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Survival of patients with colon and rectal cancer in central and northern Denmark, 1998–2009  [cached]
Ostenfeld EB,Erichsen R,Iversen LH,Gandrup P
Clinical Epidemiology , 2011,
Abstract: Eva B Ostenfeld1, Rune Erichsen1, Lene H Iversen1,2, Per Gandrup3, Mette N rgaard1, Jacob Jacobsen11Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 2Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark; 3Department of Surgery A, Aarhus University Hospital, Aalborg, DenmarkObjective: The prognosis for colon and rectal cancer has improved in Denmark over the past decades but is still poor compared with that in our neighboring countries. We conducted this population-based study to monitor recent trends in colon and rectal cancer survival in the central and northern regions of Denmark.Material and methods: Using the Danish National Registry of Patients, we identified 9412 patients with an incident diagnosis of colon cancer and 5685 patients diagnosed with rectal cancer between 1998 and 2009. We determined survival, and used Cox proportional hazard regression analysis to compare mortality over time, adjusting for age and gender. Among surgically treated patients, we computed 30-day mortality and corresponding mortality rate ratios (MRRs).Results: The annual numbers of colon and rectal cancer increased from 1998 through 2009. For colon cancer, 1-year survival improved from 65% to 70%, and 5-year survival improved from 37% to 43%. For rectal cancer, 1-year survival improved from 73% to 78%, and 5-year survival improved from 39% to 47%. Men aged 80+ showed most pronounced improvements. The 1- and 5-year adjusted MRRs decreased: for colon cancer 0.83 (95% confidence interval CI: 0.76–0.92) and 0.84 (95% CI: 0.78–0.90) respectively; for rectal cancer 0.79 (95% CI: 0.68–0.91) and 0.81 (95% CI: 0.73–0.89) respectively. The 30-day postoperative mortality after resection also declined over the study period. Compared with 1998–2000 the 30-day MRRs in 2007–2009 were 0.68 (95% CI: 0.53–0.87) for colon cancer and 0.59 (95% CI: 0.37–0.96) for rectal cancer.Conclusion: The survival after colon and rectal cancer has improved in central and northern Denmark during the 1998–2009 period, as well as the 30-day postoperative mortality.Keywords: neoplasms, survival, epidemiology, colorectal cancer
Survival in patients with synchronous liver metastases in central and northern Denmark, 1998 to 2009  [cached]
Høyer M,Erichsen R,Gandrup P,Nørgaard M
Clinical Epidemiology , 2011,
Abstract: Morten H yer1,2, Rune Erichsen1, Per Gandrup3, Mette N rgaard1, Jacob Bonde Jacobsen11Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 2Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; 3Department of Gastrointestinal Surgery, Aarhus University Hospital, Aalborg, DenmarkObjective: In Denmark, the strategy for treatment of cancer with metastases to the liver has changed dramatically during the period 1998 to 2009, when multidisciplinary care and a number of new treatments were introduced. We therefore examined the changes in survival in Danish patients with colorectal carcinoma (CRC) or other solid tumors (non-CRC) who had liver metastases at time of diagnosis.Study design and methods: We included patients diagnosed with liver metastases synchronous with a primary cancer (ie, a solid cancer diagnosed at the same date or within 60 days after liver metastasis diagnosis) during the period 1998 to 2009 identified through the Danish National Registry of Patients. We followed those who survived for more than 60 days in a survival analysis (n = 1021). Survival and mortality rate ratio (MRR) at 1, 3, and 5 years stratified by year of diagnosis were estimated using Cox proportional hazards regression analysis.Results: In the total study population of 1021 patients, 541 patients had a primary CRC and 480 patients non-CRC. Overall, the 5-year survival improved from 3% (95% confidence interval [CI]: 1%–6%) in 1998–2000 to 10% (95% CI: 6%–14%) in 2007 to 2009 (predicted value). The 5-year survival for CRC-patients improved from 1% (95% CI: 0%–5%) to 11% (95% CI: 6%–18%) whereas survival for non-CRC patients only increased from 5% (95% CI: 1%–10%) to 8% (95% CI: 4%–14%).Conclusion: We observed improved survival in patients with liver metastases in a time period characterized by introduction of a structured multidisciplinary care and improved treatment options. The survival gain was most prominent for CRC-patients.Keywords: liver metastases, colorectal cancer, noncolorectal cancer, survival improvement
Differences in Survival between Colon and Rectal Cancer from SEER Data  [PDF]
Yen-Chien Lee, Yen-Lin Lee, Jen-Pin Chuang, Jenq-Chang Lee
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0078709
Abstract: Background Little is known about colorectal cancer or colon and rectal cancer. Are they the same disease or different diseases? Objectives The aim of this epidemiology study was to compare the features of colon and rectal cancer by using recent national cancer surveillance data. Design and setting Data included colorectal cancer (1995–2008) from the Surveillance, Epidemiology, and End Results Program (SEER) database. Only adenocarcinoma was included for analysis. Patients A total of 372,130 patients with a median follow-up of 32 months were analyzed. Main outcome measures Mean survival of patients with the same stage of colon and rectal cancer was evaluated. Results Around 35% of patients had stage information. Among them, colon cancer patients had better survival than those with rectal cancer, by a margin of 4 months in stage IIB. In stage IIIC and stage IV, rectal cancer patients had better survival than colon cancer patients, by about 3 months. Stage IIB colorectal cancer patients had a poorer prognosis than those with stage IIIA and IIIB colorectal cancer. After adjustment of age, sex and race, colon cancer patients had better survival than rectal cancer of stage IIB, but in stage IIIC and IV, rectal cancer patients had better survival than colon cancer. Limitations The study is limited by its retrospective nature. Conclusion This was a population-based study. The prognosis of rectal cancer was not worse than that of colon cancer. Local advanced colorectal cancer had a poorer prognosis than local regional lymph node metastasis. Stage IIB might require more aggressive chemotherapy, and no less than that for stage III.
Survival of women with breast cancer in central and northern Denmark, 1998–2009  [cached]
Lietzen LW,Sørensen GV,Ording AG,Garne JP
Clinical Epidemiology , 2011,
Abstract: Lone Winther Lietzen1, Gitte Vrelits S rensen1, Anne Gulbech Ording1, Jens Peter Garne2, Peer Christiansen3, Mette N rgaard1, Jacob Jacobsen11Department of Clinical Epidemiology, 2Department of Breast Surgery, Aalborg Hospital, 3Breast and Endocrine Section, Department of Surgery P, Aarhus University Hospital, DenmarkObjective: Breast cancer is the most common cancer among women worldwide. The Nordic countries have relatively high survival, but Denmark has a lower survival than neighboring countries. A breast cancer screening program was introduced in 2007 and 2008 in the northern and central regions of Denmark respectively. We aimed to examine possible changes in survival of Danish breast cancer patients in central and northern Denmark in the period 1998–2009.Materials and methods: From the northern and central Denmark regions, we included all women (n = 13,756) with an incident diagnosis of breast cancer, as recorded in the Danish National Registry of Patients during the period January 1, 1998 through December 31, 2009. We calculated age-stratified survival and used Cox proportional hazard regression to estimate mortality rate ratios (MRRs) for all breast cancer patients.Results: Median age was 62 years (21–102 years). The overall 1-year survival improved steadily over the period from 90.9% in 1998–2000 to 94.4% in 2007–2009, corresponding to a 1-year age adjusted MRR of 0.68 in 2007–2009 compared with the reference period 1998–2000. We estimated the 5-year survival to improve from 70.0% in 1998–2000 to 74.7% in 2007–2009, corresponding to a 5-year age adjusted MRR of 0.82 in 2007–2009 compared with the reference period 1998–2000. For middle-aged women (50–74 years) 1-year survival increased from 92.8% in 1998–2000 to 96.6% in 2008–2009, and 5-year survival was expected to increase from 73.9% in 1998–2000 to 80.2% in 2007–2009. Among younger women (15–49 years) and elderly women (>75 years), 1-year survival and 5-year predicted survival did not change over the two time periods.Conclusion: Survival of breast cancer patients has improved in Denmark over the period 1998–2009, and this change was most distinct in women aged 50–74 years. Survival improved even before the implementation of a formal breast cancer screening program.Keywords: breast neoplasm, mortality, epidemiology, population-based
Survival of patients with ovarian cancer in central and northern Denmark, 1998–2009  [cached]
Grann AF,Nørgaard M,Blaakær J,Søgaard-Andersen E
Clinical Epidemiology , 2011,
Abstract: Anne Fia Grann1, Mette N rgaard1, Jan Blaak r2, Erik S gaard-Andersen3, Jacob Bonde Jacobsen11Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 2Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark; 3Department of Gynaecology and Obstetrics, Aalborg University Hospital, Aalborg, DenmarkObjective: To examine time trends of survival and mortality of ovarian cancer in the central and northern Denmark regions during the period 1998–2009.Study design and setting: We conducted a cohort study including women recorded with a first-time diagnosis of ovarian cancer in the Danish National Registry of Patients (DNRP) between 1998 and 2009. Patients were followed for survival through the Danish Civil Registration System. We determined survival stratified by age, and used Cox proportional hazard regression analyses to obtain mortality rate ratios (MRRs) to assess changes over time.Results: We found no improvement in overall ovarian cancer survival between 1998 and 2009. One-year survival was 71% in 1998–2000 and 68% in 2007–2009. Three-year survival declined from 48% in 1998–2000 to 46% in 2007–2009 (predicted), and 5-year survival declined from 40% in 1998–2000 to 37% in 2007–2009 (predicted). Compared with the period 1998–2000, the age-adjusted 1-year MRR was 1.05 (95% confidence interval CI: 0.86–1.28) for the period 2007–2009, and the predicted age-adjusted 3- and 5-year MRRs were 0.96 (95% CI: 0.83–1.12) and 0.99 (95% CI: 0.86–1.14), respectively. Results are not adjusted for tumor stage as this information was not available. We also observed a decline in the annual number of incident ovarian cancer patients during the study period, most pronounced in the youngest age group.Conclusion: The survival of ovarian cancer patients did not improve during the study period. This lack of improvement contrasts with the national cancer strategies implemented during this last decade, focusing on improving the survival of ovarian cancer patients.Keywords: ovarian neoplasm, outcome research, MRR, mortality rate ratio
Survival of patients with primary liver cancer in central and northern Denmark, 1998–2009  [cached]
Montomoli J,Erichsen R,Nørgaard M,Høyer M
Clinical Epidemiology , 2011,
Abstract: Jonathan Montomoli1, Rune Erichsen1, Mette N rgaard1, Morten H yer2, Jesper Bach Hansen3, Jacob Bonde Jacobsen11Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 2Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; 3Medical Department of Gastroenterology, Aalborg Hospital, Aalborg, DenmarkObjective: Primary liver cancer (PLC) is a serious disease with high mortality. During the last decade, improvements in the diagnostic procedures and treatment of PLC may have improved survival. However, few updated longitudinal studies examined this issue. In a population-based setting, we studied changes in the prognoses over time.Methods: Between 1998 and 2009, we identified all patients with PLC in the central and northern Denmark regions, with a combined population of 1.8 million. We determined age- and period-stratified survival, and computed mortality rate ratios (MRRs) with 95% confidence intervals (CIs), using Cox proportional hazard regression to assess changes over time, while controlling for age and gender. We conducted the analyses for PLC overall and separately for hepatocellular carcinoma (HCC) and cholangiocarcinoma, respectively.Results: We included 1064 patients with PLC. Their median age was 69 years (range 17–94 years). The number of patients diagnosed with PLC in the period 2007–2009 was approximately 40% higher than the number in 1998–2000. One-year survival increased from 16% in 1998–2000 to 28% in 2007–2009, corresponding to an adjusted 1-year MRR of 0.65 (95% CI: 0.54–0.79). In patients aged ,60 years, we found the most pronounced increase in 1-year survival, from 14% to 49% in women and from 19% to 41% in men. The 3- and 5-year survival in the entire cohort increased from 5% to a predicted 11% and from 2% to a predicted 7% during our study period, respectively. Accordingly, the expected 3- and 5-year adjusted MRRs were 0.68 (95% CI: 0.57–0.82) and 0.68 (95% CI: 0.57–0.81), respectively. One-, 3-, and 5-year survival improved during the study period for both HCC and cholangiocarcinoma.Conclusion: PLC survival remains poor in the Danish population, although we observed an increase over the period 1998–2009, particularly in young people.Keywords: liver neoplasm, prognosis, mortality, epidemiology
Survival of invasive bladder cancer patients, 1998–2009; a central and northern Denmark population-based cohort study  [cached]
Lund L,Erichsen R,Nørgaard M,Larsen EH
Clinical Epidemiology , 2011,
Abstract: Lars Lund1,2, R Erichsen1, M N rgaard1, E H Larsen3, M Borre4, J Jacobsen11Department of Clinical Epidemiology, Aarhus University Hospital, Denmark; 2Department of Urology, Viborg Hospital, Denmark; 3Department of Urology, Aarhus University Hospital, Aalborg, Denmark; 4Department of Urology, Aarhus University Hospital, Skejby, DenmarkObjective: Invasive bladder cancer (IBC) is a common urological malignancy accounting for 4%–5% of all cancers in Denmark. Our aim was to examine possible changes in short- and long-term survival of patients with IBC during 1998–2009.Study design and setting: Data on all patients (N = 4032) with an incident diagnosis of IBC within a population of 1.8 million were retrieved from the Danish National Registry of Patients from 1998 to 2009. We computed survival after 1, 3, and 5 years, stratified by age and gender, and estimated mortality rate ratios (MRR) using Cox proportional hazard regression to compare mortality over time, controlling for age and gender. Data on tumor stage or histology were not included.Results: During the study period, the annual numbers of incident IBC patients remained stable. The median age was 74 years in each of the four 3-year periods in the study. The survival was relatively stable during the first three periods, whilst data from the last period showed modest improvement. The overall 1-year survival increased from 68% in 1998–2000 to 70% in 2007–2009, corresponding to an age and gender adjusted MRR of 0.89 (95% confidence interval [CI] 0.76–1.03). The 3- and 5-year survival was predicted to increase from 44% to 49% and from 35% to 40% respectively. This corresponded to a 3-year age and gender adjusted MRR of 0.87 (95% CI 0.77–0.98) and a 5-year MRR of 0.88 (95% CI 0.79–0.99). The 1-, 3-, and 5-year survival increased for men in all age groups (<70 years, 70–79 years, ≥80 years) and in women only in the 70–79-year age group. Conclusion: The survival of IBC patients increased slightly in northern and central Denmark in the 1998–2009 period.Keywords: outcome research, MRR, mortality rate ratio
Pancreatic cancer survival in central and northern Denmark from 1998 through 2009: a population-based cohort study  [cached]
Cronin-Fenton DP,Erichsen R,Mortensen FV,Dikinis S
Clinical Epidemiology , 2011,
Abstract: Deirdre P Cronin-Fenton1, Rune Erichsen1, Frank V Mortensen2, Sarunas Dikinis3, Mette N rgaard1, Jacob Jacobsen11Department of Clinical Epidemiology, Aarhus University Hospital, Denmark; 2Department of Gastrointestinal Surgery L, Aarhus University Hospital, Denmark; 3Department of Gastrointestinal Surgery A, Aalborg Hospital, Aarhus University Hospital, DenmarkObjectives: Pancreatic cancer has a relatively low incidence but ranks fourth among cancer-related deaths in western countries. In Denmark, cancer survival generally is lower than in other countries with comparable health care systems. As a result, in 2000, a national strategy to improve cancer survival was introduced. Here we examine time trends in survival and relative mortality among pancreatic cancer patients, using Danish population and medical databases.Methods: Using the Danish National Patient Registry (DNPR), we identified all incident pancreatic cancer patients (n = 2968) diagnosed between 1998 and 2009 in the Central and North Denmark Regions. We computed the 1-, 3-, and 5-year survival and relative mortality (MRR) and associated 95% confidence intervals (CI) adjusting for age and gender. Among surgical patients, we also computed 30-day mortality and 30-day MRR.Results: Median age at diagnosis was approximately 71 years. The annual number of patients increased from 189 in 1998–2000 to 302 in 2007–2009. There was a slight improvement in 1-, 3-, and 5-year survival over time from 14.8% to 17.7%; 3.5% to a predicted 5.6%; and from 2.0% to a predicted 3.8%, from 1998–2000 to 2007–2009, respectively. Correspondingly, the adjusted relative mortality decreased from 1998–2000 to 2007–2009. Thirty-day post-operative mortality decreased from 12.2% in 1998–2000 to 5.8% in 2007–2009, corresponding to a 30-day MRR of 0.38, 95% CI = 0.09, 1.6 in 2007–2009.Conclusion: There was a slight, albeit modest, improvement in survival and relative mortality in pancreatic cancer patients between 1998 and 2009. As we lacked staging information, it is not clear if this improvement is attributable to earlier stage at diagnosis. However, these improvements likely reflect the national cancer strategy which aimed to centralize cancer services and involved the introduction of palliative and adjuvant chemotherapy for pancreatic cancer in Denmark. The dismal prognosis of pancreatic cancer means that efforts to improve survival need to be intensified.Keywords: pancreatic cancer, survival, relative mortality, epidemiology
Survival of prostate cancer patients in central and northern Denmark, 1998–2009  [cached]
Borre M,Erichsen R,Lund L,Larsen EH
Clinical Epidemiology , 2011,
Abstract: Michael Borre1,2, Rune Erichsen1, Lars Lund3, Erik H jkj r Larsen4, Mette N rgaard1, Jacob Bonde Jacobsen11Department of Clinical Epidemiology, Aarhus University Hospital, Denmark; 2Department of Urology, Aarhus University Hospital, Skejby, Denmark; 3Department of Urology, Region Hospital Viborg, Denmark; 4Department of Urology, Aarhus University Hospital, Aalborg, DenmarkObjective: Prostate cancer is the most common noncutaneous cancer among Danish men. During the last decade, use of prostate specific antigen (PSA) testing has increased, and in clinically localized prostate cancer, curative intended treatment has gained a footing. Our aim was to examine possible changes in the short- and long-term survival of patients with prostate cancer during 1998–2009.Study design and setting: From two Danish regions (population, 1.8 million) we included all patients (N = 10,547) with an incident diagnosis of prostate cancer retrieved from the Danish National Registry of Patients. We determined survival after 1, 3, and 5 years, stratified by age, and estimated mortality rate ratios (MRRs) using Cox proportional hazard regression to assess changes over time, controlling for age.Results: During the study period, the annual number of incident prostate cancer patients more than doubled, and the median age at diagnosis decreased from 74 to 70 years. The survival improved over the study period, particularly in the last half of the period (2004–2009). Thus, 1-year survival increased from 80% (1998–2000) to 90% (2007–2009), corresponding to an age-adjusted MRR of 0.54 (95% confidence interval CI: 0.46–0.63). The expected increase in 3- and 5-year survival was even more pronounced: 47%–73% and 34%–60%, respectively. This corresponded to a 3-year age-adjusted MRR of 0.46 (95% CI: 0.42–0.51) and a 5-year MRR of 0.50 (95% CI: 0.46–0.54). The 1-, 3-, and 5-year overall survival increased in all age groups (<70 years, 70–79 years, ≥80 years).Conclusion: Survival after prostate cancer has improved in Denmark within the last decade. Although diagnosis and treatment improvements could explain this, length and lead time bias are likely to have influenced our results.Keywords: outcome research, MRR, mortality rate ratio
Survival of patients with kidney cancer in central and northern Denmark, 1998–2009  [cached]
Pelant T,Larsen EH,Lund L,Borre M
Clinical Epidemiology , 2011,
Abstract: Tau Pelant1,2, Erik H jkj r Larsen1,2, Lars Lund3, Michael Borre4, Rune Erichsen1, Mette N rgaard1, Jacob Bonde Jacobsen11Department of Clinical Epidemiology, Aarhus University Hospital, Denmark; 2Department of Urology, Aarhus University Hospital, Aalborg, Denmark; 3Department of Urology, Viborg Hospital, Denmark; 4Department of Urology, Aarhus University Hospital, Skejby, DenmarkObjective: For decades, kidney cancer patients in Denmark have had lower survival than patients in the other Scandinavian countries. Our aim was to study possible changes in survival of patients with kidney cancer after implementation of two national Danish cancer plans.Study design and setting: From 1998 through 2009 we included all patients (N = 2659) with an incident diagnosis of kidney cancer in two Danish regions (population 1.8 million). Data were retrieved from the Danish National Registry of Patients. We computed survival after 1, 3, and 5 years, stratified by age, and estimated mortality rate ratios (MRRs) using Cox regression to assess changes over time, controlling for age and gender. We lacked data on stage distribution. Among patients who had a nephrectomy we also computed 30-day mortality and 30-day MRRs.Results: During the study period, we identified 2659 patients with kidney cancer. The annual number of patients increased from 583 in the period 1998–2000 to 853 in the period 2007–2009. The median age at diagnosis was 69 years throughout the study period. The overall 1-year survival improved from 56% (1998–2000) to 63% (2007–2009), corresponding to an adjusted MRR of 0.78 (95% confidence interval [CI] 0.66–0.93). We predicted the 3-year survival to increase from 40% to 51% and the 5-year survival to increase from 33% to 42%, corresponding to predicted MRRs of 0.76 (95% CI 0.66–0.87) and 0.77 (95% CI 0.68–0.89), respectively. Survival increased in all age groups (15–59 years, 60–74 years, 75+ years) and in both genders, except for men below 60 years, for whom the 1-year survival declined from 76% to 69%. The 30-day mortality after nephrectomy declined from 4% to 2% during the study period.Conclusion: We observed an improvement in the survival and relative mortality in kidney cancer patients, although not in men younger than 60 years.Keywords: kidney neoplasm, outcome research, mortality rate ratio, MRR
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