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Dahlberg J, Adok C, Bümming P, Demir A, Hedbäck G, Nilsson B, Nilsson M, Jansson S. Incidence, detection and outcome of differentiated thyroid cancer in Western Sweden. BJS Open 2021; 5:6408929. [PMID: 34686878 PMCID: PMC8536871 DOI: 10.1093/bjsopen/zrab099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/24/2021] [Indexed: 11/12/2022] Open
Abstract
Background It is unclear whether the increasing incidence of thyroid cancer (TC) due to increased diagnosis of small and indolent tumours might mask a real increase of clinically significant cancers. The aim of this study was to correlate surgery, pathology and outcome data of individual patients to the mode of primary detection (palpation, by imaging or incidental) to assess if TC incidence has increased. Methods The Swedish Cancer Registry identified all patients with TC in Västra Götaland County representing approximately 1.6 million inhabitants. Clinical information was retrieved from medical records of patient cohorts from three study intervals (2001–2002, 2006–2007 and 2011–2014) comprising 60 per cent of all TC patients. Data were also obtained from the NORDCAN registry to compare of TC incidence with other Nordic countries. Results Between 2001 and 2014, the annualized standard incidence rate/100 000 population (ASR) of TC increased from 3.14 to 10.71 in women and from 1.12 to 3.77 in men. This was higher than the mean incidence for Sweden but similar to that in Norway and Finland. Differentiated TC (DTC) increased more than threefold. The majority of tumours (64 per cent) were detected by palpation. Larger tumours (10–20, 21–40 and greater than 40 mm) increased as much as microcarcinomas (less than 10 mm). Only 5 per cent of the tumours were detected by imaging. All disease-specific deaths (8.5 per cent of DTC in the first two cohorts) and most patients with recurrent or persistent disease (6.6 per cent of DTC cases) were diagnosed due to tumour-related symptoms. Conclusion DTC in Western Sweden gradually increased between 2001 and 2014. The majority of tumours were detected by palpation suggesting a real increase in the incidence of clinically significant thyroid malignancies.
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Affiliation(s)
- J Dahlberg
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Regional Cancer Centre West, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - C Adok
- Regional Cancer Centre West, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - P Bümming
- Department of Surgery Skaraborg Hospital, Skaraborgs Sjukhus, Skövde, Sweden
| | - A Demir
- Department of Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - G Hedbäck
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - B Nilsson
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - M Nilsson
- Sahlgrenska Centre for Cancer Research, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - S Jansson
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
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Nilsson B, Sjölund K, Kindblom LG, Meis-Kindblom JM, Bümming P, Nilsson O, Andersson J, Ahlman H. Adjuvant imatinib treatment improves recurrence-free survival in patients with high-risk gastrointestinal stromal tumours (GIST). Br J Cancer 2007; 96:1656-8. [PMID: 17533389 PMCID: PMC2359924 DOI: 10.1038/sj.bjc.6603797] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Palliative imatinib treatment has dramatically improved survival in patients with malignant gastrointestinal stromal tumours, particularly in patients with tumours harbouring activating KIT mutations. To evaluate the effectiveness of adjuvant imatinib after radical surgery, a consecutive series of patients with high-risk tumours (n=23) was compared with historic controls (n=48) who were treated with surgery alone. The mean follow-up period was over 3 years in both groups. Only 1 out of 23 patients (4%) in the adjuvant treatment group developed recurrent disease compared to 32 out of 48 patients (67%) in the control group. This preliminary study indicates that 1 year of adjuvant treatment with imatinib dramatically improves recurrence-free survival. Confirmation of these findings awaits the results of ongoing randomised studies.
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Affiliation(s)
- B Nilsson
- Lundberg Laboratory for Cancer Research, Department of Surgery at the Sahlgrenska Academy, Göteborg University, Göteborg 41345, Sweden.
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Abstract
A key task for health policymakers is to optimise the outcome of health care interventions. The pricing of a new generation of cancer drugs, in combination with limited health care resources, has highlighted the need for improved methodology to estimate outcomes of different treatment options. Here we introduce new general methodology, which for the first time employs continuous hazard functions for analysis of survival data. Access to continuous hazard functions allows more precise estimations of survival outcomes for different treatment options. We illustrate the methodology by calculating outcomes for adjuvant treatment of gastrointestinal stromal tumours with imatinib mesylate, which selectively inhibits the activity of a cancer-causing enzyme and is a hallmark representative for the new generation of cancer drugs. The calculations reveal that optimal drug pricing can generate all win situations that improve drug availability to patients, make the most of public expenditure on drugs and increase pharmaceutical company gross profits. The use of continuous hazard functions for analysis of survival data may reduce uncertainty in health care resource allocation, and the methodology can be used for drug price negotiations and to investigate health care intervention thresholds. Health policy makers, pharmaceutical industry, reimbursement authorities and insurance companies, as well as clinicians and patient organisations, should find the methodology useful.
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Affiliation(s)
- T Simonsson
- Department of Biomedicine, Sahlgrenska Academy at Göteborg University, Göteborg SE-405 30, Sweden
| | - K Sjölund
- Department of Surgery, Lundberg Laboratory for Cancer Research, Sahlgrenska Academy at Göteborg University, Göteborg SE-413 45, Sweden
| | - P Bümming
- Department of Surgery, Lundberg Laboratory for Cancer Research, Sahlgrenska Academy at Göteborg University, Göteborg SE-413 45, Sweden
| | - H Ahlman
- Department of Surgery, Lundberg Laboratory for Cancer Research, Sahlgrenska Academy at Göteborg University, Göteborg SE-413 45, Sweden
| | - B Nilsson
- Department of Surgery, Lundberg Laboratory for Cancer Research, Sahlgrenska Academy at Göteborg University, Göteborg SE-413 45, Sweden
| | - A Odén
- Department of Mathematical Sciences, Chalmers University of Technology, Göteborg SE-412 96, Sweden
- E-mail:
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Bümming P, Ahlman H, Andersson J, Meis-Kindblom JM, Kindblom LG, Nilsson B. Population-based study of the diagnosis and treatment of gastrointestinal stromal tumours. Br J Surg 2006; 93:836-43. [PMID: 16705644 DOI: 10.1002/bjs.5350] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Abstract
Background
The aim of this retrospective population-based study, which was conducted before the introduction of imatinib, was to evaluate the role of surgery in patients with gastrointestinal stromal tumours (GISTs) and clarify which subgroups might benefit from adjuvant treatment.
Methods
Two hundred and fifty-nine patients with clinically detected GISTs were studied. Univariate and multivariate analyses were performed to identify predictors for recurrent disease and survival.
Results
Thirty of 48 patients with high-risk GISTs and all of those with overtly malignant tumours developed recurrent tumour after complete (R0) resection. Thirty-four of 38 first recurrences occurred within 36 months of surgery. No recurrence was observed after 72 months. R0 resection, achieved in 48 (80 per cent) of 60 patients with high-risk tumours, was significantly associated with a decreased risk of death from tumour recurrence (P = 0·008).
Conclusion
Completeness of surgical resection is an independent prognostic factor in patients with high-risk GISTs. A period of adjuvant treatment with imatinib is recommended in patients with high-risk or overtly malignant GISTs who have undergone R0 resection and have a tumour-free interval of less than 6 years.
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Affiliation(s)
- P Bümming
- Department of Surgery, The Lundberg Laboratory for Cancer Research, Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden
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Bümming P, Andersson J, Meis-Kindblom JM, Klingenstierna H, Engström K, Stierner U, Wängberg B, Jansson S, Ahlman H, Kindblom LG, Nilsson B. Neoadjuvant, adjuvant and palliative treatment of gastrointestinal stromal tumours (GIST) with imatinib: a centre-based study of 17 patients. Br J Cancer 2003; 89:460-4. [PMID: 12888812 PMCID: PMC2394385 DOI: 10.1038/sj.bjc.6600965] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Malignant gastrointestinal stromal tumours (GIST) have a poor prognosis. Since these tumours are resistant to conventional radiation and chemotherapy, surgery has been the mainstay of treatment. However, surgery is usually inadequate for the treatment of malignant GIST. Imatinib, a KIT tyrosine kinase inhibitor, has recently been found to have a dramatic antitumour effect on GIST. In this centre-based study of 17 consecutive patients with high-risk or overtly malignant GIST, imatinib was used in three different settings - palliatively, adjuvantly, and neoadjuvantly. The treatment was found to be safe and particularly effective in tumours with activating mutations of exon 11 of the KIT gene. Clinical response to imatinib treatment correlated morphologically to tumour necrosis, hyalinisation, and reduced proliferative activity. The value of neoadjuvant imatinib treatment was illustrated in one case.
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Affiliation(s)
- P Bümming
- Department of Surgery, Lundberg Laboratory for Cancer Research, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden
| | - J Andersson
- Department of Pathology, Lundberg Laboratory for Cancer Research, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden
| | - J M Meis-Kindblom
- Department of Pathology, Lundberg Laboratory for Cancer Research, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden
| | - H Klingenstierna
- Department of Radiology, Lundberg Laboratory for Cancer Research, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden
| | - K Engström
- Department of Oncology, Lundberg Laboratory for Cancer Research, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden
| | - U Stierner
- Department of Oncology, Lundberg Laboratory for Cancer Research, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden
| | - B Wängberg
- Department of Surgery, Lundberg Laboratory for Cancer Research, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden
| | - S Jansson
- Department of Surgery, Lundberg Laboratory for Cancer Research, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden
| | - H Ahlman
- Department of Surgery, Lundberg Laboratory for Cancer Research, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden
| | - L-G Kindblom
- Department of Pathology, Lundberg Laboratory for Cancer Research, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden
| | - B Nilsson
- Department of Surgery, Lundberg Laboratory for Cancer Research, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden
- Department of Surgery, Lundberg Laboratory for Cancer Research, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden. E-mail:
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