Lower Relative Survival Research Articles

Carcinoma of endocrine organs: Results of the RARECARE project

The rarity or the asymptomatic character of endocrine tumours results in a lack of epidemiological studies on their incidence and survival patterns. The aim of this study was to describe the incidence, prevalence and survival of endocrine tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002, registered in 89 population-based cancer registries (CRs) with follow-up until 31st December 2003. These data give an unique overview of the burden of endocrine carcinomas in Europe.A list of tumour entities based on the third International Classification of Diseases for Oncology was provided by the project Surveillance of rare cancer in Europe (RARECARE) project. Over 33,594 cases of endocrine carcinomas were analysed in this study.Incidence rates increased with age and were highest in patients 65 years of age or older. In 2003, more than 315,000 persons in the EU (27 countries) were alive with a past diagnosis of a carcinoma of endocrine organs. The incidence of pituitary carcinoma equalled four per 1,000,000 person years and showed the strongest decline in survival with increasing age. Thyroid cancer showed the highest crude incidence rates (four per 100,000 person years) and was the only entity with a gender difference: (female-to-male ratio: 2:9). Parathyroid carcinoma was the rarest endocrine entity with two new cases per 10,000,000 person years. For adrenal carcinoma, the most remarkable observations were a higher survival for women compared to men (40% compared to 32%, respectively) and a particularly low relative survival of 24% in patients 65years of age or older.More high quality studies on rare cancers, with additional information, e.g. on stage and therapeutic approach, are needed and may be of help in partly explaining the observed variation in survival.

Development of an antibody ELISA for potency testing of furunculosis (Aeromonas salmonicida subsp salmonicida) vaccines in Atlantic salmon (Salmo salar L)

The study was conducted in Atlantic salmon to establish the initial and basic scientific documentation for an alternative batch potency test for salmon furuculosis vaccines. We assessed the antibody response development for Aeromonas salmonicida vaccines at different immunisation temperatures (3, 12 and 18 °C), by an enzyme-linked-immunosorbent assay (ELISA) 3, 6, 9 and 12 weeks post vaccination, and the correlation between antibody response and protection in cohabitation challenge experiments performed 6 and 12 weeks post vaccination. Fish immunised with a vaccine containing full antigen dose had a significant increase in antibody response after 252 day degrees and the measured values correlated well with protection after 500 day degrees. Fish vaccinated with a reduced antigen dose showed a significant lower antibody response than fish vaccinated with the full dose vaccine at all samplings, and showed a similar low relative percent survival (RPS) in the challenges. The results from this study indicate that an antibody ELISA can discriminate between vaccines of different antigen content and the method may replace challenge tests in batch potency testing of furunculosis vaccines in Atlantic salmon. An immunisation temperature of 12 °C and sampling after 6–9 weeks, seemed to be the most appropriate time for using antibody responses to confirm batch potency.

Evaluation of the Performance of Dialdehyde Cellulose Filters against Airborne and Waterborne Bacteria and Viruses

The filtration efficiency and the inactivation performance of a dialdehyde cellulose (DAC) filter against airborne and waterborne bacteria and viruses were investigated. The DAC filter was synthesized by periodate oxidation of a cellulose filter. To evaluate the performance, the inactivation efficiency (determined by comparing the concentration of viable microbes obtained from control and experimental samples) and the relative survival fraction (calculated by comparing the viable microbes from an untreated filter and a treated filter) were introduced. For water filtration tests, the viable removal efficiency and the relative survival fraction of untreated and treated filters of different treatment times were investigated by testing with E. coli and MS2 bacteriophage. The treated filter presented a slightly higher viable removal efficiency and a significantly lower relative survival fraction as treatment time increased. Increasing the residence time by lowering the filtration velocity resulted in a higher viable removal efficiency and lower survival fraction. In air filtration tests, the physical removal efficiency, viable removal efficiency, and relative survival fraction of untreated and 12-h treated filters were investigated. The removal efficiency and relative survival fraction of the treated filter increased and decreased, respectively, with increasing relative humidity. The pressure drop of the treated filter was significantly lower than that of the untreated filter, which resulted in a higher filter quality. The DAC filter with sufficient moisture content had a higher removal efficiency, lower pressure drop, and better disinfection capability, which are all important attributes for practical biocidal applications.

Quantifying differences in breast cancer survival between England and Norway

Background: Survival from breast cancer is lower in the UK than in some other European countries. We compared survival in England and Norway by age and time from diagnosis. Methods: We included 303,648 English and 24,919 Norwegian cases of breast cancer diagnosed 1996–2004 using flexible parametric relative survival models, enabling improved quantification of differences in survival. Crude probabilities were estimated to partition the probability of death due to all causes into that due to cancer and other causes and to estimate the number of “avoidable” deaths. Results: England had lower relative survival for all ages with the difference increasing with age. Much of the difference was due to higher excess mortality in England in the first few months after diagnosis. Older patients had a higher proportion of deaths due to other causes. At 5 years post diagnosis, a woman aged 85 in England had probabilities of 0.35 of dying of cancer and 0.32 of dying of other causes, whilst in Norway they were 0.26 and 0.35. By eight years the number of “avoidable” all-cause deaths in England was 1020 with the number of “avoidable” breast cancer related deaths 1488. Conclusion: Lower breast cancer survival in England is mainly due to higher mortality in the first year after diagnosis. Crude probabilities aid our understanding of the impact of disease on individual patients and help assess different treatment options.

Socioeconomic differences in survival among breast cancer patients in the Netherlands not explained by tumor size

There seem to be socioeconomically differences in survival for females with breast cancer, usually associated with a higher stage of disease. However, differences within tumor size have not been studied. Aim of this study is to assess differences in survival according to socioeconomic status (SES), stratified for tumor size and stage at diagnosis, for females with breast cancer in the Netherlands. All females diagnosed with breast cancer (1995-2005) were selected from the Netherlands Cancer Registry. Patients were linked to a SES database according to postal code. A multivariable logistic regression was used to assess factors associated with SES. Overall survival (OS) and relative survival (RS) were calculated. Overall, 127,599 patients were included. Higher SES was associated with lower T-stage (P < 0.0001). A decreased survival (OS and RS) was found for patients with a lower SES. Also within different size groups, RS was different. Overall, 10-year OS for the high SES group was 65 and 58% for the low SES group (hazard ratio 1.1, P < 0.001) and RS was 79 versus 74% (relative excess risk, RER 1.2; P < 0.001). The socioeconomic differences remained statistically significant (P < 0.001) after adjustment for age, year of diagnosis, grade, TNM stage, and treatment. For the lowest SES group 777 deaths could be avoided. Socioeconomic differences in survival of breast cancer patients were observed in the Netherlands. Higher stage at diagnosis of patients with a lower SES only partly explains the decreased survival. Policies aimed at the reduction of socioeconomic health inequalities might be important to improve survival of breast cancer.

Immune enhancement of chemotherapeutants on lymphocystis disease virus (LDV) infected Paralichthys olivaceus

In olive flounder, Paralichthys olivaceus infected with lymphocystis disease virus (LDV) bath treatment with formalin, hydrogen peroxide or Jenoclean at 50, 100, and 200 ppm daily 10 min for 60 days enhanced the innate immune response and disease resistance. Jenoclean enhanced the immune parameters at the lowest concentration of 50 ppm; on the other hand, hydrogen peroxide bath treatment enhanced the immunity level at 100 ppm, while formalin was effective only at 200 ppm. A low cumulative mortality and high relative percent survival was noted in Jenoclean treated group followed by formalin and hydrogen peroxide treated groups. In olive flounder at low concentrations of 50 ppm or 100 ppm hydrogen peroxide and Jenoclean effectively prevent LDV infection.

Age, Tumor Size and Relative Survival of Patients With Localized Renal Cell Carcinoma: A Surveillance, Epidemiology and End Results Analysis

Recent data demonstrate that age may be a significant independent prognostic variable following treatment for renal cell carcinoma. We analyzed data from the SEER (Surveillance, Epidemiology and End Results) database to evaluate the relative survival of patients treated surgically for localized renal cell carcinoma as related to tumor size and patient age. Patients in the SEER database with localized renal cell carcinoma were stratified into cohorts by age and tumor size. Three and 5-year relative survival, the ratio of observed survival in the cancer population to the expected survival of an age, sex and race matched cancer-free population, was calculated with SEER-Stat. Brown's method was used for hypothesis testing. A total of 8,578 patients with surgically treated, localized renal cell carcinoma were identified. While 3 and 5-year survival for patients with small (less than 4 cm) renal cell carcinoma was no different from that of matched cancer-free controls, patients treated for large (greater than 7 cm) localized renal cell carcinoma experienced decreased 5-year relative survival across all age groups. Therefore, age was not a significant predictor of relative survival for patients with small (less than 4 cm) or large (greater than 7 cm) tumors. However, a statistically significant trend toward lower relative survival with increasing age was demonstrated in patients with medium size tumors (4 to 7 cm). Hypothesis testing confirmed these findings. These data suggest that relative survival is high in patients with tumors less than 4 cm and lower in patients with tumors larger than 7 cm regardless of age. However, increasing age may be related to worse outcomes in patients with tumors 4 to 7 cm. The cause of this observation warrants further investigation.

The starvation–predation risk trade‐off, body mass and population status in the Common Starling Sturnus vulgaris

It is theoretically and empirically well established that body mass variation in small birds reflects a trade‐off between starvation risk and predation risk. This occurs because carrying increased fat reserves reduces starvation risk but also results in a higher predation risk due to reduced escape flight performance and/or the increased foraging exposure needed to maintain a higher body mass. In principle, therefore, the theory of mass‐dependent predation risk could be used to understand how a bird perceives and responds to the risks in its environment, because its mass will reflect the predictability of foraging opportunities and predation risk. Mass in birds may then provide a relatively straightforward way of assessing the foraging environment of birds and so the potential conservation problems a species faces. This study tests, for the first time for any species, how body mass changes in response to changing starvation risk, changing predation risk and changing population status. Common Starling Sturnus vulgaris mass varies as predicted by starvation–predation risk trade‐off theory: mass is lower when foraging conditions are more favourable and when predation risk is increased. The populations that are declining the most strongly have higher mass, which is most likely indicative of a poor foraging environment, leading to lower relative survival. The results suggest that increased mass in Starlings, and possibly in other species, may provide an indication of the poor quality of the foraging environment and/or rapidly declining populations.

Population-based study of local surgery for rectal cancer

The aim was to determine long-term survival and recurrence rates after local excision of rectal cancer from a prospectively registered population-based database. Swedish Rectal Cancer Registry data from 1995 to 2001, including 10 181 patients of whom 643 (6.3 per cent) had a local excision, were analysed. Complete 5-year follow-up data from 1995 to 1998 were available. Cumulative relative and cancer-specific survival rates, and rates of local recurrence and distant metastases, were calculated by actuarial methods. The 5-year cancer-specific survival rate for 256 patients with stage I disease who had local excision was 95.3 (95 per cent confidence interval 91.5 to 99.1) per cent. The 5-year local recurrence rate was 7.2 per cent. After adjustment for age, sex, tumour stage and preoperative radiotherapy, the relative risk of death from cancer was the same as that after major resection. Population-based results after local excision of rectal cancer are the same as those reported in controlled series for early-stage tumours after abdominal resection. A low relative survival and a high median age indicate the use of local excision in patients with a high level of co-morbidity. To achieve acceptable long-term results, optimal preoperative and postoperative staging is needed.

Survival from Uveal Melanoma in England and Wales 1986 to 2001

Purpose: To analyse survival from uveal melanoma diagnosed in England and Wales between 1986-1999 and followed up to 2001. Methods: Data from the National Cancer Registry at the Office for National Statistics were analysed. The data were compiled from population-based cancer registries covering all of England and Wales for all adults (aged 15–99) diagnosed with primary ocular malignancy, excluding eyelid tumours. Level of poverty was based on the national classification of area of residence at time of diagnosis. Regression models explored the influence of sex, age, and level of poverty on relative survival for patients diagnosed with uveal melanoma during successive calendar periods. Results: Of 5,519 adults identified with primary ocular malignancy, 4,717 had melanoma, of which 4,308 (91%) were eligible for analysis. Two-thirds (67%) of the ocular melanomas were uveal, 5% conjunctival, and 2% orbital; the subsite was unspecified in 26%. Relative survival from uveal melanoma was 95% at 1 year and 72% at 5 years. There was no statistically significant variation in 1-year or 5-year survival by sex or poverty level and no significant trend over time. Older patients had significantly worse survival (p < 0.001). Conclusions: This study provides national population-based survival estimates for England and Wales for uveal melanoma, the most common primary intraocular malignancy in adults. Five-year relative survival, an important indicator of the quality of cancer care, has not improved since the 1980s. Greater age, but not gender or level of poverty, is associated with a poorer prognosis. A standardised classification of uveal melanoma is required to improve reporting to cancer registries. Further research is required to explore reasons for lower relative survival in older persons.

Larval condition and vulnerability to predation: reply to comment by Suthers

Discussion 1538 Scientists recognize that observations and experiments at a variety of spatial and temporal scales and in a variety of different systems are required to obtain a complete understanding of a particular phenomenon. However, scientists also recognize that an individual study can usually only focus on one particular system at a certain time and place and that many different studies are required to achieve a general conclusion. The objective of our study on larval capelin (Mallotus villosus) (Elliott and Leggett 1998) was to provide an experimental test of whether larvae in poor condition had lower relative survival rates than larvae in good condition when exposed to a predator. We employed an experimental design that had been successfully used by a variety of other researchers (Litvak and Leggett 1992; Pepin et al. 1992; Pepin and Shears 1995; Elliott and Leggett 1996) to test selective mortality hypotheses under laboratory conditions in small aquaria. In our abstract, we explicitly stated that the results of our study “suggest that RNA/DNA ratios are not useful indicators of vulnerability to predation for larval capelin.” Clearly, we did not intend to have this conclusion be considered a broad statement that applied to all other systems. As in all scientific disciplines, we presented our data with the intention that other researchers would conduct further studies using a variety of experimental systems and protocols to provide further tests that would either support or refute our results. After a variety of studies on this topic had been conducted, we would hope that a metanalysis would provide a more complete understanding of the effects of larval condition on vulnerability to predation. Ultimately, the results of this research could lead to the incorporation of lar val condition indices into assessments of the future survival probabilities of larvae into fisheries models. Unfortunately, in the comment by Suthers, our conclusions have been overstated and interpreted as a definitive re jection of the utility of RNA/DNA ratios and larval dry weight in the study of larval condition. As stated above, our conclusions pertained to larval capelin and only in the context of the experimental conditions employed. Furthermore, in the second to last paragraph of Elliott and Leggett (1998), we explicitly stated that our conclusions are based on our results, some of which are in contrast with previous studies of larval capelin in small enclosures: “This difference in out come may result from the use of different experimental conditions and predator species or from the possibility that different measures of larval size (length versus dry weight) may not be equivalent in their influence on the vulnerability of larvae to predation.” In other words, variation in the spe cies used or experimental protocol could have caused a different result (as has been reported in many other studies of selective mortality). A general conclusion on the influence

The survival of foreign subsidiaries and domestically-owned companies in Denmark, 1895–19951

Over a long time period, 1895-1995, foreign subsidiaries in Denmark were found to have a lower survival-probability than domestically-owned manufacturing companies. The difference is highly significant and robust to control for size and industry effects. Since the number of foreign subsidiaries increased enormously throughout the period, lower relative survival rates are probably not an indicator of performance failure from the viewpoint of the parent companies. While low survival rates in foreign subsidiaries may be attributable to a number of factors (including differences between sales and production subsidiaries), this paper proposes governance differences between foreign subsidiaries and domestically-owned companies as a possible explanation. Consistent with hypothesized differences in corporate governance, domestically-owned companies are found to have higher equity reserves (equity/ assets ratios), which is found to have a positive impact on survival. For given equity - asset ratios no significant survival differences were found between the two groups.

Do morphology and stage explain the inferior lung cancer survival in Denmark?

Danish lung cancer patients diagnosed during 1983-1987 experienced 5-yr relative survival rates 2-7% inferior to patients in the other Nordic countries, despite the similarity of cancer registration and healthcare systems in the Nordic countries. Is the inferior relative survival in Denmark due to differences in morphology or stage of lung cancers? The present study compared in detail the survival of 92,719 patients diagnosed with lung cancer during 1978-1992 in Denmark, Finland, and Norway. In particular, differences in morphology and extent of disease were studied. A poor survival rate for small cell anaplastic lung carcinoma compared with all other morphologies was confirmed. However, this could not explain the relative survival differences observed between countries. Extent of disease was the most important predictor of survival. Part of the observed survival differences could be explained by a less favourable stage distribution in Denmark, combined with a slightly lower relative survival rate for those with metastatic disease. Differences in treatment are unlikely to explain the findings, although delays in diagnosing and treating patients in Denmark compared with neighbouring countries could partially explain the lower patient survival in Denmark. In conclusion, the main factor in the lower survival rate in Denmark is unfavourable stage distribution.

Larval condition and vulnerability to predation: an analysis based on mixed-prey experiments

Many recent studies in larval fish ecology measure larval nutritional condition (e.g., RNA/DNA ratios), with the ultimate goal of assessing future survival probabilities. Larvae of intermediate or poor condition are generally considered to be more vulnerable to predators than larvae in good condition. The objective of our study was to experimentally test whether larvae in poor condition have lower relative survival rates when exposed to a predator. We conducted mixed-prey experiments with larval capelin (Mallotus villosus) on days 6, 8, and 10 posthatching by putting 75 fed and 75 starved larvae in 38-L containers with (treatments) and without (controls) predators (juvenile lumpfish, Cyclopterus lumpus). There were no significant differences in the mean condition (RNA/DNA ratios) or dry weights of larvae recovered from controls and treatments. These results suggest that RNA/DNA ratios are not useful indicators of vulnerability to predation for larval capelin.

Relative Survival of Cancer Patients: A Comparison between Denmark and the other Nordic Countries

The results of a Nordic collaborative project revealed that Danish cancer patients had a poorer prognosis than patients in the other Nordic countries for some major cancer sites. The present study was undertaken to further explore the differences in survival between Denmark and the other Nordic countries. All cancer cases diagnosed in the Nordic countries during 1958 to 1991/92 were included in the analysis. Relative survival and excess mortality were calculated for intervals in the first five years after diagnosis. Since the 1950s, the prognosis of cancer patients has improved in all the countries, but more moderately in Denmark. For cancers of the stomach, colon, rectum, breast (female), and prostate, the Danish patients had a markedly lower relative survival than the patients in the other countries. They also had the lowest proportion of localized tumours. It appears that Danish cancer patients are diagnosed at a later stage of disease than patients in the other Nordic countries.

Prognostic factors for thyroid carcinoma. A population-based study of 15,698 cases from the Surveillance, Epidemiology and End Results (SEER) program 1973-1991.

A number of prognostic factors for thyroid carcinoma have been identified, including sociodemographic characteristics, such as age and gender, and tumor characteristics, such as histology and stage. The relative importance of these factors as independent predictors of survival for patients with papillary, follicular, anaplastic, and medullary thyroid carcinoma has been extensively studied but remains uncertain. The authors used data collected by the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute between 1973 and 1991 to investigate prognostic factors for each of the major histologic types of thyroid carcinoma in a population-based patient series and to assess the effect of these factors as predictors of survival. Both tumor and sociodemographic characteristics were independently associated with survival. Patients with papillary carcinoma had the highest 10-year relative survival (0.98), followed by those with follicular carcinoma (0.92) and medullary carcinoma (0.80). Anaplastic tumors had the lowest 10-year relative survival (0.13). Stage at diagnosis and differentiation status were strong independent prognostic factors for each histologic type. Advanced stage at diagnosis was a stronger prognostic factor for medullary carcinoma than for other histologic types. Increasing age was associated with lower relative survival for each histologic type. Gender, marital status, and ethnicity were significant, but weaker, predictors of survival. Survival varied markedly among patients with different histologic types of thyroid carcinoma. Stage at diagnosis and tumor differentiation were important prognostic factors for each histologic type. Age at diagnosis was a stronger predictor of survival for patients with follicular and medullary carcinoma than for patients with papillary carcinoma.

Survival and Mortality in Prostatic Cancer: A Study Based on the Swedish cancer register

A total of 44,300 cases of prostatic cancer, comprising 99% of all newly diagnosed living cases reported to the Swedish Cancer Registry in 1960 through 1978 constituted a cohort followed up for 1-19 years. Survival rates were adjusted for expected mortality in the general population and were expressed as relative survival (RS). RS for the total cohort after 5, 10 and 20 years was 51, 34 and 17% respectively, with an annual excess death rate of about 8% which persisted also after long-term observation. RS was similar in age groups between 45 and 74 years, whereas among patients older than 74 years at diagnosis approximately 10% lower RS appeared early and was persistent. RS improved for patients diagnosed at consecutive 5-year periods. Thus, the high mortality rate in old age groups and the low long-term RS contradicted the concept that biologically inactive tumours constitute a significant proportion of prostatic cancers diagnosed in clinical practice.

Laboratory survival of four prey in the presence of northern pike

I determined experimentally the relative survival of similar-sized yellow perch (Perca flavescens), brook stickleback (Culaea inconstans), fathead minnow (Pimephales promelas), and finescale dace (Phoxinus neogaeus), individually and in all possible species combinations, in the presence of northern pike (Esox lucius). Overall, perch showed the highest, sticklebacks and dace the intermediate, and fatheads the lowest relative survival. Differential laboratory survival of prey demonstrates the utility of single species experiments in predicting the results of multiple prey and predator interactions. The results also support the hypothesis that piscivory can maintain the distinctness of assemblages of predation-tolerant and piscivorous species versus assemblages of predation-intolerant species.

Long-Term Survival in Prostatic Carcinoma, with Special Reference to Age as a Prognostic Factor. A Nation-Wide Study

A total of 44 300 cases of prostatic cancer, comprising 90% of all newly diagnosed cases reported to the Swedish Cancer Registry in 1960 through 1978, constituted a cohort followed up for 1–19 years. Survival rates were adjusted for expected mortality in the general population, and were expressed as relative survival (RS). RS for the total cohort after 5, 10 and IS years was 51, 34 and 24%. respectively, with an annual excess death rate of about 8% which persisted also after long-term observation. RS was similar in the age groups between 45 and 74 years. whereas among patients older than 74 at diagnosis, approximately 10% lower RS appeared early and was persistent. These data demonstrated that the highly varying natural course of prostatic cancer is only slightly related to patient age at diagnosis. The low long-term relative survival rate definitely contradicted the concept that biologically inactive (latent) tumours constitute a significant proportion of the prostatic cancers diagnosed in clinical practice.

Long-term survival in prostatic carcinoma, with special reference to age as a prognostic factor. A nation-wide study.

A total of 44,300 cases of prostatic cancer, comprising 90% of all newly diagnosed cases reported to the Swedish Cancer Registry in 1960 through 1978, constituted a cohort followed up for 1-19 years. Survival rates were adjusted for expected mortality in the general population, and were expressed as relative survival (RS). RS for the total cohort after 5, 10 and 15 years was 51, 34 and 24%, respectively, with an annual excess death rate of about 8% which persisted also after long-term observation. RS was similar in the age groups between 45 and 74 years, whereas among patients older than 74 at diagnosis, approximately 10% lower RS appeared early and was persistent. These data demonstrated that the highly varying natural course of prostatic cancer is only slightly related to patient age at diagnosis. The low long-term relative survival rate definitely contradicted the concept that biologically inactive (latent) tumours constitute a significant proportion of the prostatic cancers diagnosed in clinical practice.