Post-colonoscopy colorectal cancer rate in the era of highdefinition colonoscopy

AIM To investigate the post-colonoscopy colorectal cancer(PCCRC) rate for high-definition(HD) colonoscopy compared with that for standard-definition colonoscopy reported previously.METHODS Using medical records at Sano Hospital(SH) and Dokkyo Medical University Koshigaya Hospital(DMUKH), we retrospectively obtained data on consecutive patients diagnosed as having CRC between January 2010 andDecember 2015. The definition of PCCRC was diagnosis of CRC between 7 and 36 mo after initial high-definition colonoscopy that had detected no cancer, and patients were divided into a PCCRC group and a non-PCCRC group. The primary outcome was the rate of PCCRC for HD colonoscopy. The secondary outcomes were factors associated with PCCRC and possible reason for occurrence of early and advanced PCCRC.RESULTS Among 892 CRC patients, 11 were diagnosed as having PCCRC and 881 had non-PCCRC. The PCCRC rate was 1.7%(8/471) at SH and 0.7%(3/421) at DMUKH. In comparison with the non-PCCRC group, the PCCRC group had a significantly higher preponderance of smaller tumors(39 mm vs 19 mm, P = 0.002), a shallower invasion depth(T1 rate, 25.4% vs 63.6%, P = 0.01), a non-polypoid macroscopic appearance(39.0% vs 85.7%, P = 0.02) and an earlier stage(59.7% vs 90.9%, P = 0.03). Possible reasons for PCCRC were "missed or new" in 9 patients(82%), "incomplete resection" in 1(9%), and "inadequate examination'" in 1(9%). Among 9 "missed or new" PCCRC, the leading cause was non-polypoid shape for early PCCRC and blinded location for advanced PCCRC.CONCLUSION The PCCRC rate for HD colonoscopy was 0.7%-1.7%, being lower than that for standard-definition colonoscopy(1.8%-9.0%) reported previously employing the same methodology.

Envita’s Precision Cancer Care: 35-Fold Improvement in Response Rates

New clinical approaches are imperative beyond the widely adopted National Comprehensive Cancer Network (NCCN) guidelines, utilized by prominent cancer institutions. Cancer is the leading cause of death among individuals younger than 85 years within the United States. Despite significant technological advances, including the expenditure of hundreds of billions, treatment outcomes and overall survival have not notably improved for most types of advanced cancer over the last several decades. Over the past 24 years, Envita Medical Centers has pioneered a unique form of personalized treatment approach for late-stage and refractory cancer patients, introducing groundbreaking innovations in the field. Our integrated algorithm utilizes advanced genomics, transcriptomics, and highly tailored immunotherapy, resulting in remarkable outcome improvements. This study presents Envita’s innovative personalized treatment algorithms and examines the response outcomes of 199 late-stage cancer patients treated at Envita Medical Centers over a two-year period. Compared to standard of care and palliative chemotherapy, Envita’s treatment demonstrated a remarkable 35-fold improvement in overall response rates (Figure 1). Moreover, 88% of the patients, the majority presenting with Stage 3 or 4 cancer, experienced a 43-fold improvement in quality of life with minimal side effects, as compared to standard of care chemotherapy and palliative care. This revolutionary success is attributed to Envita’s personalized therapeutic algorithms, which incorporate customized immunotherapy. Envita’s precision care approach has also achieved a 100% better response rate compared to over 65 global chemotherapy clinical trials with more than 2700 patients. The results from this study suggest that a wider utilization of Envita’s personalized approach can significantly benefit patients with late-stage and refractory cancer.

Impact of Relative Dose Intensity (RDI) on Survival in Non-Metastatic Breast Cancer: Nigerian Experience

Background: This study was initiated to determine practices patterns in adjuvant chemotherapy for non-metastatic breast cancer and to examine the relationship between received dose intensity (RDI) and survival in patients with breast cancer Nigeria. Methods: Our study was a retrospective analysis of patients with breast cancer recruited from 2012 and 2015. A total of 204 patients were initially entered into the study, 102 were lost to follow-up leaving 102 patients who were suitable for the survival analysis. Survival time was calculated from 106 days, the scheduled end of chemotherapy. Results: The total average RDI for patients was 74%. Over the 204 patients that were reviewed, 144 (70.6%) had some reduction of RDI. This subgroup had an average RDI of 63%. On average, 79% of the intended dose of chemotherapy was given. The time to completion of chemotherapy was 1.33 times that specified by the protocol. Dose delays an overall reduction was mainly attributed to intolerability and financial constraints. Survival by RDI showed a significant decrease in survival rate for patients with RDI of >49% (Hazard Ratio = 3.473, 95% CI 1.21 - 9.91, P = 0.020);RDI of 50% - 59% (Hazard Ratio = 3.916, 95% CI 1.01 - 15.18, P = 0.048);RDI of 60% - 69% (Hazard Ratio = 4.462, 95% CI 1.65 - 12.03, P = 0.003) compared with patients who received an RDI of 100%. Although associated with poorer prognosis, there were no significant changes in the survival rate for patients with RDI of 70% - 79% (Hazard Ratio = 1.667, 95% CI 0.56 - 4.96, P = 0.359);RDI of 80% - 89% (Hazard Ratio = 1.620, 95% CI 0.47 - 5.53, P = 0.441);RDI 90% - 99% (Hazard Ratio = 1.590, 95% CI 0.53 - 4.73, P = 0.405) compared with patients who received an RDI of 100%. Conclusion: This study provides evidence that decreased RDI of <70% in non-metastatic breast cancer patients is strongly associated with decreased overall survival.

Association of cancer prevention awareness with esophageal cancer screening participation rates: Results from a population-based cancer screening program in rural China

Objective: : China have implemented population-based esophageal cancer(EC) screening programs, however,the participant rates were relatively low. This study was conducted to examine the association between cancer prevention knowledge and EC screening participation rates(PRs).Methods: : Data in the analyses were obtained from a population-based cancer screening program in four provinces in China since 2007. In the course of 2007-2016, participants who were evaluated as high risk for EC and subsequently recommended for endoscopy examination were included in the final analysis. One-way analysis of variance test, Chi-square test and logistic regression analysis were applied.Results: : A total of 28,543 individuals assessed as high-risk population for EC were included in this study, with13,036 males(45.67%) and 15,507 females(54.33%). The prevalence rates of current smoking and alcohol drinking were higher in males(58.25% and 44.22%, respectively) than in females(5.35% and 4.05%, respectively).Participants of females, and those who had older age, lower income, as well as higher education level and cancer prevention knowledge level were more likely to undergo endoscopy. Multivariable analysis showed that higher cancer prevention knowledge was associated with higher PR for endoscopic screening [adjusted odd ratio(aORQ4/Q1) =1.511, 95% confidence interval(95% CI): 1.398-1.632] among our study subjects. This association between cancer prevention knowledge and compliance with endoscopic screening also tends to be strong within subgroups of males, females, aged below 60 years, aged 60 years and above, and lower level of education(illiterate individuals and those with junior high education or less).Conclusions: : Our results displayed a positive relationship between cancer prevention knowledge and PRs for endoscopic screening, implying cancer prevention awareness being an independent influence factor for compliance with EC screening. Promoting public campaigns about comprehensive knowledge of cancer prevention seemed to be a reasonable and effective strategy to improve population PRs for EC screening.

Effect of preoperative biliary drainage on surgical results after pancreaticoduodenectomy in patients with distal common bile duct cancer:Focused on the rate of decrease in serum bilirubin

AIM: To examine if the rate of decrease in serum bilirubin after preoperative biliary drainagecan be used as a predicting factor for surgical complications and postoperative recovery after pancreaticoduodenectomy in patients with distal common bile duct cancer.METHODS: A retrospective study was performed in 49 consecutive patients who underwent pancrea-ticoduodenectomy for distal common bile duct cancer. Potential risk factors were compared between the complicated and uncomplicated groups. Also, the rates of decrease in serum bilirubin were compared pre- and postoperatively. RESULTS: Preoperative biliary drainage (PBD) was performed in 40 patients (81.6%). Postoperative morbidity and mortality rates were 46.9% (23/49) and 6.1% (3/49), respectively. The presence or absence of PBD was not different between the complicated and uncomplicated groups. In patients with PBD, neither the absolute level nor the rate of decrease in serum bilirubin was significantly different. Patients with rapid decrease preoperatively showed faster decrease during the first postoperative week (5.5 ± 4.4 μmol/L vs -1.7 ± 9.9 μmol/L, P = 0.004).CONCLUSION: PBD does not affect the surgical outcome of pancreaticoduodenectomy in patients with distal common bile duct cancer. There is a certain group of patients with a compromised hepatic excretory function, which is represented by the slow rate of decrease in serum bilirubin after PBD.

Cancer incidence and patient survival rates among the residents in the Pudong New Area of Shanghai between 2002 and 2006

With the growing threat of malignancy to health,it is necessary to analyze cancer incidence and patient survival rates among the residents in Pudong New Area of Shanghai to formulate better cancer prevention strategies.A total of 43,613 cancer patients diagnosed between 2002 and 2006 were recruited from the Pudong New Area Cancer Registry.The incidence,observed survival rate,and relative survival rate of patients grouped by sex,age,geographic area,and TNM stage were calculated using the Kaplan-Meier,life table,and Ederer II methods,respectively.Between 2002 and 2006,cancer incidence in Pudong New Area was 349.99 per 100,000 person-years,and the 10 most frequently diseased sites were the lung,stomach,colon and rectum,liver,breast,esophagus,pancreas,brain and central nervous system,thyroid,and bladder.For patients with cancers of the colon and rectum,breast,thyroid,brain and central nervous system,and bladder,the 5-year relative survival rate was greater than 40%,whereas patients with cancers of the liver and pancreas had a 5-year relative survival rate of less than 10%.The 1-year to 5-year survival rates for patients grouped by sex,age,geographic area,and TNM stage differed significantly(all P<0.001).Our results indicate that cancer incidence and patient survival in Pudong New Area vary by tumor type,sex,age,geographic area,and TNM stage.

Decreasing Birth Rate Determining Worldwide Incidence and Regional Variation of Female Breast Cancer

Purpose: Urbanization, obesity and ageing associated with lifestyle changes (Westernized diet patterns, pollution, physical inactivity) have been proposed as the major contributing factors for the global rise in breast cancer (BCa) and have been the variables used to predict the future breast cancer rate. At the same time, socio-economic level, instead of birth rate, has been proposed for explanation of dramatic regional variations of breast cancer incidence. We sought to determine which factor plays the determining role in predicting worldwide breast cancer incidence rates and regional variations. Methods: Bivariate correlation was conducted to examine the relationships between country-specific estimates of birth rate, BCa incidence, urbanization, overweight, ageing and GDP. Partial correlation was performed to identify the correlation between BCa incidence with each independent variable while we controlled the other four variables. Multiple linear regression was used to identify the most significant predictors of BCa incidence. Post hoc Scheff and independent T-Test analysis were performed to compare mean differences in BCa incidence rates and residuals of BCa standardised on birth rate in the WHO regions, and UN developed and developing regions respectively. Results: Worldwide, BCa incidence rate tends to increase while birth rate decreases and urbanization, overweight, ageing and GDP increase. However, birth rate was the only variable that had a significant correlation with BCa incidence when controlled for the other four variables. Birth rate was the only significant predictor of BCa incidence in regression analysis. Multiple mean differences of BCa incidence between regions were significant, but all disappeared when the contributing effect of birth rate on BCa incidence rate was removed. Conclusions: Birth rate plays a determining role in worldwide BCa incidence rate and regional variations. Current BCa projection methods may estimate future rates of BCa poorly if they fail to incorporate the impact of birth rate.

Incidence and mortality rate of esophageal cancer has decreased during past 40 years in Hebei Province,China

Background： Hebei province is located in North of China with of approximately 6% of whole national population. It is known as a high-risk area for esophageal cancer in China and worldwide. The aim of our study was to estimate the esophageal cancer burden and trend in Hebei Province. Methods： Eight cancer registries in Hebei Province submitted cancer registry data to the Hebei Provincial Cancer Registry Center. All data were qualified and compiled for cancer statistics in 2011. The pooled data were stratified by gender and age group （0, 1-4, 5-9, 10-14...80＋）. Incidence and mortality rates were age-standardized to World Segi＇s population standard and expressed per 100,000 persons. In addition, proportions and cumulative incidence/mortality rates for esophageal cancer were calculated. Esophageal cancer mortality data during the periods 1973-1975, 1990-1992, and 2004-2005 were extracted from the national death surveys. Mortality and incidence rate data from Cixian and Shexian were obtained from population-based cancer registries in each county. Results： The estimated number of newly diagnosed esophageal cancer cases and deaths in 2011 in Hebei Province was 24,318 and 18,226, respectively. The crude incidence rate of esophageal cancer was 33.37/100,000 （males, 42.18/100,000 and females, 24.31/100,000）. The age-standardized rate by world standard population （ASRW） was 28.09/100,000, ranking third among all cancers. The esophageal cancer mortality rate was 25.01/100,000 （males, 31.40/100,000 and females, 18.45/100,000）, ranking third in deaths among all cancers. The mortality rates of esophageal cancer displayed a significant decreasing trend in Hebei Province from 1973-1975 （ASRW =48.69/100,000） to 2004-2005 （ASRW =28.02/100,000）, with a decreased rate of 42.45%. In Cixian, the incidence of esophageal cancer decreased from 250.76/100,000 to 106.74/100,000 in males and from 153.86/100,000 to 75.41/100,000 in females, with annual percentage changes （APC） of 2.13 and 2.16, while the mortality rates declined with an APC of 2.46 for males and 3.10 for females from 1988 to 2011. In Shexian, the incidence rate decreased from 116.90/100,000 to 74.12/100,000 in males and from 46.98/100,000 to 40.64/100,000 in females, while the mortality rates declined, with an APC of 4.89 in males from 2003 to 2011. Conclusions： Although the incidence and mortality rates of esophageal cancer remain high, an obvious decreasing trend has been observed in Hebei Province, as well as in high-risk regions, such as Cixian and Shexian, over the past 40 years.

CHARACTERISTICS OF MORTALITY RATES FROM BREAST AND OVARIAN CANCER IN JAPAN

Objective: Breast and ovarian cancer is rare in Japan compared with other developed countries but their mortality rates are increasing. It is necessary to examine the experience of Japan as a guide to further prevent breast and ovarian cancer in our country. Methods: We conducted an epidemiological study of breast and ovarian cancer in the past 50 years to investigate the trends and characteristics of the mortality rates in Japan. The numbers of age-specific death from breast and ovarian cancer and the population of 5-year groups were obtained from the Vital Statistics of Japan. The truncated age specific mortality rates were calculated according to the patterns of age specific mortality rates from both cancers. Age adjustments were made to the standard world population. Results: In the past 50 years, mortality rates of breast and ovarian cancer increased about 2 or 6 fold, respectively. This increase was most marked over 50 years old. The death pattern of breast cancer was same as that of ovarian cancer, but that of ovarian cancer changed greatly with time. The birth cohort study had some interesting findings. Common to breast and ovarian cancer, the later the year of birth, the higher the mortality rates from both malignancies in later life. Conclusion: The increase of the yearly mortality rates from breast and ovarian cancer might be due to changes in lifestyle and environmental factors. We are very concerned about dietary practices. Further investigation is needed to clarify the possible causes of animal food.

Fixed Dose Rate versus Standard Dose Rate Infusion of Gemcitabine and Cisplatin in Advanced Stage Non-Small Cell Lung Cancer

Background: Comparing the efficacy and safety of gemcitabine at a fixed-dose rate (FDR) infusion (10 mg/m2/min) with the standard dose rate infusion in patients with locally advanced and metastatic non-small squamous cell carcinoma (NSCLC). Methods: The study randomized 60 patients with confirmed diagnosis of NSCLC to receive gemcitabine at a dose of 1000 mg/m2 on days 1 and 8 given as a 30-min infusion (Arm A) or at a rate of 10 mg/m2/min (Arm B). Cisplatin 75 mg/m2 was administered intravenously on day 2 in both arms. Results: No difference in overall response rate (46.6% versus 43.3%). Median time to progression for Arm A was 7 months (95% CI, 6.207 - 7.793 months), versus 6 months for Arm B (95% CI, 4.990 - 7.010 months). Median survival time was comparable [12 months (95% CI, 8.588 - 15.412 months) versus 11 months (95% CI, 9.066 - 12.934 months)] respectively. Two-year survival (18% versus 11%, p = 0.38) was detected. No treatment related deaths occurred. Main hematological toxicities were grade I and II neutropenia, in 36.7% and 53.3% respectively (p = 0.044). Grade III anemia was observed in 10% and 6.7% in both arms respectively (p = 0.024). Grade I and II nausea and vomiting was observed in 50% and 46.7%. Conclusions: FDR gemcitabine in combination with cisplatin had equivalent efficacy and more severe hematologic toxicities compared to the standard 30-min gemcitabine infusion with cisplatin in patients with advanced NSCLC.

New endoscopy advances to refine adenoma detection rate for colorectal cancer screening:None is the winner

Colorectal cancer(CRC) is the third most common cancer in males and second in females, and globally the fourth cause for cancer death worldwide. Oncological screening of CRC has a major role in the management of the disease and it is mostly performed by colonoscopy. Anyway, effectiveness of endoscopic screening for CRC strictly depends on adequate detection and removal of potentially precancerous lesions, and accuracy of colonoscopy in detection of adenomas is still suboptimal. For this reason, several technological advances have been implemented in order to improve the diagnostic sensitivity of colonoscopy in adenoma detection. Among these:(1) Visual technologies such as chromoendoscopy and narrow band imaging;(2) optical innovation as high definition endoscopy, full-spectrum endoscopy or Third Eye Retroscope; and(3) mechanical advances as Cap assisted colonoscopy, Endocuff, Endoring and G-Eye endoscope. All these technologies advances have been tested over time by clinical studies with mixed results. Which of them is more likely to be successful in the next future?

First-line erlotinib and fixed dose-rate gemcitabine for advanced pancreatic cancer

AIM: To investigate activity, toxicity, and prognostic factors for survival of erlotinib and fixed dose-rate gemcitabine (FDR-Gem) in advanced pancreatic cancer. METHODS: We designed a single-arm prospective, multicentre, open-label phase Ⅱ study to evaluate the combination of erlotinib (100 mg/d, orally) and weekly FDR-Gem (1000 mg/m 2 , infused at 10 mg/m 2 per minute) in a population of previously untreated patients with locally advanced, inoperable, or metastatic pancreatic cancer. Primary endpoint was the rate of progression-free survival at 6 mo (PFS-6); secondary endpoints were overall response rate (ORR), response duration, tolerability, overall survival (OS), and clinical benefit. Treatment was not considered to be of further interest if the PFS-6 was < 20% (p0 = 20%), while a PFS-6 > 40% would be of considerable interest (p1 = 40%); with a 5% rejection error (α = 5%) and a power of 80%, 35 fully evaluable patients with metastatic disease were required to be enrolled in order to complete the study. Analysis of prognostic factors for survival was also carried out. RESULTS: From May 2007 to September 2009, 46 patients were enrolled (male/female: 25/21; median age: 64 years; median baseline carbohydrate antigen 19-9 (CA 19-9): 897 U/mL; locally advanced/metastatic disease: 5/41). PFS-6 and median PFS were 30.4% and 14 wk (95%CI: 10-19), respectively; 1-year and median OS were 20.2% and 26 wk (95%CI: 8-43). Five patients achieved an objective response (ORR: 10.9%, 95%CI: 1.9-19.9); disease control rate was 56.5% (95%CI: 42.2-70.8); clinical benefit rate was 43.5% (95%CI: 29.1-57.8). CA 19-9 serum levels were decreased by > 25% as compared to baseline in 14/23 evaluable patients (63.6%). Treatment was well-tolerated, with skin rash being the most powerful predictor of both longer PFS (P < 0.0001) and OS (P = 0.01) at multivariate analysis (median OS for patients with or without rash: 42 wk vs 15 wk, respectively, Log-rank P = 0.03). Additional predictors of better outcome were: CA 19-9 reduction, female sex (for PFS), and good performance status (for OS). CONCLUSION: Primary study endpoint was not met. However, skin rash strongly predicted erlotinib efficacy, suggesting that a pharmacodynamic-based strategy for patient selection deserves further investigation.

APPROACH OF FIVE-YEAR-AVERAGE HAZARD RATES FOR THE BREAST CANCER PATIENTS AND ANALYSES OF PROGNOSTIC FACTORS-AN APPLICATION OF COX REGRESSION MODEL

Objective: To compare with fiveyear survival after surgery for the 116 breast cancer patients treated at the First Teaching Hospital (FTH) and the 866 breast cancer patients at Hpital du SaintSacrement (HSS). Methods: Using Cox regression model, after eliminating the confounders, to develop the comparison of the fiveyear average hazard rates between two hospitals and among the levels of prognostic factors. Results: It has significant difference for the old patients (50 years old or more) between the two hospitals. Conclusion: Tumor size at pathology and involvement of lymph nodes were important prognostic factors.

The Experience of Pain and Anxiety in Cervical Cancer Patients Undergoing Multiple Fraction High-Dose Rate Brachytherapy: A Prospective Observational Study

Purpose: To evaluate the anxiety and pain levels of cervical cancer patients undergoing intracavitary multifraction high-dose rate (HDR) brachytherapy, as part of a process to develop guidelines for quality patient-centered care. Methods: Cervical cancer patients (n = 31) undergoingmultiple fraction HDR brachytherapy treatment at the National Institute of Oncology in Rabat (Morocco) completed ratings of pain and anxiety intensity using 11-point verbal analog scales, at 6 key time points over 2 brachytherapy insertion procedures and 4 brachytherapy fractions. Women were evaluated for psychological status at baseline before starting the brachytherapy process using the Hospital Anxiety and Depression Scale (HADS). Scores were grouped as follows: 0 - 7 = normal, 8 - 10 = borderline, 11 - 21 = abnormal. Factors that could affect anxiety levels such as education level, relationship status, number of pregnancies and prior surgical history were documented. Results: Between July and August 2020, 31 women with a median age of 49.6 years were evaluated (range: 27 - 70). The HADS score identified depression in 5 patients (16.1%) and anxiety in 12 patients (38.7%). Throughout both treatment procedures, anticipatory anxiety was reported, with a maximum intensity in the operating room during spinal anesthesia (3.23 ± 1.7) and during applicator insertion (2.97 ± 2.4). Moderate-to-severe anxiety scores were reported in 25.8% and 22.6% of patients respectively. Level of education showed a significant correlation with anxiety scores (p = 0.027). Pain increased significantly during the procedure (p ± 1.4) and applicator removal (4.74 ± 1.5) turned out to be the most painful parts of the procedure. No correlation was found between pain and anxiety levels. Conclusion: Intracavitary multifraction high-dose rate brachytherapy is associated with mild to moderate levels of pain and anxiety, although a subset of patients reported more severe symptoms and may require additional medical and psychological support, with particular emphasis on bed-rest duration and applicator removal. The development of effective interventions (both pharmacological and non-pharmacological) is needed to improve women’s experiences of brachytherapy for locally advanced cervical cancer.

Experiences of Women Receiving Multifraction High Dose-Rate Brachytherapy for Cervical Cancer: A Prospective Qualitative Study

Objective: The aim of this study was to establish cervical cancer patients’ expectations and experiences during high dose-rate (HDR) intracavitary brachytherapy procedure, as part of a process to develop guidelines for quality patient-centered care. Methodology: A prospective, qualitative study with a descriptive phenomenological approach was used. Purposive sampling was carried out to recruit 31 women undergoing HDR brachytherapy for cervical cancer from June to August 2020 at the National Institute of Oncology in Rabat. Semi-structured, one-to-one interviews guided by a theme list were conducted by a female radiation oncologist in Arabic before, during and after treatment. The following aspects were discussed: expectations, experiences in the waiting room, in the treatment room, and suggestions for improvement. Data was transcribed, translated and thematic analysis performed. Results: Most of the patients felt unprepared and did not have a clear understanding of brachytherapy. Brachytherapy was a difficult experience causing fear and anxiety throughout treatment. Most women dreaded the procedure, before receiving the first treatment and even after having had one. Pain was a major problem for the participants. Some women compared this pain to childbirth, a process they preferred to brachytherapy. Patients agreed that the preventative medication received was not efficient to relieve the pain. Despite these negative experiences, patients were left with a positive outlook. Dialogue with the healthcare professionals, support from their family and fellow patients, envisaged outcomes and desires to heal were used to cope, whilst faith and spirituality gave them strength to endure the procedure. Conclusion: Women undergoing uterovaginal brachytherapy for cervical cancer experience pain and emotional distress. Providing patients with adequate information, more sensitive support during the procedure and debriefing afterwards could lessen feelings of fear and anxiety. Our findings advocate for the revision of pain management protocols. Further studies should be carried out to define patient-centered recommendations and provide quality care to this group of women.

2021年重庆市宫颈癌发病率、死亡率与生存率分析

目的:了解2021年重庆市宫颈癌发病率、死亡率与五年生存率,为开展恶性肿瘤防治提供依据。方法:收集整理2021年重庆市新发宫颈癌发病死亡数据,分析2021年重庆市宫颈癌发病率、标化发病率、死亡率、标化死亡率、年龄别发病率与死亡率。中国人口标化率采用2000年第五次人口普查标准人口构成进行标化,世界人口标化率采用2000年世界人口构成进行标化。不同性别和地区率的比较采用χ^(2)检验。对2016年新报告的宫颈癌病例进行主动和被动生存随访,采用生存分析寿命表法计算观察生存率,采用乘积极限法(Kaplan-Meier)计算平均生存时间,生存率的比较采用Log Rank of Mantel-Cox进行统计检验。结果:2021年重庆市宫颈癌发病率、中国标化发病率、世界标化发病率分别为21.60/10万、14.64/10万与14.71/10万,宫颈癌发病率农村(23.32/10万)高于城市(17.67/10万)(χ^(2)=6.96,P<0.01)。宫颈癌死亡率、中国标化死亡率、世界标化死亡率分别为5.00/10万、2.79/10万与3.02/10万,宫颈癌死亡率农村(5.65/10万)高于城市(3.53/10万)(χ^(2)=5.42,P=0.02)。2021年重庆市宫颈癌五年生存率为64.32%,城市地区宫颈癌五年生存率(76.35%)高于农村地区(59.79%),差异有统计学意义(χ^(2)=46.65,P<0.01)。结论:重庆市宫颈癌发病率与死亡率高,五年生存率较低,应重视宫颈癌的防治。

Survival Rate Analysis on Breast Cancer Cases at Univesity College Hospital, Ibadan, Nigeria

Breast cancer is one of the leading diseases that affect women’s lives. It affects their lives in so many ways by denying them the required standard of health needed to carry out all of their daily activities for some days, weeks, months or years before eventually causing death. This research estimates the survival rate of breast cancer patients and investigates the effects of stage of tumor, gender, age, ethnic group, occupation, marital status and type of cancer upon the survival of patients. Data used for the study were extracted from the case file of patients in the Radiation Oncology Department, University College Hospital, Ibadan using a well-structured pro forma in which 74 observations were censored and 30 events occurred. The Kaplan-Meier estimator was used to estimate the overall survival probability of breast cancer patients following their recruitment into the study and determine the mean and median survival times of breast cancer patients following their time of recruitment into the study. Since there are different groups with respect to the stages of tumor at the time of diagnosis, the log-rank test was used to compare the survival curve of the stages of tumor with considering p-values below 0.05 as statistically significant. Multivariate Cox regression was used to investigate the effects of some variables on the survival of patients. The overall cumulative survival probability obtained is 0.175 (17.5%). The overall estimated mean time until death is 28.751 weeks while the median time between admission and death is 23 weeks. As the p-value (0.000032) of the log-rank test for comparing stages of tumor is less than 0.05, it is concluded that there is significant evidence of a difference in survival times for the stages of tumor. The survival function plot for the stages of tumor shows that patients with stage III tumor are less likely to survive. From the estimated mean time until death for the stages of tumor, it was deduced that stage I tumor patients have an increased chance of survival. Types of cancer, gender, marital status, ethnic group, occupation and patient’s age at entry into the study are not important predictors of chances of survival.

High-dose-rate intraluminal brachytherapy during preoperative chemoradiation for locally advanced rectal cancers

AIM:To determine the feasibility and safety of high dose rate intraluminal brachytherapy(HDR-ILBT) boost during preoperative chemoradiation for rectal cancer.METHODS:Between 2008 and 2009,thirty-six patients with locally advanced rectal cancer(≥ T3 or N+),were treated initially with concurrent capecitabine(825 mg/m2 oral twice daily) and pelvic external beam radiotherapy(EBRT)(45 Gy in 25 fractions),then were randomized to group A;HDR-ILBT group(n = 17) to receive 5.5-7 Gy×2 to gross tumor volume(GTV) and group B;EBRT group(n = 19) to receive 5.4 Gy×3 fractions to GTV with EBRT.All patients underwent total mesorectal excision.RESULTS:Grade 3 acute toxicities were registered in 12 patients(70.6%) in group A and in 8(42.1%) in group B.Complete pathologic response of T stage(ypT0) in group A was registered in 10 patients(58.8%) and in group B,3 patients(15.8%) had ypT0(P < 0.0001).Sphincter preservation was reported in 6/9 patients(66.7%) in group A and in 5/10 patients(50%) in group B(P < 0.01).Overall radiological response was 68.15% and 66.04% in Group A and B,respectively.During a median follow up of 18 mo,late grade 1 and 2 sequelae were registered in 3 patients(17.6%) and 4 patients(21.1%) in the groups A and B,respectively.CONCLUSION:HDR-ILBT was found to be effective dose escalation technique in preoperative chemoradiation for rectal cancers,with higher response rates,downstaging and with manageable acute toxicities.

Usage of Cox-Regression Model for Forecasting of Survival Rate in Patients with the Early Stage of Non-Small Cell Lung Cancer

In the past decades a lot of investigations were focused on searching for more accurate markers of lung cancer progression. Researchers indicate that molecular markers may be useful in forecasting of treatment outcome and overall survival rate in patients with non-small cell lung cancer. The aim of our research was to create a forecasting model in order to identify patients with stage I-II of non-small cell lung cancer and dismal prognosis. Our research covered 254 patients with the early stage of non-small cell lung cancer who underwent a cure from June 2008 till December2012 inthe Department of Thoracic Surgery of Zaporizhzhia Regional Clinical Oncologic Dispensary. Surgery was performed for all patients. Adjuvant chemotherapy was performed for 101 patients. In order to carry out multivariate Cox-regression analysis, STATISTICA 6.0 (StatSoft Inc.) program was used. The most significant from 39 variables were selected (tumor size, histological form of tumor, volume of surgical intervention, volume of conducted lymph node dissection, Ki-67 expression, EGFR expression, E-cadherin expression). We propose the computer system which can forecast survival rate in patients with the early stage of non-small cell lung cancer.