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Chen EYT, Leontyeva Y, Lin CN, Wang JD, Clements MS, Dickman PW. Comparing Survival Extrapolation within All-Cause and Relative Survival Frameworks by Standard Parametric Models and Flexible Parametric Spline Models Using the Swedish Cancer Registry. Med Decis Making 2024; 44:269-282. [PMID: 38314657 PMCID: PMC10988990 DOI: 10.1177/0272989x241227230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 12/29/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND In health technology assessment, restricted mean survival time and life expectancy are commonly evaluated. Parametric models are typically used for extrapolation. Spline models using a relative survival framework have been shown to estimate life expectancy of cancer patients more reliably; however, more research is needed to assess spline models using an all-cause survival framework and standard parametric models using a relative survival framework. AIM To assess survival extrapolation using standard parametric models and spline models within relative survival and all-cause survival frameworks. METHODS From the Swedish Cancer Registry, we identified patients diagnosed with 5 types of cancer (colon, breast, melanoma, prostate, and chronic myeloid leukemia) between 1981 and 1990 with follow-up until 2020. Patients were categorized into 15 cancer cohorts by cancer and age group (18-59, 60-69, and 70-99 y). We right-censored the follow-up at 2, 3, 5, and 10 y and fitted the parametric models within an all-cause and a relative survival framework to extrapolate to 10 y and lifetime in comparison with the observed Kaplan-Meier survival estimates. All cohorts were modeled with 6 standard parametric models (exponential, Weibull, Gompertz, log-logistic, log-normal, and generalized gamma) and 3 spline models (on hazard, odds, and normal scales). RESULTS For predicting 10-y survival, spline models generally performed better than standard parametric models. However, using an all-cause or a relative survival framework did not show any distinct difference. For lifetime survival, extrapolating from a relative survival framework agreed better with the observed survival, particularly using spline models. CONCLUSIONS For extrapolation to 10 y, we recommend spline models. For extrapolation to lifetime, we suggest extrapolating in a relative survival framework, especially using spline models. HIGHLIGHTS For survival extrapolation to 10 y, spline models generally performed better than standard parametric models did. However, using an all-cause or a relative survival framework showed no distinct difference under the same parametric model.Survival extrapolation to lifetime within a relative survival framework agreed well with the observed data, especially using spline models.Extrapolating parametric models within an all-cause survival framework may overestimate survival proportions at lifetime; models for the relative survival approach may underestimate instead.
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Affiliation(s)
- Enoch Yi-Tung Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Yuliya Leontyeva
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Chia-Ni Lin
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Mark S. Clements
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul W. Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Moberg L, Sundqvist A, Holmberg E, Dickman PW, Borgfeldt C. Vulvar cancer incidence and net survival in Sweden 1960 to 2019: A population-based national study. Acta Obstet Gynecol Scand 2024; 103:561-571. [PMID: 38071449 PMCID: PMC10867366 DOI: 10.1111/aogs.14747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Vulvar cancer is a rare gynecological cancer affecting mostly older women. The aim of this population-based study was to investigate the incidence and net survival of vulvar cancer in Swedish women from 1960 to 2019. MATERIAL AND METHODS Data were retrieved from the mandatory Swedish Cancer Registry consisting of all women diagnosed with vulvar cancer between 1960 and 2019. Only women with a morphologically verified diagnosis of vulvar cancer were included. The individuals were then further matched with the Swedish Death Registry up until May 31, 2020. RESULTS In total, 8499 women were included with the following morphologies: squamous cell carcinoma 7250 (85.8%), malignant melanoma 539 (6.4%), adenocarcinoma 401 (4.8%) and other: 259 (3.1%). More than 50% of vulvar cancer cases occurred in women aged between 65 and 84 years of age. The 5-year age-standardized net survival increased from 53.0% (95% confidence interval [CI] 48.9-57.5) in 1960 to 72.1% (95% CI 68.8-75.5) in 2019. The proportion of adenocarcinoma among all cases increased from 2.0% to 8.7% between the 1960s and 2010s and an increase in age-standardized 5-year net survival was found for adenocarcinoma. CONCLUSIONS The age-standardized incidence of vulvar cancer cases in Sweden was stable between 1960 and 2019. During the study period, an increase in adenocarcinoma and a decrease in malignant melanoma cases was found. Five-year net survival increased by 20 percent units during the study period. For squamous cell carcinoma, an increased age-specific 5-year net survival was observed for all age groups, apart for women aged ≥85.
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Affiliation(s)
- Louise Moberg
- Department of Obstetrics and GynecologySkåne University Hospital Lund, Lund UniversityLundSweden
| | - Avalon Sundqvist
- Department of Obstetrics and GynecologySkåne University Hospital Lund, Lund UniversityLundSweden
| | - Erik Holmberg
- Department of OncologyUniversity of Gothenburg Institute of Clinical SciencesGothenburgSweden
| | - Paul W. Dickman
- Department of Medical Epidemiology and BiostatisticsKarolinska InstituteStockholmSweden
| | - Christer Borgfeldt
- Department of Obstetrics and GynecologySkåne University Hospital Lund, Lund UniversityLundSweden
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Hellgren R, Tolocka E, Saracco A, Wilczek B, Sundbom A, Hall P, Dickman PW. Comparing the diagnostic accuracy, reading time, and inter-rater agreement of breast MRI abbreviated and full protocols: a multi-reader study. Acta Radiol 2024; 65:195-201. [PMID: 38115682 PMCID: PMC10903132 DOI: 10.1177/02841851231216552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/02/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Earlier studies have shown that abbreviated protocol magnetic resonance imaging (AB-MRI) has similar diagnostic accuracy as the full protocol (Full MRI). PURPOSE To compare the diagnostic accuracy, reading time, and inter-rater agreement of AB-MRI to Full MRI among women without known increased familial risk of breast cancer or prior biopsy. MATERIAL AND METHODS In total, 395 MRI examinations were included in this study. Three readers were blinded to all patient information. The AB-MRI and Full MRI were read separately and in a different random order for each of the readers. Scores 1-2 were considered test negative while scores 3-5 were test positive. A positive reference test was the diagnosis of malignancy; a negative reference test was the absence of a diagnosis of breast cancer within a two-year follow-up. We used a generalized estimating equations approach to compare sensitivity and specificity between the two protocols. We used t-tests to compare the average reading time and Krippendorff's alpha to compare inter-rater agreement. RESULTS MRI examinations of 395 women (median age=56 years) were evaluated. For AB-MRI and Full MRI, respectively, the sensitivity was 93.0% (95% CI=90.6-95.0) vs. 92.0% (95% CI=89.4-94.1), the specificity was 91.7% (95% CI=90.3-92.9) vs. 94.3% (95% CI=93.2-95.3), average reading time was 67 vs. 126 s, and the inter-rater agreement 0.79 vs. 0.83. The difference in sensitivity was not statistically significant (P=0.840), but the difference in specificity was significant (P=0.003). CONCLUSION AB-MRI has similar sensitivity, but somewhat lower specificity. The average reading time for the abbreviated protocol is lower, as is inter-rater agreement.
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Affiliation(s)
- Roxanna Hellgren
- Department of Medical Imaging, Division of Breast Imaging, Södersjukhuset, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ernst Tolocka
- Department of Medical Imaging, Division of Breast Imaging, Södersjukhuset, Stockholm, Sweden
| | - Ariel Saracco
- Department of Mammography, Evidia, Stockholm, Sweden
| | - Brigitte Wilczek
- Department of Medical Imaging, Division of Breast Imaging, Södersjukhuset, Stockholm, Sweden
| | - Ann Sundbom
- Department of Medical Imaging, Division of Breast Imaging, Södersjukhuset, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Weibull CE, Sjöberg J, Dickman PW, Björkholm M. Splenectomised Hodgkin lymphoma patients: does severe pneumococcal disease pose a problem today and what is the best long-term strategy? Acta Oncol 2023; 62:1942-1944. [PMID: 37708099 DOI: 10.1080/0284186x.2023.2256468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Caroline E Weibull
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jan Sjöberg
- Department of Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
- NDA Group, Stockholm, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Björkholm
- Department of Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
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Myklebust TÅ, Aagnes B, Nilssen Y, Rutherford M, Lambert PC, Andersson TML, Johansson ALV, Dickman PW, Møller B. Improving communication of cancer survival statistics-feasibility of implementing model-based algorithms in routine publications. Br J Cancer 2023; 129:819-828. [PMID: 37433898 PMCID: PMC10449893 DOI: 10.1038/s41416-023-02360-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Routine reporting of cancer patient survival is important, both to monitor the effectiveness of health care and to inform about prognosis following a cancer diagnosis. A range of different survival measures exist, each serving different purposes and targeting different audiences. It is important that routine publications expand on current practice and provide estimates on a wider range of survival measures. We examine the feasibility of automated production of such statistics. METHODS We used data on 23 cancer sites obtained from the Cancer Registry of Norway (CRN). We propose an automated way of estimating flexible parametric relative survival models and calculating estimates of net survival, crude probabilities, and loss in life expectancy across many cancer sites and subgroups of patients. RESULTS For 21 of 23 cancer sites, we were able to estimate survival models without assuming proportional hazards. Reliable estimates of all desired measures were obtained for all cancer sites. DISCUSSION It may be challenging to implement new survival measures in routine publications as it can require the application of modeling techniques. We propose a way of automating the production of such statistics and show that we can obtain reliable estimates across a range of measures and subgroups of patients.
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Affiliation(s)
- Tor Åge Myklebust
- Department of Registration, Cancer Registry Norway, Oslo, Norway.
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway.
| | - Bjarte Aagnes
- Department of Registration, Cancer Registry Norway, Oslo, Norway
| | - Yngvar Nilssen
- Department of Registration, Cancer Registry Norway, Oslo, Norway
| | - Mark Rutherford
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
- International Agency for Research on Cancer, Lyon, France
| | - Paul C Lambert
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Therese M L Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna L V Johansson
- Department of Registration, Cancer Registry Norway, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Bjørn Møller
- Department of Registration, Cancer Registry Norway, Oslo, Norway
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Herbst F, Dickman PW, Moberg L, Högberg T, Borgfeldt C. Increased incidence and improved survival in endometrial cancer in Sweden 1960-2014: a population-based registry survey. BMC Cancer 2023; 23:276. [PMID: 36973669 PMCID: PMC10045609 DOI: 10.1186/s12885-023-10746-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND An investigation of trends of incidence and net survival (NS) for endometrial cancer in Sweden. METHODS Morphologically verified endometrial carcinoma diagnosed 1960 to 2014 were collected from the nation-wide Swedish Cancer Registry. Endometrial cancer patients were assessed with regards to time trends for incidence and 54,825 cases remained for survival analyses. Cases diagnosed 1995 to 2014 were categorized according to detailed morphology and from 2005 to 2014 FIGO stage was also categorized. RESULTS There was a trend of increasing incidence of endometrial carcinoma for women above 55 years of age. NS was improved at 5- and 10-year follow-up. The 5-year net survival in 2010-2014 was 86%. The most prominent improvement in NS was found in the elderly women above 75 years of age. CONCLUSIONS This study observed increased incidence of endometrial cancer in Sweden from 1960 to 2014. The progress in diagnostics and treatment, seem to have improved the net survival, especially in elderly women.
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Affiliation(s)
- Filip Herbst
- Department of Obstetrics and Gynecology, Skåne University Hospital Lund, Lund University, Klinikgatan 12, 221 85, Lund, Sweden.
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Louise Moberg
- Department of Obstetrics and Gynecology, Skåne University Hospital Lund, Lund University, Klinikgatan 12, 221 85, Lund, Sweden
| | - Thomas Högberg
- Department of Cancer Epidemiology, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - Christer Borgfeldt
- Department of Obstetrics and Gynecology, Skåne University Hospital Lund, Lund University, Klinikgatan 12, 221 85, Lund, Sweden
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Sars C, Sackey H, Frisell J, Dickman PW, Karlsson F, Kindts I, Marta GN, Freitas-Junior R, Tvedskov TF, Kassem L, Ali AS, Ihalainen H, Neron M, Kontos M, Kaidar-Person O, Meattini I, Francken AB, van Duijnhoven F, Moberg IO, Marinko T, Kollar A, Ahmed M, Remoundos D, Banks J, Jagsi R, Dossett LA, Lindqvist EK. Current clinical practice in the management of phyllodes tumors of the breast: an international cross-sectional study among surgeons and oncologists. Breast Cancer Res Treat 2023; 199:293-304. [PMID: 36879102 PMCID: PMC9988205 DOI: 10.1007/s10549-023-06896-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE Phyllodes tumors of the breast are rare fibroepithelial lesions that are classified as benign, borderline or malignant. There is little consensus on best practice for the work-up, management, and follow-up of patients with phyllodes tumors of the breast, and evidence-based guidelines are lacking. METHODS We conducted a cross-sectional survey of surgeons and oncologists with the aim to describe current clinical practice in the management of phyllodes tumors. The survey was constructed in REDCap and distributed between July 2021 and February 2022 through international collaborators in sixteen countries across four continents. RESULTS A total of 419 responses were collected and analyzed. The majority of respondents were experienced and worked in a university hospital. Most agreed to recommend a tumor-free excision margin for benign tumors, increasing margins for borderline and malignant tumors. The multidisciplinary team meeting plays a major role in the treatment plan and follow-up. The vast majority did not consider axillary surgery. There were mixed opinions on adjuvant treatment, with a trend towards more liberal regiments in patients with locally advanced tumors. Most respondents preferred a five-year follow-up period for all phyllodes tumor types. CONCLUSIONS This study shows considerable variation in clinical practice managing phyllodes tumors. This suggests the potential for overtreatment of many patients and the need for education and further research targeting appropriate surgical margins, follow-up time and a multidisciplinary approach. There is a need to develop guidelines that recognize the heterogeneity of phyllodes tumors.
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Affiliation(s)
- Carl Sars
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Helena Sackey
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77, Stockholm, Sweden.,Division of Cancer, Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Jan Frisell
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77, Stockholm, Sweden.,Division of Cancer, Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Karlsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77, Stockholm, Sweden.,Division of Cancer, Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | | | | | - Ruffo Freitas-Junior
- CORA Advanced Center for Diagnosis of Breast Diseases, Hospital das Clínicas, Federal University of Goias, Goiânia, Brazil
| | | | - Loay Kassem
- Department of Clinical Oncology, Cairo University Hospitals, Cairo, Egypt
| | - Ahmed S Ali
- Department of Clinical Oncology, Cairo University Hospitals, Cairo, Egypt
| | - Hanna Ihalainen
- Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mathias Neron
- Institut du Cancer de Montpellier, Surgical Oncology Department, Université Montpellier, Montpellier, France
| | - Michalis Kontos
- 1st Department of Surgery, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Orit Kaidar-Person
- Breast Radiation Unit, Sheba Tel Hashomer, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy.,Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | | | - Ingvild Ona Moberg
- Department of Breast and Endocrine Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Tanja Marinko
- Institute of Oncology, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Attila Kollar
- Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Mahbubl Ahmed
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Lesly A Dossett
- Department of Surgery, University of Michigan, Ann Arbor, USA
| | - Ebba K Lindqvist
- Department of Clinical Science and Education, Stockholm South General Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Stockholm South General Hospital, Stockholm, Sweden
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Bairkdar M, Chen EYT, Dickman PW, Hesselstrand R, Westerlind H, Holmqvist M. Survival in Swedish patients with systemic sclerosis: a nationwide population-based matched cohort study. Rheumatology (Oxford) 2023; 62:1170-1178. [PMID: 35984290 PMCID: PMC9977125 DOI: 10.1093/rheumatology/keac474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To conduct the first-ever nationwide, population-based cohort study investigating survival patterns of all patients with incident SSc in Sweden compared with matched individuals from the Swedish general population. METHODS We used the National Patient Register to identify patients with incident SSc diagnosed between 2004 and 2015 and the Total Population Register to identify comparators (1:5), matched on sex, birth year and residential area. We followed them until death, emigration or the end of 2016. Follow-up of the general population comparators started the same date as their matched patients were included. We estimated all-cause survival using the Kaplan-Meier method, crude mortality rates and hazard ratios (HRs) using flexible parametric models. RESULTS We identified 1139 incident patients with SSc and 5613 matched comparators. The median follow-up was 5.0 years in patients with SSc and 6.0 years for their comparators. During follow-up, 268 deaths occurred in patients with SSc and 554 in their comparators. The 5-year survival was 79.8% and the 10-year survival was 67.7% among patients with SSc vs 92.9% and 84.8%, respectively, for the comparators (P < 0.0001). The mortality rate in patients with SSc was 42.1 per 1000 person-years and 15.8 per 1000 person-years in their comparators, corresponding to an HR of 3.7 (95% CI 2.9, 4.7) at the end of the first year of follow-up and 2.0 (95% CI 1.4, 2.8) at the end of the follow-up period. CONCLUSION Despite advances in understanding the disease and in diagnostic methods over the past decades, survival is still severely impacted in Swedish patients diagnosed with SSc between 2004 and 2015.
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Affiliation(s)
- Majd Bairkdar
- Division of Clinical Epidemiology, Department of Medicine, Solna
| | - Enoch Yi-Tung Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm
| | - Roger Hesselstrand
- Department of Clinical Sciences Lund, Section for Rheumatology, Lund University and Skåne University Hospital, Lund
| | - Helga Westerlind
- Division of Clinical Epidemiology, Department of Medicine, Solna
| | - Marie Holmqvist
- Division of Clinical Epidemiology, Department of Medicine, Solna
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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Batyrbekova N, Bower H, Dickman PW, Ravn Landtblom A, Hultcrantz M, Szulkin R, Lambert PC, Andersson TML. Modelling multiple time-scales with flexible parametric survival models. BMC Med Res Methodol 2022; 22:290. [PMID: 36352351 PMCID: PMC9644623 DOI: 10.1186/s12874-022-01773-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND There are situations when we need to model multiple time-scales in survival analysis. A usual approach in this setting would involve fitting Cox or Poisson models to a time-split dataset. However, this leads to large datasets and can be computationally intensive when model fitting, especially if interest lies in displaying how the estimated hazard rate or survival change along multiple time-scales continuously. METHODS We propose to use flexible parametric survival models on the log hazard scale as an alternative method when modelling data with multiple time-scales. By choosing one of the time-scales as reference, and rewriting other time-scales as a function of this reference time-scale, users can avoid time-splitting of the data. RESULT Through case-studies we demonstrate the usefulness of this method and provide examples of graphical representations of estimated hazard rates and survival proportions. The model gives nearly identical results to using a Poisson model, without requiring time-splitting. CONCLUSION Flexible parametric survival models are a powerful tool for modelling multiple time-scales. This method does not require splitting the data into small time-intervals, and therefore saves time, helps avoid technological limitations and reduces room for error.
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Affiliation(s)
- Nurgul Batyrbekova
- grid.4714.60000 0004 1937 0626Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ,grid.511386.8SDS Life Science AB, Stockholm, Sweden
| | - Hannah Bower
- grid.4714.60000 0004 1937 0626Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Paul W. Dickman
- grid.4714.60000 0004 1937 0626Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Ravn Landtblom
- grid.4714.60000 0004 1937 0626Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden ,grid.416648.90000 0000 8986 2221Department of Medicine, Division of Hematology, Stockholm South Hospital, Stockholm, Sweden
| | - Malin Hultcrantz
- grid.4714.60000 0004 1937 0626Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden ,grid.51462.340000 0001 2171 9952Department of Medicine, Myeloma Service, Memorial Sloan-Kettering Cancer Center, New York, NY USA
| | - Robert Szulkin
- grid.4714.60000 0004 1937 0626Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ,grid.511386.8SDS Life Science AB, Stockholm, Sweden
| | - Paul C. Lambert
- grid.4714.60000 0004 1937 0626Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ,grid.9918.90000 0004 1936 8411Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Therese M-L. Andersson
- grid.4714.60000 0004 1937 0626Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Sundqvist A, Moberg L, Dickman PW, Högberg T, Borgfeldt C. Time Trends for Incidence and Net Survival of Cervical Cancer in Sweden 1960-2014-A Nationwide Population-Based Study. Cancer Epidemiol Biomarkers Prev 2022; 31:1572-1581. [PMID: 35654420 PMCID: PMC9344906 DOI: 10.1158/1055-9965.epi-21-1323] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/24/2022] [Accepted: 05/23/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The aim was to investigate time trends for incidence and long-term net survival in the morphologic subtypes and stages of cervical cancer in Sweden during the period 1960 to 2014. METHODS Women with invasive cervical cancer were identified through the Swedish Cancer Registry. Incidence and net survival were calculated according to morphology, age at diagnosis, and FIGO stage at diagnosis. RESULTS In total, 29,579 cases of invasive cervical cancer between 1960 and 2014 were included. The age-standardized incidence for squamous cell carcinoma (SCC) decreased until 2000; thereafter, the incidence rate stagnated, and a small increase was found in 2014. The incidence of adenocarcinoma continuously increased. The age-standardized 5-year net survival increased. However, decreasing net survival with increasing age was found. A higher stage at diagnosis showed a worse net survival. SCC and adenocarcinoma did not statistically differ as regards net survival in the last years of the study. CONCLUSIONS Age-standardized 5-year net survival improved between 1960 and 2014. A positive trend for short- and long-term net survival was seen for women ages 18 to 64 years but long-term net survival for women ≥75 years decreased. In this study, age and FIGO stage at diagnosis were found to be important prognostic factors in determining net survival. The morphologies, SCC, and adenocarcinoma did not statistically differ as regards net survival in the last years of the study. IMPACT This study demonstrates longitudinal data on cervical cancer in Sweden for over 50 years with sub analyses on morphology, age, and stage at diagnosis.
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Affiliation(s)
- Avalon Sundqvist
- Department of Obstetrics and Gynecology, Skåne University Hospital Lund, Lund University, Sweden.,Corresponding Author: Avalon Sundqvist, Skåne University Hospital, SE-221 85 Lund, Sweden. Phone: 464-617-3751; E-mail:
| | - Louise Moberg
- Department of Obstetrics and Gynecology, Skåne University Hospital Lund, Lund University, Sweden
| | - Paul W. Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Thomas Högberg
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Sweden
| | - Christer Borgfeldt
- Department of Obstetrics and Gynecology, Skåne University Hospital Lund, Lund University, Sweden
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11
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Johansson ALV, Dickman PW, Eloranta S, Björkholm M. Reproductive history, as measured by parity, age at first birth and sex of offspring, and cancer-specific survival after a haematological malignancy. Acta Oncol 2022; 61:764-772. [PMID: 35451928 DOI: 10.1080/0284186x.2022.2064726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Overall, women have better cancer-specific survival than men following haematological malignancies. The effect of reproductive factors on prognosis in women remains unknown and population-based studies are needed. MATERIAL AND METHODS A nationwide cohort of 21,237 Swedish women with a recorded haematological malignancy at ages 18-69 years was identified in the Swedish Cancer Register 1970-2018. Pre-diagnosis childbirths for each woman were linked to the Swedish Multigeneration Register. Net survival and excess hazard ratios for parity, age at first birth, time since the latest birth, and sex of offspring were estimated using flexible parametric models adjusted for age, year, and educational level. RESULTS In unadjusted analyses, parity (p = 0.0012) and high age at first birth (p < 0.0001) were associated with better survival. After co-adjustments for reproductive factors and confounders, the associations were attenuated. The adjusted association with parity was mainly observed among women aged above 40 years at diagnosis (p = 0.0033). The associations with reproductive factors were non-significant across subtypes of haematological malignancy. There was a tendency of higher excess mortality for an increasing number of boys compared to girls, although only significant for women with three or more children (p = 0.0126). CONCLUSION Reproductive factors were in part associated with survival following diagnosis of a haematological malignancy. However, the effect sizes were small with inconsistent association patterns, and thus reproductive factors may only partly contribute to the survival advantage of women over men.
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Affiliation(s)
- Anna L. V. Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Cancer Registry of Norway, Oslo, Norway
| | - Paul W. Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Eloranta
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Björkholm
- Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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12
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Batyrbekova N, Bower H, Dickman PW, Szulkin R, Lambert PC, Andersson TML. Potential bias introduced by not including multiple time-scales in survival analysis: a simulation study. COMMUN STAT-SIMUL C 2022. [DOI: 10.1080/03610918.2022.2038626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Nurgul Batyrbekova
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- SDS Life Science AB, Stockholm, Sweden
| | - Hannah Bower
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Paul W. Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Robert Szulkin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- SDS Life Science AB, Stockholm, Sweden
| | - Paul C. Lambert
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Therese M.-L. Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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13
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Kalager M, Adami HO, Dickman PW, Lagergren P, Steindorf K. Cancer outcomes research - a European challenge Part II: Opportunities and priorities. Mol Oncol 2021; 16:2300-2311. [PMID: 34939327 PMCID: PMC9208079 DOI: 10.1002/1878-0261.13169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 11/09/2022] Open
Abstract
In Part I of our review of cancer outcome research, we analysed pros and cons of various measures relevant to quantifying the burden of cancer. Based on our recommendations in Part I, we now discuss in Part II opportunities and priorities in four areas of outcome research: primary prevention; early detection screening; treatment; and quality‐of‐life assessment. We recommend the establishment of an infrastructure that facilitates high‐quality research in these areas: (a) progress in primary prevention can be assessed most directly by monitoring cancer incidence although the interpretation of temporal trends is notoriously confounded by numerous factors that complicate causal inference. (b) preventive screening, with the aim to prevent advanced disease, appears to work well in in some tumours but not in others. It will require randomized control trials (RCTs) to quantify benefits and harms although conclusive studies are increasingly difficult to undertake. We therefore propose learning screening programmes (randomization at the time of rolling out population‐based programmes) as the most feasible approach. (c) New therapeutic interventions tailored to the individual patient often require assessment in RCTs with rather complex and dynamic structure, making their design and analyses increasingly challenging but also more suited to be executed as academic, PI‐initiated trials. (d) We next discuss assessment of quality‐of‐life aspects. Quality of life is a neglected component in outcome research with an urgent need for development, validation and standardization. We finally recommend four initiatives that would pave the way for a valid and informative assessment of the goals for improved cancer control in Europe as defined by the European Academy of Cancer Sciences.
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Affiliation(s)
- Mette Kalager
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Hans-Olov Adami
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Lagergren
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; and Department of Surgery and Cancer, Imperial College London, London, UK
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
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14
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Steingrímsson V, Lund SH, Dickman PW, Weibull CE, Björkholm M, Landgren O, Kristinsson SY. Survival, causes of death, and the prognostic role of comorbidities in chronic lymphocytic leukemia in the pre-ibrutinib era: A population-based study. Eur J Haematol 2021; 108:145-153. [PMID: 34714556 DOI: 10.1111/ejh.13720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/15/2021] [Accepted: 10/25/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate temporal trends in survival and causes of death in patients with chronic lymphocytic leukemia (CLL) in a nationwide study. METHODS The cohort consisted of 13,009 Swedish CLL patients diagnosed 1982-2013. Relative survival (RS) and excess mortality rate ratios (EMRR) with 95% confidence intervals (95% CIs) were estimated using flexible parametric survival models. Cause-specific hazard ratios (HRs) were estimated for the linear effect of 10-year increase in year of diagnosis. RESULTS The excess mortality decreased comparing 2003-2013 to 1982-1992 (EMRR = 0.53, 95% CI 0.48-0.58). The 5-year RS increased between 1982 and 2012 for patients >51 years at diagnosis and improved for patients ≤51 years after 2002. The rate of CLL-specific deaths decreased over time (HR = 0.78, 95% CI 0.75-0.81). Compared to patients with no comorbidity, patients with 1 and 2+ Charlson Comorbidity Index points had HR = 1.35 (95% CI 1.25-1.45) and HR = 1.47 (95% CI 1.37-1.57) for CLL-related mortality, respectively. CONCLUSION Survival in CLL patients improved in the era of chemoimmunotherapy, and this was largely explained by reduced CLL-related mortality. The increased rate of CLL-related mortality in patients with comorbidities emphasizes the importance of the newer and better tolerated targeted therapy.
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Affiliation(s)
| | - Sigrún H Lund
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Caroline E Weibull
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
| | - Magnus Björkholm
- Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Ola Landgren
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | - Sigurður Y Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
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15
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Orrason AW, Garmo H, Styrke J, Dickman PW, Stattin P. Comparison of Relative Survival and Cause-Specific Survival in Men With Prostate Cancer According to Age and Risk Category: A Nationwide, Population-Based Study. Am J Epidemiol 2021; 190:2053-2063. [PMID: 34007984 PMCID: PMC8485148 DOI: 10.1093/aje/kwab146] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Received: 09/20/2020] [Revised: 05/09/2021] [Accepted: 05/13/2021] [Indexed: 11/25/2022] Open
Abstract
Net survival, estimated in a relative survival (RS) or cause-specific survival (CSS) framework, is a key measure of the effectiveness of cancer management. We compared RS and CSS in men with prostate cancer (PCa) according to age and risk category, using Prostate Cancer data Base Sweden, including 168,793 men younger than age 90 years, diagnosed 1998–2016 with PCa. RS and CSS were compared according to age and risk category based on TNM (tumor, nodes, and metastases) stage, Gleason score, and prostate-specific antigen level. Each framework requires assumptions that are unlikely to be appropriate for PCa. Ten-year RS was substantially higher than CSS in men aged 80–89 with low-risk PCa: 125% (95% confidence interval: 113, 138) versus 85% (95% confidence interval: 82, 88). In contrast, RS and CSS were similar for men under age 70 and for all men with regional or distant metastases. Both RS and CSS produce biased estimates of net survival for men with low- and intermediate-risk PCa, in particular for men over 80. Due to biases, net survival is overestimated in analysis of RS but underestimated in analysis of CSS. These results highlight the importance of evaluating the underlying assumptions for each method, because the “true” net survival is expected to lie between the limits of RS and CSS.
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Affiliation(s)
- Andri Wilberg Orrason
- Correspondence to Andri Wilberg Orrason, Department of Surgical Sciences, Uppsala University Hospital, 751 85 Uppsala, Sweden (e-mail: )
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16
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Kalager M, Adami HO, Lagergren P, Steindorf K, Dickman PW. Cancer outcomes research-a European challenge: measures of the cancer burden. Mol Oncol 2021; 15:3225-3241. [PMID: 34003576 PMCID: PMC8637567 DOI: 10.1002/1878-0261.13012] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/21/2021] [Accepted: 05/14/2021] [Indexed: 01/13/2023] Open
Abstract
In a mission that aims to improve cancer control throughout Europe, the European Academy of Cancer Sciences has defined two key indicators of progress: within one to two decades, overall cancer-specific 10-year survival should reach 75%, and in each country, overall cancer mortality rates should be convincingly declining. To lay the ground for assessment of progress and to promote cancer outcomes research in general, we have reviewed the most common population-based measures of the cancer burden. We emphasize the complexities and complementary approaches to measure cancer survival and the novel opportunities for improved assessment of quality of life. We propose that: incidence and mortality rates are standardized to the European population; net survival is used as the measure of prognosis but with proper adjustments for confounding when temporal trends in overall cancer survival are assessed; and cancer-specific quality of life is measured by a combination of existing questionnaires and utilizes emerging communication technologies. We conclude that all measures are important and that a meaningful interpretation also requires a deep understanding of the larger clinical and public health context.
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Affiliation(s)
- Mette Kalager
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Norway
| | - Hans-Olov Adami
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Norway.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Lagergren
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Department of Surgery and Cancer, Imperial College London, UK
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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17
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Leandersson P, Hogberg T, Dickman PW, Malander S, Borgfeldt C. Incidence and survival of epithelial ovarian, fallopian tube, peritoneal, and undesignated abdominal/pelvic cancers in Sweden 1960-2014: A population-based cohort study. BMC Cancer 2021; 21:465. [PMID: 33902507 PMCID: PMC8077696 DOI: 10.1186/s12885-021-08169-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 04/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background Despite improved surgical and oncological treatment, ovarian cancer continues to be the most lethal of the gynecologic malignancies. We aimed to analyze survival trends in epithelial ovarian cancer with regard to age, tumor site, and morphology in Sweden 1960 to 2014. Methods A nationwide population-based study was conducted using data from the Swedish Cancer Registry on 46,350 women aged 18 or older with a diagnosis of epithelial ovarian, fallopian tube, peritoneal, or undesignated abdominal/pelvic cancer 1960 to 2014. Analyses of age-standardized incidence and relative survival (RS) were performed and time trends modelled according to age, tumor site, and morphology. Results Overall incidence of ovarian, tubal, peritoneal, and undesignated abdominal/pelvic cancers declined since 1980. Median age at diagnosis increased. Serous carcinoma increased in incidence. RS at 1, 2 and 5 years from diagnosis improved since 1960, although not for the youngest and the oldest patients. Ten-year RS did not improve. The best RS was found for fallopian tube cancer and the worst RS for undesignated abdominal/pelvic cancer. Among the morphologic subgroups, endometrioid carcinoma had the best RS. Conclusions Survival in epithelial ovarian, tubal, peritoneal, and undesignated abdominal/pelvic cancers in Sweden has improved over the last six decades. Advances in epithelial ovarian cancer treatment have extended life for the first 5 years from diagnosis but 10-year survival remains poor.
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Affiliation(s)
- Pia Leandersson
- Reproductive Medicine Center, Skåne University Hospital Malmö, Lund University, Jan Waldenströms Gata 47, 21428, Malmö, Sweden.
| | - Thomas Hogberg
- Department of Cancer Epidemiology, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Malander
- Department of Oncology and Pathology, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - Christer Borgfeldt
- Department of Obstetrics and Gynecology, Skåne University Hospital Lund, Lund University, Lund, Sweden
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18
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Chen EYT, Sachs MC, Dickman PW. No evidence of substantial underreporting of COVID-19 deaths in Taiwan during 2020. J Formos Med Assoc 2021; 120:1788-1789. [PMID: 33832837 PMCID: PMC7988443 DOI: 10.1016/j.jfma.2021.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Enoch Yi-Tung Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.
| | - Michael C Sachs
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
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19
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Qaderi SM, Andersson TML, Dickman PW, de Wilt JHW, Verhoeven RHA. Temporal improvements noted in life expectancy of patients with colorectal cancer; a Dutch population-based study. J Clin Epidemiol 2021; 137:92-103. [PMID: 33836257 DOI: 10.1016/j.jclinepi.2021.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/22/2021] [Accepted: 03/28/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Specific survival estimates are needed for the increasing number of colorectal cancer (CRC) survivors. The aim of this population-based study was to determine conditional loss in expectation of life (LEL) due to CRC. STUDY DESIGN AND SETTING All surgically treated patients with CRC registered in the Netherlands Cancer Registry with stage I-III between 1990-2016, were included (N = 203,216). Estimates of conditional LEL were predicted using flexible parametric models and the total life years lost due to cancer were estimated. RESULTS LEL decreased with older age and patients with rectal cancer or higher disease stage had highest LEL. In 2010, LEL for sixty-year old male and female patients was 2 vs. 2, 4 vs. 4, and 7 vs. 8 years for colon cancer, and 2 vs. 2, 4 vs. 5 and 7 vs. 8 years for rectal cancer, respectively. Conditional LEL in patients with CRC decreased during follow-up. Patients with combined stage I-III colon and rectal cancer in 2010 lost an estimated 18,628 and 11,336 life years. CONCLUSION This study quantified the impact of CRC on patient's life expectancy, both on individual and population level and demonstrated temporal improvements in CRC survival. These results provide meaningful information that can be used during follow-up.
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Affiliation(s)
- Seyed M Qaderi
- Department of Surgical Oncology, Radboud university medical center, Nijmegen, The Netherlands.
| | - Therese M L Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Johannes H W de Wilt
- Department of Surgical Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Rob H A Verhoeven
- Department of Surgical Oncology, Radboud university medical center, Nijmegen, The Netherlands; Department of Research and Development, Comprehensive Netherlands Cancer Organization, Utrecht, The Netherlands
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20
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Weibull CE, Lambert PC, Eloranta S, Andersson TML, Dickman PW, Crowther MJ. A multistate model incorporating estimation of excess hazards and multiple time scales. Stat Med 2021; 40:2139-2154. [PMID: 33556998 DOI: 10.1002/sim.8894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 12/26/2020] [Accepted: 01/12/2021] [Indexed: 01/08/2023]
Abstract
As cancer patient survival improves, late effects from treatment are becoming the next clinical challenge. Chemotherapy and radiotherapy, for example, potentially increase the risk of both morbidity and mortality from second malignancies and cardiovascular disease. To provide clinically relevant population-level measures of late effects, it is of importance to (1) simultaneously estimate the risks of both morbidity and mortality, (2) partition these risks into the component expected in the absence of cancer and the component due to the cancer and its treatment, and (3) incorporate the multiple time scales of attained age, calendar time, and time since diagnosis. Multistate models provide a framework for simultaneously studying morbidity and mortality, but do not solve the problem of partitioning the risks. However, this partitioning can be achieved by applying a relative survival framework, allowing us to directly quantify the excess risk. This article proposes a combination of these two frameworks, providing one approach to address (1) to (3). Using recently developed methods in multistate modeling, we incorporate estimation of excess hazards into a multistate model. Both intermediate and absorbing state risks can be partitioned and different transitions are allowed to have different and/or multiple time scales. We illustrate our approach using data on Hodgkin lymphoma patients and excess risk of diseases of the circulatory system, and provide user-friendly Stata software with accompanying example code.
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Affiliation(s)
- Caroline E Weibull
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Paul C Lambert
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sandra Eloranta
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Therese M L Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Michael J Crowther
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
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21
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Zhao J, Gabriel E, Norda R, Höglund P, Baden L, Diedrich BA, Marits P, Enoksson SL, Gansner JM, Kaufman R, Dickman PW, Edgren G. Frequent platelet donation is associated with lymphopenia and risk of infections: A nationwide cohort study. Transfusion 2021; 61:464-473. [PMID: 33186486 PMCID: PMC7894559 DOI: 10.1111/trf.16175] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recently, plateletpheresis donations using a widely used leukoreduction system (LRS) chamber have been associated with T-cell lymphopenia. However, clinical health consequences of plateletpheresis-associated lymphopenia are still unknown. STUDY DESIGN AND METHODS A nationwide cohort study using the SCANDAT3-S database was conducted with all platelet- and plasmapheresis donors in Sweden between 1996 and 2017. A Cox proportional hazards model, using donations as time-dependent exposures, was used to assess the risk of infections associated with plateletpheresis donations using an LRS chamber. RESULTS A total of 74 408 apheresis donors were included. Among donors with the same donation frequency, plateletpheresis donors using an LRS chamber were at an increased risk of immunosuppression-related infections and common bacterial infections in a dose-dependent manner. While very frequent donors and infections were rare in absolute terms resulting in wide confidence intervals (CIs), the increased risk was significant starting at one-third or less of the allowed donation frequency in a 10-year exposure window, with hazard ratios reaching 10 or more. No plateletpheresis donors that used an LRS chamber experienced a Pneumocystis jirovecii, aspergillus, disseminated mycobacterial, or cryptococcal infection. In a subcohort (n = 42), donations with LRS were associated with low CD4+ T-cell counts (Pearson's R = -0.41; 95% CI, - 0.63 to -0.12). CONCLUSION Frequent plateletpheresis donation using an LRS chamber was associated with CD4+ T-cell lymphopenia and an increased risk of infections. These findings suggest a need to monitor T-lymphocyte counts in frequent platelet donors and to conduct future investigations of long-term donor health and for regulators to consider steps to mitigate lymphodepletion in donors.
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Affiliation(s)
- Jingcheng Zhao
- Department of Medicine Solna, Clinical Epidemiology DivisionKarolinska InstitutetStockholmSweden
| | - Erin Gabriel
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Rut Norda
- Department of Immunology, Genetics and PathologyUppsala UniversityUppsalaSweden
| | - Petter Höglund
- Department of Medicine Huddinge, Center for Hematology and Regnerative Medicine (HERM)Karolinska InstitutetStockholmSweden
- Department of Clinical Immunology and Transfusion MedicineKarolinska University HospitalStockholmSweden
| | - Lindsey Baden
- Division of Infectious DiseasesBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Beatrice A. Diedrich
- Department of Clinical Immunology and Transfusion MedicineKarolinska University HospitalStockholmSweden
- Department of Clinical Science, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
| | - Per Marits
- Department of Clinical Immunology and Transfusion MedicineKarolinska University HospitalStockholmSweden
- Department of Clinical Science, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
| | - Sara L. Enoksson
- Department of Clinical Immunology and Transfusion MedicineKarolinska University HospitalStockholmSweden
- Department of Clinical Science, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
| | - John M. Gansner
- Hematology DivisionBrigham and Women's HospitalBostonMassachusettsUSA
| | - Richard Kaufman
- Department of PathologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Paul W. Dickman
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Gustaf Edgren
- Department of Medicine Solna, Clinical Epidemiology DivisionKarolinska InstitutetStockholmSweden
- Department of CardiologySödersjukhusetStockholmSweden
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22
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Eloranta S, Smedby KE, Dickman PW, Andersson TM. Cancer survival statistics for patients and healthcare professionals - a tutorial of real-world data analysis. J Intern Med 2021; 289:12-28. [PMID: 32656940 DOI: 10.1111/joim.13139] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/27/2020] [Indexed: 01/04/2023]
Abstract
Monitoring survival of cancer patients using data collected by population-based cancer registries is an important component of cancer control. In this setting, patient survival is often summarized using net survival, that is survival from cancer if there were no other possible causes of death. Although net survival is the gold standard for comparing survival between groups or over time, it is less relevant for understanding the anticipated real-world prognosis of patients. In this review, we explain statistical concepts targeted towards patients, clinicians and healthcare professionals that summarize cancer patient survival under the assumption that other causes of death exist. Specifically, we explain the appropriate use, interpretation and assumptions behind statistical methods for competing risks, loss in life expectancy due to cancer and conditional survival. These concepts are relevant when producing statistics for risk communication between physicians and patients, planning for use of healthcare resources, or other applications when consideration of both cancer outcomes and the competing risks of death is required. To reinforce the concepts, we use Swedish population-based data of patients diagnosed with cancer of the breast, prostate, colon and chronic myeloid leukaemia. We conclude that when choosing between summary measures of survival it is critical to characterize the purpose of the study and to determine the nature of the hypothesis under investigation. The choice of terminology and style of reporting should be carefully adapted to the target audience and may range from summaries for specialist readers of scientific publications to interactive online tools aimed towards lay persons.
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Affiliation(s)
- S Eloranta
- From the, Department of Medicine, Division of Clinical Epidemiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - K E Smedby
- From the, Department of Medicine, Division of Clinical Epidemiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Division of Hematology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - P W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - T M Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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23
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Hellgren R, Saracco A, Strand F, Eriksson M, Sundbom A, Hall P, Dickman PW. The association between breast cancer risk factors and background parenchymal enhancement at dynamic contrast-enhanced breast MRI. Acta Radiol 2020; 61:1600-1607. [PMID: 32216451 PMCID: PMC7720360 DOI: 10.1177/0284185120911583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Background parenchymal enhancement (BPE) of normal tissue at breast magnetic resonance imaging is suggested to be an independent risk factor for breast cancer. Its association with established risk factors for breast cancer is not fully investigated. Purpose To study the association between BPE and risk factors for breast cancer in a healthy, non-high-risk screening population. Material and Methods We measured BPE and mammographic density and used data from self-reported questionnaires in 214 healthy women aged 43–74 years. We estimated odds ratios for the univariable association between BPE and risk factors. We then fitted an adjusted model using logistic regression to evaluate associations between BPE (high vs. low) and risk factors, including mammographic breast density. Results The majority of women had low BPE (84%). In a multivariable model, we found statistically significant associations between BPE and age (P = 0.002) and BMI (P = 0.03). We did find a significant association between systemic progesterone medication and BPE, but due to small numbers, the results should be interpreted with caution. The adjusted odds ratio for high BPE was 3.1 among women with density D (compared to B) and 2.1 for density C (compared to B). However, the association between high BPE and density was not statistically significant. We did not find statistically significant associations with any other risk factors. Conclusion Our study confirmed the known association of BPE with age and BMI. Although our results show a higher likelihood for high BPE with increasing levels of mammographic density, the association was not statistically significant.
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Affiliation(s)
- Roxanna Hellgren
- Department of Medical Imaging, Division of Breast Imaging, Södersjukhuset, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ariel Saracco
- Department of Medical Imaging, Division of Breast Imaging, Södersjukhuset, Stockholm, Sweden
| | - Fredrik Strand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Thoracic Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ann Sundbom
- Department of Medical Imaging, Division of Breast Imaging, Södersjukhuset, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Södersjukhuset, Stockholm, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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24
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Qaderi SM, Dickman PW, de Wilt JHW, Verhoeven RHA. Conditional Survival and Cure of Patients With Colon or Rectal Cancer: A Population-Based Study. J Natl Compr Canc Netw 2020; 18:1230-1237. [PMID: 32886900 DOI: 10.6004/jnccn.2020.7568] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/27/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The increasing number of colorectal cancer (CRC) survivors need survival estimates that account for the time already survived. The aim of this population-based study was to determine conditional survival, cure proportions, and time-to-cure (TTC) of patients with colon or rectal cancer. MATERIALS AND METHODS All patients with pathologic stage I-III CRC treated with endoscopy or surgery, diagnosed and registered in the Netherlands Cancer Registry between 1995 and 2016, and aged 18 to 99 years were included. Conditional survival was calculated for those diagnosed before and after 2007. Cure proportions were calculated using flexible parametric models. RESULTS A total of 175,384 patients with pathologic stage I (25%), II (38%), or III disease (37%) were included. Conditional 5-year survival of patients with stage I, II, and III colon cancer having survived 5 years was 98%, 94%, and 92%, respectively. For patients with stage I-III rectal cancer, this was 96%, 89%, and 85%, respectively. Statistical cure in patients with colon cancer was reached directly after diagnosis (stage I) to 6 years (stage III) after diagnosis depending on age, sex, and disease stage. Patients with rectal cancer reached cure 0.5 years after diagnosis (stage I) to 9 years after diagnosis (stage III). In 1995, approximately 42% to 46% of patients with stage III colon or rectal cancer, respectively, were considered cured, whereas in 2016 this percentage increased to 73% to 78%, respectively. CONCLUSIONS The number of patients with CRC reaching cure has increased substantially over the years. This study's results provide valuable insights into trends of CRC patient survival and are important for patients, clinicians, and policymakers.
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Affiliation(s)
- Seyed M Qaderi
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; and
| | - Johannes H W de Wilt
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rob H A Verhoeven
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Research & Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
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25
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Hultcrantz M, Ravn Landtblom A, Andréasson B, Samuelsson J, Dickman PW, Kristinsson SY, Björkholm M, Andersson TML. Incidence of myeloproliferative neoplasms - trends by subgroup and age in a population-based study in Sweden. J Intern Med 2020; 287:448-454. [PMID: 31927786 PMCID: PMC7598815 DOI: 10.1111/joim.13019] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/07/2019] [Accepted: 11/25/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The reported incidence of Philadelphia-negative myeloproliferative neoplasms (MPNs) differs substantially between previous reports, likely due to true regional differences in incidence and/or variations in the quality and coverage of the cancer registers. OBJECTIVE We therefore assessed MPN incidence in Sweden during recent years using prospectively collected information captured in Swedish health registers. METHODS Patients with MPNs were identified through the Swedish Cancer Register and Swedish Blood Cancer Register between 2000 and 2014. Information on the Swedish population was obtained from the Human Mortality Database. Crude and age-standardized incidence rates of MPNs with 95% confidence intervals (CIs) were calculated. RESULTS A total of 6281 MPN cases were reported to the Swedish Cancer Register and Swedish Blood Cancer Register during 2000-2014. The age-standardized, to the Swedish population in 2000, incidence for all MPNs was 4.45 (95% confidence interval [CI] 4.34-4.56)/100 000 person-years. The age-standardized incidence for polycythemia vera was 1.48 (1.42-1.54), for essential thrombocythemia 1.60 (1.53-1.66) and for primary myelofibrosis 0.52 (0.48-0.56)/100 000 person-years, respectively. The incidence rate of MPNs was substantially higher in the older compared to the younger age groups. The incidence increased during the study period, likely to do better reporting and increasing age of the general population. CONCLUSION The reported MPN incidences in our study, which were in the higher interval of previously published studies, are likely more accurate compared to previous reports due to the population-based setting and high level of coverage in the Swedish Cancer and Blood Cancer Registers.
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Affiliation(s)
- M Hultcrantz
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - A Ravn Landtblom
- Department of Medicine, Stockholm South Hospital and Karolinska Institutet, Stockholm, Sweden
| | - B Andréasson
- Hematology Section, NU Hospital Group, Uddevalla, Sweden
| | - J Samuelsson
- Department of Hematology, University Hospital Linkoping, Linkoping, Sweden
| | - P W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - S Y Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Hematology, Landspitali National University Hospital, Reykjavik, Iceland
| | - M Björkholm
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - T M-L Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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26
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Richters A, Dickman PW, Witjes JA, Boormans JL, Kiemeney LALM, Aben KKH. Bladder cancer survival: Women only fare worse in the first two years after diagnosis. Urol Oncol 2019; 37:853-861. [PMID: 31481299 DOI: 10.1016/j.urolonc.2019.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/23/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES It has consistently been shown that women who are diagnosed with bladder cancer have lower survival than men, but the exact mechanism remains unknown. Most studies assumed that the sex-specific mortality ratio is constant over time, possibly resulting in inaccurate estimates in various periods of follow-up. This study aimed to investigate the sex-specific excess mortality in bladder cancer patients and its variation over follow-up time. METHODS Observational cohort study. Using data from the population-based Netherlands Cancer Registry, we studied 24,169 patients diagnosed between 2003 and 2014 with histologically confirmed ≥T1 bladder cancer with follow-up until January 2018. We used flexible parametric relative survival models to estimate excess mortality as a function of time for each sex and to explore the effect of covariates on these functions. RESULTS Female patients (24%) had worse clinical tumor, node, and metastasis-stage at diagnosis and more often a nonurothelial tumor histology. The excess mortality ratio of sex was not constant over time; in the first two years after diagnosis excess mortality rates for women were higher than for men, but lower thereafter; this applied to both nonmuscle-invasive and muscle-invasive bladder cancer subgroups. Baseline differences in age, tumor, node, and metastasis-stage and histology accounted for only part of the excess mortality gap. CONCLUSIONS The assumption of proportional hazards over time leads to underestimation of the excess mortality ratio for women in the first two years and overestimation thereafter, when excess mortality is comparable for women and men. Clinicians should incorporate the initial sex-specific poorer outcome in their considerations regarding prognosis and treatment options for female patients, e.g., more invasive treatment and neo-adjuvant treatment. These findings also point towards a mechanism of micrometastatic disease, warranting assessment of sex-specific efficacy in randomized controlled trials on treatments in this patient population.
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Affiliation(s)
- A Richters
- Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands.
| | - P W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - J A Witjes
- Department of Urology, Radboud university medical center, Nijmegen, the Netherlands
| | - J L Boormans
- Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - L A L M Kiemeney
- Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands
| | - K K H Aben
- Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands; Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands
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27
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Bower H, Crowther MJ, Rutherford MJ, Andersson TML, Clements M, Liu XR, Dickman PW, Lambert PC. Capturing simple and complex time-dependent effects using flexible parametric survival models: A simulation study. COMMUN STAT-SIMUL C 2019. [DOI: 10.1080/03610918.2019.1634201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Hannah Bower
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Michael J. Crowther
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Therese M.-L. Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mark Clements
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Xing-Rong Liu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul W. Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul C. Lambert
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Health Sciences, University of Leicester, Leicester, UK
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28
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Bower H, Andersson TML, Syriopoulou E, Rutherford MJ, Lambe M, Ahlgren J, Dickman PW, Lambert PC. Potential gain in life years for Swedish women with breast cancer if stage and survival differences between education groups could be eliminated – Three what-if scenarios. Breast 2019; 45:75-81. [DOI: 10.1016/j.breast.2019.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/13/2019] [Accepted: 03/09/2019] [Indexed: 11/29/2022] Open
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29
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Hellgren RJ, Sundbom AE, Czene K, Izhaky D, Hall P, Dickman PW. Does three-dimensional functional infrared imaging improve breast cancer detection based on digital mammography in women with dense breasts? Eur Radiol 2019; 29:6227-6235. [PMID: 31115623 PMCID: PMC6795638 DOI: 10.1007/s00330-019-06248-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/30/2019] [Accepted: 04/19/2019] [Indexed: 11/30/2022]
Abstract
Purpose We aimed to estimate the incremental cancer detection rate achieved by adding three-dimensional functional infrared imaging (3DIRI) to digital mammography in women with dense breasts. Materials and methods In this prospective study conducted between December 2014 and April 2016, 1727 women (median age 56) with percentage volumetric breast density > 6% were recruited at routine screening mammography to undergo additional 3DIRI. The 3DIRI findings were classified as negative or positive. Women with a negative mammography but positive 3DIRI were referred to dynamic contrast-enhanced MRI, whereas all other women underwent routine follow-up based on the mammography finding. Diagnosis of breast cancer was verified by histopathologic examination. The number of women diagnosed with a malignancy formed the basis of our statistical analysis. Results Mammography detected 7 cancers in 7 women. Of 1692 women with negative mammography, 222 women (13%) had a positive 3DIRI of which 219 underwent MRI. An additional 6 cancers were identified in 5 women, increasing the diagnostic yield from 7 of 1727 (0.41%) to 12 of 1727 (0.69%). The incremental cancer detection rate associated with using 3DIRI to select women for MRI was 5 of 222 (22.5 additional cancers per 1000). Conclusion The use of 3DIRI to select women for an additional MRI can result in the detection of additional cancers in women with dense breasts, but at the expense of additional false positives and considerably lower positive predictive value of the combined examinations. Additional studies are necessary to evaluate the role of 3DIRI as an adjunct to mammography. Key Points • Use of three-dimensional functional infrared imaging to select women for an MRI in addition to screening mammography has the potential to improve breast cancer detection in women with dense breasts. Electronic supplementary material The online version of this article (10.1007/s00330-019-06248-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Roxanna J Hellgren
- Department of Medical Imaging, Division of Breast Imaging, Södersjukhuset, 118 83, Stockholm, Sweden. .,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Ann E Sundbom
- Department of Medical Imaging, Division of Breast Imaging, Södersjukhuset, 118 83, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - David Izhaky
- Department of Research and Development, Real Imaging, 1 Golan St., 7019802, Airport City, Israel
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden.,Department of Oncology, Södersjukhuset, 118 83, Stockholm, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden
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30
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Weibull CE, Björkholm M, Glimelius I, Lambert PC, Andersson TML, Smedby KE, Dickman PW, Eloranta S. Temporal trends in treatment‐related incidence of diseases of the circulatory system among Hodgkin lymphoma patients. Int J Cancer 2019; 145:1200-1208. [DOI: 10.1002/ijc.32142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/08/2018] [Accepted: 01/08/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Caroline E. Weibull
- Department of Medical Epidemiology and BiostatisticsKarolinska Institutet Stockholm Sweden
| | - Magnus Björkholm
- Division of Haematology, Department of Medicine SolnaKarolinska University Hospital Stockholm Sweden
| | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Experimental and Clinical OncologyUppsala University Uppsala Sweden
- Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska Institutet Stockholm Sweden
| | - Paul C. Lambert
- Department of Medical Epidemiology and BiostatisticsKarolinska Institutet Stockholm Sweden
- Biostatistics Research Group, Department of Health SciencesUniversity of Leicester Leicester United Kingdom
| | | | - Karin E. Smedby
- Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska Institutet Stockholm Sweden
| | - Paul W. Dickman
- Department of Medical Epidemiology and BiostatisticsKarolinska Institutet Stockholm Sweden
| | - Sandra Eloranta
- Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska Institutet Stockholm Sweden
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31
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Mozumder SI, Dickman PW, Rutherford MJ, Lambert PC. InterPreT cancer survival: A dynamic web interactive prediction cancer survival tool for health-care professionals and cancer epidemiologists. Cancer Epidemiol 2018; 56:46-52. [PMID: 30032027 DOI: 10.1016/j.canep.2018.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/11/2018] [Accepted: 07/14/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are a variety of ways for quantifying cancer survival with each measure having advantages and disadvantages. Distinguishing these measures and how they should be interpreted has led to confusion among scientists, the media, health care professionals and patients. This motivates the development of tools to facilitate communication and interpretation of these statistics. METHODS "InterPreT Cancer Survival" is a newly developed, publicly available, online interactive cancer survival tool targeted towards health-care professionals and epidemiologists (http://interpret.le.ac.uk). It focuses on the correct interpretation of commonly reported cancer survival measures facilitated through the use of dynamic interactive graphics. Statistics presented are based on parameter estimates obtained from flexible parametric relative survival models using large population-based English registry data containing information on survival across 6 cancer sites; Breast, Colon, Rectum, Stomach, Melanoma and Lung. RESULTS Through interactivity, the tool improves understanding of various measures and how survival or mortality may vary by age and sex. Routine measures of cancer survival are reported, however, individualised estimates using crude probabilities are advocated, which is more appropriate for patients or health care professionals. The results are presented in various interactive formats facilitating understanding of individual risk and differences between various measures. CONCLUSIONS "InterPreT Cancer Survival" is presented as an educational tool which engages the user through interactive features to improve the understanding of commonly reported cancer survival statistics. The tool has received positive feedback from a Cancer Research UK patient sounding board and there are further plans to incorporate more disease characteristics, e.g. stage.
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Affiliation(s)
- Sarwar Islam Mozumder
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, UK.
| | - Paul W Dickman
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Mark J Rutherford
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, UK.
| | - Paul C Lambert
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, UK; Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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32
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Weibull CE, Johansson ALV, Eloranta S, Smedby KE, Björkholm M, Lambert PC, Dickman PW, Glimelius I. Contemporarily Treated Patients With Hodgkin Lymphoma Have Childbearing Potential in Line With Matched Comparators. J Clin Oncol 2018; 36:2718-2725. [PMID: 30044694 DOI: 10.1200/jco.2018.78.3514] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose With excellent cure rates for young patients with Hodgkin lymphoma (HL), there is an increasing number of female survivors of HL interested in becoming pregnant. Here, we report childbearing among contemporarily treated HL survivors in comparison with the general population. Material and Methods Using Swedish registers, 449 women (ages 18 to 40 years) diagnosed with HL between 1992 and 2009 and in remission 9 months after diagnosis were identified. Patients were age- and calendar-year-matched to 2,210 population comparators. Rates of first postdiagnosis childbirth were calculated. Hazard ratios (HRs) with 95% CIs were estimated for different follow-up periods using Cox regression. Cumulative probabilities of first childbirth were calculated in the presence of the competing risk of death or relapse. Results Twenty-two percent of relapse-free patients with HL had a child during follow-up, and first childbirth rates increased over time, from 40.2 per 1,000 person-years (1992 to 1997) to 69.7 per 1,000 person-years (2004 to 2009). For comparators, childbirth rates remained stable (70.1 per 1,000 person-years). Patients diagnosed between 2004 and 2009 had a cumulative probability of childbirth similar to comparators. Three years or more after diagnosis, no differences in childbirth rates were observed between patients and comparators, regardless of stage or treatment. Patients who received six to eight courses of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone had a lower childbirth rate than comparators during the first 3 years (HR, 0.23; 95% CI, 0.06 to 0.94), as did patients who received six to eight courses of chemotherapy and radiotherapy (HR, 0.21; 95% CI, 0.07 to 0.65). Conclusion Childbearing potential among female survivors of HL has improved over time, and childbirth rates 3 years after diagnosis in contemporarily treated patients are, in the absence of relapse, similar to those in the general population, regardless of stage and treatment.
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Affiliation(s)
- Caroline E Weibull
- Caroline E. Weibull, Anna L.V. Johansson, Sandra Eloranta, Paul C. Lambert, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby and Magnus Björkholm, Karolinska Institutet and Karolinska University Hospital, Stockholm; Ingrid Glimelius, Uppsala University and Uppsala Akademiska Hospital, Uppsala, Sweden; Anna L.V. Johansson, Cancer Registry of Norway, Oslo, Norway; and Paul C. Lambert, University of Leicester, Leicester, United Kingdom
| | - Anna L V Johansson
- Caroline E. Weibull, Anna L.V. Johansson, Sandra Eloranta, Paul C. Lambert, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby and Magnus Björkholm, Karolinska Institutet and Karolinska University Hospital, Stockholm; Ingrid Glimelius, Uppsala University and Uppsala Akademiska Hospital, Uppsala, Sweden; Anna L.V. Johansson, Cancer Registry of Norway, Oslo, Norway; and Paul C. Lambert, University of Leicester, Leicester, United Kingdom
| | - Sandra Eloranta
- Caroline E. Weibull, Anna L.V. Johansson, Sandra Eloranta, Paul C. Lambert, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby and Magnus Björkholm, Karolinska Institutet and Karolinska University Hospital, Stockholm; Ingrid Glimelius, Uppsala University and Uppsala Akademiska Hospital, Uppsala, Sweden; Anna L.V. Johansson, Cancer Registry of Norway, Oslo, Norway; and Paul C. Lambert, University of Leicester, Leicester, United Kingdom
| | - Karin E Smedby
- Caroline E. Weibull, Anna L.V. Johansson, Sandra Eloranta, Paul C. Lambert, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby and Magnus Björkholm, Karolinska Institutet and Karolinska University Hospital, Stockholm; Ingrid Glimelius, Uppsala University and Uppsala Akademiska Hospital, Uppsala, Sweden; Anna L.V. Johansson, Cancer Registry of Norway, Oslo, Norway; and Paul C. Lambert, University of Leicester, Leicester, United Kingdom
| | - Magnus Björkholm
- Caroline E. Weibull, Anna L.V. Johansson, Sandra Eloranta, Paul C. Lambert, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby and Magnus Björkholm, Karolinska Institutet and Karolinska University Hospital, Stockholm; Ingrid Glimelius, Uppsala University and Uppsala Akademiska Hospital, Uppsala, Sweden; Anna L.V. Johansson, Cancer Registry of Norway, Oslo, Norway; and Paul C. Lambert, University of Leicester, Leicester, United Kingdom
| | - Paul C Lambert
- Caroline E. Weibull, Anna L.V. Johansson, Sandra Eloranta, Paul C. Lambert, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby and Magnus Björkholm, Karolinska Institutet and Karolinska University Hospital, Stockholm; Ingrid Glimelius, Uppsala University and Uppsala Akademiska Hospital, Uppsala, Sweden; Anna L.V. Johansson, Cancer Registry of Norway, Oslo, Norway; and Paul C. Lambert, University of Leicester, Leicester, United Kingdom
| | - Paul W Dickman
- Caroline E. Weibull, Anna L.V. Johansson, Sandra Eloranta, Paul C. Lambert, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby and Magnus Björkholm, Karolinska Institutet and Karolinska University Hospital, Stockholm; Ingrid Glimelius, Uppsala University and Uppsala Akademiska Hospital, Uppsala, Sweden; Anna L.V. Johansson, Cancer Registry of Norway, Oslo, Norway; and Paul C. Lambert, University of Leicester, Leicester, United Kingdom
| | - Ingrid Glimelius
- Caroline E. Weibull, Anna L.V. Johansson, Sandra Eloranta, Paul C. Lambert, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby and Magnus Björkholm, Karolinska Institutet and Karolinska University Hospital, Stockholm; Ingrid Glimelius, Uppsala University and Uppsala Akademiska Hospital, Uppsala, Sweden; Anna L.V. Johansson, Cancer Registry of Norway, Oslo, Norway; and Paul C. Lambert, University of Leicester, Leicester, United Kingdom
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Björkholm M, Weibull CE, Eloranta S, Smedby KE, Glimelius I, Dickman PW. Greater attention should be paid to developing therapies for elderly patients with Hodgkin lymphoma-A population-based study from Sweden. Eur J Haematol 2018; 101:106-114. [PMID: 29727497 DOI: 10.1111/ejh.13090] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Forty percent of Hodgkin lymphoma (HL) patients are older than 50 years at diagnosis, a fact which is not commonly recognized. Older patients do significantly worse than younger patients and are rarely included in clinical trials. METHODS Using data from Swedish Cancer and Lymphoma Registries, we estimated relative survival ratios (RSRs) for 7997 HL patients (diagnosed 1973-2013; 45% ≥50 years). RESULTS The 1-year RSRs (95% confidence interval; CI) for males aged 45-59, 60-69, 70-80, and 81 years and over, diagnosed in 2013, were 0.95 (0.91-0.97), 0.88 (0.81-0.92), 0.74 (0.63-0.81), and 0.52 (0.35-0.67), respectively. The corresponding 1-year RSRs for females were 0.97 (0.94-0.98), 0.91 (0.85-0.95), 0.82 (0.73-0.88), and 0.66 (0.50-0.77). No improvements in 1-year of 5-year relative survival from 2000 to 2013 were observed for patients aged 45-59 or 60-69 but there were modest improvements for patients aged 70 years and older. Importantly, we saw no changes in the distribution of disease or patient characteristics between 2000 and 2013. CONCLUSIONS Elderly patients constitute a large group with clearly unmet medical needs. Our findings motivate a more active approach to including elderly patients in clinical trials. Our study provides a baseline for outcome comparison after the broader introduction of targeted drugs.
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Affiliation(s)
- Magnus Björkholm
- Department of Medicine, Division of Hematology, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Caroline E Weibull
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Eloranta
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden
| | - Karin E Smedby
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden
| | - Ingrid Glimelius
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden.,Department of Immunology, Genetics and Pathology, Clinical and Experimental Oncology, Uppsala University and Uppsala Akademiska Hospital, Uppsala, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Bower H, Andersson TML, Crowther MJ, Dickman PW, Lambe M, Lambert PC. Adjusting Expected Mortality Rates Using Information From a Control Population: An Example Using Socioeconomic Status. Am J Epidemiol 2018; 187:828-836. [PMID: 29020167 DOI: 10.1093/aje/kwx303] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 08/02/2017] [Indexed: 12/18/2022] Open
Abstract
Expected or reference mortality rates are commonly used in the calculation of measures such as relative survival in population-based cancer survival studies and standardized mortality ratios. These expected rates are usually presented according to age, sex, and calendar year. In certain situations, stratification of expected rates by other factors is required to avoid potential bias if interest lies in quantifying measures according to such factors as, for example, socioeconomic status. If data are not available on a population level, information from a control population could be used to adjust expected rates. We have presented two approaches for adjusting expected mortality rates using information from a control population: a Poisson generalized linear model and a flexible parametric survival model. We used a control group from BCBaSe-a register-based, matched breast cancer cohort in Sweden with diagnoses between 1992 and 2012-to illustrate the two methods using socioeconomic status as a risk factor of interest. Results showed that Poisson and flexible parametric survival approaches estimate similar adjusted mortality rates according to socioeconomic status. Additional uncertainty involved in the methods to estimate stratified, expected mortality rates described in this study can be accounted for using a parametric bootstrap, but this might make little difference if using a large control population.
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Affiliation(s)
- Hannah Bower
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Therese M -L Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Michael J Crowther
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden
| | - Paul C Lambert
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
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Thorsteinsdottir S, Dickman PW, Landgren O, Blimark C, Hultcrantz M, Turesson I, Björkholm M, Kristinsson SY. Dramatically improved survival in multiple myeloma patients in the recent decade: results from a Swedish population-based study. Haematologica 2018; 103:e412-e415. [PMID: 29567776 DOI: 10.3324/haematol.2017.183475] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sigrun Thorsteinsdottir
- Department of Internal Medicine, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ola Landgren
- Myeloma Service, Division of Hematologic Oncology, Memorial Sloan-Kettering Cancer Center, NY, USA
| | - Cecilie Blimark
- Department of Internal Medicine, Hematology Section, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Malin Hultcrantz
- Myeloma Service, Division of Hematologic Oncology, Memorial Sloan-Kettering Cancer Center, NY, USA.,Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Ingemar Turesson
- Department of Hematology and Coagulation Disorders, Skane University Hospital, Malmo, Sweden
| | - Magnus Björkholm
- Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Sigurdur Y Kristinsson
- Department of Internal Medicine, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland .,Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
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Hultcrantz M, Björkholm M, Dickman PW, Landgren O, Derolf ÅR, Kristinsson SY, Andersson TML. Risk for Arterial and Venous Thrombosis in Patients With Myeloproliferative Neoplasms: A Population-Based Cohort Study. Ann Intern Med 2018; 168:317-325. [PMID: 29335713 PMCID: PMC7533681 DOI: 10.7326/m17-0028] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Patients with myeloproliferative neoplasms (MPNs) are reported to be at increased risk for thrombotic events. However, no population-based study has estimated this excess risk compared with matched control participants. OBJECTIVE To assess risk for arterial and venous thrombosis in patients with MPNs compared with matched control participants. DESIGN Matched cohort study. SETTING Population-based setting in Sweden from 1987 to 2009, with follow-up to 2010. PATIENTS 9429 patients with MPNs and 35 820 matched control participants. MEASUREMENTS The primary outcomes were rates of arterial and venous thrombosis. Flexible parametric models were used to calculate hazard ratios (HRs) and cumulative incidence with 95% CIs. RESULTS The HRs for arterial thrombosis among patients with MPNs compared with control participants at 3 months, 1 year, and 5 years were 3.0 (95% CI, 2.7 to 3.4), 2.0 (CI, 1.8 to 2.2), and 1.5 (CI, 1.4 to 1.6), respectively. The corresponding HRs for venous thrombosis were 9.7 (CI, 7.8 to 12.0), 4.7 (CI, 4.0 to 5.4), and 3.2 (CI, 2.9 to 3.6). The rate was significantly elevated across all age groups and was similar among MPN subtypes. The 5-year cumulative incidence of thrombosis in patients with MPNs showed an initial rapid increase followed by gentler increases during follow-up. The HR for venous thrombosis decreased during more recent calendar periods. LIMITATION No information on individual laboratory results or treatment. CONCLUSION Patients with MPNs across all age groups have a significantly increased rate of arterial and venous thrombosis compared with matched control participants, with the highest rates at and shortly after diagnosis. Decreases in the rate of venous thrombosis over time likely reflect advances in clinical management. PRIMARY FUNDING SOURCE The Cancer Research Foundations of Radiumhemmet, Blodcancerfonden, the Swedish Research Council, the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, the Adolf H. Lundin Charitable Foundation, and Memorial Sloan Kettering Cancer Center.
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Affiliation(s)
- Malin Hultcrantz
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden, and Memorial Sloan Kettering Cancer Center, New York, New York (M.H.)
| | - Magnus Björkholm
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden (M.B., Å.R.D.)
| | - Paul W Dickman
- Karolinska Institutet, Stockholm, Sweden (P.W.D., T.M.A.)
| | - Ola Landgren
- Memorial Sloan Kettering Cancer Center, New York, New York (O.L.)
| | - Åsa R Derolf
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden (M.B., Å.R.D.)
| | - Sigurdur Y Kristinsson
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden, and University of Iceland and Landspítali National University Hospital, Reykjavik, Iceland (S.Y.K.)
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Landtblom AR, Bower H, Andersson TML, Dickman PW, Samuelsson J, Björkholm M, Kristinsson SY, Hultcrantz M. Second malignancies in patients with myeloproliferative neoplasms: a population-based cohort study of 9379 patients. Leukemia 2018. [PMID: 29535425 DOI: 10.1038/s41375-018-0027-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
To determine the risk of a wide range of second malignancies in patients with myeloproliferative neoplasms (MPNs), we conducted a large population-based study and compared the results to matched controls. From national Swedish registers, 9379 patients with MPNs diagnosed between 1973 and 2009, and 35,682 matched controls were identified as well as information on second malignancies, with follow-up until 2010. Hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated using Cox regression and a flexible parametric model. There was a significantly increased risk of any non-hematologic cancer with HR of 1.6 (95% CI: 1.5-1.7). The HRs for non-melanoma skin cancer was 2.8 (2.4-3.3), kidney cancer 2.8 (2.0-4.0), brain cancer 2.8 (1.9-4.2), endocrine cancers 2.5 (1.6-3.8), malignant melanoma 1.9 (1.4-2.7), pancreas cancer 1.8 (1.2-2.6), lung cancer 1.7 (1.4-2.2), and head and neck cancer 1.7 (1.2-2.6). The HR of second malignancies was similar across all MPN subtypes, sex, and calendar periods of MPN diagnosis. The risk of developing a hematologic malignancy was also significantly increased; the HR for acute myeloid leukemia was 46.0 (32.6-64.9) and for lymphoma 2.6 (2.0-3.3). In conclusion, our study provides robust population-based support of an increased cancer risk in MPN patients.
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Affiliation(s)
- Anna Ravn Landtblom
- Department of Medicine, Division of Hematology, Stockholm South Hospital and Karolinska Institutet, Stockholm, Sweden.
| | - Hannah Bower
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Therese M-L Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jan Samuelsson
- Department of Medicine, Division of Hematology, Stockholm South Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Magnus Björkholm
- Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Sigurdur Yngvi Kristinsson
- Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.,Faculty of Medicine, University of Iceland and Department of Hematology, Landspitali National University Hospital, Reykjavik, Iceland
| | - Malin Hultcrantz
- Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Myeloma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Johansson AL, Andersson TML, Hsieh CC, Jirström K, Cnattingius S, Fredriksson I, Dickman PW, Lambe M. Tumor characteristics and prognosis in women with pregnancy-associated breast cancer. Int J Cancer 2017; 142:1343-1354. [DOI: 10.1002/ijc.31174] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/24/2017] [Accepted: 11/07/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Anna L.V. Johansson
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Therese M.-L. Andersson
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Chung-Cheng Hsieh
- Department of Molecular, Cell and Cancer Biology; University of Massachusetts Medical School; Worcester MA
| | - Karin Jirström
- Department of Clinical Sciences Lund, Division of Oncology and Pathology; Lund University; Lund Sweden
| | - Sven Cnattingius
- Department of Medicine Solna, Clinical Epidemiology Unit; Karolinska University Hospital Solna, Karolinska Institutet; Stockholm Sweden
| | - Irma Fredriksson
- Department of Molecular Medicine and Surgery; Karolinska Institutet, Karolinska University Hospital Solna; Stockholm Sweden
- Department of Breast and Endocrine Surgery; Karolinska University Hospital Solna; Stockholm Sweden
| | - Paul W. Dickman
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
- Regional Cancer Centre; Akademiska sjukhuset; Uppsala Sweden
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Radkiewicz C, Johansson ALV, Dickman PW, Lambe M, Edgren G. Sex differences in cancer risk and survival: A Swedish cohort study. Eur J Cancer 2017; 84:130-140. [PMID: 28802709 DOI: 10.1016/j.ejca.2017.07.013] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/05/2017] [Accepted: 07/11/2017] [Indexed: 02/07/2023]
Abstract
AIM The aim of this study is to firmly delineate temporal and age trends regarding sex discrepancies in cancer risk and survival as well as quantifying the potential gain achieved by eliminating this inequality. METHODS We performed a population-based cohort study using data on all adult incident cancer cases (n = 872,397) recorded in the Swedish Cancer Register in 1970-2014. To assess the associations between sex and cancer risk and sex and survival, male-to-female incidence rate ratios (IRRs) and excess mortality ratios (EMRs) adjusted for age and year of diagnosis were estimated using Poisson regression. RESULTS Men were at increased risk for 34 of 39 and had poorer prognosis for 27 of 39 cancers. Women were at increased risk for 5 of 39 and had significantly poorer survival for 2 of 39 cancers. IRRs among male predominant sites ranged from 1.05; 95% confidence interval (CI), 1.03--1.1 (lung adenocarcinoma) to 8.0; 95% CI, 7.5-8.5 (larynx). EMRs among sites with male survival disadvantage ranged from 1.1; 95% CI, 1.03-1.1 (colon) to 2.1; 95% CI, 1.5--2.8 (well-differentiated thyroid). CONCLUSION Male sex is associated with increased risk and poorer survival for most cancer sites. Identifying and eliminating factors driving the observed sex differences may reduce the global cancer burden.
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Affiliation(s)
- Cecilia Radkiewicz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-171 77 Stockholm, Sweden.
| | - Anna L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-171 77 Stockholm, Sweden.
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-171 77 Stockholm, Sweden.
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-171 77 Stockholm, Sweden.
| | - Gustaf Edgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-171 77 Stockholm, Sweden.
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Zeebari Z, Lundin A, Dickman PW, Hallgren M. Are Changes in Alcohol Consumption Among Swedish Youth Really Occurring ‘in Concert’? A New Perspective Using Quantile Regression. Alcohol Alcohol 2017; 52:487-495. [DOI: 10.1093/alcalc/agx020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/25/2017] [Indexed: 01/19/2023] Open
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Törner A, Stokkeland K, Svensson Å, Dickman PW, Hultcrantz R, Montgomery S, Duberg AS. The underreporting of hepatocellular carcinoma to the cancer register and a log-linear model to estimate a more correct incidence. Hepatology 2017; 65:885-892. [PMID: 27533761 DOI: 10.1002/hep.28775] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 07/19/2016] [Indexed: 01/15/2023]
Abstract
UNLABELLED The Cancer Register (CR) in Sweden has reported that the incidence of primary liver cancer (PLC) has slowly declined over the last decades. Even though all cancers, irrespective of diagnostic method, should be reported to the CR, the PLC incidence may not reflect the true rate. Improved diagnostic tools have enabled diagnosis of hepatocellular carcinoma based on noninvasive methods without histological verification, possibly associated with missed cancer reports or misclassification in the CR. Our objective was to study the completeness and assess the underreporting of PLC to the CR and to produce a more accurate estimate based on three registers. The CR, the Cause of Death Register, and the Patient Register were investigated. Differences and overlap were examined, the incidence was estimated by merging data from the registers, and the number reported to none of the registers was estimated using a log-linear capture-recapture model. The results show that 98% of the PLCs reported to the CR were histologically verified; 80% were hepatocellular carcinoma and 20% were intrahepatic cholangiocarcinoma. Unspecified liver cancer decreased over time and constituted <10% of all reported liver cancers. The CR may underestimate the liver cancer incidence by 37%-45%, primarily due to missed cancer reports. The estimated annual number of liver cancers increased over time, but the standardized incidence was stable around 11 per 100,000. Hepatitis C-associated liver cancer increased and constituted 20% in 2010. CONCLUSION There was an underreporting of PLC diagnosed by noninvasive methods; the incidence was considerably higher than estimated by the CR, with a stable incidence over time; reporting needs to improve and combining registers is recommended when studying incidence. (Hepatology 2017;65:885-892).
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Affiliation(s)
- Anna Törner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Knut Stokkeland
- Department of Medicine, Visby Hospital, Visby, Sweden.,Department of Medicine, Gastroenterology and Hepatology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Åke Svensson
- Department of Mathematics, Stockholm University, Stockholm, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Rolf Hultcrantz
- Department of Medicine, Gastroenterology and Hepatology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College London, UK
| | - Ann-Sofi Duberg
- Department of Infectious Diseases, School of Medical Sciences, Örebro University, Örebro, Sweden
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Affiliation(s)
- Hannah Bower
- Hannah Bower, Karolinska Institutet, Stockholm, Sweden; Magnus Björkholm, Karolinska University Hospital, Stockholm, Sweden; Paul W. Dickman, Karolinska Institutet, Stockholm, Sweden; Martin Höglund, University Hospital Uppsala, Uppsala, Sweden; Paul C. Lambert, Karolinska Institutet, Stockholm, Sweden, and University of Leicester, Leicester, United Kingdom; and Therese M.-L. Andersson, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Björkholm
- Hannah Bower, Karolinska Institutet, Stockholm, Sweden; Magnus Björkholm, Karolinska University Hospital, Stockholm, Sweden; Paul W. Dickman, Karolinska Institutet, Stockholm, Sweden; Martin Höglund, University Hospital Uppsala, Uppsala, Sweden; Paul C. Lambert, Karolinska Institutet, Stockholm, Sweden, and University of Leicester, Leicester, United Kingdom; and Therese M.-L. Andersson, Karolinska Institutet, Stockholm, Sweden
| | - Paul W. Dickman
- Hannah Bower, Karolinska Institutet, Stockholm, Sweden; Magnus Björkholm, Karolinska University Hospital, Stockholm, Sweden; Paul W. Dickman, Karolinska Institutet, Stockholm, Sweden; Martin Höglund, University Hospital Uppsala, Uppsala, Sweden; Paul C. Lambert, Karolinska Institutet, Stockholm, Sweden, and University of Leicester, Leicester, United Kingdom; and Therese M.-L. Andersson, Karolinska Institutet, Stockholm, Sweden
| | - Martin Höglund
- Hannah Bower, Karolinska Institutet, Stockholm, Sweden; Magnus Björkholm, Karolinska University Hospital, Stockholm, Sweden; Paul W. Dickman, Karolinska Institutet, Stockholm, Sweden; Martin Höglund, University Hospital Uppsala, Uppsala, Sweden; Paul C. Lambert, Karolinska Institutet, Stockholm, Sweden, and University of Leicester, Leicester, United Kingdom; and Therese M.-L. Andersson, Karolinska Institutet, Stockholm, Sweden
| | - Paul C. Lambert
- Hannah Bower, Karolinska Institutet, Stockholm, Sweden; Magnus Björkholm, Karolinska University Hospital, Stockholm, Sweden; Paul W. Dickman, Karolinska Institutet, Stockholm, Sweden; Martin Höglund, University Hospital Uppsala, Uppsala, Sweden; Paul C. Lambert, Karolinska Institutet, Stockholm, Sweden, and University of Leicester, Leicester, United Kingdom; and Therese M.-L. Andersson, Karolinska Institutet, Stockholm, Sweden
| | - Therese M.-L. Andersson
- Hannah Bower, Karolinska Institutet, Stockholm, Sweden; Magnus Björkholm, Karolinska University Hospital, Stockholm, Sweden; Paul W. Dickman, Karolinska Institutet, Stockholm, Sweden; Martin Höglund, University Hospital Uppsala, Uppsala, Sweden; Paul C. Lambert, Karolinska Institutet, Stockholm, Sweden, and University of Leicester, Leicester, United Kingdom; and Therese M.-L. Andersson, Karolinska Institutet, Stockholm, Sweden
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Bower H, Björkholm M, Dickman PW, Höglund M, Lambert PC, Andersson TML. Life Expectancy of Patients With Chronic Myeloid Leukemia Approaches the Life Expectancy of the General Population. J Clin Oncol 2016. [PMID: 27325849 DOI: 10.1200/jco.2015.66.2866.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE A dramatic improvement in the survival of patients with chronic myeloid leukemia (CML) occurred after the introduction of imatinib mesylate, the first tyrosine kinase inhibitor (TKI). We assessed how these changes affected the life expectancy of patients with CML and life-years lost as a result of CML between 1973 and 2013 in Sweden. MATERIALS AND METHODS Patients recorded as having CML in the Swedish Cancer Registry from 1973 to 2013 were included in the study and followed until death, censorship, or end of follow-up. The life expectancy and loss in expectation of life were predicted from a flexible parametric relative survival model. RESULTS A total of 2,662 patients with CML were diagnosed between 1973 and 2013. Vast improvements in the life expectancy of these patients were seen over the study period; larger improvements were seen in the youngest ages. The great improvements in life expectancy translated into great reductions in the loss in expectation of life. Patients of all ages diagnosed in 2013 will, on average, lose < 3 life-years as a result of CML. CONCLUSION Imatinib mesylate and new TKIs along with allogeneic stem cell transplantation and other factors have contributed to the life expectancy in patients with CML approaching that of the general population today. This will be an important message to convey to patients to understand the impact of a CML diagnosis on their life. In addition, the increasing prevalence of patients with CML will have a great effect on future health care costs as long as continuous TKI treatment is required.
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Affiliation(s)
- Hannah Bower
- Hannah Bower, Magnus Björkholm, Paul W. Dickman, Paul C. Lambert, and Therese M.-L. Andersson, Karolinska Institutet; Magnus Björkholm, Karolinska University Hospital Solna, Stockholm; Martin Höglund, University Hospital Uppsala, Uppsala, Sweden; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; and Therese M.-L. Andersson, Danish Cancer Society, Copenhagen, Denmark.
| | - Magnus Björkholm
- Hannah Bower, Magnus Björkholm, Paul W. Dickman, Paul C. Lambert, and Therese M.-L. Andersson, Karolinska Institutet; Magnus Björkholm, Karolinska University Hospital Solna, Stockholm; Martin Höglund, University Hospital Uppsala, Uppsala, Sweden; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; and Therese M.-L. Andersson, Danish Cancer Society, Copenhagen, Denmark
| | - Paul W Dickman
- Hannah Bower, Magnus Björkholm, Paul W. Dickman, Paul C. Lambert, and Therese M.-L. Andersson, Karolinska Institutet; Magnus Björkholm, Karolinska University Hospital Solna, Stockholm; Martin Höglund, University Hospital Uppsala, Uppsala, Sweden; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; and Therese M.-L. Andersson, Danish Cancer Society, Copenhagen, Denmark
| | - Martin Höglund
- Hannah Bower, Magnus Björkholm, Paul W. Dickman, Paul C. Lambert, and Therese M.-L. Andersson, Karolinska Institutet; Magnus Björkholm, Karolinska University Hospital Solna, Stockholm; Martin Höglund, University Hospital Uppsala, Uppsala, Sweden; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; and Therese M.-L. Andersson, Danish Cancer Society, Copenhagen, Denmark
| | - Paul C Lambert
- Hannah Bower, Magnus Björkholm, Paul W. Dickman, Paul C. Lambert, and Therese M.-L. Andersson, Karolinska Institutet; Magnus Björkholm, Karolinska University Hospital Solna, Stockholm; Martin Höglund, University Hospital Uppsala, Uppsala, Sweden; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; and Therese M.-L. Andersson, Danish Cancer Society, Copenhagen, Denmark
| | - Therese M-L Andersson
- Hannah Bower, Magnus Björkholm, Paul W. Dickman, Paul C. Lambert, and Therese M.-L. Andersson, Karolinska Institutet; Magnus Björkholm, Karolinska University Hospital Solna, Stockholm; Martin Höglund, University Hospital Uppsala, Uppsala, Sweden; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; and Therese M.-L. Andersson, Danish Cancer Society, Copenhagen, Denmark
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Bower H, Björkholm M, Dickman PW, Höglund M, Lambert PC, Andersson TML. Life Expectancy of Patients With Chronic Myeloid Leukemia Approaches the Life Expectancy of the General Population. J Clin Oncol 2016; 34:2851-7. [PMID: 27325849 DOI: 10.1200/jco.2015.66.2866] [Citation(s) in RCA: 519] [Impact Index Per Article: 64.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE A dramatic improvement in the survival of patients with chronic myeloid leukemia (CML) occurred after the introduction of imatinib mesylate, the first tyrosine kinase inhibitor (TKI). We assessed how these changes affected the life expectancy of patients with CML and life-years lost as a result of CML between 1973 and 2013 in Sweden. MATERIALS AND METHODS Patients recorded as having CML in the Swedish Cancer Registry from 1973 to 2013 were included in the study and followed until death, censorship, or end of follow-up. The life expectancy and loss in expectation of life were predicted from a flexible parametric relative survival model. RESULTS A total of 2,662 patients with CML were diagnosed between 1973 and 2013. Vast improvements in the life expectancy of these patients were seen over the study period; larger improvements were seen in the youngest ages. The great improvements in life expectancy translated into great reductions in the loss in expectation of life. Patients of all ages diagnosed in 2013 will, on average, lose < 3 life-years as a result of CML. CONCLUSION Imatinib mesylate and new TKIs along with allogeneic stem cell transplantation and other factors have contributed to the life expectancy in patients with CML approaching that of the general population today. This will be an important message to convey to patients to understand the impact of a CML diagnosis on their life. In addition, the increasing prevalence of patients with CML will have a great effect on future health care costs as long as continuous TKI treatment is required.
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MESH Headings
- Age Factors
- Aged
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Life Expectancy
- Middle Aged
- Protein Kinase Inhibitors/administration & dosage
- Stem Cell Transplantation/statistics & numerical data
- Sweden/epidemiology
- Transplantation, Homologous
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Affiliation(s)
- Hannah Bower
- Hannah Bower, Magnus Björkholm, Paul W. Dickman, Paul C. Lambert, and Therese M.-L. Andersson, Karolinska Institutet; Magnus Björkholm, Karolinska University Hospital Solna, Stockholm; Martin Höglund, University Hospital Uppsala, Uppsala, Sweden; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; and Therese M.-L. Andersson, Danish Cancer Society, Copenhagen, Denmark.
| | - Magnus Björkholm
- Hannah Bower, Magnus Björkholm, Paul W. Dickman, Paul C. Lambert, and Therese M.-L. Andersson, Karolinska Institutet; Magnus Björkholm, Karolinska University Hospital Solna, Stockholm; Martin Höglund, University Hospital Uppsala, Uppsala, Sweden; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; and Therese M.-L. Andersson, Danish Cancer Society, Copenhagen, Denmark
| | - Paul W Dickman
- Hannah Bower, Magnus Björkholm, Paul W. Dickman, Paul C. Lambert, and Therese M.-L. Andersson, Karolinska Institutet; Magnus Björkholm, Karolinska University Hospital Solna, Stockholm; Martin Höglund, University Hospital Uppsala, Uppsala, Sweden; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; and Therese M.-L. Andersson, Danish Cancer Society, Copenhagen, Denmark
| | - Martin Höglund
- Hannah Bower, Magnus Björkholm, Paul W. Dickman, Paul C. Lambert, and Therese M.-L. Andersson, Karolinska Institutet; Magnus Björkholm, Karolinska University Hospital Solna, Stockholm; Martin Höglund, University Hospital Uppsala, Uppsala, Sweden; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; and Therese M.-L. Andersson, Danish Cancer Society, Copenhagen, Denmark
| | - Paul C Lambert
- Hannah Bower, Magnus Björkholm, Paul W. Dickman, Paul C. Lambert, and Therese M.-L. Andersson, Karolinska Institutet; Magnus Björkholm, Karolinska University Hospital Solna, Stockholm; Martin Höglund, University Hospital Uppsala, Uppsala, Sweden; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; and Therese M.-L. Andersson, Danish Cancer Society, Copenhagen, Denmark
| | - Therese M-L Andersson
- Hannah Bower, Magnus Björkholm, Paul W. Dickman, Paul C. Lambert, and Therese M.-L. Andersson, Karolinska Institutet; Magnus Björkholm, Karolinska University Hospital Solna, Stockholm; Martin Höglund, University Hospital Uppsala, Uppsala, Sweden; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; and Therese M.-L. Andersson, Danish Cancer Society, Copenhagen, Denmark
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Baade PD, Dasgupta P, Dickman PW, Cramb S, Williamson JD, Condon JR, Garvey G. Quantifying the changes in survival inequality for Indigenous people diagnosed with cancer in Queensland, Australia. Cancer Epidemiol 2016; 43:1-8. [DOI: 10.1016/j.canep.2016.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/30/2016] [Accepted: 05/03/2016] [Indexed: 12/15/2022]
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Lambe M, Johansson ALV, Andersson TM, Hsieh CC, Cnattingius S, Dickman PW. Abstract P6-10-07: Family history and risk of pregnancy-associated breast cancer (PABC). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-10-07] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The risk of breast cancer is at least doubled in young women with a family history of breast cancer. Pregnancy has a dual effect on breast cancer risk; a short-term increase followed by a long-term protection. It has been hypothesized that women with a genetic predisposition for breast cancer are particularly susceptible to physiological changes during childbearing that may influence short term risk.
Materials & methods: We followed a cohort of women aged 15 to 44 years between 1963 and 2009 identified in Swedish registers. Family history was defined as having a mother or sister with breast cancer. In a case-cohort analysis, we estimated incidence rate ratios of breast cancer during pregnancy and time intervals up to 10 years post-delivery.
Results: In 3,452,506 women, there were 15,548 cases of breast cancer (1,208 were pregnancy-associated (PABC), defined as breast cancer during or within 2 years of pregnancy). Compared to nulliparous women, the risk of breast cancer was decreased during pregnancy, similar during 1st year and increased during 2nd year post-delivery. The pattern was similar in women with or without family history of breast cancer. A peak in risk was observed 5-6 years following the first birth regardless of family history. After a second birth, this peak was only present in women with a family history.
Conclusions: Our results indicate that women with a family history of breast cancer do not have a different breast cancer risk during and within 10 years following pregnancy compared to women without a family history.
Citation Format: Lambe M, Johansson ALV, Andersson TM, Hsieh C-C, Cnattingius S, Dickman PW. Family history and risk of pregnancy-associated breast cancer (PABC). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-10-07.
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Affiliation(s)
- M Lambe
- Karolinska Institutet, Stockholm, Sweden; University of Massachusetts Medical School, Worcester, MA; Clinical Epidemiology Unit, Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - ALV Johansson
- Karolinska Institutet, Stockholm, Sweden; University of Massachusetts Medical School, Worcester, MA; Clinical Epidemiology Unit, Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - TM Andersson
- Karolinska Institutet, Stockholm, Sweden; University of Massachusetts Medical School, Worcester, MA; Clinical Epidemiology Unit, Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - C-C Hsieh
- Karolinska Institutet, Stockholm, Sweden; University of Massachusetts Medical School, Worcester, MA; Clinical Epidemiology Unit, Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - S Cnattingius
- Karolinska Institutet, Stockholm, Sweden; University of Massachusetts Medical School, Worcester, MA; Clinical Epidemiology Unit, Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - PW Dickman
- Karolinska Institutet, Stockholm, Sweden; University of Massachusetts Medical School, Worcester, MA; Clinical Epidemiology Unit, Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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Bower H, Andersson TML, Björkholm M, Dickman PW, Lambert PC, Derolf ÅR. Continued improvement in survival of acute myeloid leukemia patients: an application of the loss in expectation of life. Blood Cancer J 2016; 6:e390. [PMID: 26849011 PMCID: PMC4771966 DOI: 10.1038/bcj.2016.3] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/17/2015] [Indexed: 01/24/2023] Open
Abstract
We evaluated temporal trends in survival of Swedish acute myeloid leukemia (AML) patients diagnosed between 1973 and 2011 using relative survival ratios (RSRs) and a measure called the loss in expectation of life (LEL). RSRs increased most for patients <60 years at diagnosis during the first calendar periods, but between 1997-2005 and 2006-2011 the most pronounced increase was for those aged 61-70 years at diagnosis; RSR changed from 0.16 (95% confidence interval (CI): 0.13-0.19) to 0.28 (95% CI: 0.23-0.33), respectively. The LEL for males aged 35 years at diagnosis was 41.0 (95% CI: 40.1-41.8) years in 1975 and 19.5 (95% CI: 16.4-22.5) years in 2011. For males aged 65 years, the corresponding figures were 13.8 (95% CI: 13.7-14.0) and 12.0 (95% CI: 11.3-12.8). Conditional LEL estimates suggested that patients who survive 5 years postdiagnosis have shorter remaining lifespan than the general population. The proportion of expected life lost (PELL) suggested that male 65-year-old patients lost 75% of their life expectancy in 2005 and 66% if they were diagnosed in 2011. Survival continued to increase to 2011, with larger improvements in those aged 61-70 years at diagnosis. The LEL and PELL are intuitive measures that may be useful in communicating survival statistics to patients, clinicians and health-care providers.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Child
- Child, Preschool
- Female
- History, 20th Century
- History, 21st Century
- Humans
- Incidence
- Infant
- Infant, Newborn
- Leukemia, Myeloid, Acute/epidemiology
- Leukemia, Myeloid, Acute/history
- Leukemia, Myeloid, Acute/mortality
- Life Expectancy
- Male
- Middle Aged
- Population Surveillance
- Registries
- Spatio-Temporal Analysis
- Sweden/epidemiology
- Young Adult
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Affiliation(s)
- H Bower
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - T M-L Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - M Björkholm
- Department of Medicine, Division of Hematology, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - P W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - P C Lambert
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Å R Derolf
- Department of Medicine, Division of Hematology, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
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Weibull CE, Eloranta S, Smedby KE, Björkholm M, Kristinsson SY, Johansson ALV, Dickman PW, Glimelius I. Pregnancy and the Risk of Relapse in Patients Diagnosed With Hodgkin Lymphoma. J Clin Oncol 2015; 34:337-44. [PMID: 26668344 DOI: 10.1200/jco.2015.63.3446] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Many patients and clinicians are worried that pregnancy after the diagnosis of Hodgkin lymphoma (HL) may increase the risk of relapse despite a lack of empirical evidence to support such concerns. We investigated if an association exists between pregnancy and relapse in women with a diagnosis of HL. MATERIALS AND METHODS Using Swedish healthcare registers combined with medical records, we included 449 women who received a diagnosis of HL between 1992 and 2009 and who were age 18 to 40 years at diagnosis. Follow-up started 6 months after diagnosis, when the patients' condition was assumed to be in remission. Pregnancy-associated relapse was defined as a relapse during pregnancy or within 5 years after delivery. Hazard ratios (HRs) with 95% CIs were estimated by using the Cox proportional hazards model. RESULTS Among the 449 women, 144 (32%) became pregnant during follow-up. Overall, 47 relapses were recorded, of which one was a pregnancy-associated relapse. The adjusted HR for the comparison of the pregnancy-associated relapse rate to the non-pregnancy-associated relapse rate was 0.29 (95% CI, 0.04 to 2.18). The expected number of relapses in women with a recent pregnancy, given that they would experience the same relapse rate as that of women without a recent pregnancy, was 3.76; the observed-to-expected ratio was 0.27 (95% exact CI, 0.01 to 1.51). CONCLUSION We found no evidence that a pregnancy after diagnosis increases the relapse rate among women whose HL is in remission. Survivors of HL need to consider a range of factors when deciding about future reproduction. However, given the results of this study, the risk of pregnancy-associated relapse does not need to be considered.
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Affiliation(s)
- Caroline E Weibull
- Caroline E. Weibull, Sandra Eloranta, Karin E. Smedby, Anna L.V. Johansson, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby, Magnus Björkholm, Sigurdur Y. Kristinsson, and Ingrid Glimelius, Karolinska University Hospital Solna, Stockholm; Ingrid Glimelius, Uppsala University, Uppsala, Sweden; and Sigurdur Y. Kristinsson, University of Iceland, Reykjavik, Iceland.
| | - Sandra Eloranta
- Caroline E. Weibull, Sandra Eloranta, Karin E. Smedby, Anna L.V. Johansson, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby, Magnus Björkholm, Sigurdur Y. Kristinsson, and Ingrid Glimelius, Karolinska University Hospital Solna, Stockholm; Ingrid Glimelius, Uppsala University, Uppsala, Sweden; and Sigurdur Y. Kristinsson, University of Iceland, Reykjavik, Iceland
| | - Karin E Smedby
- Caroline E. Weibull, Sandra Eloranta, Karin E. Smedby, Anna L.V. Johansson, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby, Magnus Björkholm, Sigurdur Y. Kristinsson, and Ingrid Glimelius, Karolinska University Hospital Solna, Stockholm; Ingrid Glimelius, Uppsala University, Uppsala, Sweden; and Sigurdur Y. Kristinsson, University of Iceland, Reykjavik, Iceland
| | - Magnus Björkholm
- Caroline E. Weibull, Sandra Eloranta, Karin E. Smedby, Anna L.V. Johansson, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby, Magnus Björkholm, Sigurdur Y. Kristinsson, and Ingrid Glimelius, Karolinska University Hospital Solna, Stockholm; Ingrid Glimelius, Uppsala University, Uppsala, Sweden; and Sigurdur Y. Kristinsson, University of Iceland, Reykjavik, Iceland
| | - Sigurdur Y Kristinsson
- Caroline E. Weibull, Sandra Eloranta, Karin E. Smedby, Anna L.V. Johansson, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby, Magnus Björkholm, Sigurdur Y. Kristinsson, and Ingrid Glimelius, Karolinska University Hospital Solna, Stockholm; Ingrid Glimelius, Uppsala University, Uppsala, Sweden; and Sigurdur Y. Kristinsson, University of Iceland, Reykjavik, Iceland
| | - Anna L V Johansson
- Caroline E. Weibull, Sandra Eloranta, Karin E. Smedby, Anna L.V. Johansson, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby, Magnus Björkholm, Sigurdur Y. Kristinsson, and Ingrid Glimelius, Karolinska University Hospital Solna, Stockholm; Ingrid Glimelius, Uppsala University, Uppsala, Sweden; and Sigurdur Y. Kristinsson, University of Iceland, Reykjavik, Iceland
| | - Paul W Dickman
- Caroline E. Weibull, Sandra Eloranta, Karin E. Smedby, Anna L.V. Johansson, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby, Magnus Björkholm, Sigurdur Y. Kristinsson, and Ingrid Glimelius, Karolinska University Hospital Solna, Stockholm; Ingrid Glimelius, Uppsala University, Uppsala, Sweden; and Sigurdur Y. Kristinsson, University of Iceland, Reykjavik, Iceland
| | - Ingrid Glimelius
- Caroline E. Weibull, Sandra Eloranta, Karin E. Smedby, Anna L.V. Johansson, Paul W. Dickman, and Ingrid Glimelius, Karolinska Institutet; Karin E. Smedby, Magnus Björkholm, Sigurdur Y. Kristinsson, and Ingrid Glimelius, Karolinska University Hospital Solna, Stockholm; Ingrid Glimelius, Uppsala University, Uppsala, Sweden; and Sigurdur Y. Kristinsson, University of Iceland, Reykjavik, Iceland
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Lambert PC, Dickman PW, Rutherford MJ. Comparison of different approaches to estimating age standardized net survival. BMC Med Res Methodol 2015; 15:64. [PMID: 26275405 PMCID: PMC4537569 DOI: 10.1186/s12874-015-0057-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 07/21/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Age-standardized net survival provides an important population-based summary of cancer survival that appropriately accounts for differences in other-cause mortality rates and standardizes the population age distribution to allow fair comparisons. Recently, there has been debate over the most appropriate method for estimating this quantity, with the traditional Ederer II approach being shown to have potential bias. METHODS We compare lifetable-based estimates (Ederer II), a new unbiased method based on inverse probability of censoring weights (Pohar Perme) and model-based estimates. We make the comparison in a simulation setting; generating scenarios where we would expect to see a large theoretical bias. RESULTS Our simulations demonstrate that even in relatively extreme scenarios there is negligible bias in age-standardized net survival when using the age-standardized Ederer II method, modelling with continuous age or using the Pohar Perme method. However, both the Ederer II and modelling approaches have some advantages over the Pohar Perme method in terms of greater precision, particularly for longer-term follow-up (10 and 15 years). CONCLUSIONS Our results show that, when age-standardizing, concern over bias with the traditional methods is unfounded. We have also shown advantages in using the more traditional and modelling methods.
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Affiliation(s)
- Paul C Lambert
- Department of Health Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK.
- Department of Medical Epidemiology and Biostatistics, Karolinska Insitutet, Stockholm, PO BOX 281, 24105, Sweden.
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Insitutet, Stockholm, PO BOX 281, 24105, Sweden.
| | - Mark J Rutherford
- Department of Health Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK.
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Hultcrantz M, Wilkes SR, Kristinsson SY, Andersson TML, Derolf ÅR, Eloranta S, Samuelsson J, Landgren O, Dickman PW, Lambert PC, Björkholm M. Risk and Cause of Death in Patients Diagnosed With Myeloproliferative Neoplasms in Sweden Between 1973 and 2005: A Population-Based Study. J Clin Oncol 2015; 33:2288-95. [PMID: 26033810 DOI: 10.1200/jco.2014.57.6652] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Myeloproliferative neoplasms (MPNs) are associated with a shortened life expectancy. We assessed causes of death in patients with MPN and matched controls using both relative risks and absolute probabilities in the presence of competing risks. PATIENTS AND METHODS From Swedish registries, we identified 9,285 patients with MPN and 35,769 matched controls. A flexible parametric model was used to estimate cause-specific hazard ratios (HRs) of death and cumulative incidence functions, each with 95% CIs. RESULTS In patients with MPN, the HRs of death from hematologic malignancies and infections were 92.8 (95% CI, 70.0 to 123.1) and 2.7 (95% CI, 2.4 to 3.1), respectively. In patients age 70 to 79 years at diagnosis (the largest patient group), the HRs of death from cardiovascular and cerebrovascular disease were 1.5 (95% CI, 1.4 to 1.7) and 1.5 (95% CI, 1.3 to 1.8), respectively; all were statistically significantly elevated compared with those of controls. In the same age group, no difference was observed in the 10-year probability of death resulting from cardiovascular disease in patients with MPN versus controls (16.8% v 15.2%) or cerebrovascular disease (5.6% v 5.2%). In patients age 50 to 59 years at diagnosis, the 10-year probability of death resulting from cardiovascular and cerebrovascular disease was elevated, 4.2% versus 2.1% and 1.9% versus 0.4%, respectively. Survival in patients with MPN increased over time, mainly because of decreased probabilities of dying as a result of hematologic malignancies, infections, and, in young patients, cardiovascular disease. CONCLUSION Patients with MPN had an overall higher mortality rate than that of matched controls, primarily because of hematologic malignancy, infections, and vascular events in younger patients. Evidently, there is still a need for effective disease-modifying agents to improve patient outcomes.
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Affiliation(s)
- Malin Hultcrantz
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Sally R Wilkes
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sigurdur Y Kristinsson
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Therese M-L Andersson
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Åsa R Derolf
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sandra Eloranta
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jan Samuelsson
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ola Landgren
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul W Dickman
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul C Lambert
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Magnus Björkholm
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
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