance status (PS) might capture the impact of comorbidity we addressed whether comorbidity can be explained by PS or whether comorbidity has an independent impact on survival. METHODS The Danish Gynecological Cancer Database (DGCD) is a national clinical database including information on comorbidity and a large number of tumor-related and patient-related factors. The Charlson Comorbidity Index was used to measure the patients' comorbidity based on the registration in DGCD. The overall mortality (OS) from the date of surgery to death or censoring was the outcome measure. RESULTS The hazard ratio (HR) for patients with comorbidity was 3.31 (1.14-1.50) compared to patients without comorbidity after adjustment for age, stage, residual tumor, histology and grade. After including PS in the model, comorbidity remained significant for OS. Age, stage, residual tumor, histology and PS prove to be independent prognostic factors as well. No association is found between comorbidity and receiving surgery or not. CONCLUSION Comorbidity is an independent prognostic factor, and has a negative impact on the survival of ovarian cancer patients. However, comorbidity has a smaller impact on survival compared with the other prognostic factors considered.
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Affiliation(s)
- Cecilie Sperling
- Quality and Patient Safety, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.
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Abstract
OBJECTIVE While the development of an index of clinical symptoms to use for the detection and diagnosis of ovarian cancer is under active investigation, the role of clinical symptoms in survival after the initial diagnosis is poorly understood. The aim of this study was to correlate the type and extent of clinical symptoms with survival outcomes in ovarian cancer. METHODS Medical records of 276 cases of primary epithelial ovarian, fallopian tube, and peritoneal cancers were evaluated. Thirty-one symptoms in 5 categories were cataloged. The significance of clinical symptoms in progression-free survival (PFS) and overall survival (OS) was evaluated. RESULTS Overall, 93.5% of ovarian cancer patients expressed at least 1 symptom at the time of initial diagnosis. The 3 most common symptoms were abdominal pain (40.6%), increased abdominal size (33.7%), and bloating (21.7%). In survival analysis, weight loss (16.3%), nausea/vomiting (13.4%), and lower extremity edema (6.5%) were significantly associated with both decreased PFS and OS (all, P < 0.05). In multivariate analysis, lower extremity edema remained the strongest significant symptom, associated with increased surgical mortality rate, decreased response rate to adjuvant chemotherapy after primary cytoreductive surgery, and diminished survival outcomes (median PFS, 4.9 vs 15.3 months, P < 0.0001; and median OS, 5.9 vs 49.1 months, P < 0.001). Multiple symptoms were associated with poor survival outcomes (individual number of symptom ≤1 vs 2 vs ≥3; median PFS, 26.8 vs 17.4 vs 11.7 months [P < 0.001]; and median OS, 70 vs 41.6 vs 37.2 months [P < 0.001]). CONCLUSIONS Lower extremity edema at initial diagnosis is a strong prognostic indicator of ovarian cancer patient.
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Naqvi K, Garcia-Manero G, Sardesai S, Oh J, Vigil CE, Pierce S, Lei X, Shan J, Kantarjian HM, Suarez-Almazor ME. Association of comorbidities with overall survival in myelodysplastic syndrome: development of a prognostic model. J Clin Oncol 2011; 29:2240-6. [PMID: 21537048 DOI: 10.1200/jco.2010.31.3353] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Patients with cancer often experience comorbidities that may affect their prognosis and outcome. The objective of this study was to determine the effect of comorbidities on the survival of patients with myelodysplastic syndrome (MDS). PATIENTS AND METHODS We conducted a retrospective cohort study of 600 consecutive patients with MDS who presented to MD Anderson Cancer Center from January 2002 to December 2004. The Adult Comorbidity Evaluation-27 (ACE-27) scale was used to assess comorbidities. Data on demographics, International Prognostic Scoring System (IPSS), treatment, and outcome (leukemic transformation and survival) were collected. Kaplan-Meier methods and Cox regression were used to assess survival. A prognostic model incorporating baseline comorbidities with age and IPSS was developed to predict survival. RESULTS Overall median survival was 18.6 months. According to the ACE-27 categories, median survival was 31.8, 16.8, 15.2, and 9.7 months for those with none, mild, moderate, and severe comorbidities, respectively (P < .001). Adjusted hazard ratios were 1.3, 1.6, and 2.3 for mild, moderate, and severe comorbidities, respectively, compared with no comorbidities (P < .001). A final prognostic model including age, IPSS, and comorbidity score predicted median survival of 43.0, 23.0, and 9.0 months for lower-, intermediate-, and high-risk groups, respectively (P < .001). CONCLUSION Comorbidities have a significant impact on the survival of patients with MDS. Patients with severe comorbidity had a 50% decrease in survival, independent of age and IPSS risk group. A comprehensive assessment of the severity of comorbidities helps predict survival in patients with MDS.
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Affiliation(s)
- Kiran Naqvi
- The University of Texas MD Anderson Cancer, Houston, TX 77030, USA
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Tetsche MS, Dethlefsen C, Pedersen L, Sorensen HT, Norgaard M. The impact of comorbidity and stage on ovarian cancer mortality: a nationwide Danish cohort study. BMC Cancer 2008; 8:31. [PMID: 18230177 PMCID: PMC2266760 DOI: 10.1186/1471-2407-8-31] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Accepted: 01/29/2008] [Indexed: 11/20/2022] Open
Abstract
Background The incidence of ovarian cancer increases sharply with age, and many elderly patients have coexisting diseases. If patients with comorbidities are diagnosed with advanced stages, this would explain the poor survival observed among ovarian cancer patients with severe comorbidity. Our aims were to examine the prevalence of comorbidity according to stage of cancer at diagnosis, to estimate the impact of comorbidity on survival, and to examine whether the impact of comorbidity on survival varies by stage. Methods From the Danish Cancer Registry we identified 5,213 patients (> 15 years old) with ovarian cancer diagnosed from 1995 to 2003. We obtained information on comorbidities from the Danish National Hospital Discharge Registry. Vital status was determined through linkage to the Civil Registration System. We estimated the prevalence of comorbidity by stage and computed absolute survival and relative mortality rate ratios (MRRs) by comorbidity level (Charlson Index score 0, 1–2, 3+), using patients with Charlson Index score 0 as the reference group. We then stratified by stage and computed the absolute survival and MRRs according to comorbidity level, using patients with Charlson score 0 and localized tumour/FIGO I as the reference group. We adjusted for age and calendar time. Results Comorbidity was more common among patients with an advanced stage of cancer. One- and five-year survival was higher in patients without comorbidity than in patients with registered comorbidity. After adjustment for age and calendar time, one-year MRRs declined from 1.8 to 1.4 and from 2.7 to 2.0, for patients with Charlson scores 1–2 and 3+, respectively. After adjustment for stage, the MRRs further declined to 1.3 and 1.8, respectively. Five-year MRRs declined similarly after adjustment for age, calendar time, and stage. The impact of severe comorbidity on mortality varied by stage, particularly among patients with tumours with regional spread/FIGO-stages II and III. Conclusion The presence of severe comorbidity was associated with an advanced stage of ovarian cancer. Mortality was higher among patients with comorbidities and the impact of comorbidity varied by stage.
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Affiliation(s)
- Mette S Tetsche
- Department of Clinical Epidemiology, Aarhus University Hospital, 8000 Aarhus, Denmark.
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Wei SH, Lin F, Wang X, Gao P, Zhang HZ. Prognostic significance of stathmin expression in correlation with metastasis and clinicopathological characteristics in human ovarian carcinoma. Acta Histochem 2007; 110:59-65. [PMID: 18054374 DOI: 10.1016/j.acthis.2007.06.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Revised: 06/13/2007] [Accepted: 06/28/2007] [Indexed: 10/22/2022]
Abstract
Stathmin, also called oncoprotein 18, is a founding member of the family of microtubule-destabilizing proteins that play a critical role in the regulation of mitosis. Stathmin is non-expressed in normal tissues, but stathmin gene is expressed at high levels in many human malignancies and the relationships between the levels of this gene expression in tumors and prognosis of the patients have been addressed. In this report, we explored the relationships between stathmin mRNA expression in ovarian carcinoma tissues and clinicopathological parameters. We collected and analyzed paraffin wax-embedded ovarian tumor biopsy tissues from 42 ovarian cancer patients in our hospital. We employed RT-PCR method and performed a densitometric analysis to determine the ratio of stathmin relative to beta-actin as an internal marker. Results showed that the stathmin mRNA expression was detected in all the ovarian carcinoma tissue samples and those samples with metastasis had higher levels of stathmin mRNA expression in initial biopsy specimens (P<0.05). Moreover, the levels of stathmin mRNA expression between samples with and without metastasis showed a statistically significant difference (P<0.05).
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Tetsche MS, Nørgaard M, Jacobsen J, Wogelius P, Sørensen HT. Comorbidity and ovarian cancer survival in Denmark, 1995-2005: a population-based cohort study. Int J Gynecol Cancer 2007; 18:421-7. [PMID: 17692093 DOI: 10.1111/j.1525-1438.2007.01036.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The impact of comorbid diseases on ovarian cancer survival is largely unknown. We therefore examined (i) the prevalence of comorbidity among ovarian cancer patients and (ii) the impact of comorbidity on ovarian cancer survival and mortality. Using hospital discharge data, we identified Danish women diagnosed with ovarian cancer between 1995 and 2005 (n= 1995 within a population of 1.6 million) and then computed Charlson comorbidity index scores (0, 1-2, and 3+). We estimated the prevalence of comorbidity and computed absolute survival and relative mortality rate ratios (MRRs) according to comorbidity level, using patients with Charlson score 0 as the reference group. During the study period, the proportion of patients without comorbidity fell from 81% to 75%, while the proportion of patients with comorbidity score 1-2 and 3+ rose from 16% to 21% and from 4% to 5%, respectively. Overall 1-year survival increased from 68% in 1995-1997 to 70% in 1998-2000 and to 73% in 2001-2004. For patients with Charlson score 1-2, 1-year adjusted MRRs were 1.1 (95% CI, 0.8-1.6) in 1995-1997, 1.3 (95% CI, 1.0-1.8) in 1998-2000, and 1.7 (95% CI, 1.3-2.4) in 2001-2004. For patients with Charlson score 3+, 1-year adjusted MRRs were 2.4 (95% CI, 1.4-4.3) in 1995-1997, 1.6 (95% CI, 1.0-2.7) in 1998-2000, and 2.2 (95% CI, 1.3-3.8) in 2001-2004. The 5-year MRRs were similar to the 1-year MRRs. One quarter of Danish women with ovarian cancer were found to have comorbid conditions, and 5% had severe comorbidity. Severe comorbidity was a predictor of poorer survival.
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Affiliation(s)
- M S Tetsche
- Department of Clinical Epidemiology, Aarhus University Hospital, Ole Worms Allé, Aarhus, Denmark.
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Aronin SI, Quagliarello VJ. Utility of prognostic stratification in adults with community-acquired bacterial meningitis. COMPREHENSIVE THERAPY 2001; 27:72-7. [PMID: 11280860 DOI: 10.1007/s12019-001-0011-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Prognostic stratification uses baseline clinical features to subdivide patients into subgroups with different risks for a particular outcome. We review the importance of prognostic stratification in internal medicine, in infectious diseases, and in adults with community-acquired bacterial meningitis.
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Affiliation(s)
- S I Aronin
- Waterbury Hospital Health Center, 64 Robbins Street, Waterbury, CT 06721, USA
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Abstract
BACKGROUND Ovarian carcinoma often is called the "silent killer" because the disease usually is not detected until an advanced stage. The authors' goal was to evaluate preoperative symptoms and factors that may contribute to delayed diagnosis for women with ovarian carcinoma. METHODS A two-page survey was distributed to 1500 women who subscribe to CONVERSATIONS!, a newsletter about ovarian carcinoma. Because the survey could be copied and given to other patients, 1725 surveys were returned from women in 46 states and 4 Canadian provinces. RESULTS The median age of the surveyed women was 52 years, and 70% had Stage III or IV disease (International Federation of Gynecology and Obstetrics). When asked about symptoms before the diagnosis of ovarian carcinoma, 95% reported symptoms, which were categorized as abdominal (77%), gastrointestinal (70%), pain (58%), constitutional (50%), urinary (34%), and pelvic (26%). Only 11% of women with Stage I/II and 3% with Stage III/IV reported no symptoms before their diagnosis. Women who ignored their symptoms were significantly more likely to be diagnosed with advanced disease compared with those who did not (P = 0.002). The time required for a health care provider to make the diagnosis was reported as less than 3 months by 55%, but greater than 6 months by 26% and greater than 1 year by 11%. Factors significantly associated with delay in diagnosis were omission of a pelvic exam at first visit; having a multitude of symptoms; being diagnosed initially with no problem, depression, stress, irritable bowel, or gastritis; not initially receiving an ultrasound, computed tomography, or CA 125 test; and younger age. The type of health care provider seen initially, insurance, and specific symptoms did not correlate with delayed diagnosis. CONCLUSIONS This large national survey confirms that the majority of women with ovarian carcinoma are symptomatic and frequently have delays in diagnosis.
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Affiliation(s)
- B A Goff
- University of Washington, Department of Obstetrics and Gynecology, Seattle, Washington 98195-6460, USA
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15
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Abstract
Observational studies are important methodologies to evaluate exposures and risk factors that are not amenable to experimental trials. They offer the advantage of being more generalizable to our patients, as these studies may have more liberal inclusion criteria than the typical randomized trial. Their disadvantage is their susceptibility to biases and their inability to control for unknown factors that may impact on the outcome of interest. Establishing causality of an association noted in observational studies is an intricate process that requires careful assessment. Clinicians and researchers should be familiar with observational studies so they may better evaluate a proposed causal relationship and the quality of reports claiming such relationships. Only then can they determine if the findings are valid and applicable to their patient population.
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Affiliation(s)
- J F Peipert
- Brown University School of Medicine, Women & Infants' Hospital, Providence, Rhode Island 02905, USA.
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