Trends In Survival Of Patients Research Articles

Trends in survival of patients diagnosed with cancer of the digestive organs in the Nordic countries 1964–2003 followed up to the end of 2006

Cancers of the digestive organs (including the oesophagus, stomach, small intestine, colon, rectum and anus, liver, gallbladder, and pancreas) constitute one-fifth of all cancer cases in the Nordic countries and is a group of diseases with diverse time trends and varying consequences for public health. In this study we examine trends in relative survival in relation to the corresponding incidence and mortality rates in the Nordic countries during the period 1964–2003. Material and methods. Data were retrieved from the NORDCAN database for the period 1964 to 2003, grouped into eight 5-year periods of diagnosis. The patients were followed up until the end of 2006. Analysis comprised trends in 5-year relative survival, excess mortality and age-specific relative survival. Results. Survival following cancers of the colon and rectum has increased continuously over the observed period, yet Danish patients fall behind those in the other Nordic countries. The largest inter-country variation is seen for the rare cancers in the small intestine. There has been little increase in prognosis for patients diagnosed with cancers of the liver, gallbladder or pancreas; 5-year survival is generally below 15%. Survival also remains consistently low for patients with oesophageal cancer, while minor increases in survival are seen among stomach cancer patients in all countries except Denmark. The concomitant incidence and mortality rates of stomach cancer have steadily decreased in each Nordic country at least since 1964. Conclusion. While the site-specific variations in mortality and survival largely reflect the extent of changing and improving diagnostic and clinical practices, the incidence trends highlight the importance of risk factor modification. Alongside the ongoing clinical advances, effective primary prevention measures, including the control of alcohol and tobacco consumption as well as changing dietary pattern, will reduce the incidence and mortality burden of digestive cancers in the Nordic countries.

Survival Trends in Patients With Gastric and Esophageal Adenocarcinomas: A Population-Based Study

To use a population-based approach to describe survival trends in patients diagnosed as having gastric or esophageal adenocarcinoma. A population-based complete chart review of all inpatient and outpatient records, using the resources of the Rochester Epidemiology Project, was conducted in Olmsted County, Minnesota (population 124,277), a primarily rural county with one large urban area. All residents of Olmsted County who were diagnosed as having gastric or esophageal adenocarcinoma from January 1, 1971, through December 31, 2000, were included in the study. The main outcomes were median survival and 2-year and 5-year survival rates, by decade of diagnosis. From 1971 through 2000, median survival for patients with gastric adenocarcinoma (n=121) decreased from 5.5 months to 3.2 months, whereas median survival for patients with esophageal adenocarcinoma (n=65) increased from 8.5 months to 11.7 months. Decade of diagnosis was not significantly associated with patient survival for either gastric or esophageal adenocarcinoma (P>.05). There was no significant shift in stage of disease at diagnosis during the 30-year period for either gastric or esophageal adenocarcinoma (P>.05). No significant change has occurred in the survival rates of this patient population with gastric or esophageal adenocarcinoma, which is representative of the US white population.

Recent trends in long-term survival of patients with chronic myelocytic leukemia: disclosing the impact of advances in therapy on the population level

Within the past decades, major advances in therapy for chronic myelocytic leukemia, including allogeneic hematopoietic stem cell transplantation, interferon therapy, and, more recently, also therapy with the tyrosine kinase inhibitor imatinib, have entered clinical practice. The impact of these advances on long-term survival on the population level should be disclosed as timely as possible. We estimated trends in age specific 5- and 10-year relative survival of chronic myelocytic leukemia patients in the United States from 1990-1992 to 2002-2004. Our analysis is based on records from 8,329 patients aged 15 years or older with a first diagnosis of chronic myelocytic leukemia included in the 1973-2004 data base of the Surveillance, Epidemiology, and End Results Program. Period analysis was used to disclose recent developments with minimum delay. Overall, 5-year relative survival increased from 27 to 49%, and 10-year relative survival increased from 9.5 to 34% between 1990-92 and 2002-04. The increase was most dramatic for younger patients, with 10-year relative survival increasing from 16 to 72% in age group 15-44 years, from 12 to 54% in age group 45-54 years, and from 8 to 34% in age group 55-64 years (p<0.0001 in all cases). Improvements were more modest and not statistically significant, and survival remained at much lower levels among age groups 65-74 and 75+ years. Our analysis discloses a dramatic recent increase in long-term survival of younger patients with chronic myelocytic leukemia which most likely reflects rapid dissemination of advances in therapy on the population level.

Historical trends in survival of hospitalized heart failure patients: 2000 versus 1995

BackgroundPopulation-based secular trends in survival of patients with congestive heart failure (CHF) are central to public health research on the burden of the syndrome.MethodsPatients 35–79 years old with a CHF discharge code in 1995 or 2000 were identified in 22 Minneapolis-St. Paul hospitals. A sample of the records was abstracted (50% of 1995 records; 38% of 2000 records). A total of 2,257 patients in 1995 and 1,825 patients in 2000 were determined to have had a CHF-related hospitalization. Each patient was followed for one year to ascertain vital status.ResultsThe risk profile of the 2000 patient cohort was somewhat worse than that of the 1995 cohort in both sex groups, but the distributions of age and left ventricular ejection fraction were similar. Within one year of admission in 2000, 28% of male patients and 27% of female patients have died, compared to 36% and 27% of their counterparts in 1995, respectively. In various Cox regression models the average year effect (2000 vs. 1995) was around 0.75 for men and 0.95 to 1.00 for women. The use of angiotensin converting-enzyme inhibitors and beta-blockers was associated with substantially lower hazard of death during the subsequent year.ConclusionSurvival of men who were hospitalized for CHF has improved during the second half of the 1990s. The trend in women was very weak, compatible with little to no change. Documented benefits of angiotensin converting-enzyme inhibitors and beta-blockers were evident in these observational data in both men and women.

110 Improving temporal trends in survival for patients with newly diagnosed heart failure in the UK general population

110 Improving temporal trends in survival for patients with newly diagnosed heart failure in the UK general population

Challenges Encountered During Closure of Atrial Septal Defects

Since the introduction of transcatheter interventional occlusion of atrial septal defects (ASDs) by King and coworkers, the device closure has become the standard treatment of selected atrial defects. Although it has become routine for standard clinical practice, increasing knowledge of intracardiac anatomy, modification of implantation techniques, and improvements in device designs are making this treatment modality increasingly applicable to a wider range of selected patients. This report summarizes the current trends in patient selection, focusing on the anatomical limits of applicability for ASD device closure, and discusses the future possibilities. Furthermore, typical complications are described with regard to the rare erosion of the atrial roof or the aortic root. Current practice is to oversize the device if the anterior rim toward the aorta tends to be diminutive, achieving a secure position of the device around the aortic root. This and the shape memory of the device may play a major role in this serious complication and should be reconsidered. Although most interventional occlusions of interatrial defects with a device have become clinically routine, some situations remain highly challenging.

Trends in Survival of Patients With Metastatic Breast Cancer

Trends in Survival of Patients With Metastatic Breast Cancer

Cancer patient survival in Sweden at the beginning of the third millennium – predictions using period analysis

Estimates of cancer patient survival made using traditional, cohort-based, methods can be heavily influenced by the survival experience of patients diagnosed many years in the past and may not be particularly relevant to recently diagnosed patients. Period-based survival analysis has been shown to provide better predictions of survival for recently diagnosed patients and earlier detection of temporal trends in patient survival than cohort analysis. We aim to provide predictions of the long-term survival of recently diagnosed cancer patients using period analysis. The period estimates are compared with the latest available cohort-based estimates. Our results, based on period analysis for the years 2000-2002, suggest an improvement in survival for many forms of cancer during recent years. For all sites combined the 5-, 10-, 15-, and 20-year relative survival ratios were 62%, 53%, 48%, and 47% for males and 67%, 62%, 60%, and 59%, for females. These estimates were 3-14% units higher than those obtained using the latest available cohorts with the respective lengths of follow-up. The interval-specific relative survival stabilised for males at 97% after 8 years of follow-up and for females at 98% after 7 years for both period and cohort analyses.

Primary retroperitoneal lymph node dissection (RPLND) for non-seminomatous germ-cell tumor (NSGCT): Impact of trends in patient selection on retroperitoneal pathology and outcome

4523 Background: Elevated pre-RPLND serum tumor markers (STM) is prognostic for relapse for clinical stage (CS) IS and pathologic stage (PS) N1 patients, and for persistence of disease for PS N2–3 patients. Since 1999, we have recommended that patients with elevated STM and/or CS IIB receive induction chemotherapy. We examined the impact of these selection criteria on outcome after primary RPLND. Methods: Since 1989, 453 patients with NSGCT have undergone primary RPLND (345 pre-1999, 108 post-1999). Data was obtained from a prospective database. A level of AFP or BhCG that was elevated and not declining according to half-life pre-RPLND was considered elevated. The median follow-up was 68 and 25 months for patients treated pre- and post-1999, respectively. Results: Pre-1999, 28 (8%) patients had elevated STM and 23 (7%) had CS IIB. Post-1999, all patients had normal STM and 1 (1%) had CS IIB. Patients treated since 1999 trended toward a lower rate of PS II (44% pre- vs. 33% post-1999, P=0.06). Among patients with PS II, those treated since 1999 were more likely to have low-volume (PN1) retroperitoneal disease at RPLND (64% vs. 40%, P=0.01), even when excluding patients with elevated STM and CS IIB (63% vs. 52%, P=0.02). Patients treated since 1999 have had lower rates of relapse after RPLND (4-year relapse-free survival 97% vs. 90%, P=0.04), even when excluding those receiving adjuvant chemotherapy (96% vs. 88%, P=0.049). In multivariate analysis, elevated STM (P=0.001) was the only significant pre-RPLND predictor of relapse when accounting for the use of adjuvant chemotherapy. Although not statistically significant, embryonal carcinoma predominance (P=0.06), treatment year (P=0.07) and clinical stage (P=0.09) may also be important predictors of relapse. Conclusions: As a result of excluding patients with elevated STM and/or CS IIB, proportionately more PS II patients have low-volume retroperitoneal disease and are likely to be cured by RPLND alone. Patients treated since 1999 may have a favorable prognosis independent of STM status and clinical stage. No significant financial relationships to disclose.

Primary retroperitoneal lymph node dissection (RPLND) for non-seminomatous germ-cell tumor (NSGCT): Impact of trends in patient selection on retroperitoneal pathology and outcome

4523 Background: Elevated pre-RPLND serum tumor markers (STM) is prognostic for relapse for clinical stage (CS) IS and pathologic stage (PS) N1 patients, and for persistence of disease for PS N2–3 patients. Since 1999, we have recommended that patients with elevated STM and/or CS IIB receive induction chemotherapy. We examined the impact of these selection criteria on outcome after primary RPLND. Methods: Since 1989, 453 patients with NSGCT have undergone primary RPLND (345 pre-1999, 108 post-1999). Data was obtained from a prospective database. A level of AFP or BhCG that was elevated and not declining according to half-life pre-RPLND was considered elevated. The median follow-up was 68 and 25 months for patients treated pre- and post-1999, respectively. Results: Pre-1999, 28 (8%) patients had elevated STM and 23 (7%) had CS IIB. Post-1999, all patients had normal STM and 1 (1%) had CS IIB. Patients treated since 1999 trended toward a lower rate of PS II (44% pre- vs. 33% post-1999, P=0.06). Among patients with PS II, those treated since 1999 were more likely to have low-volume (PN1) retroperitoneal disease at RPLND (64% vs. 40%, P=0.01), even when excluding patients with elevated STM and CS IIB (63% vs. 52%, P=0.02). Patients treated since 1999 have had lower rates of relapse after RPLND (4-year relapse-free survival 97% vs. 90%, P=0.04), even when excluding those receiving adjuvant chemotherapy (96% vs. 88%, P=0.049). In multivariate analysis, elevated STM (P=0.001) was the only significant pre-RPLND predictor of relapse when accounting for the use of adjuvant chemotherapy. Although not statistically significant, embryonal carcinoma predominance (P=0.06), treatment year (P=0.07) and clinical stage (P=0.09) may also be important predictors of relapse. Conclusions: As a result of excluding patients with elevated STM and/or CS IIB, proportionately more PS II patients have low-volume retroperitoneal disease and are likely to be cured by RPLND alone. Patients treated since 1999 may have a favorable prognosis independent of STM status and clinical stage. No significant financial relationships to disclose.

Trends in long-term survival following surgery for gastric cancer: A single institution experience

We reviewed cases at our institution in an attempt to identify temporal trends in survival of patients with operable gastric cancer. We analyzed data on 1632 patients who received a diagnosis of gastric adenocarcinoma between 1975 and 1995 and who underwent surgery at our institution. The time trends were examined by comparing three time periods (1975-1984, 1985-1989 and 1990-1995). Over time there was an improvement in the R0 resection rate: the rate significantly increased from 65% to 83%. Short-term outcomes following surgery have improved, with 30-day mortality dropping from 3.5% to 1%. The overall survival curve continuously improved with time. The five-year survival rates improved from 43% to 61%. The increased use of extended lymph node dissection with careful examination for metastases allowed for more accurate TNM staging. The incidence of peritoneal failure remains high, with peritoneal recurrence observed in 49% of the patients who underwent R0 resection between 1985 and 1995 and who experienced recurrences. Our results demonstrated that current efforts to improve gastric cancer management are finally meeting with noticeable success. However, advanced-stage cancer remains a medical problem. Multimodal treatment of advanced disease will be an important theme in coming years.

Safe evolution towards routine off-pump coronary artery bypass: negotiating the learning curve.

Off-pump coronary artery bypass (OPCAB) hopes to avoid morbidity associated with cardiopulmonary bypass, improving clinical outcomes. Yet its technical difficulty and unfamiliarity raise concern that adoption of OPCAB might be associated with poorer outcomes during each surgeon's 'learning curve'. We examined trends in patient selection over time as a single surgeon's practice evolved to routine OPCAB. Between 10-1-96 and 12-31-01, 1479 consecutive patients had isolated coronary artery bypass grafting (CABG). Clinical data were gathered prospectively and reviewed retrospectively. Trends in adoption of OPCAB and clinical outcomes were examined. There were 756 OPCAB and 723 CABG/cardiopulmonary bypass patients. The practice evolved from 90% conventional CABG to 93% OPCAB. An abrupt transition coincided with evolution of techniques to expose the obtuse marginal arteries, and improvements in suction-based coronary stabilizers. Mortality was 1.0% for the off-pump group and 2.1% for the on-pump group. Careful patient selection helped maintain acceptable outcomes during the 'learning curve'. Patients with depressed left ventricular ejection fraction, left main disease, and complex three vessel disease were excluded from OPCAB until significant experience (>200 cases) was attained. Presently, all isolated coronary bypass cases are candidates for OPCAB except patients with ischemic ventricular arrhythmias, those in cardiac arrest, and those for whom previous left pneumonectomy or deep pectus excavatum prevent rightward mobilization of heart. Despite a significant learning curve, evolution to routine OPCAB can be achieved while maintaining good patient outcomes. The development of specialized techniques, coronary stabilizers, and apical suction devices allows the application of OPCAB to virtually all coronary bypass patients, as surgeon experience matures.

Survival Trends of Patients Treated at the National Cancer Center Hospital, Japan, from 1962 to 1994

The National Cancer Center (NCC) was established in 1962 in Tokyo as a national institute within the Ministry of Health and Welfare of the national government of Japan. However, there has not been a report on the long-term trends in survival rates at the NCC Hospital. In this paper, we show time trends in 5year relative survival rates (RSR) at the NCC Hospital from 1962 to 1994. All patients who were hospitalized at the NCC Hospital and diagnosed as having malignant neoplasms were registered, at each admission, with the hospital registration system managed by the Statistics and Survey Section. The subjects of this study were selected from this hospital cancer registry database. Patients of nationality other than Japanese were excluded from the study, because such patients could not easily be followed up to assess survival. All registered patients were tracked by the Statistics and Survey Section, using residential records of patients kept by municipal governments throughout Japan. Tracking surveys were conducted every year for the patients whose first admission was within 5 years from the date of the survey. The survival time of each patient was calculated from the date of first admission and either the date of death or the latest date at which the patient could be confirmed to be alive using residential records or hospital records of outpatient visits. The 5-year crude survival rate was calculated using the life table method and the 5-year RSR was calculated by adjusting for deaths from causes other than cancer, using the life table of the entire Japanese population (1,2,3). The number of patients who were hospitalized at the NCC Hospital for the first time for the treatment of malignant neoplasms is shown in Table 1 by gender, 10-year age group and the year of first admission. In total, 48 745 patients, comprising 24 976 males and 23 769 females, were treated for malignant neoplasms during their first hospitalization. Time trends in 5-year relative survival rates are shown for all sites combined and major sites by gender in Table 2. Time trends in RSR for major sites are shown in Fig. 1(a) for males and Fig. 1(b) for females. The RSR for all sites combined showed a substantial improvement for both males and females. In particular, those sites that had poorer survival rates early in the studied time period showed larger improvements.

Temporal trends in survival of patients with esophageal adenocarcinoma in the United States: 1973–1997

Temporal trends in survival of patients with esophageal adenocarcinoma in the United States: 1973–1997

Temporal trends in survival of patients with esophageal adenocarcinoma in the United States: 1973–1997

Temporal trends in survival of patients with esophageal adenocarcinoma in the United States: 1973–1997

Trends in survival of patients with hepatocellular carcinoma between 1977 and 1996 in the United States

The recent increase in the incidence of hepatocellular cancer in the United States is thought to underlie the rising mortality of this malignancy. However, it remains unknown whether survival of patients with hepatocellular carcinoma (HCC) has changed during the same time period. Using the SEER database (Surveillance, Epidemiology, and End Results) of the National Cancer Institute, we examined the temporal changes and determinants of survival among patients with histologically proven HCC over a 20-year period. Between 1977 and 1996, 7,389 patients diagnosed with HCC were followed in the survival database of SEER. The overall 1-year relative survival rate increased from 14% (95% confidence intervals (CI): 12-16) during 1977-1981 to 23% (95% CI: 21-24) during 1992 to 1996. Between the same two time periods, less improvement was seen in the 5-year survival rates, which increased from 2% (95% CI: 1-3) to only 5% (95% CI: 4-7). The median survival increased slightly from 0.57 years during 1977 to 1981 to 0.64 years during 1992 to 1996. In general, there were no significant differences in survival between men and women or between ethnic groups. During 1987 to 1991, a small fraction (0.8%) of patients underwent radical surgery; these patients had 1-year survival of 59% (95% CI: 35-83%), and 5-year survival of 35% (95% CI: 12-58%). Similar rates were seen during 1992-1996. In conclusion, a small improvement in survival of patients with HCC was seen between 1977 and 1996. Most of this apparent benefit is restricted to the first year following cancer diagnosis, raising the possibility of lead-time bias. There were no significant differences related to gender or ethnicity. (H EPATOLOGY 2001;33:62-65.)

Trends in survival for patients diagnosed with cancer in Vaud, Switzerland, between 1974 and 1993

Analysis of trends in cancer survival in defined well surveilled populations can provide useful indications on advancements in cancer management and treatment. Survival rates from the Vaud Cancer Registry were computed for 31,158 cases registered in 1984-1993, and compared with those registered in 1974-1978 and 1979-1983. A systematic, albeit generally moderate, tendency towards increasing five-year relative survival was observed for both sexes and most major cancer sites, including oral cavity and pharynx (0.38-0.43). stomach (0.21-0.26), colon (0.49-0.55), rectum (0.45-0.51), lung (0.08-0.12), skin melanoma (0.67-0.89), female breast (0.67-0.80), endometrium (0.72-0.84), ovary (0.28-0.37). prostate (0.44-0.66), testis (0.73-0.96), bladder (0.31-0.50), kidney and renal pelvis (0.41-0.59), thyroid (0.73-0.81), non-Hodgkin's lymphomas (0.37-0.63), Hodgkin's disease (0.61-0.81), and leukaemias (0.27-0.39). Survival for all cancers and both sexes combined, rose from 0.51 0.64 (0.57 for males, 0.71- for females). No appreciable change in survival was observed for cancers of oesophagus, liver, gallbladder, pancreas, larynx, cervix uteri, brain, multiple myeloma, as well as unidentified or unknown origin neoplasms. Survival estimates for most cancer sites are comparable to the US SEER dataset, and their pattern of trends are discussed in terms of improved diagnosis and treatment for various neoplasms.

Survival of patients with HTLV-I-associated lymph node lesions

Adult T-cell leukaemia/lymphoma (ATLL), is a malignant condition associated with human T-cell leukaemia virus type I (HTLV-I). Usually, although not uniformly, histopathological examination of the lymph nodes shows a pleomorphic type. In addition, some patients with pre-overt ATLL show a Hodgkin's disease-like morphology and lymph nodes in non-neoplastic carriers show features of lymphadenitis. To characterize further the clinicopathological features of HTLV-I-associated lymphadenopathy, the histopathological features of the lymph nodes of 289 patients were classified into five types: lymphadenitis ( n=14), Hodgkin's-like (Hodgkin's) ( n=18), pleomorphic (medium and large cells) ( n=219), pleomorphic small cell ( n=11), and anaplastic large cell (ALC) ( n=27). Survival data were analysed according to the histopathological features of the lymph nodes. The pleomorphic type, which showed typical features of ATLL, was associated with a highly aggressive course and an initially high mortality, followed by a rapid decrease in survival. This pattern was also observed in patients with the ALC type. All cases with lymphadenitis were still alive at the end of the study, while survival progressively decreased in the Hodgkin's type. The small cell type showed an initial rapid decrease in survival followed by a plateau. These results show that the survival trends of patients with pleomorphic and anaplastic lymph node lesions are similar to those with ATL lymphoma, while patients with the lymphadenitis type of lesion were considered to have a non-neoplatic status. There is at present no effective therapy for ATLL, but in the future, these classification and survival data might be useful for the selection of appropriate chemotherapeutic regimens for patients with ATLL.

Trends in survival of patients with ovarian cancer in Saarland, Germany, 1976-1995.

We aimed to monitor recent progress in survival of patients with ovarian cancer. We assessed trends in survival in 1976-1995 among patients notified to the population-based cancer registry of Saarland, Germany, with a first diagnosis of ovarian cancer below the age of 80 years. A new statistical methodology was applied that allows the most timely detection of changes in survival rates. There was a dramatic, ongoing increase in 5-year relative survival rates from 36.6% in 1976-1980 to 60.1% in 1991-1995 among patients whose cancer was detected below the age of 55 years, and from 23.7% to 42.9% in patients aged 55-64 years at the time of diagnosis. No such improvement was seen among older patients, who continued to have a very poor prognosis. Therefore, the variation of prognosis with age was strongly increasing over time. Improvement of prognosis in younger patients most likely reflects the benefits of more aggressive surgery and chemotherapy in these age groups. Efforts should be made to overcome obstacles to more successful therapy for older patients.

Hypothermic circulatory arrest in neurovascular surgery

OBJECTIVE: One of the largest contemporary neurosurgical experiences with hypothermic circulatory arrest was analyzed for trends in patient selection and clinical variables affecting outcome. METHODS: During a 12-year period, 60 patients underwent 62 circulatory arrest procedures: 54 had posterior circulation aneurysms, 4 had anterior circulation aneurysms, and 2 had other lesions (hemangioblastoma and vertebral artery atherosclerosis). RESULTS: The surgical morbidity and mortality rates associated with hypothermic circulatory arrest were 13.3 and 8.3%, respectively. At late follow-up, 76% of the patients had good outcomes (Glasgow Outcome Scale scores of 1 and 2), 5% had poor outcomes (Glasgow Outcome Scale scores of 3 and 4), and 18% had died. After 1992, circulatory arrest was limited to posterior circulation aneurysms and included increasing numbers of basilar trunk aneurysms. Patient outcome correlated with preoperative neurological condition (admission Glasgow Coma Scale score, P < 0.001; Hunt and Hess grade, P = 0.037; and age, P = 0.007). Preservation of perforating arteries was paramount to achieving a good outcome (P = 0.005); duration of circulatory arrest was not. CONCLUSION: Current indications for hypothermic circulatory arrest include only giant and complex posterior circulation aneurysms that cannot be treated using conventional techniques or that recur after endovascular coiling. Surgical morbidity and mortality rates reflect the increasing complexity of the aneurysms treated but are still more favorable than the natural history of these lesions. This experience demonstrates that management in specialized neurovascular centers can minimize the morbidity associated with circulatory arrest so that it remains a viable treatment option for complex posterior circulation aneurysms.