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PubMed1981

Survival following breast cancer surgery in the elderly.

A retrospective analysis was performed on a series of 780 patients with breast cancer who underwent surgery, with emphasis on survival in the 138 patients over 70 years of age (elderly group). Absolute survival rates were determined using life table methods. Relative survival figures were derived from absolute figures by adjusting for expected longevity in each group. Patients over 70 years of age had overall 5 and 10 year absolute survival rates of 54% and 41%, respectively, which did not differ significantly from survival rates of younger patients. Relative five-year survival rates for the elderly were actually higher than those of younger patients, being 90% for those with local disease and 65% for those with regional disease. Survival in the elderly was comparable to that of younger patients, irrespective of race, type of surgery, histology or tumor size. These findings support the conclusion that there is little justification for avoiding conventional operative treatment in elderly patients with breast cancer solely on the basis of advanced age.

Age Factors↗

PubMed1984

Thyroid carcinoma in Malmö, 1960-1977. Epidemiologic, clinical, and prognostic findings in a defined urban population.

One hundred four cases of clinically significant thyroid carcinoma (TC) occurred in a demographically well defined area with, on an average, 243,000 inhabitants, during an 18-year period, corresponding to a yearly incidence of 2.4 per 100,000. During the later years of the study there was an increase of the age-standardized incidence of differentiated TC. The reason for this is suggested to be a greater health awareness, because only the number of tumors with less advanced growth increased. Sixty-one patients had, as the only presenting sign, a solitary thyroid nodule, while 24 had obviously malignant disease. All cases were revised histologically. Sixty-six patients were found to have papillary carcinoma, whereas 22 cases were diagnosed as follicular, 4 as medullary, and 12 as anaplastic. The prognosis, as estimated by the life-table method, was worse for patients with anaplastic cancer followed by follicular, papillary, and medullary. Within the papillary group, patients with occult cancer, i.e., thyroid tumor not larger than 1.5 cm, and intrathyroidal cancer, i.e., thyroid tumor larger than 1.5 cm but not penetrating the thyroid capsule, had a cumulated survival rate not significantly different from the expected rate, and only 1 of the 46 patients belonging to these two subgroups, died from TC.

Adenocarcinoma↗

PubMed1984

Multiple primary tumors in association with prostatic cancer.

One hundred forty-six patients with clinically nonmetastatic carcinoma of the prostate were treated at Columbia-Presbyterian Medical Center from 1964 through 1976. Of these 146 patients, 24 (16.4%) had developed at least one additional primary cancer. This review contrasts the 122 patients who had a single primary prostate cancer only with the 24 patients who had additional primary carcinomas with respect to age, racial distribution, clinical stage, and prostate cancer histology including Gleason's score, patterns of failure of prostate cancer, and survival data. Local failure and distant failure were less in the multiple primary group. Patients with high Gleason's scores appear to be at greater risk for second primaries. Five-year observed survival (by actuarial life table method) for the single prostate primary group was 76.5%, and 5-year observed survival of the prostate multiple primary group where prostate cancer appeared first was 71%.

Adult↗

PubMed1985

Subsequent upper aerodigestive malignancies following treatment of esophageal cancer.

One hundred ninety-eight patients received radiation therapy for carcinoma of the esophagus. Eight patients subsequently developed at least one other epidermoid carcinoma within the upper aerodigestive tract. Analysis by life-table method suggests a steadily increasing risk for second malignancies as survival lengthens. Implications with regard to the treatment and management of patients with squamous cell carcinoma of the esophagus are discussed and the relevant literature is reviewed.

Carcinoma, Squamous Cell↗

PubMed1985

Leukemia relapse in long-term survivors of acute leukemia.

Between 1964 and 1982, 862 patients with acute leukemia who were collected from medical institutions throughout the country had a survival of 5 years or longer. Their remission has been achieved mainly with a combination therapy of vincristine and prednisone in childhood acute leukemia and daunomycin, cytosine arabinoside, 6-mercaptopurine, prednisone (DCMP) regimen in adult acute leukemia. Among 320 relapsed patients, 88 (38.8%) of 227 children had a primary relapse in the marrow, 85 in the central nervous system (CNS), 37 in the testis/ovary, and 13 in a combined site. The large majority of adult relapsed patients relapsed in the marrow. Ninety-three patients who experienced only one relapse had a much longer prolongation of survival, not yet reaching a median over 14 years after diagnosis, compared to those experiencing two or more relapses. Survival curves in five groups of patients divided by length of maintained remission were investigated by the life table method. In children as well as adults, survival duration in patients on 5 or more years maintained remission was significantly longer than that in the other maintained groups. With respect to relation between frequency of CNS relapse and type of CNS prophylaxis, there was no statistically significant difference between patients who received CNS prophylaxis and patients who did not. However, a better survival was observed in patients who received CNS prophylaxis with cranial radiation plus intrathecal methotrexate. Thus, long-term clinical follow-up might provide important information for the therapeutic strategy against acute leukemia.

Actuarial Analysis↗

PubMed1989

Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases.

Two of the most important prognostic indicators for breast cancer are tumor size and extent of axillary lymph node involvement. Data on 24,740 cases recorded in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute were used to evaluate the breast cancer survival experience in a representative sample of women from the United States. Actuarial (life table) methods were used to investigate the 5-year relative survival rates in cases with known operative/pathologic axillary lymph node status and primary tumor diameter. Survival rates varied from 45.5% for tumor diameters equal to or greater than 5 cm with positive axillary nodes to 96.3% for tumors less than 2 cm and with no involved nodes. The relation between tumor size and lymph node status was investigated in detail. Tumor diameter and lymph node status were found to act as independent but additive prognostic indicators. As tumor size increased, survival decreased regardless of lymph node status; and as lymph node involvement increased, survival status also decreased regardless of tumor size. A linear relation was found between tumor diameter and the percent of cases with positive lymph node involvement. The results of our analyses suggest that disease progression to distant sites does not occur exclusively via the axillary lymph nodes, but rather that lymph node status serves as an indicator of the tumor's ability to spread.

Breast Neoplasms↗

PubMed1990

Survival of the older patient compared with the younger patient with Hodgkin's disease. Influence of histologic type, staging, and treatment.

Age as an independent risk factor for survival of Hodgkin's disease (HD) was investigated using data for the 6345 patients in the American College of Surgeons, Patterns of Care Study. Patients were divided into those 15 to 34 years of age, and those older than 50 years. Older patients had higher rates of advanced stage and B symptoms (e.g., Stage IVB, 19.7% compared with 7.7%) and significantly higher rates of poor prognosis histologic types, odds ratio (OR) = 3.7. The older population with clinical stage (CS) I and II disease was also less likely to have received any of the selected staging procedures, bone marrow biopsy, lymphogram, or laparotomy (OR = 4.48). The two populations were equivalently understaged when CS was compared with pathologic stage (PS). In each category the older patients were more likely to have received no therapy; for PS I and II disease the OR for older patients compared with the younger patient was 2.14. When stratified by PS, B symptom status, histologic type, and treatment the older patients continued to show poorer 5-year survival by the life-table method. The authors' hypothesis--that older patients equivalently staged and treated would have no significant difference in long-term survival--was not substantiated by the data. However, in the analyses in which corrections for the known risk factors were made, the difference in survival was not as great as that in the crude, unstratified data. This study, as well as other recent studies utilizing smaller numbers of patients, finds age an independent predictor of poorer survival in HD patients.

Adolescent↗

PubMed1991

Cancer incidence among asbestos-exposed chemical industry workers: an extended observation period.

A previous study on the incidence of cancer in a cohort of 286 asbestos-exposed electrochemical industry workers observed from 1953 through 1980 has been extended with another 8 years of follow-up. The incidence of cancer was derived from the Cancer Registry of Norway, and the expected figures were calculated by a life table method. During the extended follow-up period from 1981 through 1988, among the cohort members there were 12 new cancer cases versus 14.2 expected (SIR 85, 95% CI 44-158). In a lightly exposed sub-cohort, the extended follow-up revealed 4 cases of lung cancer or pleural mesothelioma (ICD, 7th revision 162-163) versus 1.6 cases expected (SIR 256, 95% CI71-654). In a heavily exposed sub-cohort, the corresponding figures were 3 and 0.5 (SIR 588, 95% CI 118-1,725).

Asbestos↗

PubMed1984

Neuroepidemiology.

Epidemiology is the study of the natural history of disease, which includes its frequency, severity, and course and the identification of "risk factors" that influence these aspects. Neuroepidemiology is that branch of epidemiology dealing with disorders that affect the nervous system. Frequency of disease is best measured by population-based rates, which are ratios of the number of cases to the population at risk, expressed as cases per unit of population. Incidence and mortality rates refer, respectively, to new cases of, and deaths caused by, a disease per unit of time and population. Prevalence rate is the cross-sectional count of cases of a disease present at a given time per unit of population. Comparison of rates often requires consideration of age-specific or age-adjusted rates rather than crude rates, all ages. Course of illness (survival, complications, recurrence) can be measured by life-table methods. The annual incidence for disease and injury of the nervous system is about 2.5% (2,500 per 100,000 population) and the prevalence is about 9.5%. Excluding all traumatic, pain, headache, alcohol, psychiatric, and special-sense disorders, neurological diseases have an annual incidence and prevalence rate, respectively, of 1.1 and 3.6% of the population.

Adolescent↗

PubMed1989

Assessment of genetic risk for Alzheimer's disease among first-degree relatives.

Life table methods were used to determine the relative risk of Alzheimer's disease (AD) in relatives of index cases with AD. Risk of AD was assessed in 967 first-degree relatives of 128 probands with clinically diagnosed AD and 572 first-degree relatives of a control group consisting of 84 subjects with Parkinson's disease (PD). Using a method that weights likelihood of correct diagnosis of AD, cumulative risk among AD relatives by age 93 was 24%, whereas relatives of the PD probands had a weighted risk of 16% by age 90. Overall, the total lifetime risk of developing dementia was similar among first-degree relatives of patients with AD and those of patients with PD. The age-specific risks were much different, however; from the age of 65 years to the age of 80 years, relatives of patients with AD had a twofold to fourfold increased risk of dementia. Equal risks were found for parents and siblings and for male and female relatives after adjustment for sex-specific patterns of survivorship. Relatives of probands with early-onset (less than or equal to 67 years) and late-onset (greater than 67 years) AD had equivalent risks of developing illness. Because onset age was found to cluster in families, the apparent increase in cumulative incidence for dementia in relatives of early-onset cases was likely due to relatives of the late-onset cases dying before developing illness.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1978

Surgical treatment of the severely ischaemic leg: I. Survival rates.

Over a 10-year period, 411 patients with atherosclerotic major artery disease causing severe ischaemia of the legs were treated by surgery. Their survival rate, assessed by the life table method, was 80 per cent at 1 year and 50 per cent at 5 years. Early and late survival rates were significantly worse in elderly patients, and in patients with extensive gangrene. Late survival rates were significantly worse in diabetics, and in patients with clinical myocardial ischaemia. Patients treated by arterial reconstruction showed a better survival rate than those treated by sympathectomy or amputation, though the latter groups contained more poor risk patients. Survival rates were not influenced by the technique of reconstruction.

Aged↗

PubMed1983

Risk of gastric cancer after Billroth II resection for duodenal ulcer.

In a follow-up study of 1000 patients, who were subjected to Billroth II resection for duodenal ulcer, the incidence and mortality of gastric carcinoma in a 22-30 year follow-up period were determined. Among the 423 survivors traced, 196 underwent gastroscopy and biopsy but carcinomas of the gastric remnant were not seen. Thus the prevalence was 0, not significantly different from the expected prevalence of 0.3. From all 1000 patients only 13 cases of gastric carcinoma were identified. This is not significantly different from the expected number of 10.6 calculated by the life table method and indirectly standardized for age, sex, place of residence and time. Even more than 15 years after operation the gastric cancer risk was only slightly increased (observed/expected = 7/4.8 +/- 1.48), but this was not significant statistically. Of 522 deaths 13 were due to gastric carcinoma, which was not significantly different from the expected number of 10.2. These epidemiological data show that individuals subjected to Billroth II resection for duodenal ulcer hardly have a higher risk of gastric carcinoma than the general population within the first decades after operation. Thus proplylactic endoscopical monitoring will be unrewarding.

Duodenal Ulcer↗

PubMed1985

Probability of false negative nodal staging in conjunction with partial axillary dissection in breast cancer.

There is a risk of overlooking lymph node metastases and thereby contributing to inaccurate nodal staging when performing partial axillary dissection in conjunction with total mastectomy in female breast cancer. The Danish Breast Cancer Cooperative Group (DBCG) analysed this risk in a prospective nation-wide adjuvant trial dealing with primary operable breast carcinoma. The series comprised 3114 patients, initially found to have lymph node negative axillae, followed for a median of 24 months (quartiles 12-40). It was found that the probability of early ipsilateral axillary relapse of cancer, estimated by means of the life table method, decreased with the number of nodes removed. After 2 years the recurrence rate was 12 per cent for patients with no lymph nodes removed, 7 per cent with one or two nodes removed and 2 per cent with three or more nodes removed. It is concluded that the risk of false negative nodal staging in conjunction with partial axillary dissection is modest, provided at least three lymph nodes are removed and found to be negative on histological examination.

Adult↗

PubMed1985

The fate of polytetrafluoroethylene grafts in lower limb bypass surgery: a six year follow-up.

The success of lower limb bypass surgery depends, in the major part, on the availability of autologous saphenous vein as the most satisfactory arterial substitute known to date. Although various prosthetic conduits, used in the absence of saphenous vein, have shown promising success on short term follow-up, more long-term comparative data are required for adequate assessment. This study analyses, by life table method, the results of 134 infra-inguinal bypass grafts using polytetrafluoroethylene (PTFE) over a 6 year period. The results reconfirm the superior long-term patency of vein bypasses compared with such prosthetic grafts. Analysis suggests that, while PTFE may give acceptable results in the immediate and short-term follow-up period, 6 year patencies approach 20-30 per cent.

Arteries↗

PubMed1991

Frequency of familial colorectal cancer.

Familial clustering of cancer is not uncommon. The frequency of familial colorectal cancer was estimated by taking family histories from 100 patients presenting with apparently sporadic colorectal cancer. Compared with controls, the relative risk of a positive family history for colorectal cancer was 4.6. Life-table methods were used to examine the observed to expected mortality from colorectal cancer. Overall there was a fourfold increase in mortality rate (P less than 0.0001), which was greatest in female relatives of patients with colonic cancer (P less than 0.001). Three families with dominant inheritance of colorectal cancer and one family with Lynch type II syndrome were identified. Nine per cent of patients had siblings who had developed colorectal cancer a median of 4 years before the diagnosis of the index patient (range 1-17 years). It is recommended that a careful family history should be obtained from all patients with colorectal cancer. Where a positive history is obtained a geneticist may determine empirical risks for the development of colorectal cancer and the appropriate method of surveillance may be selected.

Adult↗

PubMed2002

Improved survival in both histologic types of oesophageal cancer in Sweden.

The prognosis among patients diagnosed with oesophageal cancer is poor with an overall 5-year survival close to 5% in most countries. Improved diagnostic and surgical strategies might influence the survival, however. We investigated the observed and relative survival among all patients in Sweden diagnosed with oesophageal adenocarcinoma (n = 1,441) or squamous cell carcinoma (n = 6395) from 1961-1996 with follow-up to December 1997. Observed survival rates were calculated by the life-table method. Relative survival rates were computed as the ratio of the observed to the expected survival. The expected survival was inferred from the survival among the entire Swedish population in the same age, sex and calendar year strata. The 5-year observed survival rate for adenocarcinoma increased from a stable figure close to 4% during the entire period 1961-1989 to 10.5% during 1990-1996. Similarly, the 5-year relative survival rate was stable around 5% during 1961-1989, but during 1990-1996 the survival was increased to 13.7%. For squamous cell carcinoma, the survival improved slightly by each decade, starting with 3.8% 5-year observed survival in 1961-1969 to 7.0% during 1990-1996. Similarly, the 5-year relative survival improved from 5.0% to 8.9% during the study period. In conclusion, the survival rates for both oesophageal adenocarcinoma and squamous cell carcinoma have increased significantly during the 1990s compared to those in the previous 3 decades (p < 0.001).

Adenocarcinoma↗

PubMed1983

Prospective study of "early" gastric cancer.

In order to elucidate the natural history of early gastric cancer, we followed up non-concurrently certain patients who had been diagnosed endoscopically as having "early' gastric cancer and who had histological evidence of cancer by biopsy, but on whom surgical resection had been delayed or had not been conducted. At the Center for Adult Diseases, Osaka, 56 cases were eligible for this study. Out of these, 27 cases progressed to advanced cancer and 16 remained at the early stage during the follow-up period (6-88 months, mean: 29 months). The remaining 13 cases had had neither surgical resection nor examinations. The survivorship function for the duration of "early" gastric cancer was estimated by the life-table method of Kaplan and Meier. The median of the duration was estimated as 37 months. The 5-year survival rate of the 34 cases on whom surgical resection had not been conducted was estimated as 64.5%. These results suggest that early diagnosis and early treatment may lead to a reduction of mortality from stomach cancer.

Adult↗

PubMedDate not supplied

Postpartum and postabortion use of the TCu-220C and Lippes Loop: A comparative study.

The postinsertion experience of 274 women with the TCu-220C and 522 women with the Lippes Loop in a university hospital family planning program in Bogotá, Colombia, has been studied by a life-table method. Pregnancy and continuation rates are similar for both devices. Although the expulsion rate of the TCu-220C is significantly lower than that of the Loop up to 12 months, higher removal rates for the TCu-220C account for the similarity in overall continuation.

Abortion, Spontaneous↗