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  • 1.
    Andersson, Therese M. -L.
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Johansson, Anna L. V.
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Fredriksson, Irma
    Karolinska Inst, Dept Mol Med & Surg, SE-17177 Stockholm, Sweden.;Karolinska Univ Hosp, Dept Breast & Endocrine Surg, Stockholm, Sweden..
    Lambe, Mats
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden.;Univ Uppsala Hosp, Reg Canc Ctr, Uppsala, Sweden..
    Cancer during pregnancy and the postpartum period: A population-based study2015In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 121, no 12, p. 2072-2077Article in journal (Refereed)
    Abstract [en]

    BACKGROUNDThe purpose of this study was to assess patterns of cancer occurrence during pregnancy and the postpartum period. METHODSThis was a register-based study using data from the Swedish Multi-Generation Register and the National Cancer Register from 1963 to 2007. Pregnancy-associated cancer (PAC) was defined as a malignancy detected during pregnancy or within 2 years of delivery and was assessed in 7 time windows: pregnancy, trimesters 1-3, 0-6 months, 7-12 months, and second year postpartum. Population incidence rates by 5-year age groups and periods were used to estimate the expected number of PACs for each site. The observed versus the expected (O/E) number of cases was estimated with 95% confidence intervals (CI). RESULTSThe 3 most common malignancies during pregnancy were melanoma (n=232), breast (n=139) and cervical cancer (n=139). With a slightly different rank order, these cancers are also the most common in women of childbearing age. The number of observed cases during pregnancy was lower than expected for all cancers, with a combined O/E ratio for all sites of 0.46 (95% CI, 0.43-0.49). The O/E ratio was close to 1 during all postpartum intervals, including 0-6 months (0.93; 95% CI, 0.88-0.98), 7-12 months (0.96; 95% CI, 0.91-1.01), and during the second year after delivery (0.95; 95% CI, 0.92-0.99). CONCLUSIONSThe rate of cancer during pregnancy was lower than expected for all sites, a finding that could not be explained entirely by delayed diagnosis. A rebound in the number of observed cases after delivery was restricted to melanoma, nervous system malignancies, and breast and thyroid cancer. Cancer 2015;121:2072-2077. (c) 2015 American Cancer Society. Fewer cancers than expected are found during pregnancy, a finding that cannot be explained entirely by delayed diagnosis.

  • 2. Boman, Krister K.
    et al.
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Hjern, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Long-term outcomes of childhood cancer survivors in Sweden: a population-based study of education, employment, and income2010In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 116, no 5, p. 1385-1391Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Studies of different national populations were indispensable for estimating the impact of illness-related disability on social outcomes in adult childhood cancer survivors. The effects of childhood cancer on educational attainment, employment, and income in adulthood in a Swedish setting were studied. METHODS: The study population was a national cohort of 1.46 million Swedish residents, including 1716 survivors of childhood cancer diagnosed before their 16th birthday, followed up in 2002 in registries at >25 years of age. Main outcomes were educational attainment, employment, and net income. Markers of persistent disability were considered, and outcomes were analyzed with multivariate linear and logistic regression models adjusted for age, sex, and socioeconomic indicators of the childhood households. RESULTS: Non-central nervous system (CNS) cancer survivors had similar education, employment, and income as the general population in adjusted models, whereas survivors of CNS tumors more often had no more than basic (< or =9 years) education (relative risk [RR], 1.80 [95% confidence interval (95% CI), 1.45-2.23]), less often attained education beyond secondary school (RR, 0.69 [95% CI, 0.58-0.81]), and less often were employed (RR, 0.85 [95% CI, 0.77-0.94]). Predicted net income from work was lower in CNS tumor survivors (P <.001) than in the general population, even after the exclusion of individuals who received economic disability compensation. CONCLUSIONS : CNS tumor survivors had poorer social outcomes compared with the general population, whereas outcomes for survivors of other childhood cancers were similar to the general population. Established late effects highlighted the importance of improved, safer pediatric CNS tumor treatment protocols and surveillance that identified individual needs for preventive and remedial measures.

  • 3.
    Dahl, Christian A. Falk
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Reinertsen, Kristin V.
    Nesvold, Inger-Lise
    Fosså, Sophie D.
    Dahl, Alv A.
    A Study of Body Image in Long-Term Breast Cancer Survivors2010In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 116, no 15, p. 3549-3557Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In this controlled postdiagnosis study, the authors examined various aspects of body image of breast cancer survivors in cross-sectional and longitudinal designs. METHODS: In 2004 and 2007 the Body Image Scale (BIS) was completed by the same 248 disease-free women who had been treated for stage II and III breast cancer between 1998 and 2002. "Poorer" body image was defined as greater than the 70th percentile (N = 76 women) of the BIS scores in contrast to "better" body image (N = 172 women). Breast cancer survivors were examined clinically in 2004, and their BIS scores were compared with the scores from an age-matched group of women from the general population. RESULTS: In this cross-sectional study, poorer body image in 2004 was associated significantly with modified radical mastectomy, undergoing or planning to undergo breast-reconstructive surgery, a change in clothing, poor physical and mental health, chronic fatigue, and reduced quality of life (QoL). In univariate analyses, most of these factors and manually planned radiotherapy were significant predictors of poorer body image in 2007. In multivariate analyses, manually planned radiotherapy, poor physical QoL and high BIS score in 2004 remained independent predictors of a poorer body image in 2007. Body image ratings were relatively stable from 2004 to 2007. Twenty-one percent of breast cancer survivors reported body image dissatisfaction, similar to the proportion of dissatisfaction in controls. CONCLUSIONS: In this cross-sectional analysis, body image in breast cancer survivors was associated with the types of surgery and radiotherapy and with mental distress, reduced health, and impaired QoL. Body image ratings were relatively stable over time, and the antecedent body image score was a strong predictor of body image at follow-up. Body image in breast cancer survivors differed very little from that in controls.

  • 4. Dall'Era, Marc A.
    et al.
    Cooperberg, Matthew R.
    Chan, June M.
    Davies, Benjamin J.
    Albertsen, Peter C.
    Klotz, Laurence H.
    Warlick, Christopher A.
    Holmberg, Lars
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Bailey, Donald E.
    Wallace, Meredith E.
    Kantoff, Philip W.
    Carroll, Peter R.
    Active surveillance for early-stage prostate cancer: review of the current literature2008In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 112, no 8, p. 1650-9Article in journal (Refereed)
    Abstract [en]

    The natural history of prostate cancer is remarkably heterogeneous and, at this time, not completely understood. The widespread adoption and application of prostate-specific antigen (PSA) screening has led to a dramatic shift toward the diagnosis of low-volume, nonpalpable, early-stage tumors. Autopsy and early observational studies have shown that approximately 1 in 3 men aged >50 years has histologic evidence of prostate cancer, with a significant portion of tumors being small and possibly clinically insignificant. Utilizing the power of improved contemporary risk stratification schema to better identify patients with a low risk of cancer progression, several centers are gaining considerable experience with active surveillance and delayed, selective, and curative therapy. A literature review was performed to evaluate the rationale behind active surveillance for prostate cancer and to describe the early experiences from surveillance protocols. It appears that a limited number of men on active surveillance have required treatment, with the majority of such men having good outcomes after delayed selective intervention for progressive disease. The best candidates for active surveillance are being defined, as are predictors of active treatment. The psychosocial ramifications of surveillance for prostate cancer can be profound and future needs and unmet goals will be discussed.

  • 5.
    Deol, Abhinav
    et al.
    Wayne State Univ, Karmanos Canc Inst, Dept Oncol, 4100 John R,4 HWCRC, Detroit, MI 48201 USA..
    Sengsayadeth, Salyka
    Vanderbilt Univ, Med Ctr, Nashville, TN USA..
    Ahn, Kwang Woo
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI 53226 USA..
    Wang, Hai-Lin
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Aljurf, Mahmoud
    King Faisal Specialist Hosp Ctr & Res, Dept Oncol, Riyadh, Saudi Arabia..
    Antin, Joseph Harry
    Dana Farber Canc Inst, Dept Med Oncol, Ctr Hematol Oncol, Boston, MA 02115 USA..
    Battiwalla, Minoo
    NHLBI, Hematol Branch, Bethesda, MD 20892 USA..
    Bornhauser, Martin
    Carl Gustav Carus Univ Hosp, Dresden, Germany..
    Cahn, Jean-Yves
    Univ Hosp, Dept Hematol, Grenoble, France..
    Camitta, Bruce
    Med Coll Wisconsin, Midwest Ctr Canc & Blood Disorders, Milwaukee, WI 53226 USA.;Childrens Hosp Wisconsin, Milwaukee, WI 53201 USA..
    Chen, Yi-Bin
    Massachusetts Gen Hosp, Div Hematol Oncol, Boston, MA 02114 USA..
    Cutler, Corey S.
    Dana Farber Canc Inst, Dept Med Oncol, Ctr Hematol Oncol, Boston, MA 02115 USA..
    Gale, Robert Peter
    Imperial Coll London, Dept Med, Div Expt Med, Hematol Res Ctr, London, England..
    Ganguly, Siddhartha
    Univ Kansas, Med Ctr, Div Hematol & Oncol, Blood & Marrow Transplantat, Kansas City, KS 66103 USA..
    Hamadani, Mehdi
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Inamoto, Yoshihiro
    Natl Canc Ctr, Div Hematopoiet Stem Cell Transplantat, Tokyo, Japan..
    Jagasia, Madan
    Vanderbilt Univ, Med Ctr, Nashville, TN USA..
    Kamble, Rammurti
    Baylor Coll Med, Ctr Cell & Gene Therapy, Div Hematol & Oncol, Houston, TX 77030 USA..
    Koreth, John
    Dana Farber Canc Inst, Dept Med Oncol, Ctr Hematol Oncol, Boston, MA 02115 USA..
    Lazarus, Hillard M.
    Univ Hosp Case Med Ctr, Seidman Canc Ctr, Cleveland, OH USA..
    Liesveld, Jane
    Univ Rochester, Med Ctr, Dept Med, Rochester, NY 14642 USA..
    Litzow, Mark R.
    Mayo Clin, Div Hematol, Rochester, NY USA.;Mayo Clin, Transplant Ctr, Rochester, NY USA..
    Marks, David I.
    Univ Hosp Bristol Natl Hlth Serv Trust, Pediat Bone Marrow Transplant, Bristol, Avon, England..
    Nishihori, Taiga
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA..
    Olsson, Richard F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Div Therapeut Immunol, Dept Lab Med, Stockholm, Sweden..
    Reshef, Ran
    Columbia Univ, Med Ctr, Blood & Marrow Transplantat Program, New York, NY USA.;Columbia Univ, Med Ctr, Columbia Ctr Translat Immunol, New York, NY USA..
    Rowe, Jacob M.
    Shaare Zedek Med Ctr, Dept Hematol, Jerusalem, Israel..
    Saad, Ayman A.
    Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL 35294 USA..
    Sabloff, Mitchell
    Univ Ottawa, Dept Med, Div Hematol, Ottawa, ON, Canada.;Ottawa Hosp, Res Inst, Ottawa, ON, Canada..
    Schouten, Harry C.
    Acad Hosp Maastricht, Dept Hematol, Maastricht, Netherlands..
    Shea, Thomas C.
    Univ North Carolina Hlth Care, Dept Med, Div Hematol & Oncol, Chapel Hill, NC USA..
    Soiffer, Robert J.
    Dana Farber Canc Inst, Dept Med Oncol, Ctr Hematol Oncol, Boston, MA 02115 USA..
    Uy, Geoffrey L.
    Washington Univ, Sch Med, Div Oncol, St Louis, MO USA..
    Waller, Edmond K.
    Emory Univ, Winship Canc Inst, Dept Hematol & Med Oncol, Atlanta, GA 30322 USA..
    Wiernik, Peter H.
    Our Lady Mercy Med Ctr, Bronx, NY USA..
    Wirk, Badeep
    Seattle Canc Care Alliance, Div Bone Marrow Transplant, Seattle, WA USA..
    Woolfrey, Ann E.
    Fred Hutchinson Canc Res Ctr, 1124 Columbia St, Seattle, WA 98104 USA..
    Bunjes, Donald
    Ulm Univ Hosp, Dept Internal Med 3, Ulm, Germany..
    Devine, Steven
    Ohio State Univ, Dept Internal Med, Comprehens Canc Ctr James, Columbus, OH 43210 USA..
    de Lima, Marcos
    Univ Hosp Case Med Ctr, Seidman Canc Ctr, Dept Med, Cleveland, OH USA..
    Sandmaier, Brenda M.
    Univ Washington, Div Med Oncol, Seattle, WA 98195 USA.;Fred Hutchinson Canc Res Ctr, Div Clin Res, 1124 Columbia St, Seattle, WA 98104 USA..
    Weisdorf, Dan
    Natl Marrow Donor Program Be Match, Ctr Int Blood & Marrow Transplant Res, Minneapolis, MN USA..
    Khoury, Hanna Jean
    Emory Univ, Winship Canc Inst, Dept Hematol & Med Oncol, Atlanta, GA 30322 USA..
    Saber, Wael
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Does FLT3 Mutation Impact Survival After Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia?: A Center for International Blood and Marrow Transplant Research (CIBMTR) Analysis2016In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 122, no 19, p. 3005-3014Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients with FMS like tyrosine kinase 3 (FLT3)-mutated acute myeloid leukemia (AML) have a poor prognosis and are referred for early allogeneic hematopoietic stem cell transplantation (HCT). METHODS: Data from the Center for International Blood and Marrow Transplant Research (CIBMTR) were used to evaluate 511 adult patients with de novo AML who underwent HCT during 2008 through 2011 to determine whether FLT3 mutations had an impact on HCT outcomes. RESULTS: In total, 158 patients (31%) had FLT3 mutations. Univariate and multivariate analyses revealed an increased risk of relapse at 3 years in the FLT3 mutated group compared with the wild-type (WT) group (38% [95% confidence interval (CI), 30%-45%] vs 28% [95% CI, 24%-33%]; P = .04; relative risk, 1.60 [95% CI, 1.15-2.22]; P = .0048). However, FLT3 mutation status was not significantly associated with nonrelapse mortality, leukemia-free survival, or overall survival. Although more patients in the FLT3 mutated group died from relapsed primary disease compared with those in the WT group (60% vs 46%), the 3-year overall survival rate was comparable for the 2 groups (mutated group: 49%; 95% CI, 40%-57%; WT group: 55%, 95% CI, 50%-60%; P = .20). CONCLUSIONS: The current data indicate that FLT3 mutation status did not adversely impact overall survival after HCT, and about 50% of patients with this mutation who underwent HCT were long-term survivors.

  • 6. Duffy, Stephen W
    et al.
    Holmberg, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Effect of mammographic service screening on stage at presentation of breast cancers in Sweden2007In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 109, no 11, p. 2205-2212Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Previous results have shown a reduction in mortality with service screening in Sweden on the order of 40%. If the rate of tumors at a later stage were similarly reduced, this would give further support to the mortality findings. METHODS: The rates of lymph node-positive cancers, of tumors >2 cm in pathological size, and of tumors of TNM stage II or worse before and after the introduction of screening were compared in 13 areas in Sweden, adjusted for changes in overall incidence during the period of study and stratified by age (40-49 and 50-69 years). RESULTS: Data were obtained on a total of 23,092 cancers and 10,177,113 person-years of observation. In women exposed to screening in the screening epoch, there was a significant 45% reduction in tumors of size >2 cm compared with the prescreening (relative risk [RR]=0.55, 95% confidence interval [CI]: 0.46-0.66) in the 40-49 age group, and a 33% reduction in the 50-69 group (RR=0.67, 95% CI: 0.62-0.72). For lymph node-positive and stage II+ disease, there were smaller but still significant reductions. No reduction in incidence in later-stage disease was observed in the unexposed women in the screening epoch. CONCLUSIONS: Screening has significantly and substantially reduced the rates of larger tumors and lymph node-positive breast cancer in Sweden, and the magnitude of the reduction is consistent with the reduction in breast cancer mortality.

  • 7.
    El-Jawahri, Areej
    et al.
    Massachusetts Gen Hosp, Boston, MA 02114 USA..
    Chen, Yi-Bin
    Massachusetts Gen Hosp, Boston, MA 02114 USA..
    Brazauskas, Ruta
    Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Milwaukee, WI 53226 USA..
    He, Naya
    Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Lee, Stephanie J.
    Fred Hutchinson Canc Res Ctr, 1124 Columbia St, Seattle, WA 98104 USA..
    Knight, Jennifer M.
    Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Majhail, Navneet
    Cleveland Clin, Cleveland, OH 44106 USA..
    Buchbinder, David
    Childrens Hosp Orange Cty, Orange, CA USA..
    Schears, Raquel M.
    Brandeis Univ, Waltham, MA USA..
    Wirk, Baldeep M.
    Seattle Canc Care Alliance, Seattle, WA USA..
    Wood, William A.
    Univ N Carolina, Chapel Hill, NC USA..
    Ahmed, Ibrahim
    Childrens Mercy Hosp & Clin, Kansas City, MO USA..
    Aljurf, Mahmoud
    King Faisal Specialist Hosp & Res Ctr, Riyadh, Saudi Arabia..
    Szer, Jeff
    Royal Melbourne Hosp, Parkville, Vic, Australia..
    Beattie, Sara M.
    Univ Ottawa, Ottawa, ON, Canada..
    Battiwalla, Minoo
    NHLBI, Bldg 10, Bethesda, MD 20892 USA..
    Dandoy, Christopher
    Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA..
    Diaz, Miguel-Angel
    Hosp Infantil Univ Nino Jesus, Madrid, Spain..
    D'Souza, Anita
    Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Freytes, Cesar O.
    Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA..
    Gajewski, James
    Oregon Hlth & Sci Univ, Portland, OR 97201 USA..
    Gergis, Usama
    New York Presbyterian Hosp, New York, NY USA..
    Hashmi, Shahrukh K.
    Brandeis Univ, Waltham, MA USA..
    Jakubowski, Ann
    Mem Sloan Kettering Canc Ctr, 1275 York Ave, New York, NY 10021 USA..
    Kamble, Rammurti T.
    Baylor Coll Med, Houston, TX 77030 USA..
    Kindwall-Keller, Tamila
    Univ Virginia Hlth Syst, Charlottesville, VA USA..
    Lazarus, Hilard M.
    Seidman Canc Ctr, Cleveland, OH USA..
    Malone, Adriana K.
    Tisch Canc Inst, New York, NY USA..
    Marks, David I.
    Univ Hosp Bristol NHS Trust, Bristol, Avon, England..
    Meehan, Kenneth
    Dartmouth Hitchcock Med Ctr, Lebanon, NH 03766 USA..
    Savani, Bipin N.
    Vanderbilt Univ, Med Ctr, Nashville, TN USA..
    Olsson, Richard F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Haematology. Karolinska Inst, Stockholm, Sweden..
    Rizzieri, David
    Duke Univ, Durham, NC USA..
    Steinberg, Amir
    Mt Sinai Hosp, New York, NY 10029 USA..
    Speckhart, Dawn
    Northside Hosp, Atlanta, GA USA..
    Szwajcer, David
    Univ Manitoba, Winnipeg, MB, Canada..
    Schoemans, Helene
    Univ Hosp Leuven, Leuven, Belgium..
    Seo, Sachiko
    East Hosp, Kashiwa, Chiba, Japan..
    Ustun, Celalettin
    Univ Minnesota, Med Ctr, Minneapolis, MN 55455 USA..
    Atsuta, Yoshiko
    Japanese Data Ctr Hematopoiet Cell Transplantat, Nagoya, Aichi, Japan.;Nagoya Univ, Grad Sch Med, Nagoya, Aichi, Japan..
    Dalal, Jignesh
    Childrens Mercy Hosp & Clin, Kansas City, MO USA..
    Sales-Bonfim, Carmem
    Univ Fed Parana, Hosp Clin, Curitiba, Parana, Brazil..
    Khera, Nandita
    Mayo Clin, Phoenix, AZ USA..
    Hahn, Theresa
    Roswell Pk Canc Inst, Buffalo, NY 14263 USA..
    Saber, Wael
    Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Impact of pre-transplant depression on outcomes of allogeneic and autologous hematopoietic stem cell transplantation2017In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 123, no 10, p. 1828-1838Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To evaluate the impact of depression before autologous and allogeneic hematopoietic cell transplantation (HCT) on clinical outcomes post-transplantation.

    METHODS: We analyzed data from the Center for International Blood and Marrow Transplant Research to compare outcomes after autologous (n=3786) or allogeneic (n=7433) HCT for adult patients with hematologic malignancies with an existing diagnosis of pre-HCT depression requiring treatment versus those without pre-HCT depression. Using Cox regression models, we compared overall survival (OS) between patients with or without depression. We compared the number of days alive and out of the hospital in the first 100 days post-HCT using Poisson models. We also compared the incidence of grade 2-4 acute and chronic graft-versus-host disease (GVHD) in allogeneic HCT.

    RESULTS: The study included 1116 (15%) patients with pre-transplant depression and 6317 (85%) without depression who underwent allogeneic HCT between 2008 and 2012. Pre-transplant depression was associated with lower OS (hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.04-1.23; P=0.004) and a higher incidence of grade 2-4 acute GVHD (HR, 1.25; 95% CI, 1.14-1.37; P<0.0001), but similar incidence of chronic GVHD. Pre-transplant depression was associated with fewer days-alive-and-out-of-the hospital (means ratio [MR]=0.97; 95% CI, 0.95-0.99; P=0.004). There were 512 (13.5%) patients with Pre-transplant depression and 3274 (86.5%) without depression who underwent autologous HCT. Pre-transplant depression in autologous HCT was not associated with OS (HR, 1.15; 95% CI, 0.98-1.34; P=0.096) but was associated with fewer days alive and out of the hospital (MR, 0.98; 95% CI, 0.97-0.99; P=0.002).

    CONCLUSION: Pre-transplant depression was associated with lower OS and higher risk of acute GVHD among allogeneic HCT recipients and fewer days alive and out of the hospital during the first 100 days after autologous and allogeneic HCT. Patients with pre-transplant depression represent a population that is at risk for post-transplant complications.

  • 8.
    Eriksson, B. K.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine.
    Larsson, E. G.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine.
    Skogseid, Britt M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine.
    Löfberg, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Lörelius, Lars-Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Öberg, K. E.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Liver embolizations of patients with malignant neuroendocrine gastrointestinal tumors1998In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 83, no 11, p. 2293-2301Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    Patients with neuroendocrine gastrointestinal tumors usually present with inoperable metastatic disease and severe hormonal symptoms. Specific chemotherapy, interferon-alpha (IFN), and somatostatin analogs are established therapies for these patients, but all of them eventually fail. Hepatic arterial embolization can provide reduction of both hormonal symptoms and tumor burden in these patients.

    METHODS

    Between 1981 and 1995, a total of 55 liver embolizations with gel foam powder were performed on 41 patients with histopathologically verified neuroendocrine tumors; 29 had carcinoid tumors and 12 had endocrine pancreatic tumors (EPTs). All patients had received medical treatment, including chemotherapy (n = 18), IFN (n = 31), and octreotide (n = 19), and were experiencing treatment failure when liver embolization was performed at a median of 37 months after diagnosis of liver metastases. Medical treatment was continued after embolization.

    RESULTS

    An overall objective response was noted in 15 of 29 patients with carcinoid tumors (52%). The median duration of effect was 12 months in patients with midgut carcinoid tumors. An overall objective response was observed in 6 of 12 patients with EPTs (50%), with a median duration of effect of 10 months. Adverse events were observed, and, in agreement with earlier reports, the rate of serious complications was 10%. Survival analyses showed a median survival of 80 months and a 5-year survival rate of 60% from the performance of embolization on patients with midgut carcinoid tumors, whereas for patients with EPTs the median survival from embolization was only 20 months.

    CONCLUSIONS

    Liver embolizations performed relatively late in the clinical course in our series appeared to be as effective as "early" embolizations in other series of patients with carcinoid tumors. The results for those with EPTs were poorer, and earlier embolizations may result in better outcomes for these patients. Considering the morbidity associated with the procedure, it is imperative to select patients according to extent of liver involvement, severity of carcinoid heart disease, and somatostatin receptor status.

  • 9.
    Eriksson, Barbro
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Ludwig Institute for Cancer Research.
    Skogseid, Britt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine.
    Lundqvist, Gudmar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Wide, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Wilander, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Molecular and Morphological Pathology.
    Öberg, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Ludwig Institute for Cancer Research.
    Medical treatment and long-term survival in a prospective study of 84 patients with endocrine pancreatic tumors1990In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 65, no 9, p. 1883-1890Article in journal (Refereed)
    Abstract [en]

    A prospective study was performed on 84 patients with neuroendocrine pancreatic tumors. Fifty-nine (70%) had malignant tumors and received causal medical treatment. Streptozotocin in combination with 5-fluorouracil or doxorubicin was used as first-line treatment and produced overall objective responses in 20 of 44 (45%) patients with a median duration of response of 27.5 months. Thirty-two patients who failed on chemotherapy subsequently received interferon treatment and 20 (63%) responded objectively with a median duration of 20.5 months. Octreotide, third-line treatment in 14 patients, produced objective responses in four patients (28%) (median duration of response, 16 months). The median survival from diagnosis in malignant cases was 6.7 years. Even if none of the current medical therapies are curative for patients with malignant endocrine pancreatic tumors, a prolonged survival would be observed during the last decade. Since the age at diagnosis has not been dramatically reduced despite improvements in diagnostic methods, the prolonged survival might be attributed to causal medical treatment.

  • 10.
    Geyer, Holly L.
    et al.
    Mayo Clin, Div Hosp Internal Med, 13400 E Shea Blvd, Scottsdale, AZ 85259 USA..
    Andreasson, Bjorn
    NU Hosp Org, Internal Med, Uddevalla, Sweden..
    Kosiorek, Heidi E.
    Mayo Clin, Sect Biostat, 13400 E Shea Blvd, Scottsdale, AZ 85259 USA..
    Dueck, Amylou C.
    Mayo Clin, Sect Biostat, 13400 E Shea Blvd, Scottsdale, AZ 85259 USA..
    Scherber, Robyn M.
    Oregon Hlth & Sci Univ, Dept Hematol & Oncol, Portland, OR 97201 USA..
    Martin, Kari A.
    Mayo Clin, Dept Psychiat, 13400 E Shea Blvd, Scottsdale, AZ 85259 USA..
    Butler, Kristina A.
    Mayo Clin, Dept Gynecol, 13400 E Shea Blvd, Scottsdale, AZ 85259 USA..
    Harrison, Claire N.
    Guys & St Thomas NHS Fdn Trust, Dept Haematol, London, England..
    Radia, Deepti H.
    Guys & St Thomas NHS Fdn Trust, Dept Haematol, London, England..
    Cervantes, Francisco
    Univ Barcelona, Dept Hematol, Hosp Clin, IDIBAPS, Barcelona, Spain..
    Kiladjian, Jean-Jacques
    Hosp St Louis, Clin Invest Ctr, Paris, France..
    Reiter, Andreas
    Univ Mannheim, Med Clin, D-68131 Mannheim, Germany..
    Birgegård, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Haematology.
    Passamonti, Francesco
    Univ Pavia, Dept Hematol, IRCCS Fdn San Matteo Polyclin, Via Palestro 3, I-27100 Pavia, Italy..
    Senyak, Zhenya
    MPN Forum, Asheville, NC USA..
    Vannucchi, Alessandro M.
    Circolo Hosp, Div Hematol, Varese, Italy..
    Paoli, Chiara
    Univ Florence, Dept Med, Florence, Italy..
    Xiao, Zhijian
    Chinese Acad Med Sci, Inst Hematol, MDS & MPN Ctr, Tianjin, Peoples R China.;Chinese Acad Med Sci, Blood Dis Hosp, Tianjin, Peoples R China.;Peking Union Med Coll, Tianjin, Peoples R China..
    Samuelsson, Jan
    Stockholm South Hosp, Dept Internal Med, Stockholm, Sweden..
    Mesa, Ruben A.
    Mayo Clin, Div Hematol Oncol, 13400 E Shea Blvd, Scottsdale, AZ 85259 USA..
    The role of sexuality symptoms in myeloproliferative neoplasm symptom burden and quality of life: An analysis by the MPN QOL International Study Group2016In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 122, no 12, p. 1888-1896Article in journal (Refereed)
    Abstract [en]

    BACKGROUNDPatients with myeloproliferative neoplasms (MPNs) including polycythemia vera, essential thrombocythemia, and myelofibrosis, are faced with oppressive symptom profiles that compromise daily functioning and quality of life. Among these symptoms, sexuality-related symptoms have emerged as particularly prominent and largely unaddressed. In the current study, the authors evaluated how sexuality symptoms from MPN relate to other patient characteristics, disease features, treatments, and symptoms. METHODSA total of 1971 patients with MPN (827 with essential thrombocythemia, 682 with polycythemia vera, 456 with myelofibrosis, and 6 classified as other) were prospectively evaluated and patient responses to the Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ C30) were collected, along with information regarding individual disease characteristics and laboratory data. Sexuality scores were compared with an age-matched, healthy control population. RESULTSOverall, patients with MPN were found to have greater sexual dysfunction compared with the healthy population (MPN-SAF score of 3.6 vs 2.0; P<.001), with 64% of patients with MPN describing some degree of sexual dysfunction and 43% experiencing severe symptoms. The presence of sexual symptoms correlated closely with all domains of patient functionality (physical, social, cognitive, emotional, and role functioning) and were associated with a reduced quality of life. Sexual problems also were found to be associated with other MPN symptoms, particularly depression and nocturnal and microvascular-related symptoms. Sexual dysfunction was more severe in patients aged >65 years and in those with cytopenias and transfusion requirements, and those receiving certain therapies such as immunomodulators or steroids. ConclusionsThe results of the current study identify the topic of sexuality as a prominent issue for the MPN population, and this area would appear to benefit from additional investigation and management. Cancer 2016;122:1888-96. (c) 2016 American Cancer Society. Sexuality problems impact all domains of functionality, depression, microvascular symptoms, and overall quality of life among patients with myeloproliferative neoplasms. These problems correlate with patient age, the presence of cytopenias, transfusion requirements, and common therapies for myeloproliferative neoplasms. See also pages 1804-6.

  • 11.
    Hallböök, Helene
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Gustafsson, Göran
    Smedmyr, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Söderhäll, Stefan
    Heyman, Mats
    Treatment outcome in young adults and children > 10 years of age with acute lymphoblastic leukemia in Sweden: A comparison between a pediatric protocol and an adult protocol2006In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 107, no 7, p. 1551-1561Article in journal (Refereed)
    Abstract [en]

    BACKGROUND. Several studies have reported a more favorable outcome for teenagers and young adults with acute lymphoblastic leukemia (ALL) when they were treated in pediatric oncology departments compared with adult hematology departments. However, biased risk grouping and high treatment-related mortality have hampered some of those comparisons. METHODS. In Sweden during the 1990s, adolescents with ALL were treated in a pediatric oncology unit or in an adult hematologic unit, depending on the initial referral. In the current national, comparative, retrospective study, patients with ALL aged 10 years to 40 years who were treated either according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL protocol (1992-2000) (NOPHO-92 protocol) or according to the Swedish Adult ALL Group protocol (1994-2000) (Adult protocol) were included. None of the protocols had age as a high-risk criterion. RESULTS. In total, 243 patients with B-precursor and T-cell ALL were treated according to the protocols. There was a significant difference in the remission rate between the NOPHO-92 protocol (99%; n = 144 patients) and the Adult protocol (90%; n = 99 patients; P <.01), and the event-free survival (EFS) was also superior for the NOPHO-92 protocol compared with the Adult protocol (P <.01). However, EFS was higher for patients aged 15 years to 25 years compared with patients aged 26 years to 40 years within the Adult protocol group (P =.01). The treatment protocol itself was identified as an independent risk factor. CONCLUSIONS. The NOPHO-92 protocol resulted in a better outcome than the Adult protocol; therefore, adolescents may benefit from the pediatric protocol treatment strategy. Prospective trials are warranted to determine whether young adults would benefit from similar treatment.

  • 12. Hellquist, Barbro Numan
    et al.
    Duffy, Stephen W.
    Abdsaleh, Shahin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Björneld, Lena
    Bordas, Pål
    Tabar, Laszlo
    Vitak, Bedrich
    Zackrisson, Sophia
    Nyström, Lennarth
    Jonsson, Håkan
    Effectiveness of Population-Based Service Screening With Mammography for Women Ages 40 to 49 Years Evaluation of the Swedish Mammography Screening in Young Women (SCRY) Cohort2011In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 117, no 4, p. 714-722Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The effectiveness of mammography screening for women ages 40 to 49 years still is questioned, and few studies of the effectiveness of service screening for this age group have been conducted. METHODS: Breast cancer mortality was compared between women who were invited to service screening at ages 40 to 49 years (study group) and women in the same age group who were not invited during 1986 to 2005 (control group). Together, these women comprise the Mammography Screening of Young Women (SCRY) cohort, which includes all Swedish counties. A prescreening period was defined to facilitate a comparison of mortality in the absence of screening. The outcome measure was refined mortality, ie, breast cancer death for women who were diagnosed during follow-up at ages 40 to 49 years. Relative risks (RRs) with 95% confidence intervals (Os) were estimated. RESULTS: There was no significant difference in breast cancer mortality during the prescreening period. During the study period, there were 803 breast cancer deaths in the study group (7.3 million person-years) and 1238 breast cancer deaths in the control group (8.8 million person-years). The average follow-up was 16 years. The estimated RR for women who were invited to screening was 0.74 (95% Cl, 0.66-0.83), and the RR for women who attended screening was 0.71 (95% CI, 0.620.80). CONCLUSIONS: In this comprehensive study, mammography screening for women ages 40 to 49 years was efficient for reducing breast cancer mortality.

  • 13. Hillerdal, Gunnar
    et al.
    Lindqvist, Ulla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Engström-Laurent, Anna
    Hyaluronan in pleural effusions and in serum1991In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 67, no 9, p. 2410-2414Article in journal (Refereed)
    Abstract [en]

    It has been suggested that a high level of hyaluronan (hyaluronic acid, HYA) in pleural fluid is an indicator of malignant mesothelioma. In 78 consecutive patients with pleural effusion of various causes the HYA concentration was measured in pleural fluid samples and in serum. Nine patients had malignant pleural mesothelioma, and in three of them the HYA level in pleural fluid was 100 mg/l or more. In 42 patients with effusions due to metastatic malignancy, the mean HYA in the pleural fluid was 75 mg/l, and in five the HYA level was above 100 mg/l. Cardiac insufficiency caused the effusion in 11 patients, of whom two had a level above 100 mg/l in pleural fluid. Four patients had a serologically confirmed viral infection and had HYA levels in pleural fluid of 8, 157, 335, and 554 mg/l, respectively. One patient had postinfectious effusion with an HYA level in pleural exudate of 748 mg/l, the highest in this investigation. Two patients had benign asbestos pleural effusions, and both had high pleural HYA levels (256 and 490 mg/l, respectively). The serum HYA values were much lower than in the pleural fluid, namely from 15 to 480 micrograms/l; the levels were independent of the levels in the pleural fluid. Thus, a high level of HYA in pleural fluid is not specific for mesothelioma but can occur in other malignant or benign diseases, and a low level does not exclude mesothelioma.

  • 14.
    Hovén, Emma
    et al.
    Department of Women’s and Children’s Health, Childhood Cancer Research Unit, Karolinska Institute, Stockholm, Sweden.
    Lannering, Birgitta
    Department of Pediatrics, The Queen Silvia Children’s Hospital, University Hospital, University of Gothenburg, Gothenburg, Sweden.
    Gustafsson, Göran
    Department of Women’s and Children’s Health, Childhood Cancer Research Unit, Karolinska Institute, Stockholm, Sweden.
    Boman, Krister K
    Department of Women’s and Children’s Health, Childhood Cancer Research Unit, Karolinska Institute, Stockholm, Sweden.
    The met and unmet health care needs of adult survivors of childhood central nervous system tumors: A double-informant, population-based study2011In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 117, no 18, p. 4294-4303Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The purpose of the current study was to examine the persistent health care needs (HCNs) of adult survivors of childhood central nervous system tumors.

    METHODS:

    In this population-based study, 526 of 679 eligible survivors and 550 parents provided data. Survivors' HCNs were assessed using a questionnaire covering 4 domains: Medical Care, care coordination and communication (Care Coordination), Illness Education, and Psychosocial Services. Needs were categorized as no need, met need, and unmet need. Outcomes were analyzed specifically in relation to survivors' functional late effects as assessed using the Health Utilities Index Mark 2/3.

    RESULTS:

    Approximately 40% of survivors experienced their HCNs as exceeding the supposed general population average, and 41% had a current HCN that was unmet. The most common unmet need concerned the Psychosocial Services domain (reported by 40%), followed by a lack of Illness Education (35%), Care Coordination (22%), and Medical Care (15%). Survivors experiencing functional late effects had greater HCNs, and a greater percentage of unmet needs. Agreement between survivor-reported and parent proxy-reported HCNs was satisfactory, whereas agreement for survivors' unmet HCNs ranged from poor to satisfactory.

    CONCLUSIONS:

    Findings based on reliable double-informant data demonstrated that a considerable percentage of adult survivors report unmet HCNs, with female sex, younger age at diagnosis, and indications of disability and poor health status comprising significant risk factors. Issues critical for improved, comprehensive, long-term follow-up care were identified. Addressing these issues adequately in clinical follow-up extending into adulthood would likely improve the quality of comprehensive care for this patient group.

  • 15. Juliusson, Gunnar
    et al.
    Karlsson, Karin
    Lazarevic, Vladimir Lj
    Wahlin, Anders
    Brune, Mats
    Antunovic, Petar
    Derolf, Åsa
    Hägglund, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Haematology.
    Karbach, Holger
    Lehmann, Sören
    Möllgård, Lars
    Stockelberg, Dick
    Hallböök, Helene
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Haematology.
    Höglund, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Haematology.
    Hematopoietic Stem Cell Transplantation Rates and Long-Term Survival in Acute Myeloid and Lymphoblastic Leukemia: Real-World Population-Based Data From the Swedish Acute Leukemia Registry 1997-20062011In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 117, no 18, p. 4238-4246Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Allogeneic stem cell transplantation (alloSCT) reduces relapse rates in acute leukemia, but outcome is hampered by toxicity. Population-based data avoid patient selection and may therefore substitute for lack of randomized trials.

    METHODS: We evaluated alloSCT rates within the Swedish Acute Leukemia Registry, including 3899 adult patients diagnosed from 1997 through 2006 with a coverage of 98% and a median follow-up of 6.2 years.

    RESULTS: AlloSCT rates and survival decreased rapidly with age >55 years. The 8-year overall survival (OS) was 65% in patients <30 years and 38% in patients <60 years and was similar for acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). Among 1073 patients <60 years, alloSCT was performed in 42% and 49% of patients with AML and ALL, respectively. Two-thirds of the alloSCTs were performed in first complete remission, and half used unrelated donors, the same in AML and ALL. Regional differences in management and outcome were found: 60% of AML patients <40 years received alloSCT in all parts of Sweden, but two-thirds of AML patients 40-59 years had alloSCT in one region compared with one-third in other regions (P<.001), with improved 8-year OS among all AML patients in this age cohort (51% vs 30%; P = .005).

    CONCLUSIONS: More Swedish AML patients received alloSCT, and long-term survival was better than in recently published large international studies, despite our lack of selection bias. There was no correlation between alloSCT rate and survival in ALL. In adult AML patients <60 years of age, a high alloSCT rate was associated with better long-term survival, but there was no such correlation in ALL.

  • 16.
    Juratli, Tareq A.
    et al.
    Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Div Neurooncol,Dept Neurol, Boston, MA 02115 USA;Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Div Hematol Oncol,Dept Neurol, Boston, MA 02115 USA;Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Div Neurooncol,Dept Med, Boston, MA 02115 USA;Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Div Hematol Oncol,Dept Med, Boston, MA 02115 USA;Tech Univ Dresden, Dept Neurosurg, Fac Med, Dresden, Germany;Tech Univ Dresden, Carl Gustav Carus Univ Hosp, Dresden, Germany.
    Jones, Pamela S.
    Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Boston, MA 02115 USA.
    Wang, Nancy
    Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Div Neurooncol,Dept Neurol, Boston, MA 02115 USA;Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Div Hematol Oncol,Dept Neurol, Boston, MA 02115 USA;Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Div Neurooncol,Dept Med, Boston, MA 02115 USA;Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Div Hematol Oncol,Dept Med, Boston, MA 02115 USA.
    Subramanian, Megha
    Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Div Neurooncol,Dept Neurol, Boston, MA 02115 USA;Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Div Hematol Oncol,Dept Neurol, Boston, MA 02115 USA;Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Div Neurooncol,Dept Med, Boston, MA 02115 USA;Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Div Hematol Oncol,Dept Med, Boston, MA 02115 USA.
    Aylwin, Simon J. B.
    Kings Coll Hosp London, Dept Endocrinol, London, England.
    Odia, Yazmin
    Baptist Hlth South Florida, Miami Canc Inst, Miami, FL USA.
    Rostami, Elham
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Enblad: Neurosurgery.
    Gudjonsson, Olafur
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Shaw, Brian L.
    Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Div Neurooncol,Dept Neurol, Boston, MA 02115 USA;Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Div Hematol Oncol,Dept Neurol, Boston, MA 02115 USA;Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Div Neurooncol,Dept Med, Boston, MA 02115 USA;Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Div Hematol Oncol,Dept Med, Boston, MA 02115 USA.
    Cahill, Daniel P.
    Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Boston, MA 02115 USA.
    Galanis, Evanthia
    Mayo Clin, Div Med Oncol, Dept Oncol, Dept Mol Med, Rochester, MN USA.
    Barker, Fred G., II
    Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Boston, MA 02115 USA.
    Santagata, Sandro
    Harvard Med Sch, Brigham & Womens Hosp, Dept Pathol, Boston, MA 02115 USA.
    Brastianos, Priscilla K.
    Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Div Neurooncol,Dept Neurol, Boston, MA 02115 USA;Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Div Hematol Oncol,Dept Neurol, Boston, MA 02115 USA;Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Div Neurooncol,Dept Med, Boston, MA 02115 USA;Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, Div Hematol Oncol,Dept Med, Boston, MA 02115 USA.
    Targeted treatment of papillary craniopharyngiomas harboring BRAF V600E mutations2019In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 125, no 17, p. 2910-2914Article in journal (Other academic)
    Abstract [en]

    Papillary craniopharyngiomas (PCPs) are characterized by the presence of BRAF V600E mutations, which are emerging as a useful guide for diagnosis and treatment decision making. The ongoing multicenter phase 2 Alliance A071601 trial is evaluating the efficacy of BRAF and mitogen-activated protein kinase kinase (MEK) inhibitors for patients with PCPs. With continued successful responses, it is proposed that BRAF (and MEK) inhibitors be evaluated for the neoadjuvant treatment of patients with PCPs.

  • 17. Lundkvist, Jonas
    et al.
    Ekman, Mattias
    Ericsson, Suzanne Rehn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Jönsson, Bengt
    Glimelius, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Cost-effectiveness of proton radiation in the treatment of childhood medulloblastoma2005In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 103, no 4, p. 793-801Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Radiation therapy is an important component in the treatment of medulloblastoma; however, in many patients, it is associated with risk of late adverse events. Proton radiation therapy has potential to reduce the risk of adverse events compared with conventional radiation, but it is associated with a higher treatment cost. The objective of the current study was to assess the cost-effectiveness of proton therapy compared with conventional radiation therapy in the treatment of childhood medulloblastoma. METHODS: The consequences of radiation therapy were evaluated using a Markov simulation model. Children age 5 years with medulloblastoma were followed. The patients were at risk of several types of adverse events, including hearing loss, intelligence quotient (IQ) loss, hypothyroidism, growth hormone deficiency (GHD), osteoporosis, cardiac disease, and secondary malignancies. The patients also were at risk of death and were divided into risk groups for normal death, death due to tumor recurrence, treatment-related cardiac death, treatment-related subsequent tumor death, or treatment-related other death. A review of the literature was conducted to estimate the parameters in the model. RESULTS: The base-case results showed that proton therapy was associated with 23,600 in cost savings and 0.68 additional quality-adjusted life-years per patient. The analyses showed that reductions in IQ loss and GHD contributed to the greatest part of the cost savings and were the most important parameters for cost-effectiveness. CONCLUSIONS: The results of the current study indicated that proton radiation therapy can be cost-effective and cost-saving compared with conventional radiation therapy in the treatment of children with medulloblastoma if the appropriate patients are selected for the therapy. However, there have been few long-term follow-up studies, and more much information on the long-term consequences of radiation therapy is needed.

  • 18.
    Michelis, Fotios V.
    et al.
    Princes Margaret Canc Ctr, Allogene Blood & Marrow Transplant Program, Toronto, ON, Canada..
    Gupta, Vikas
    Princes Margaret Canc Ctr, Allogene Blood & Marrow Transplant Program, Toronto, ON, Canada..
    Zhang, Mei-Jie
    Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI 53226 USA..
    Wang, Hai-Lin
    Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Dept Med, Milwaukee, WI 53226 USA..
    Aljurf, Mahmoud
    Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Dept Med, Milwaukee, WI 53226 USA.;King Faisal Specialist Hosp Ctr & Res, Dept Oncol, Riyadh, Saudi Arabia..
    Bacher, Ulrike
    Univ Med Gottingen, Dept Hematol Oncol, Gottingen, Germany.;Univ Canc Ctr Hamburg, Interdisciplinary Clin Stem Cell Transplantat, Hamburg, Germany..
    Beitinjaneh, Amer
    Univ Miami, Miami, FL USA..
    Chen, Yi-Bin
    Massachusetts Gen Hosp, Div Hematol Oncol, Boston, MA 02114 USA..
    DeFilipp, Zachariah
    Emory Univ Hosp, 1364 Clifton Rd NE, Atlanta, GA 30322 USA..
    Gale, Robert Peter
    Imperial Coll London, Dept Med, Div Expt Med, Hematol Res Ctr, London, England..
    Kebriaei, Partow
    Univ Texas MD Anderson Canc Ctr, Dept Stem Cell Transplantat, Div Canc Med, Houston, TX 77030 USA..
    Kharfan-Dabaja, Mohamed
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA..
    Lazarus, Hillard M.
    Univ Hosp, Case Med Ctr, Seidman Canc Ctr, Dept Med, Cleveland, OH USA..
    Nishihori, Taiga
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA..
    Olsson, Richard F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Lab Med, Div Therapeut Immunol, Stockholm, Sweden.
    Oran, Betul
    Imperial Coll London, Dept Med, Div Expt Med, Hematol Res Ctr, London, England.;Univ Texas MD Anderson Canc Ctr, Dept Stem Cell Transplantat, Div Canc Med, Houston, TX 77030 USA..
    Rashidi, Armin
    Washington Univ, Sch Med, Div Oncol, St Louis, MO USA..
    Rizzieri, David A.
    Duke Univ, Div Hematol Malignancies & Cellular Therapy, Durham, NC USA..
    Tallman, Martin S.
    Mem Sloan Kettering Canc Ctr, Dept Med, Leukemia Serv, 1275 York Ave, New York, NY 10021 USA..
    de Lima, Marcos
    Univ Hosp, Case Med Ctr, Seidman Canc Ctr, Dept Med, Cleveland, OH USA..
    Khoury, H. Jean
    Emory Univ Hosp, 1364 Clifton Rd NE, Atlanta, GA 30322 USA..
    Sandmaier, Brenda M.
    Univ Washington, Div Med Oncol, Seattle, WA 98195 USA.;Fred Hutchinson Canc Res Ctr, Div Clin Res, 1124 Columbia St, Seattle, WA 98104 USA..
    Weisdorf, Daniel
    Univ Minnesota, Med Ctr, Dept Med, Div Hematol Oncol & Transplantat, Minneapolis, MN 55455 USA..
    Saber, Wael
    Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Dept Med, Milwaukee, WI 53226 USA..
    Cytogenetic Risk Determines Outcomes After Allogeneic Transplantation in Older Patients With Acute Myeloid Leukemia in Their Second Complete Remission: A Center for International Blood and Marrow Transplant Research Cohort Analysis2017In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 123, no 11, p. 2035-2042Article in journal (Refereed)
    Abstract [en]

    BACKGROUND Allogeneic hematopoietic cell transplantation (HCT) offers curative potential to a number of older patients with acute myeloid leukemia (AML) in their first complete remission. However, there are limited data in the literature concerning post-HCT outcomes for older patients in their second complete remission (CR2).

    METHODS The purpose of the current study was to retrospectively investigate within the Center for International Blood and Marrow Transplant Research database parameters influencing post-transplant outcomes for patients 60 years of age or older undergoing HCT for AML in CR2.

    RESULTS In total, 196 patients from 78 centers were identified; the median age was 64 years (range, 60-78 years). Seventy-one percent had a Karnofsky performance status >= 90 at the time of HCT. Reduced-intensity conditioning regimens were used in 159 patients (81%). A univariate analysis demonstrated a 3-year overall survival (OS) rate of 42% (95% confidence interval [CI], 35%-49%), a leukemia-free survival rate of 37% (95% CI, 30%-44%), a cumulative incidence of nonrelapse mortality of 25% (95% CI, 19%-32%), and a cumulative incidence of relapse (CIR) of 38% (95% CI, 31%-45%). A multivariate analysis demonstrated that cytogenetic risk was the only independent risk factor for OS (P=.023) with a hazard ratio (HR) of 1.14 (95% CI, 0.59-2.19) for intermediate-risk cytogenetics and an HR of 2.32 (95% CI, 1.05-5.14) for unfavorable-risk cytogenetics. For CIR, cytogenetic risk was also the only independent prognostic factor (P=.01) with an HR of 1.10 (95% CI, 0.47-2.56) for intermediate-risk cytogenetics and an HR of 2.98 (95% CI, 1.11-8.00) for unfavorable-risk cytogenetics.

    CONCLUSIONS Allogeneic HCT is a curative treatment option for older patients with AML in CR2, particularly for those with favorable or intermediate cytogenetic risk.

  • 19.
    Myers, Regina M.
    et al.
    Childrens Hosp Philadelphia, Div Hematol & Oncol, Philadelphia, PA 19104 USA..
    Hill, Brian T.
    Cleveland Clin, Taussig Canc Inst, Dept Hematol & Med Oncol, Cleveland, OH 44106 USA..
    Shaw, Bronwen E.
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Kim, Soyoung
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Div Biostat, Inst Hlth & Soc, Milwaukee, WI 53226 USA..
    Millard, Heather R.
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Battiwalla, Minoo
    NHLBI, Hematol Branch, Bethesda, MD 20892 USA..
    Majhail, Navneet S.
    Cleveland Clin, Taussig Canc Inst, Blood & Marrow Transplant Program, Cleveland, OH 44106 USA..
    Buchbinder, David
    Childrens Hosp Orange Cty, Div Pediat Hematol, Orange, CA 92668 USA..
    Lazarus, Hillard M.
    Case Western Reserve Univ, Univ Hosp Cleveland, Med Ctr, Seidman Canc Ctr, Cleveland, OH 44106 USA..
    Savani, Bipin N.
    Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA..
    Flowers, Mary E. D.
    Fred Hutchinson Canc Res Ctr, Div Clin Res, 1124 Columbia St, Seattle, WA 98104 USA..
    D'Souza, Anita
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Ehrhardt, Matthew J.
    St Jude Childrens Res Hosp, 332 N Lauderdale St, Memphis, TN 38105 USA..
    Langston, Amelia
    Emory Univ, Winship Canc Inst, Dept Hematol & Med Oncol, Atlanta, GA 30322 USA..
    Yared, Jean A.
    Univ Maryland, Dept Med, Div Hematol Oncol, Greenebaum Comprehens Canc Ctr,Blood & Marrow Tra, Baltimore, MD 21201 USA..
    Hayashi, Robert J.
    Washington Univ, Sch Med, Dept Pediat, Div Pediat Hematol Oncol, St Louis, MO 63110 USA..
    Daly, Andrew
    Tom Baker Canc Clin, Calgary, AB, Canada..
    Olsson, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Div Therapeut Immunol, Dept Lab Med, Stockholm, Sweden.
    Inamoto, Yoshihiro
    Natl Canc Ctr, Div Hematopoiet Stem Cell Transplantat, Tokyo, Japan..
    Malone, Adriana K.
    Icahn Sch Med Mt Sinai, Tisch Canc Inst, New York, NY 10029 USA..
    DeFilipp, Zachariah
    Massachusetts Gen Hosp, Blood & Marrow Transplant Program, Boston, MA 02114 USA..
    Margossian, Steven P.
    Boston Childrens Hosp, Dept Pediat Oncol, Boston, MA USA.;Dana Farber Canc Inst, Boston, MA 02115 USA..
    Warwick, Anne B.
    Uniformed Serv Ind Hlth Sci, Dept Pediat, Bethesda, MD USA..
    Jaglowski, Samantha
    Ohio State Univ, Med Ctr, Div Hematol, Columbus, OH 43210 USA..
    Beitinjaneh, Amer
    Univ Miami, Miami, FL USA..
    Fung, Henry
    Fox Chase Canc Ctr, Dept Med Oncol, 7701 Burholme Ave, Philadelphia, PA 19111 USA..
    Kasow, Kimberly A.
    Univ N Carolina, Div Hematol Oncol, Dept Pediat, Chapel Hill, NC USA..
    Marks, David I.
    Univ Hosp Bristol NHS Trust, Adult Bone Marrow Transplant, Bristol, Avon, England..
    Reynolds, Jana
    Baylor Univ, Med Ctr, Dallas, TX USA..
    Stockerl-Goldstein, Keith
    Washington Univ, Sch Med, Div Oncol, St Louis, MO USA..
    Wirk, Baldeep
    Seattle Canc Care Alliance, Div Bone Marrow Transplant, Seattle, WA USA..
    Wood, William A.
    Univ N Carolina, Div Hematol Oncol, Dept Med, Chapel Hill, NC USA..
    Hamadani, Mehdi
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Satwani, Prakash
    Columbia Univ, Med Ctr, Dept Pediat, Div Pediat Hematol Oncol & Stem Cell Transplantat, New York, NY USA..
    Long-Term Outcomes Among 2-Year Survivors of Autologous Hematopoietic Cell Transplantation for Hodgkin and Diffuse Large B-Cell Lymphoma2018In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 124, no 4, p. 816-825Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Autologous hematopoietic cell transplantation (auto-HCT) is a standard therapy for relapsed classic Hodgkin lymphoma (cHL) and diffuse large B-cell lymphoma (DLBCL); however, long-term outcomes are not well described.

    METHODS: This study analyzed survival, nonrelapse mortality, late effects, and subsequent malignant neoplasms (SMNs) in 1617 patients who survived progression-free for >= 2 years after auto-HCT for cHL or DLBCL between 1990 and 2008. The median age at auto-HCT was 40 years; the median follow-up was 10.6 years.

    RESULTS: The 5-year overall survival rate was 90% (95% confidence interval [CI], 87%-92%) for patients with cHL and 89% (95% CI, 87%-91%) for patients with DLBCL. The risk of late mortality in comparison with the general population was 9.6-fold higher for patients with cHL (standardized mortality ratio [SMR], 9.6) and 3.4-fold higher for patients with DLBCL (SMR, 3.4). Relapse accounted for 44% of late deaths. At least 1 late effect was reported for 9% of the patients. A total of 105 SMNs were confirmed: 44 in the cHL group and 61 in the DLBCL group. According to a multivariate analysis, older age, male sex, a Karnofsky score < 90, total body irradiation (TBI) exposure, and a higher number of lines of chemotherapy before auto-HCT were risk factors for overall mortality in cHL. Risk factors in DLBCL were older age and TBI exposure. A subanalysis of 798 adolescent and young adult patients mirrored the outcomes of the overall study population.

    CONCLUSIONS: Despite generally favorable outcomes, 2-year survivors of auto-HCT for cHL or DLBCL have an excess late-mortality risk in comparison with the general population and experience an assortment of late complications.

  • 20. Mårtensson, Gunnar
    et al.
    Thylen, Anders
    Lindqvist, Ulla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Hjerpe, Anders
    The sensitivity of hyaluronan analysis of pleural fluid from patients with malignant mesothelioma and a comparison of different methods1994In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 73, no 5, p. 1406-1410Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hyaluronan may be used as a marker for malignant mesothelioma, thus indicating its mesodermal origin. METHODS: The sensitivity as a diagnostic test of three different methods for hyaluronan analyses of pleural fluid was examined in patients with biopsy-verified malignant pleural mesothelioma. RESULTS: A quantitative high-performance liquid-chromatography (HPLC) method was performed on fluids from 43 patients. Using a cutoff level of 100 mg/l, higher levels were noted in 30 (70%) patients, with a median value of 220 mg/l (mean, 560 mg/l; range, 20-6600 mg/l). An identical median value (220 mg/l) was obtained with a radioassay method when simultaneously performed on paired samples from 21 patients (correlation coefficient, 0.91). A qualitative precipitation test using 0.5% cetylpyridinium chloride combined with a quantitative viscosimetric method was significantly less sensitive (P < 0.01). CONCLUSION: Hyaluronan analyses is beneficial in distinguishing malignant mesothelioma if methods such as the evaluated HPLC or radioassay with a sensitivity of 70% toward mesothelioma are used and other known causes of elevated content are considered.

  • 21.
    Pekar, Gyula
    et al.
    Central Hospital Falun, Department of Pathology and Clinical Cytology, Falun, Sweden.
    Gere, Maria
    Central Hospital Falun, Department of Pathology and Clinical Cytology, Falun, Sweden.
    Tarjan, Miklos
    Central Hospital Falun, Department of Pathology and Clinical Cytology, Falun, Sweden.
    Hellberg, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Tot, Tibor
    Central Hospital Falun, Department of Pathology and Clinical Cytology, Falun, Sweden.
    Molecular Phenotype of the Foci in Multifocal Invasive Breast Carcinomas2014In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 120, no 1, p. 26-34Article in journal (Refereed)
    Abstract [en]

    BACKGROUND Multiple synchronous, ipsilateral, invasive foci of breast carcinomas are frequent and are associated with a poorer prognosis. Few studies have investigated the prognostic and therapeutic implications of heterogeneity of such foci.

    METHODS The authors reviewed the tumor type, grade, and size of all invasive foci in a series of 110 multifocal breast carcinomas documented on large-format slides. Molecular phenotype was determined by immunohistochemistry in tissue microarray blocks using 3 classification systems. The survival of patients who had tumors with microscopic (tumor type and/or grade) heterogeneity and of those who had tumors with phenotypic heterogeneity was compared with the survival of patients who had multifocal homogeneous tumors using Kaplan-Meier curves. The hazard ratio of dying from breast cancer was also calculated.

    RESULTS Intertumoral heterogeneity in tumor type and grade was detected in 16 of 110 tumors (14.6%) and in 6 of 110 tumors (5.5%), respectively. The molecular phenotype of invasive tumor foci within the same breast differed in 10% to 12.7% of patients (11-14 of 110 tumors), depending on the classification system used. Patients who had phenotypically heterogeneous, multifocal cancers had a greater risk of dying from disease (HR=2.879; 95%CI=1.084-7.649; P=.034) and had significantly shorter survival (P=.016). Phenotypic differences were most common in patients who had tumors that were homogeneous in terms of tumor type (11 of 18 tumors) and histology grade (14 of 18 tumors). Phenotyping additional tumor foci had the potential to influence the therapeutic decisions in up to 8 patients.

    CONCLUSIONS Phenotyping more than 1 invasive focus of multifocal breast carcinomas only if the individual foci deviate microscopically appears to be insufficient, because phenotypic intertumoral heterogeneity may be observed in microscopically identical foci and has potential prognostic and therapeutic consequences. 

  • 22.
    Pekar, Gyula
    et al.
    Department of Pathology and Clinical Cytology, Falun Central Hospital, Falun, Sweden.
    Hofmeyer, Syster
    Landstinget Dalarna.
    Tabár, László
    Landstinget Dalarna.
    Tarján, Miklós
    Landstinget Dalarna.
    Chen, Tony Hsiu-Hsi
    Division of biostatistics, Graduate institute of epidemiology and preventive medicine, National Taiwan University.
    Yen, Amy Ming-Fang
    Chiu, Sherry Yueh-Hsia
    Hellberg, Dan
    Gere, Mária
    Tot, Tibor
    Multifocal breast cancer documented in large-format histology sections: long-term follow-up results by molecular phenotypes.2013In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 119, no 6Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The prognostic significance of molecular phenotype in breast cancer is well established in the literature. Recent studies have demonstrated that subgross lesion distribution (unifocal, multifocal, and diffuse) and disease extent also carry prognostic significance in this disease. However, the correlation of molecular phenotypes with subgross parameters has not yet been investigated in detail.

    METHODS: In total, 444 consecutive invasive breast cancers that were documented in large-format histology slides and worked up with detailed radiologic-pathologic correlation were sampled into tissue microarray blocks and stained immunohistochemically to delineate the molecular subtypes.

    RESULTS: Diffuse or multifocal distribution of the invasive component of breast carcinomas in this series was associated with a 4.14-fold respectively 2.75-fold risk of cancer-related death compared with unifocal tumors irrespective of molecular phenotype. Patients who had human epidermal growth factor receptor 2 (HER2)-positive cancers; estrogen receptor-negative, progesterone receptor-negative, and HER2-negative (triple-negative) cancers; or basal-like cancers had a 2.18-fold, 2.33-fold, and 4.07-fold risk of dying of disease, respectively, compared with patients who had luminal A carcinomas. Unifocal luminal A, HER2-positive, and basal-like cancers were associated with significantly better long-term survival outcomes than their multifocal or diffuse counterparts; luminal B and triple-negative tumors also had the same tendency. In multivariate analysis, patient age, tumor size category, lymph node status, lesion distribution, and molecular phenotypes remained significant.

    CONCLUSIONS: Multifocality and diffuse distribution of the invasive component were associated with significantly poorer survival in women with breast carcinomas compared with unifocal disease in patients with luminal A, HER2 type, and basal-like cancers. Molecular classification of breast cancer is a powerful tool but gains in power when combined with conventional and subgross morphologic parameters.

  • 23. Pettersson, Andreas
    et al.
    Gerke, Travis
    Fall, Katja
    Pawitan, Yudi
    Holmberg, Lars
    Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
    Giovannucci, Edward L
    Kantoff, Philip W
    Adami, Hans-Olov
    Rider, Jennifer R
    Mucci, Lorelei A
    The ABC model of prostate cancer: A conceptual framework for the design and interpretation of prognostic studies.2017In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 123, no 9, p. 1490-1496Article in journal (Refereed)
    Abstract [en]

    There has been limited success in identifying prognostic biomarkers in prostate cancer. A partial explanation may be that insufficient emphasis has been put on clearly defining what type of marker or patient category a biomarker study aims to identify and how different cohort characteristics affect the ability to identify such a marker. In this article, the authors put forth the ABC model of prostate cancer, which defines 3 groups of patients with localized disease that an investigator may seek to identify: patients who, within a given time frame, will not develop metastases even if untreated (category A), will not develop metastases because of radical treatment (category B), or will develop metastases despite radical treatment (category C). The authors demonstrate that follow-up time and prostate-specific antigen screening intensity influence the prevalence of patients in categories A, B, and C in a study cohort, and that prognostic markers must be tested in both treated and untreated cohorts to accurately distinguish the 3 groups. The authors suggest that more emphasis should be put on considering these factors when planning, conducting, and interpreting the results from prostate cancer biomarker studies, and propose the ABC model as a framework to aid in that process. Cancer 2017;123:1490-1496. © 2017 American Cancer Society.

  • 24.
    Ribom, Dan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Eriksson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Hartman, Magdalena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Genetics and Pathology.
    Engler, Henry
    Uppsala University Positron Emission Tomography Center, University Hospital, Uppsala, Sweden.
    Nilsson, Anna
    Uppsala University Positron Emission Tomography Center, University Hospital, Uppsala, Sweden.
    Långstrom, Bengt
    Uppsala University Positron Emission Tomography Center, University Hospital, Uppsala, Sweden.
    Bolander, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Bergstrom, Mats
    Uppsala University Positron Emission Tomography Center, University Hospital, Uppsala, Sweden.
    Smits, Anja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Positron emission tomography 11C-methionine and survival in patients with low-grade gliomas2001In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 92, no 6, p. 1541-1549Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    Considerable numbers of patients with low-grade gliomas experience an early malignant course and may benefit from aggressive treatment. These patients are difficult to identify using established prognostic factors. A retrospective study was performed to determine whether the 11C-methionine uptake in tumor is a survival factor in adult patients with supratentorial gliomas classified as World Health Organization Grade 2.

    METHODS

    The authors identified 89 patients with histologically confirmed low-grade gliomas in whom an 11C-methionine positron emission tomography (PET) scan had been performed as part of the diagnostic tumor investigation from 1983 to 1998. Clinical data were collected, and the PET scans were re-evaluated according to a fixed protocol. The 11C-methionine uptake in the tumor and relevant clinical parameters were entered into univariate and multivariate survival analyses.

    RESULTS

    At the end of the study, 49 patients (55.1%) had died. The median overall survival was 5.7 years. Low methionine uptake was significantly favorable in the multivariate survival analysis (P = 0.04) along with oligodendroglioma (P = 0.003). In the histologic subgroups, 11C-methionine uptake was an important survival factor among patients with astrocytomas (P = 0.05) and oligodendrogliomas (P = 0.03). Tumor resection was a favorable prognostic factor in patients with high methionine uptake (P = 0.01) but not in patients with low uptake.

    CONCLUSIONS

    Baseline 11C-methionine PET is a prognostic indicator in patients with low-grade gliomas. The results imply that PET is a valuable tool in the clinical management of these patients and may assist in the selection of patients for therapy.

  • 25. Samuelsson, Jan
    et al.
    Hasselbalch, Hans
    Bruserud, Öystein
    Temerinac, Snezana
    Brandberg, Yvonne
    Merup, Mats
    Linder, Olle
    Björkholm, Magnus
    Pahl, Heike L.
    Birgegård, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    A phase II trial of pegylated interferon alpha-2b therapy for polycythemia vera and essential thrombocythemia: feasibility, clinical and biologic effects, and impact on quality of life2006In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 106, no 11, p. 2397-2405Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Conventional interferon-alpha (IFN) is an effective treatment for patients with myeloproliferative disorders. However, many patients discontinue therapy because of side effects. METHODS: In this 24-month, Phase II feasibility study of pegylated interferon alpha-2b (PEG-IFN) treatment, a starting dose of 0.5 microg/kg per week was received by 21 patients with polycythemia vera (PV) and 21 patients with essential thrombocythemia (ET). The treatment objective, a complete platelet response (CR), was a platelet count<400x10(9)/L in symptomatic patients and <600 in asymptomatic patients. Neutrophil polycythemia rubra vera-1 (PRV-1) messenger RNA expression was analyzed prior to and during therapy. Quality of life (QoL) was investigated by using the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire. RESULTS: At 6 months, 29 of 42 patients (69%) had achieved a CR after a median of 83 days. The CR rate was not related to diagnosis, gender, or previous therapy. Nineteen patients completed the planned 2-year treatment in CR. No thromboembolic or bleeding complications were observed. Phlebotomy requirements were reduced in the majority of patients with PV. Five of 14 patients (36%) who initially were positive for PRV-1 achieved normalized PRV-1 expression under PEG-IFN treatment. Side effects were the cause of therapy failure in 16 of 23 patients. However, only 8 of 19 patients reported any side effects at 2 years. The QLQ-C30 revealed clinically significant impairments in several aspects of QoL at 6 months; however, at 2 years, QoL measurements were not different from baseline. CONCLUSIONS: PEG-IFN effectively reduced platelet counts in 29 of 42 patients, but only 19 patients maintained a CR at 2 years. The reversal of PRV-1 positivity noted in a subset of patients suggested that PEG-IFN may have an effect on the malignant clone. PEG-IFN is a valuable therapeutic alternative for patients who tolerate its initial side effects.

  • 26. Sandblom, Gabriel
    et al.
    Ladjevardi, Sam
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Urology.
    Garmo, Hans
    Varenhorst, Eberhard
    The impact of prostate-specific antigen level at diagnosis on the relative survival of 28,531 men with localized carcinoma of the prostate2008In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 112, no 4, p. 813-9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To evaluate the predictive value of prostate-specific antigen (PSA) in a population-based cohort, the authors analyzed relative survival in all men with localized prostate cancer who were registered in the Swedish National Prostate Cancer Register (NPCR) from 1996 to 2005. METHODS: All men aged <75 years with localized tumors were identified in the NPCR. A Poisson regression analysis was performed using observed death as response and the expected death rate as offset. The expected and observed numbers of survivors were calculated with stratification for PSA level and 3 categories of tumor differentiation (Gleason score 2-6, 7, and 8-10). The regression model included PSA as linear splines with a breakpoint at a PSA level of 4 ng/mL and with tumor differentiation as a categoric variable. RESULTS: The Poisson regression analysis indicated a U-shaped curve for all 3 groups, with a negative correlation between PSA and relative survival in men with PSA levels <4 ng/mL and a positive correlation for men with PSA levels >4 ng/mL. The correlation was significant for all 3 groups, but the negative correlation between PSA and relative survival was significantly more pronounced in the group with Gleason scores from 8 to 10 than in the other 2 Gleason score groups. CONCLUSIONS: The demonstration of an inverse correlation between PSA level and relative survival in the group of men with PSA levels <4 ng/mL indicated the presence of a small but clinically important subgroup with undifferentiated tumors who have cells that have lost the ability to secrete PSA. This group should be taken into consideration when deciding on treatment and when choosing a cutoff level in PSA screening programs.

  • 27.
    Schriber, Jeffrey R.
    et al.
    Virginia G Piper Canc Ctr, Canc Transplant Inst, Scottsdale, AZ USA.;Arizona Oncol, Scottsdale, AZ USA..
    Hari, Parameswaran N.
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, 9200 West Wisconsin Ave, Milwaukee, WI 53226 USA..
    Ahn, Kwang Woo
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, 9200 West Wisconsin Ave, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Dept Biostat, Inst Hlth & Soc, 9200 West Wisconsin Ave, Milwaukee, WI 53226 USA..
    Fei, Mingwei
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, 9200 West Wisconsin Ave, Milwaukee, WI 53226 USA..
    Costa, Luciano J.
    Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL 35294 USA..
    Kharfan-Dabaja, Mohamad A.
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA..
    Angel-Diaz, Miguel
    Hosp Infantil Univ Nino Jesus, Dept Hematol Oncol, Madrid, Spain..
    Gale, Robert P.
    Imperial Coll London, Dept Med, Div Expt Med, Hematol Res Ctr, London, England..
    Ganguly, Siddharatha
    Univ Kansas, Med Ctr, Div Hematol & Oncol, Blood & Marrow Transplantat, Kansas City, KS 66103 USA..
    Girnius, Saulius K.
    Univ Cincinnati, Div Hematol Oncol, Cincinnati, OH USA..
    Hashmi, Shahrukh
    Mayo Clin, Dept Internal Med, Rochester, MN USA..
    Pawarode, Attaphol
    Univ Michigan, Sch Med, Dept Internal Med, Blood & Marrow Transplantat Program,Div Hematol O, Ann Arbor, MI USA..
    Vesole, David H.
    Hackensack Univ, Med Ctr, John Theurer Canc Ctr, Hackensack, NJ USA..
    Wiernik, Peter H.
    Our Lady Mercy Med Ctr, Div Hematol Oncol, Bronx, NY USA..
    Wirk, Baldeep M.
    Seattle Canc Care Alliance, Div Bone Marrow Transplant, Seattle, WA USA..
    Marks, David I.
    Univ Hosp Bristol Natl Hlth Serv Trust, Adult Bone Marrow Transplant, Bristol, Avon, England..
    Nishihori, Taiga
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA..
    Olsson, Richard F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Lab Med, Div Therapeut Immunol, Stockholm, Sweden..
    Usmani, Saad Z.
    Carolinas HealthCare Syst, Levine Canc Inst, Dept Hematol & Med Oncol, Charlotte, NC USA..
    Mark, Tomer M.
    Weill Cornell Med Coll, Dept Med, New York, NY USA..
    Nieto, Yago L.
    Univ Texas MD Anderson Canc Ctr, Dept Stem Cell Transplantat & Cellular Therapy, Houston, TX 77030 USA..
    D'Souza, Anita
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, 9200 West Wisconsin Ave, Milwaukee, WI 53226 USA..
    Hispanics Have the Lowest Stem Cell Transplant Utilization Rate for Autologous Hematopoietic Cell Transplantation for Multiple Myeloma in the United States: A CIBMTR Report2017In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 123, no 16, p. 3141-3149Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Race/ethnicity remains an important barrier in clinical care. The authors investigated differences in the receipt of autologous hematopoietic cell transplantation (AHCT) among patients with multiple myeloma (MM) and outcomes based on race/ethnicity in the United States. METHODS: The Center for International Blood and Marrow Transplant Research database was used to identify 28,450 patients who underwent AHCT for MM from 2008 through 2014. By using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results 18 registries, the incidence of MM was calculated, and a stem cell transplantation utilization rate (STUR) was derived. Post-AHCT outcomes were analyzed among patients ages 18 to 75 years who underwent melphalan-conditioned peripheral cell grafts (N = 24,102). RESULTS: The STUR increased across all groups from 2008 to 2014. The increase was substantially lower among Hispanics (range, 8.6%-16.9%) and non-Hispanic blacks (range, 12.2%-20.5%) compared with non-Hispanic whites (range, 22.6%-37.8%). There were 18,046 non-Hispanic whites, 4123 non-Hispanic blacks, and 1933 Hispanic patients. The Hispanic group was younger (P <.001). Fewer patients older than 60 years underwent transplantation among Hispanics (39%) and nonHispanic blacks (42%) compared with non-Hispanic whites (56%). A Karnofsky score <90% and a hematopoietic cell transplantation comorbidity index score >3 were more common in non-Hispanic blacks compared with Hispanic and non-Hispanic whites (P <.001). More Hispanics (57%) versus non-Hispanic blacks (54%) and non-Hispanic whites (52%; P <.001) had stage III disease. More Hispanics (48%) versus non-Hispanic blacks (45%) and non-Hispanic whites (44%) had a very good partial response or better before transplantation (P =.005). Race/ethnicity did not impact post-AHCT outcomes. CONCLUSIONS: Although the STUR increased, it remained low and was significantly lower among Hispanics followed by non-Hispanic blacks compared with non-Hispanic whites. Race/ethnicity did not impact transplantation outcomes. Efforts to increase the rates of transplantation for eligible patients who have MM, with an emphasis on groups that underuse transplantation, are warranted. (C) 2017 American Cancer Society.

  • 28. Sorbye, Halfdan
    et al.
    Pfeiffer, Per
    Cavalli-Björkman, Nina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Qvortrup, Camilla
    Holsen, Mari H.
    Wentzel-Larsen, Tore
    Glimelius, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Clinical trial enrollment, patient characteristics, and survival differences in prospectively registered metastatic colorectal cancer patients2009In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 115, no 20, p. 4679-87Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Trial accrual patterns were examined to determine whether metastatic colorectal cancer (mCRC) patients enrolled in trials are representative of a general cancer population concerning patient characteristics and survival.

    METHODS: A total of 760 mCRC patients referred for their first oncological consideration at 3 hospitals in Scandinavia covering defined populations were registered consecutively during 2003 to 2006. Clinical trial enrollment, patient characteristics, and treatment were recorded prospectively, and the follow-up was complete.

    RESULTS: Palliative chemotherapy was initiated in 61% of the patients. Approximately one-third (36%) of patients receiving chemotherapy were included in a trial. The main reason for nonparticipation was failed eligibility criteria (69%). The median survival after chemotherapy was 15.8 months for all patients, and 18 months after combination chemotherapy. Trial patients had better prognostic characteristics and significantly longer survival than nontrial patients: 21.3 months versus 15.2 months when receiving combination chemotherapy. Poor performance status was the main reason for giving best supportive care only, and the median survival was then only 2.1 months. The median survival for all 760 nonresectable mCRC patients was 10.7 months.

    CONCLUSIONS: mCRC patients enrolled into clinical trials differ in characteristics from patients receiving chemotherapy outside protocol and have better survival, even when given the same treatment. Although trial patients have a median survival close to 2 years, survival is lower for all patients receiving chemotherapy and much lower for all patients diagnosed with mCRC. Studies that better accept the heterogeneity of the population with mCRC are needed.

  • 29. Svarvar, Catarina
    et al.
    Böhling, Tom
    Berlin, Örjan
    Gustafson, Pelle
    Folleras, Gunnar
    Bjerkehagen, Bodil
    Domanski, Henryk A
    Sundby Hall, Kirsten
    Tukiainen, Erkki
    Blomqvist, Carl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Clinical course of nonvisceral soft tissue leiomyosarcoma in 225 patients from the Scandinavian Sarcoma Group2007In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 109, no 2, p. 282-291Article in journal (Refereed)
    Abstract [en]

    BACKGROUND. Leiomyosarcoma of nonvisceral soft tissues is an uncommon malignant tumor; thus, only small numbers of cases have been reported. This study was based on a large series of patients from the Scandinavian Sarcoma Group Register acquired during a 15-year period (from 1986 to 2001). Follow-up information was available for all patients. METHODS. The authors analyzed the clinical features of 225 patients with cutaneous, subcutaneous, or deep-seated leiomyosarcoma of the extremities, trunk wall, and superficial parts of the head and neck region to determine the natural course of the disease. Only patients who received their treatment at a specialist sarcoma center were included. Re-evaluation of histopathology was performed. RESULTS. The age of the patients (121 women and 104 men) ranged from 20 years to 98 years (median, 70 years), and the tumors ranged in size from 0.6 cm to 35 cm (median, 4.0 cm). Eighty-two percent of the tumors were classified as high grade. The median follow-up for survivors was 5.5 years. The local treatment was adequate in 154 of 206 patients (75%) who were without metastasis at presentation. At 10 years, 84% of the 206 patients with localized disease at presentation were free from local recurrence, 66% remained metastasis free, and 49% were alive. Multivariate analysis showed that higher malignancy grade (P = .006), larger tumor size (P =.003), and deeper tumor location (P =.002) were correlated significantly with decreased metastasis-free survival, inadequate local treatment was correlated with local recurrence (P =.007), and high malignancy grade was correlated with decreased overall survival (P =.007). CONCLUSIONS. The long-term prognosis for patients with subcutaneous and deep-seated soft tissue leiomyosarcoma remains poor despite the ability to achieve adequate local control through nonmutilating surgery with or without radiotherapy.

  • 30.
    Valachis, Antonis
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Mamounas, Eleftherios P.
    Univ Florida, Hlth Canc Ctr Orlando Hlth, Comprehens Breast Program, Orlando, FL USA.
    Mittendorf, Elizabeth A.
    Univ Texas MD Anderson Canc Ctr, Dept Breast Surg Oncol, Houston, TX 77030 USA.
    Hayashi, Naoki
    St Lukes Int Hosp, Dept Breast Surg, Tokyo, Japan.
    Ishitobi, Makoto
    Osaka Int Canc Inst, Dept Breast Surg, Osaka, Japan;Osaka Int Canc Inst, Dept Endocrine Surg, Osaka, Japan.
    Natoli, Clara
    Univ G DAnnunzio, Dept Oral Med & Biotechnol Sci, Chieti, Italy.
    Fitzal, Florian
    Med Univ Vienna, Dept Surg, Breast Hlth Ctr, Vienna, Austria.
    Rubio, Isabel T.
    Univ Hosp VAll dHebron, Breast Canc Ctr, Breast Surg Oncol, Barcelona, Spain.
    Tiezzi, Daniel G.
    Univ Sao Paulo, Ribeirao Preto Med Sch, Breast Dis Div, Dept Gynecol & Obstet, Sao Paulo, Brazil.
    Shin, Hee-Chul
    Chung Ang Univ Hosp, Dept Surg, Seoul, South Korea.
    Anderson, Stewart J.
    Univ Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Natl Surg Adjuvant Breast & Bowel Project,Biostat, Pittsburgh, PA 15261 USA.
    Hunt, Kelly K.
    Univ Texas MD Anderson Canc Ctr, Dept Breast Surg Oncol, Houston, TX 77030 USA.
    Matsuda, Naoko
    St Lukes Int Hosp, Dept Breast Surg, Tokyo, Japan.
    Ohsumi, Shozo
    NHO Shikoku Canc Ctr, Dept Breast Oncol, Matsuyama, Ehime, Japan.
    Totomi, Athina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Nilsson, Cecilia
    Vastmanlands Cty Hosp, Ctr Clin Res, Vasteras, Sweden.
    Risk factors for locoregional disease recurrence after breast‐conserving therapy in patients with breast cancer treated with neoadjuvant chemotherapy: An international collaboration and individual patient meta‐analysis2018In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 124, no 14, p. 2923-2930Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Several studies have reported a high risk of local disease recurrence (LR) and locoregional disease recurrence (LRR) in patients with breast cancer after neoadjuvant chemotherapy (NCT) and breast-conserving therapy (BCT). The objective of the current study was to identify potential risk factors for LR and LRR after NCT and BCT. METHODS: Individual patient data sets from 9 studies were pooled. The outcomes of interest were the occurrence of LR and/or LRR. A 1-stage meta-analytic approach was used. Cox proportional hazards regression models were applied to identify factors that were predictive of LR and LRR, respectively. RESULTS: A total of 9 studies (4125 patients) provided their data sets. The 10-year LR rate was 6.5%, whereas the 10-year LRR rate was 10.3%. Four factors were found to be associated with a higher risk of LR: 1) estrogen receptor-negative disease; 2) cN+disease; 3) a lack of pathologic complete response in axilla (pN0); and 4) pN2 to pN3 disease. The predictive score for LR determined 3 risk groups: a low-risk, intermediate-risk, and high-risk group with 10-year LR rates of 4.0%, 7.9%, and 20.4%, respectively. Two additional factors were found to be associated with an increased risk of LRR: cT3 to cT4 disease and a lack of pathologic complete response in the breast. The predictive score for LRR determined 3 risk groups; a low-risk, intermediate-risk, and high-risk group with 10-year LRR rates of 3.2%, 10.1%, and 24.1%, respectively. CONCLUSIONS: BCT after NCT appears to be an oncologically safe procedure for a large percentage of patients with breast cancer. Two easy-to-use clinical scores were developed that can help clinicians to identify patients at higher risk of LR and LRR after NCT and BCT and individualize the postoperative treatment plan and follow-up.

  • 31. van Hemelrijck, Mieke
    et al.
    Drevin, Linda
    Holmberg, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Garmo, Hans
    Adolfsson, Jan
    Stattin, Pär
    Primary cancers before and after prostate cancer diagnosis2012In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 118, no 24, p. 6207-6216Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The occurrence of multiple cancers may indicate common etiology; and, although some studies have investigated the risk of second primary cancers after prostate cancer (PCa), there are no studies on cancers before PCa.

    METHODS:

    The PCBaSe Sweden database is based on the National Prostate Cancer Register (NPCR), which covers >96% of PCa cases. The authors estimated the prevalence and cumulative incidence of different cancers before and after PCa diagnosis in 72,613 men according to PCa treatment and disease stage in PCBaSe and their matched comparison cohort of men who were free of PCa.

    RESULTS:

    In total, 6829 men were diagnosed with another primary cancer before their PCa diagnosis, including 138 men at the time of PCa diagnosis and 5230 men were diagnosed after PCa diagnosis. Cancer of the bladder or colon and nonmelanoma of the skin were the 3 most frequently observed cancers before and after PCa diagnosis. At the time of PCa diagnosis, the prevalence of these 3 cancers was 1.94% for bladder cancer, 1.08% for colon cancer, and 1.08% for nonmelanoma skin cancer, compared with 1.30%, 0.96%, and 1.03%, respectively, for the matched comparison cohort. Five years after PCa diagnosis, the difference in incidence proportion between PCa men and their comparison cohort was 7‰ (95% CI, 5.6‰-8.5‰), 1.3‰ (0‰-2.6‰), and 1.6‰ (0.6‰-2.6‰) for these 3 cancers, respectively. From a uro-oncologic point of view, it is interesting to note that the prevalence of kidney cancer at the time of PCa diagnosis was 0.42% compared with 0.28% for the matched comparison cohort.

    CONCLUSIONS:

    Approximately 17% of all PCa occurred in combination with another primary cancer (before or after PCa diagnosis). Detection bias probably explains part of this observation, but further investigations are required to assess possible underlying mechanisms.

  • 32. Van Hemelrijck, Mieke
    et al.
    Garmo, Hans
    Holmberg, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Walldius, Göran
    Jungner, Ingmar
    Hammar, Niklas
    Lambe, Mats
    Prostate cancer risk in the Swedish AMORIS study: the interplay among triglycerides, total cholesterol, and glucose2011In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 117, no 10, p. 2086-2095Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In a cohort including 5112 prostate cancer (pCa) patients, the authors investigated associations among triglycerides (TG), total cholesterol (TC), and pCa while taking into account glucose. METHODS: A cohort (n = 200,660) based on 4 groups of men, according to age at cohort entry, with TG, TC, and glucose measurements was selected from the Apolipoprotein MOrtality RISk (AMORIS) database. Of these, 5112 men developed pCa. Multivariate Cox proportional hazard models were used to analyze associations among TG, TC, and pCa. Competing risks were assessed graphically. RESULTS: Age-stratified analyses for quartiles of TG, TC, and glucose showed a negative association between glucose and pCa risk (HR, 0.93; 95% CI, 0.86-1.01), 0.93 (0.86-1.01), 0.87 (0.81-0.94) for the second, third, and fourth quartiles compared with the first (P-trend = .001). Stratified analysis by glucose levels (< 6.11 or >= 6.11 mmol/L) showed a positive association between hypertriglyceridemia (TG >= 1.71 mmol/L) and pCa risk, when there were high glucose levels (HR, 1.23; 95% CI, 1.01-1.48). No association was found for hypercholesterolemia (TC >= 6.50 mmol/L). Competing risk analysis showed that protective effects of glucose were overestimated in conventional Cox proportional hazard models and strengthened positive findings between TG and pCa risk. CONCLUSIONS: The authors' findings supported the hypothesis that factors of the glucose and lipid metabolism influence pCa risk. Competing risk assessment showed that it is important to take into account the long natural history and age distribution of pCa when interpreting results. The authors' findings indicate another reason to fight the increasing prevalence of obesity and dyslipidemia.

  • 33.
    Welin, Staffan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Sorbye, Halfdan
    Sebjornsen, Sigrunn
    Knappskog, Stian
    Busch, Christian
    Öberg, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Clinical effect of temozolomide-based chemotherapy in poorly differentiated endocrine carcinoma after progression on first-line chemotherapy2011In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 117, no 20, p. 4617-4622Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients with metastatic poorly differentiated endocrine carcinoma (PDEC) usually have a short survival. The chemotherapy combination of cisplatin and etoposide is frequently used as first-line palliative chemotherapy. There are, however, no published studies concerning second-line treatment of the disease. Temozolomide has shown clinical effect in well-differentiated endocrine carcinomas. This study was performed to evaluate the effect of temozolomide in PDEC patients who had progressed on first-line treatment.

    METHODS: Twenty-five patients with PDEC (mainly gastrointestinal) were treated with temozolomide alone or in combination with capecitabine. A subset of patient also received bevacizumab. MGMT methylation was analyzed in tissue specimens. Data were collected retrospectively.

    RESULTS: One patient had a complete response, and 7 patients had partial response (33% response rate). Median duration of response was 19 months. Another 9 (38%) patients had a stable disease, after progression at inclusion, with a median duration of 18 months. Median progression-free survival for all patients was 6 months, and median overall survival was 22 months. Only 1 patient had a MGMT methylation.

    CONCLUSIONS: Treatment with temozolomide alone or in combination with capecitabine and bevacizumab resulted in objective response or stabilization in 71% of PDEC patients who failed on first-line chemotherapy. These results indicated that temozolomide may be used as second-line treatment in PDEC.

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