Long-term Survival Of Women Research Articles

Hospital volume differences and five-year survival from breast cancer.

The purpose of this study was to determine the effect of hospital volume on long-term survival for women with breast cancer. Survival analysis and proportional-hazard modeling were used to assess 5-year survival and risk of death, adjusting for clinical and sociodemographic variables. At 5 years, patients from very low-volume hospitals had a 60% greater risk of all-cause mortality than patients from high-volume hospitals. Hospital volume of breast cancer surgical cases has a strong positive effect on 5-year survival. Research is needed to identify whether processes of care, especially postsurgical adjuvant treatments, contribute to survival differences.

Survival of women with advanced ovarian cancer and complete pathologic response at second-look laparotomy

The purpose of the study was to analyze the determinants of long term survival in women with advanced ovarian cancer and negative second-look laparotomy. A series of 140 advanced (Stage III-IV) ovarian cancer patients (median age, 54 years; range, 22-74 years) with negative second-look laparotomy after primary surgery and chemotherapy is included in the analysis. At first diagnosis, all patients were treated with radical or debulking surgery. After primary surgery, the patients were treated with a chemotherapy regimen based on cisplatin or carboplatin alone or in combination with other drugs. All second-look laparotomies were performed 6-8 months after first surgery. The overall survival rates were 76% at 3 years, 66% at 5 years, and 51% at 8 years. The corresponding rates for disease free survival were 57, 50, and 43%, respectively. Survival rates were better for women with a residual tumor 1 cm or less after primary surgery. The 5-year probability of survival was 78% in this group, compared with 55% in women with a residual tumor more than 1 cm (log rank test, P < 0.05). Survival rates for women with tumor Grade 3 tended to be worse than Grades 1-2, but the difference was only of borderline statistical significance. No relationship emerged between survival and age, histotype, and presence of ascites at diagnosis. Women with a residual tumor 1 cm or less and positive lymph nodes had a 66% 5-year probability of survival, compared with 85% for women with a residual tumor 1 cm or less and negative lymph nodes. This difference was significant (log rank test, P = 0.05). The 5-year survival probabilities were 47 and 58%, respectively, in women with a residual tumor more than 1 cm and positive or negative lymph nodes. This analysis shows a favorable long term survival rate for women with advanced ovarian cancer and complete pathologic response after debulking surgery and postoperative chemotherapy. It further suggests that lymph nodal status is a prognostic factor for women with minimal residual tumor after surgery.

Improved breast cancer survival in all age groups.

Both short and long term survival of women with breast cancer has improved considerably in all age groups, results of a study from The Netherlands suggests.

Treatment options in stage IB cervical cancer: Radical hysterectomy and radiotherapy

The long-term survival of women with stage I cervical cancers is excellent. Microinvasive tumors can be acceptably treated with low morbidity by simple extrafascial hysterectomy. Tumors beyond the microscopic stage require more aggressive therapy with either radical hysterectomy or radiotherapy. Within stage I, tumor volume is the major predictor of complete response and cure. Most often, this is estimated by the clinical measurement of cervical diameter. Lymph node spread is also correlated with risk of treatment failure and death from disease. Patients with tumor diameters of 4 cm or less can usually be offered either therapy option. Although different complications are associated with each modality, the overall incidence of severe problems is small for both. We favor radical hysterectomy for premenopausal women who wish to retain natural hormonal function and who have no major contraindications to surgery. Postmenopausal patients, those with larger tumors, and, perhaps, those with high-grade tumors may be better treated by irradiation. Women with very large tumors and those with lymph node metastases represent significant treatment challenges and should be considered for experimental protocols.

Parasternal sonography of the internal mammary vessels: technique, normal anatomy, and lymphadenopathy.

Metastasis to the internal mammary lymph nodes adversely affects the disease-free interval and long-term survival in women with breast carcinoma. Since staging of disease in this lymphatic chain is rarely performed at the time of definitive surgical treatment, noninvasive methods have been advocated. The authors present their preliminary experience with a sonographic technique for evaluating the internal mammary lymph nodes, artery, and vein. Longitudinal and transverse images of the first through fourth parasternal rib interspaces were acquired with a 5.0- or 7.5-MHz linear-array real-time system. The method was evaluated prospectively in 36 control subjects and in seven patients (six with metastatic breast cancer and one with lymphocytic lymphoma) who had enlarged internal mammary lymph nodes at thoracic computed tomography (CT). The longitudinal scans routinely demonstrated the internal mammary vessels in the upper interspaces. Lymphatic structures were not identified in the control group. In contrast, sonographic findings corresponding to the CT findings of lymphadenopathy were present in all seven patients. The authors believe that parasternal sonography is a promising technique that merits further study.

Disappearance of metastatic breast cancer after oophorectomy.

LONG-TERM survival in women with disseminated breast cancer and particularly with visceral metastases is unusual. Among 128 patients with visceral involvement described by Gardner,1 survival ranged...