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J W Coebergh

Publications and source records attributed to J W Coebergh.

At least 73 records · Page 4Linked to original sources
PubMed1999

Unchanged survival of gastric cancer in the southeastern Netherlands since 1982: result of differential trends in incidence according to Laurén type and subsite.

Despite widespread use of endoscopy and improved surgical treatment, the prognosis for gastric cancer remains poor. Although the incidence has been declining for more than 2 decades, unfavourable changes in relative frequency of histological subtypes and subsites may have occurred. We therefore assessed the nature and impact of these changes in association with socio-economic status in a population-based study during the period 1983-1995. Furthermore, tumour characteristics were analysed as predictors of survival for 1,543 cases recorded in the Eindhoven Cancer Registry during the period 1983-1992. Overall 5-year relative survival remained at 22%, being 70%, 37% and 11% for stage I, II and III, respectively. The Laurén histological type and location were also found to have prognostic value. Tumours with the worst prognosis (diffuse type and located at the cardia) developed predominantly in younger patients and were increasing. Moreover, unlike for other tumours, high educational status was associated with unfavourable prognosis. Stage at diagnosis and survival have remained unchanged, despite likely improvements in early detection through better access to endoscopy and better supportive care after surgical treatment. The unfavourable, in part relative, changes in incidence are likely to be responsible for the lack of improvement of survival rates.

Adult↗
PubMed1999

Local recurrence after breast conservation therapy for early stage breast carcinoma: detection, treatment, and outcome in 266 patients. Dutch Study Group on Local Recurrence after Breast Conservation (BORST).

BACKGROUND: Controversy exists concerning the roles of mammography and physical examination in the detection of local recurrence after conservation therapy for breast carcinoma. In addition, the prognostic factors for and optimal treatment of patients with local recurrence are uncertain. METHODS: At eight radiotherapy institutes, two cancer institutes, and one surgical clinic in the Netherlands, regular follow-up of patients who underwent breast conservation therapy between 1980 and 1992 identified 266 patients with local recurrence in the breast. These patients exhibited no clinical signs of distant metastases at the time of diagnosis of the local recurrence. Data on the method of detection were available for 189 patients (72%). Local recurrence was diagnosed by mammography alone in 47 cases (25%). Of all patients, 85% underwent salvage mastectomy, 8% underwent local excision, 4% received systemic treatment only, and 3% remained untreated. Specimens of the primary tumor were available for review from 238 of the 266 patients (89%). RESULTS: Local recurrences detected by mammography alone were smaller than those detected by physical examination (P = 0.04). At 5 years from the date of salvage treatment, the overall survival rate for all 266 patients was 61% (95% confidence interval [CI], 55-67%), and the distant recurrence free survival rate was 47% (95% CI, 40-53%). For the 25 patients with noninvasive recurrence, these figures were 95% and 94%, respectively. Skin involvement, the extent of recurrence (< or = 10 mm vs. >10 mm), and both lymph node status and histologic grade of the primary disease were strong predictors for distant metastases in patients with invasive recurrence. CONCLUSIONS: Patients with invasive local recurrence more than 1 cm in size are at a substantial risk for distant disease. The better distant disease free survival for patients with recurrence measuring 1 cm or less may indicate that early detection can improve the treatment outcome. Recurrence with skin involvement should be considered generalized disease.

Adult↗
PubMed1999

Prevalence of co-morbidity and its relationship to treatment among unselected patients with Hodgkin's disease and non-Hodgkin's lymphoma, 1993-1996.

A population-based series of patients with cancer is likely to comprise more patients with serious co-morbidity than clinical trials because of restrictive eligibility criteria for the latter. Since co-morbidity may influence decision-making, we studied the age-specific prevalence of co-morbidity and its relationship to applied treatment. Data on all 194 patients with Hodgkin's disease (HD) and on 904 patients with non-Hodgkin's lymphoma (NHL) diagnosed between 1993 and 1996 were derived from the Eindhoven Cancer Registry. In the age-group below 60 years, 87% of patients with HD and 80% with NHL did not have a co-morbid condition. The prevalence of serious co-morbidity was 56% for patients with Hodgkin's disease who were 60 years and over and 43% and 61% for non Hodgkin patients who were 60-69 years and 70 years and over, respectively. The most common co-morbid conditions were cardiovascular disease (18%), hypertension (13%), chronic obstructive pulmonary disease (COPD; 13%), and diabetes mellitus (10%) for elderly Hodgkin's patients. For non-Hodgkin's patients of 60-69 years and 70 years and over, cardiovascular disease (15 and 22%, respectively), hypertension (14 and 14%, respectively), COPD (6 and 10% respectively), and diabetes mellitus (8 and 10%, respectively) were the most prevalent co-morbid conditions. The presence of co-morbidity was not related to stage or grade of disease at diagnosis. In the presence of co-morbidity, 50% less chemotherapy was administered to elderly patients with Hodgkin's disease and 10-15% less to elderly patients with non-Hodgkin's lymphoma. The presence of co-morbidity was associated with a decreased overall survival within the first 4 months after diagnosis in both Hodgkin's disease and non-Hodgkin's lymphoma for all age-groups. In conclusion, serious co-morbidity was found for more than half of all lymphoma patients who were 60 years and older. Elderly patients with serious co-morbidity received chemotherapy less often, which is likely to affect survival adversely, as was indicated by a decreased survival within the first 4 months after diagnosis.

Adolescent↗
PubMed1999

High grade MALT-lymphoma of the breast.

A 65-year-old woman presented with a rapidly growing breast tumor, initially diagnosed as a carcinoma. Histology showed a breast lymphoma of high grade MALT-type. A lymphoma should always be considered in the differential diagnosis of a breast tumor, because it needs a different work-up and treatment. The subgroup of NHL of Mucosa-Associated-Lymphoid-Tissue origin has different clinical behaviour, as illustrated in this report.

Aged↗
PubMed1999

Differences between hereditary and sporadic ovarian cancer.

Approximately 5% of ovarian cancer cases can be attributed to an autosomal dominant inheritance factor. The majority of these cases are due to germline mutations in the BRCA1 or BRCA2 tumoursupressor genes. Patients with hereditary disease do not exhibit pathognomonic features that would allow distinction from non-hereditary (sporadic) cases of ovarian cancer. Our studies are aimed at identifying clinical, histopathological as well as molecular genetic differences between hereditary and sporadic ovarian cancer. Clinical studies of the ovarian cancer cases in 31 families revealed differences regarding age at onset and stage as well as in survival compared with cancer registry controls. The molecular studies of hereditary ovarian cancer are still underway and some preliminary data is discussed.

Age Factors↗
PubMed1999

Serious co-morbidity among unselected cancer patients newly diagnosed in the southeastern part of The Netherlands in 1993-1996.

The purpose of this study was to determine the prevalence of serious concomitant conditions at diagnosis among unselected patients with cancer, increasingly older in industrialized countries. About 34,000 newly diagnosed cancer patients were recorded in the Eindhoven Cancer Registry between 1993 and 1996; subsequently data on serious co-morbidity, classified according to the Charlson scheme (J Chron Dis 1987; 40: 373-383), were collected from the clinical records by registry personnel. Co-morbid conditions were present in 12% of adult patients below 45 years of age, 28% of those 45-59 years, 53% of those 60-74 years, and 63% of patients over 75 years of age, the prevalence being highest for patients with lung (58%), kidney (54%), stomach (53%), bladder (53%), and prostate cancer (51%). Males exhibited a 10% higher prevalence than females with similar tumors. Among patients over 60 years the most frequent conditions were heart and vascular diseases (ranging across the various tumors from 10% to 30%), hypertension (11-25%), another cancer (10-20%), COPD (chronic obstructive pulmonary disease) (3-25%), and diabetes mellitus (5-25%). Inclusion of frequent co-morbid conditions in prognostic research as well as the development of specific guidelines for patient care seems warranted.

Adult↗
PubMed1999

Population density and childhood leukaemia: results of the EUROCLUS Study.

The EUROCLUS study assembled incidence data for 13,551 cases of childhood leukaemia (CL) diagnosed between 1980 and 1989 in 17 countries (or regions of countries). These were referenced by location at diagnosis to small census areas of which there were 25,723 in the study area. Population counts, surface area and, hence, population density were available for all these small areas. Previous analyses have shown limited extra-Poisson variation (EPV) of case counts within small areas; this is most pronounced in areas of intermediate population density (150-499 persons/km2). In this study, the data set was examined in more detail for evidence that variations in incidence and EPV of CL are associated with population density. Incidence showed a curvilinear association with population density and was highest in areas which were somewhat more densely populated (500-750 persons/km2), where the incidence rate ratio relative to areas having > or = 1000 persons/km2 was 1.16 (95% confidence interval 1.07-1.26) and the P value for quadratic trend across eight strata of population density was 0.02. Incidence in these areas is uniformly elevated and showed no evidence of heterogeneity (i.e. EPV). Statistically significant evidence of EPV was evident amongst some of the areas previously classified as intermediate density areas (specifically, those with a density of 250-499 persons/km2, P < 0.001 for CL). These results were interpreted in terms of the current aetiological hypotheses for CL which propose that exposure to localised epidemics of one or more common infectious agent may contribute to the development of leukaemia. They suggest that such epidemics arise regularly in moderately densely populated areas and also sporadically in areas which are somewhat less densely populated. Although other interpretations are possible, these results may assist in the identification of characteristics which infectious agents must possess if direct or indirect causes of CL.

Child↗
PubMed1999

The rise in incidence of lymphomas in Europe 1985-1992.

A collaborative study was carried out of the descriptive epidemiology of the lymphomas from seven countries across Europe in the period 1985-1992. Careful attention was paid to sources of information and the data quality in close collaboration with expert histopathologists. The data were classified as non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD). An attempt was made to put the data into a modified version of the Revised European American Lymphoma (REAL) classification. We observed an overall rise in total NHL throughout the time period in all European countries but no such trend in HD. The increase in NHL overall being 4.2% per annum, representing an increase of 4.8% in males and 3.4% in females per annum, was only marked in middle and old age. Such increases were observed in all participating areas except in Burgundy. Different countries, however, have different base rates, the rates being highest in Scandinavia and the Netherlands. The analysis by subcategory classification suggested that the increase in NHL was confined to the follicle centre cell type, extranodal B-cell, nodal T-cell and nodal lymphomas not otherwise specified, categories. These new observations present a picture of real increase in case incidence with no obvious explanation. The increases in NHL do not appear to be due solely to better diagnoses. Pending other explanations or refutation, these present a compelling picture of an inexorable rise in incidence of this disease.

Adolescent↗
PubMed1999

Family history of breast cancer and local recurrence after breast-conserving therapy. The Dutch Study Group on Local Recurrence after Breast Conservation (BORST).

The impact of a family history of breast cancer on the local recurrence (LR) risk after breast-conserving therapy (BCT) was performed within the framework of a large, multicentre matched case-control study of risk factors for LR after BCT (BORST study). Family history was assessed for 218 breast cancer patients with LR (cases) and 480 patients without LR (controls). Detailed histological tumour features were determined by review of the primary tumour. The risk of LR for patients with a positive family history was similar to or less than that of non-familial patients (unadjusted odds ratio (ORunadj) 0.66 (95% confidence interval (CI) 0.40-1.08)). Familial patients were older than non-familial patients (P = 0.07) and their tumours had a lower histological grade (P = 0.07). A second primary tumour occurred significantly more often in familial patients (P = 0.02). Adjustment for these factors did not essentially alter the results (ORadj 0.71 (0.38-1.32)). Separate analyses according to age at onset (younger and older than 50 years) and time to LR/site of LR produced similar results. The sole presence of a positive family history of breast cancer does not appear to be a risk factor for local recurrence after BCT. Whilst this might be different for genetically predisposed patients, a positive family history does not appear to be a contra-indication for BCT.

Breast Neoplasms↗
PubMed1999

Histological determinants for different types of local recurrence after breast-conserving therapy of invasive breast cancer. Dutch Study Group on local Recurrence after Breast Conservation (BORST)

The purpose of this study was to determine which histological factors are associated with an increased risk for local recurrence in the breast after breast-conserving therapy for early breast cancer (TNM stage I and II) and whether risk patterns vary according to menopausal status and type of local recurrence. Through complete follow-up of the patients of eight regional radiation oncology departments, two cancer institutes and one surgical clinic in The Netherlands, 360 patients were identified with local recurrence in the breast after having received breast-conserving therapy (local tumour excision, axillary dissection and irradiation of the whole breast and a boost to the tumour bed) during the 1980s. For each case, two controls with a follow-up of similar duration without local recurrence were randomly selected. Histological slides of the primary tumour were reviewed. Among premenopausal patients the risk of recurrence for those younger than 35 years was significantly higher than that for premenopausal patients of 45 years or older (relative risk (RR) 2.9; 95% confidence interval (95% CI) 1.3-6.6, P < 0.05). The risk of recurrence at or near the site of the primary tumour was most significantly increased for patients with high grade extensive intraductal component (EIC) adjacent to the primary tumour (RR 4.1; 95% CI 1.7-9.8, P < 0.01). Microscopic margin involvement was an important risk indicator for diffuse recurrence and recurrence in the skin of the breast, especially in the presence of vascular invasion (RR 25; 95% CI 4.0-150, P < 0.001). To prevent local recurrence at or near the site of the primary tumour, local excision with a 1-2 cm margin of healthy tissue and a 15 Gy boost seemed adequate local treatment for patients with well differentiated EIC. In contrast, a wider surgical margin, a higher boost dose or mastectomy should be considered for patients with poorly differentiated EIC. Microscopic margin involvement in the presence of vascular invasion significantly increases the risk of diffuse recurrence or recurrence in the skin.

Adult↗
PubMed1999

Striking increase in incidence of prostate cancer in men aged < 60 years without improvement in prognosis.

Increased awareness and improved diagnostic techniques have led to earlier diagnosis of prostate cancer and increased detection of subclinical cases, resulting in improved prognosis. We postulated that the considerable increase in incidence under age 60 is not attributable only to increased detection. To test this hypothesis, we studied incidence, mortality and relative survival among middle-aged patients diagnosed in south-east Netherlands and East Anglia (UK) between 1971 and 1994. Prostate-specific antigen (PSA) testing did not occur before 1990. Between 1971 and 1989, the age-standardized incidence at ages 40-59 increased from 8.8 to 12.5 per 10(5) in The Netherlands and from 7.0 to 11.6 per 10(5) in East Anglia. Five-year relative survival did not improve in East Anglia and even declined in southeast Netherlands from 65% [95% confidence interval (CI) 47-83) in 1975-79 to 48% (CI 34-62) in 1985-89. Mortality due to prostate cancer among men aged 45-64 years increased by 50% in south-east Netherlands and by 61% in East Anglia between 1971 and 1989, but decreased slightly in the 1990s. Because other factors adversely influencing the prognosis are unlikely, our results indicate an increase in the incidence of fatal prostate cancer among younger men in the era preceding PSA testing.

Adult↗
PubMed1999

Increase in and stabilization of incidence and mortality of primary cutaneous malignant melanoma in Western Netherlands, 1980-95.

In summer 1989, a skin cancer campaign was organized in the coastal area of western Netherlands. In order to assess the impact of this and future campaigns on detection rates for melanomas of various thicknesses, a frame of reference for the epidemiology of cutaneous melanoma was established. We performed a retrospective investigation of all melanomas diagnosed in this region in the period 1980-95. A total of 3705 (2967 invasive and 738 in situ melanomas) cases was analysed. During the 1980s the age-adjusted incidence of invasive melanoma steadily increased (from five in 100,000 to 11 in 100,000 for men and from nine in 100,000 to 14 in 100,000 for women). Since 1988/89 the rate has remained stable for men and has increased only slightly among women. Detection rates for in situ melanomas followed the same pattern. Mortality rates remained largely unchanged for both sexes (European standard rates are about 2.6 in 100,000 for men and 2.2 in 100,000 for women). The median Breslow thickness decreased from 1.2 to 1.1 mm for men and from 1.1 to 0.8 mm for women. A marked increase occurred in the proportion of thin melanomas in comparison with intermediate and thick tumours, particularly among women. The female/male ratio declined in the period studied from 2.0 to 1.5. Directly after the campaign in 1989 a temporary increase occurred in the total number of melanomas diagnosed, largely due to more thin melanomas (</= 1.50 mm). These findings are discussed, particularly the possible implications of the most remarkable finding of this study: the stabilization of the incidence rates in recent years. We conclude, given the recent stabilization of rates and the relative favourable thickness, that screening or surveillance should be confined to high-risk groups.

Aged↗
PubMed1999

Comorbidity in patients with prostate cancer and its relevance to treatment choice.

OBJECTIVE: To evaluate the prevalence of comorbidity among patients with prostate cancer in relation to tumour and patient characteristics and to assess if comorbidity was a determining factor in the treatment choice for patients with localized prostate cancer. PATIENTS AND METHODS: Serious comorbidity was recorded in the Eindhoven Cancer Registry (according to a published list of such diseases) for all patients (2941) with prostate cancer newly diagnosed between 1993 and 1996 in the southern part of The Netherlands. Logistic regression was then used to assess which factors determined the treatment choice. RESULTS: The prevalence of at least one serious comorbid condition was 38% for patients aged 60-69 years, 48% when aged 70-74 years and 53% for those aged >/=75 years, the cardiovascular and chronic obstructive lung diseases being most frequent. Patients aged 60-69 years were more likely to be treated with radical prostatectomy for moderately differentiated tumour confined to the prostate, or when younger and diagnosed in a hospital with a high case-load. The presence of comorbidity had little influence of this choice. CONCLUSION: Comorbidity was common in patients with prostate cancer, but the decision of urologists in the southern Netherlands to use radical prostatectomy was determined largely by the patient's age and the urologist's experience.

Age Factors↗
PubMed1999

The relationship between findings on pre-treatment mammograms and local recurrence after breast-conserving therapy for invasive breast cancer.

AIMS: This study was planned (a) to determine the correlation between findings on the pre-treatment mammogram and local recurrence after breast-conserving therapy (BCT), and (b) to analyse the relationship between mammographical features, specific pathological characteristics and the need for re-excision. METHOD: The size and outline of the lesion, the presence of suspect microcalcifications and signs of multifocality on pre-treatment mammograms of 39 patients with local recurrence after BCT and 126 randomly selected control patients without local recurrence were compared. Tissue slides of the primary tumour were reviewed to confirm the histological type and grade, the aspect of the margins, microscopic margin involvement, presence of vascular invasion and the presence and extent of an intraductal component. RESULTS: Among patients </=50 years of age, the proportion with a mammographically occult tumour was 48% of the patients with local recurrence and 26% of the control group (P=0.05). In the age group >/=50 years, 67% of the patients with local recurrence had a non-circumscribed lesion compared to 9% of the control group (P<0.001). Suspect microcalcifications on the mammogram were associated with the finding of an extensive intraductal component, vascular invasion and a higher histological grade by the pathologist. Patients with a non-circumscribed density or a scirrhous lesion needed re-excision more often (30 and 33%, respectively) than those with a well-circumscribed density (9%). CONCLUSIONS: Although the number of patients was small, this study indicates that some mammographical features are associated with a higher risk of local recurrence after BCT and the need for re-excision. This was supported by the findings of the pathological review.

Breast Neoplasms↗
PubMed1999

Increased risk of fatal prostate cancer may explain the rise in mortality in The Netherlands.

BACKGROUND: Several lines of evidence suggest that, as a result of improved diagnostic techniques, the increase in incidence of prostate cancer is due largely to increased detection of subclinical cases. Between 1971 and 1989, a considerable increase in incidence was found in Southeastern Netherlands among men aged under 60 years without an improvement in prognosis. We hypothesized that in addition to the increase due to increased detection, a genuine increase in incidence has occurred in the last two decades and that this should be reflected in national mortality rates. METHODS: Age-specific and age-adjusted mortality rates were calculated to determine whether mortality due to prostate cancer continued to increase after 1990. Using log-linear Poisson modelling according to Clayton and Schifflers, we estimated the contribution of period and cohort effects to prostate cancer mortality between 1955 and 1994. RESULTS: The age-adjusted mortality increased from 22 in 1955-1959 to 33 per 10(5) in 1990-1994 (European standardized rate). For men under 65, the rates stabilized after 1989. The age-cohort model fitted the data better than the age-period model. Therefore, the increase in mortality can be explained largely by the increasing risk for successive birth cohorts for men born until 1930. However, more frequent reporting of prostate cancer as the underlying cause of death (partly attributable to a decline in competing causes of death) may have occurred as well. CONCLUSIONS: Our findings suggest an increased risk of fatal prostate cancer in The Netherlands between 1955 and 1994.

Aged↗
PubMed1999

Consensus on the management of malignant melanoma of the skin in The Netherlands. Dutch Melanoma Working Party.

In 1996 the Dutch Melanoma Working Party, in co-operation with the National Organization for Quality Assurance in Hospitals in the Netherlands and the Dutch Association of Comprehensive Cancer Centres, organized the third consensus conference on the management of melanoma of the skin. The following guidelines were approved. The recommended margin for diagnostic excision is 2 mm of macroscopically normal skin around the lesion; the margins for therapeutic excision are 1 cm of normal skin for a Breslow thickness of < or = 2 mm and 2 cm for a Breslow thickness of > 2 and < or = 4 mm. A margin of at least 2 cm also appears to be justified for thicker melanomas. Elective lymph node dissection is not recommended. Sentinel node biopsy appears to be a promising method to detect occult metastases in the regional lymph nodes. If regional lymph node metastases are present, therapeutic regional lymph node dissection must be conducted. Isolated regional perfusion is indicated for inoperable tumour growth in an extremity. Radiotherapy can be applied curatively (for example, if surgery is not possible), palliatively (if desired in combination with hyperthermia) or postoperatively (if non-radical resection is suspected). Adjuvant systemic therapy for melanoma patients is still experimental. Atypical (dysplastic) naevi and congenital naevi are major risk factors for melanoma. No consensus has been reached about the prophylactic excision of all congenital naevi. A follow-up period of 5 years is sufficient for patients with a melanoma of < or = 1.5 mm Breslow thickness (provided there are no histological signs of regression) and of 10 years when the Breslow thickness is > 1.5 mm. The patient should be actively involved in the follow-up (inspection, palpation). Regular routine blood tests, radiological examination and ultrasound scanning are not considered to be worthwhile. There is no evidence that the growth of micro-metastases is stimulated by hormonal changes during pregnancy or contraceptive pill use. Excessive exposure to ultraviolet radiation should be discouraged. Regular population screening for melanoma is not considered to be worthwhile, owing to the relatively low frequency and the predominantly favourable stage at the time of diagnosis, particularly in young people.

Diagnosis↗
PubMed1999

Increased but low incidence and poor survival of malignant mesothelioma in the southeastern part of The Netherlands since 1970: a population-based study.

Changes in the incidence and survival rates for malignant mesothelioma in the southeastern part of The Netherlands since 1970 were investigated, using data from the Eindhoven Cancer Registry (ECR). The exposure to asbestos in this area is presumed to be limited. Most of the mesotheliomas occurred in the pleura, where there were 119 (88%) against 15 (11%) in the peritoneum and two in the tunica vaginalis testis. Compared to other European countries, the incidence rate for the southeastern part of The Netherlands was fairly low in the second half of the 1980s. Between 1975 and 1994 the age-adjusted incidence rates (ESR) for pleural mesothelioma increased twofold (from 10 to 19 per one million person-years among men and from 2.4 to 3.8 among women). The rate for peritoneal mesothelioma remained constant. The overall relative 0.5-, 1-, and 3-year survival rates remained 68, 42, and 8%, respectively. The fourfold higher incidence rate for men compared with women reflects the fact that mesothelioma is mainly an occupational disease. In view of presumed limited exposure to asbestos and small geographical variation, the incidence of mesothelioma in the southeastern part of The Netherlands will probably remain low, despite an increase in the past decades.

Adult↗