Probability Of Surgical Resection Research Articles

Impact of socioeconomic status on presentation, treatment and outcomes of patients with pancreatic cancer.

Objective: To assess the impact of socioeconomic status (SES) on the patterns of care and outcomes of patients with pancreatic cancer. Materials & methods: Surveillance, Epidemiologyand End Resultsspecialized SES registry has been accessed and patients with pancreatic cancer diagnosed (2000-2015) were evaluated. The following SES variables were included: employment percentage, percent of people above the poverty line, percent of people identified as working-class, educational level, median rent, median household valueand median household income. Within this SES registry, patients were classified according to their census-tract SES into three groups (where group-1 represents the lowest SES category and group-3 represents the highest SES category). Multivariable logistic regression analysis was used to assess the impact of SES on access to surgical resection and multivariable Cox regression analysis was used to assess the impact of SES on pancreatic cancer-specific survival. Kaplan-Meier survival estimates were also used to compare overall survival (OS)outcomes according to SES. Results: A total of 83,902 pancreatic cancer patients were included in the current analysis. Within multivariable logistic regression analysis among patients with a localized/regional disease, patients with lower SES were less likely to undergo surgical resection for pancreatic cancer (odds ratio: 0.719; 95% CI: 0.673-0.767; p < 0.001). Among patients with a localized/regional disease who underwent surgical resection, patients with higher SES have better OS(median OS for group-3: 20.0vs 17.0months for group-1; p < 0.001). Moreover, patients with lower SES have worse pancreatic cancer-specific survival compared with patients with higher SES: (hazard ratio for group-1 vs group-3: 1.212; 95% CI: 1.135-1.295; p < 0.001). Conclusion: Poor neighborhood SES is associated with more advanced disease at presentation, less probability of surgical resectionand even poorer outcomes after surgical resection.

Incidence, disease phenotype at diagnosis, and early disease course in inflammatory bowel diseases in Western Hungary, 2002–2006

Recent trends indicate a change in the epidemiology of inflammatory bowel diseases (IBD), with previously low incidence areas now reporting a progressive rise in the incidence. Our aim was to analyze the incidence and disease phenotype at diagnosis in IBD in the population-based Veszprem Province database, which included incident patients diagnosed between January 1, 2002 and December 31, 2006. Data of 393 incident patients were analyzed (ulcerative colitis [UC]: 220, age-at-diagnosis: 40.5 years; Crohn's disease [CD]: 163, age-at-diagnosis: 32.5 years; and indeterminate colitis [IC]: 10). Both hospital and outpatient records were collected and comprehensively reviewed. Adjusted mean incidence rates were 8.9/10(5) person-years for CD and 11.9/10(5) person-years in UC. Peak onset age in both CD and UC patients was 21-30 years old. Location at diagnosis in UC was proctitis in 26.8%, left-sided colitis in 50.9%, and pancolitis in 22.3%. The probability of proximal extension and colectomy after 5 years was 12.7% and 2.8%. The disease location in CD was ileal in 20.2%, colonic in 35.6%, ileocolonic in 44.2%, and upper gastrointestinal in four patients. Behavior at diagnosis was stenosing/penetrating in 35.6% and perianal in 11.1%. Patients with colonic disease were older at diagnosis compared to patients with ileal or ileocolonic disease. In a Kaplan-Meier analysis, probability of surgical resection was 9.8%, 18.5%, and 21.3% after 1, 3, and 5 years of disease duration, respectively. The incidence of IBD in Veszprem Province in the last decade was high, equal to that in high-incidence areas in Western European countries. Early disease course is milder compared to data reported in the literature.

Intestinal cancer risk and mortality in patients with Crohn's disease

Background: It is important to know about mortality, risk of intestinal cancer, and surgical intervention as well as possible predictive factors for patients with Crohn's disease. These prognostic parameters were estimated by regular follow-up of a complete, regional incidence cohort of 373 patients. Methods: Annual assessments of clinical conditions were the basis for statistical evaluation with life table analysis, calculations of relative risk, and lifetime cancer risk. Results: Survival curves for the total group of patients with Crohn's disease and the background population did not differ. However, a subgroup of patients aged 20–29 years at diagnosis (P = 0.04) and a subgroup of patients with extensive small bowel disease (P = 0.03) showed slightly increased mortality within the first 5 years. Cancer in small and/or large bowel occurred in 3 patients vs. an expected 1.8(P = NS). Small bowel cancer was found in 2 patients vs. the 0.04 expected (P = 0.001). Lifetime risk of intestinal cancer was 4.1% compared with 3.8% for the Danish population in general (P = NS). Probability of surgical resection within 15 years after diagnosis was 70%. The initial extent of disease significantly influenced the probability for resection, which was 78% in ileocecal enteritis and 44% in all other localizations within 5 years after diagnosis. Conclusions: The overall mortality and lifetime risk of cancer in patients with Crohn's disease was not found increased, although the risk of rare small bowel cancer was significantly increased.