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Zhang T, Zhu H, Hu H, Hu H, Zhan W, Jiang L, Tang M, Escobar D, Huang W, Feng Y, Zhou J, Zou M. Cardiovascular-specific mortality and risk factors in colorectal Cancer patients: A cohort study based on registry data of over 500,000 individuals in the US. Prev Med 2024; 179:107796. [PMID: 38070711 DOI: 10.1016/j.ypmed.2023.107796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the most common cancers worldwide, and recent studies have found that CRC patients are at increased risk for cardiovascular disease (CVD). This study aimed to investigate competing causes of death and prognostic factors among a large cohort of CRC patients and to describe cardiovascular-specific mortality in relation to the US standard population. METHODS This registry-based cohort study identified patients diagnosed with CRC between 1973 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database in the US. Cumulative mortality functions, conditional standardized mortality ratios, and cause-specific hazard ratios were calculated. RESULTS Of the 563,298 eligible CRC patients included in this study, 407,545 died during the follow-up period. CRC was the leading cause of death, accounting for 49.8% of all possible competing causes of death. CVD was the most common non-cancer cause of death, accounting for 17.8% of total mortality. This study found that CRC patients have a significantly increased risk of cardiovascular-specific mortality compared to the US standard population, with the risk increasing with age and extended survival time. CONCLUSION This study highlights the need to develop multidisciplinary prevention and management strategies for CRC and CVD to improve CRC patients' survival and quality of life.
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Affiliation(s)
- Taolan Zhang
- Department of Pharmacy, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China; School of Pharmacy, Hengyang Medical College, University of South China, Hengyang, Hunan, China; Institute of Clinical Medicine, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Hongxia Zhu
- Department of Pharmacy, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China; School of Pharmacy, Hengyang Medical College, University of South China, Hengyang, Hunan, China
| | - Hongjuan Hu
- Department of Public Health Service, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Haihong Hu
- Department of Pharmacy, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China; School of Pharmacy, Hengyang Medical College, University of South China, Hengyang, Hunan, China
| | - Wendi Zhan
- Department of Pharmacy, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China; School of Pharmacy, Hengyang Medical College, University of South China, Hengyang, Hunan, China
| | - Lingxiang Jiang
- Department of Radiation Oncology, Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ming Tang
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - David Escobar
- Department of Cancer Biology, College of Medicine & Life Sciences, University of Toledo, Toledo, OH, USA
| | - Wei Huang
- The First Affiliated Hospital, Health Management Center, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Yaoguang Feng
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China.
| | - Junlin Zhou
- The First Affiliated Hospital, Health Management Center, Hengyang Medical School, University of South China, Hengyang 421001, China.
| | - Mingxiang Zou
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China.
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Goffredo P, Boatman S, Troester A, Marmor S, Hassan I, Gaertner W, Madoff R. Radiotherapy Does Not Increase Long Term Cardiovascular Mortality in Colorectal Cancer Patients. Am Surg 2023; 89:4961-4962. [PMID: 36413459 DOI: 10.1177/00031348221142588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Affiliation(s)
- Paolo Goffredo
- Division of Colon & Rectal Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Sonja Boatman
- Division of Colon & Rectal Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Alexander Troester
- Division of Colon & Rectal Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Schelomo Marmor
- Division of Colon & Rectal Surgery, University of Minnesota, Minneapolis, MN, USA
- Center for Clinical Quality and Outcomes Discovery and Evaluation (C-QODE), University of Minnesota, Minneapolis, MN, USA
| | - Imran Hassan
- Department of Surgery, University of Iowa, Iowa City, IA, USA
| | - Wolfgang Gaertner
- Division of Colon & Rectal Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Robert Madoff
- Division of Colon & Rectal Surgery, University of Minnesota, Minneapolis, MN, USA
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Sciuto A, Peltrini R, Andreoli F, Di Santo Albini AG, Di Nuzzo MM, Pirozzi N, Filotico M, Lauria F, Boccia G, D’Ambra M, Lionetti R, De Werra C, Pirozzi F, Corcione F. Could Stoma Be Avoided after Laparoscopic Low Anterior Resection for Rectal Cancer? Experience with Transanal Tube in 195 Cases. J Clin Med 2022; 11:jcm11092632. [PMID: 35566757 PMCID: PMC9104879 DOI: 10.3390/jcm11092632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 02/04/2023] Open
Abstract
Anastomotic leakage is the most-feared complication of rectal surgery. Transanal devices have been suggested for anastomotic protection as an alternative to defunctioning stoma, although evidence is conflicting, and no single device is widely used in clinical practice. The aim of this paper is to investigate the safety and efficacy of a transanal tube for the prevention of leakage following laparoscopic rectal cancer resection. A transanal tube was used in the cases of total mesorectal excision with low colorectal or coloanal anastomosis, undamaged doughnuts, and negative intraoperative air-leak test. The transanal tube was kept in place until the seventh postoperative day. A total of 195 consecutive patients were retrieved from a prospective surgical database and included in the study. Of these, 71.8% received preoperative chemoradiotherapy. The perioperative mortality rate was 1.0%. Anastomotic leakage occurred in 19 patients, accounting for an incidence rate of 9.7%. Among these, 13 patients underwent re-laparoscopy and ileostomy, while 6 patients were managed conservatively. Overall, the stoma rate was 6.7%. The use of a transanal tube may be a suitable strategy for anastomotic protection following restorative rectal cancer resection. This approach could avoid the burden of a stoma in selected patients with low anastomoses.
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Affiliation(s)
- Antonio Sciuto
- Department of General Surgery, Santa Maria delle Grazie Hospital, 80078 Pozzuoli, Italy;
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, 80125 Naples, Italy
- Correspondence:
| | - Roberto Peltrini
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.P.); (A.G.D.S.A.); (M.M.D.N.); (N.P.); (M.F.); (F.L.); (G.B.); (M.D.); (R.L.); (C.D.W.); (F.C.)
| | - Federica Andreoli
- Department of Minimally Invasive Surgery, Cristo Re Hospital, 00167 Rome, Italy;
| | - Andrea Gianmario Di Santo Albini
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.P.); (A.G.D.S.A.); (M.M.D.N.); (N.P.); (M.F.); (F.L.); (G.B.); (M.D.); (R.L.); (C.D.W.); (F.C.)
| | - Maria Michela Di Nuzzo
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.P.); (A.G.D.S.A.); (M.M.D.N.); (N.P.); (M.F.); (F.L.); (G.B.); (M.D.); (R.L.); (C.D.W.); (F.C.)
| | - Nello Pirozzi
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.P.); (A.G.D.S.A.); (M.M.D.N.); (N.P.); (M.F.); (F.L.); (G.B.); (M.D.); (R.L.); (C.D.W.); (F.C.)
| | - Marcello Filotico
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.P.); (A.G.D.S.A.); (M.M.D.N.); (N.P.); (M.F.); (F.L.); (G.B.); (M.D.); (R.L.); (C.D.W.); (F.C.)
| | - Federica Lauria
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.P.); (A.G.D.S.A.); (M.M.D.N.); (N.P.); (M.F.); (F.L.); (G.B.); (M.D.); (R.L.); (C.D.W.); (F.C.)
| | - Giuseppe Boccia
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.P.); (A.G.D.S.A.); (M.M.D.N.); (N.P.); (M.F.); (F.L.); (G.B.); (M.D.); (R.L.); (C.D.W.); (F.C.)
| | - Michele D’Ambra
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.P.); (A.G.D.S.A.); (M.M.D.N.); (N.P.); (M.F.); (F.L.); (G.B.); (M.D.); (R.L.); (C.D.W.); (F.C.)
| | - Ruggero Lionetti
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.P.); (A.G.D.S.A.); (M.M.D.N.); (N.P.); (M.F.); (F.L.); (G.B.); (M.D.); (R.L.); (C.D.W.); (F.C.)
| | - Carlo De Werra
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.P.); (A.G.D.S.A.); (M.M.D.N.); (N.P.); (M.F.); (F.L.); (G.B.); (M.D.); (R.L.); (C.D.W.); (F.C.)
| | - Felice Pirozzi
- Department of General Surgery, Santa Maria delle Grazie Hospital, 80078 Pozzuoli, Italy;
| | - Francesco Corcione
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.P.); (A.G.D.S.A.); (M.M.D.N.); (N.P.); (M.F.); (F.L.); (G.B.); (M.D.); (R.L.); (C.D.W.); (F.C.)
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Kuiper JG, van Herk-Sukel MPP, Lemmens VEPP, Kuiper MJ, Kuipers EJ, Herings RMC. Risk of heart failure among colon and rectal cancer survivors: a population-based case-control study. ESC Heart Fail 2022; 9:2139-2146. [PMID: 35451236 PMCID: PMC9288790 DOI: 10.1002/ehf2.13923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/02/2022] [Accepted: 03/27/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS This population-based case-control study aims to investigate the occurrence of heart failure (HF) among colon and rectal cancer survivors compared with a cancer-free control population taking into account pre-existing cardiovascular risk factors and the influence of treatment. METHODS AND RESULTS Colon and rectal cancer survivors diagnosed between 2007 and 2014 were selected from a linked cohort of cancer and primary care data in the Netherlands and matched based on gender, birth year, general practitioner (GP) practice, and follow-up period to cancer-free controls. The occurrence of HF was identified based on GP recorded diagnoses after index date (diagnosis date for cases). A Cox proportional hazards model was used to estimate hazard ratios (HRs), adjusted for age, sex, hypertension, diabetes, and hypercholesterolaemia. A total of 5333 colon cancer cases and 2468 rectal cancer cases could be matched to a total of 31 204 cancer-free controls. A statistically significant increased risk of HF was seen among all cases compared with cancer-free controls (HR 1.33; 95% confidence interval: 1.12-1.59). This was also seen when analysing colon cancer and rectal cancer separately. Being diagnosed with stage IV cancer, having hypertension, or having hypercholesterolaemia statistically significantly increased the risk of HF among colon cancer. Hypertension was a statistically significant risk factor for developing HF among rectal cancer cases. CONCLUSIONS Colon and rectal cancer survivors are at increased risk for developing HF. More awareness should be created by treating physicians and GPs for this potential increased risk in order to further improve survival.
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Affiliation(s)
- Josephina G Kuiper
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, Utrecht, 3528 AE, The Netherlands.,Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Myrthe P P van Herk-Sukel
- Department of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Valery E P P Lemmens
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.,Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Mathijs J Kuiper
- Department of Cardiology, Haga Hospital, The Hague, The Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, Utrecht, 3528 AE, The Netherlands.,Department of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam, The Netherlands
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5
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Daguenet E, Maison M, Tinquaut F, Giroux EA, Bertoletti L, Suchaud JP, Rancoule C, Guy JB, Magné N. Venous thromboembolism and radiation therapy: The final radiation-induced thrombosis study analysis. Cancer Med 2022; 11:1753-1762. [PMID: 35199492 PMCID: PMC9041075 DOI: 10.1002/cam4.4559] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/10/2021] [Accepted: 01/07/2022] [Indexed: 12/21/2022] Open
Abstract
Background Thromboembolic events frequently complicate the course of malignancy and represent a major cause of morbidity and mortality in cancer patients. In contrast to chemotherapy and other systemic therapies, little is known about the impact of ionizing radiations on the incidence of venous thromboembolism (VTE) in cancer patients. Methods In the present prospective study, we aimed to investigate the incidence, management, and outcome of VTE in newly diagnosed cancer patients who received curative radiotherapy. Results VTE was found in 8 patients, out of 401 patients at a median time of 80 days after radiotherapy initiation. The incidence rate of VTE at 6 months post‐treatment was 2% (95% CI, 0.9–3.7), with 50% of cases occurring during the radiotherapy course and 50% of cases in patients who received or were receiving chemotherapy. As none of the patients harbored a personal history of VTE, no prophylactic measure was initiated during cancer therapy. Most patients received monotherapy with low‐molecular‐weight heparin and were still on surveillance at the end of the study. No specific clinical risk factor was identified that might systematically indicate the need of thromboprophylaxis in the context of curative radiotherapy. Conclusions Although this pan‐cancer descriptive study did not relate an increased risk of short‐term thrombosis following ionizing radiation, it provides important insight as a basis for future studies with subcategories of cancer, in order to in fine guide further recommendations in frail patients. Clinical trial registration number NCT02696447.
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Affiliation(s)
- Elisabeth Daguenet
- Département Universitaire de la Recherche et de l'Enseignement, Institut de Cancérologie Lucien Neuwirth, St-Priest-en-Jarez, France.,Département de Radiothérapie, Institut de Cancérologie Lucien Neuwirth, St-Priest-en-Jarez, France
| | - Mathilde Maison
- Département Universitaire de la Recherche et de l'Enseignement, Institut de Cancérologie Lucien Neuwirth, St-Priest-en-Jarez, France.,Département de Radiothérapie, Institut de Cancérologie Lucien Neuwirth, St-Priest-en-Jarez, France
| | - Fabien Tinquaut
- Département Universitaire de la Recherche et de l'Enseignement, Institut de Cancérologie Lucien Neuwirth, St-Priest-en-Jarez, France
| | - Eric-Alban Giroux
- Département Universitaire de la Recherche et de l'Enseignement, Institut de Cancérologie Lucien Neuwirth, St-Priest-en-Jarez, France
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France.,INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France.,INSERM, Saint-Etienne, France
| | | | - Chloé Rancoule
- Département Universitaire de la Recherche et de l'Enseignement, Institut de Cancérologie Lucien Neuwirth, St-Priest-en-Jarez, France.,Département de Radiothérapie, Institut de Cancérologie Lucien Neuwirth, St-Priest-en-Jarez, France
| | - Jean-Baptiste Guy
- Département Universitaire de la Recherche et de l'Enseignement, Institut de Cancérologie Lucien Neuwirth, St-Priest-en-Jarez, France
| | - Nicolas Magné
- Département Universitaire de la Recherche et de l'Enseignement, Institut de Cancérologie Lucien Neuwirth, St-Priest-en-Jarez, France.,Département de Radiothérapie, Institut de Cancérologie Lucien Neuwirth, St-Priest-en-Jarez, France
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6
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Temraz S, Moukalled N, Gerotziafas GT, Elalamy I, Jara-Palomares L, Charafeddine M, Taher A. Association between Radiotherapy and Risk of Cancer Associated Venous Thromboembolism: A Sub-Analysis of the COMPASS-CAT Study. Cancers (Basel) 2021; 13:cancers13051033. [PMID: 33801174 PMCID: PMC7957620 DOI: 10.3390/cancers13051033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 12/21/2022] Open
Abstract
Simple Summary Cancer patients are at an increased risk of developing venous thromboembolism (VTE) compared to non-cancer patients. VTE in cancer patients poses as a financial burden and influences quality of life and is correlated with increased morbidity and mortality. Several cancer-related and patient-related risk factors have been shown to be predictors of VTE in cancer patients. However, the effect of radiotherapy on development of thrombosis in cancer patients is not extensively explored. In this report, radiotherapy was significantly associated with increased risk for VTE. The risk of VTE was higher in women, patients >50 and those receiving chemo- or hormonal therapy. Abstract Background: The role and effect of radiotherapy in the development of VTE has not been extensively explored; Methods: This is a post-hoc analysis from the COMPASS-CAT trial. Patients with breast, lung, colon or ovarian cancer, with early, locally advanced or metastatic disease and receiving chemotherapy were included. Primary endpoint was documented symptomatic VTE; Results: A total of 1355 patients were enrolled between November 2013 and November 2015. Of those, 194 patients were excluded because of missing data or the use of anticoagulation. Of the evaluable patients, 361 patients received radiotherapy (33.6%) At a median follow up of 6 months, 9.1% (n = 33) of patients receiving radiotherapy developed a VTE event (excluding those with missing data on follow up). After applying the competing risk model, radiotherapy remained significantly associated with increased risk for VTE (HR 2.47, 95% CI: 1.47–4.12, p = 0.001). Stratification analysis for the cohort that received radiotherapy revealed an increased risk of VTE in women compared to men (10.8% vs. 2.7%; p = 0.03), in those older than 50 (12.2% vs. 3.7%; p = 0.011); for patients receiving anthracycline chemotherapy (14.4% vs. 2.9%; p < 0.001) and hormonal therapy (12.9% vs. 3.9%; p < 0.001); Conclusions: Analysis from the COMPASS-CAT revealed a significant correlation between radiotherapy and VTE in patients with cancer. Further studies are needed to better understand the potential cellular toxicity associated with radiotherapy.
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Affiliation(s)
- Sally Temraz
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut, Beirut 1107 2020, Lebanon; (S.T.); (N.M.); (M.C.)
| | - Nour Moukalled
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut, Beirut 1107 2020, Lebanon; (S.T.); (N.M.); (M.C.)
| | - Grigorios T. Gerotziafas
- Cancer Biology and Therapeutics, INSERM UMR S938, Institut Universitaire de Cancérologie (IUC), Sorbonne Université, 75012 Paris, France; (G.T.G.); (I.E.)
- Haemostasis and Thrombosis Centre, Biological Hematology Department, Hôpital Tenon, AP-HP Sorbonne Université, CEDEX 20, 75970 Paris, France
| | - Ismail Elalamy
- Cancer Biology and Therapeutics, INSERM UMR S938, Institut Universitaire de Cancérologie (IUC), Sorbonne Université, 75012 Paris, France; (G.T.G.); (I.E.)
- Haemostasis and Thrombosis Centre, Biological Hematology Department, Hôpital Tenon, AP-HP Sorbonne Université, CEDEX 20, 75970 Paris, France
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Luis Jara-Palomares
- Respiratory Department, Medical Surgical Unit of Respiratory Diseases, Hospital Virgen del RocIo, 41013 Seville, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Maya Charafeddine
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut, Beirut 1107 2020, Lebanon; (S.T.); (N.M.); (M.C.)
| | - Ali Taher
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut, Beirut 1107 2020, Lebanon; (S.T.); (N.M.); (M.C.)
- Correspondence: ; Tel.: +961-1-374374/374444
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Mathes T, Rombey T, Kuss O, Pieper D. No inexplicable disagreements between real-world data-based nonrandomized controlled studies and randomized controlled trials were found. J Clin Epidemiol 2021; 133:1-13. [PMID: 33359322 DOI: 10.1016/j.jclinepi.2020.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 12/07/2020] [Accepted: 12/15/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES We assessed disagreements between nonrandomized controlled studies based on real-world data (NRCS-RWDs) and randomized controlled trials (RCTs). STUDY DESIGN AND SETTING We systematically searched for studies that compared treatment effect estimates from NRCS-RWDs and RCTs on the same clinical question. We assessed the potential difference between NRCS-RWDs and RCTs related to internal and external validity. We calculated various meta-epidemiological measures to assess agreement. In case of disagreements, we tried to identify the probable causes of disagreements. RESULTS We included 12 studies comparing 15 treatment effect estimates of NRCS-RWDs and RCTs. There were many potential causes of disagreement. Ninety-five percent confidence intervals overlapped for 12 of 15 treatment effect estimates. Our analysis on predicted vs. observed overlap showed that there were no more disagreements than expected by chance. We observed only two substantial differences between the 15 treatment effect estimates. In both cases, we identified risk of bias in the NRCS-RWDs as the most probable cause of disagreement. CONCLUSION Our findings suggest that there are clinical questions where the difference in risk of bias between a well-conducted NRCS-RWD and an RCT is negligible. In our analysis, threats to external validity appeared to have no or only a weak impact on the disagreements of treatment effect estimates.
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Affiliation(s)
- Tim Mathes
- Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, 51067 Cologne, Germany.
| | - Tanja Rombey
- Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, 51067 Cologne, Germany
| | - Oliver Kuss
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research, Heinrich Heine University Düsseldorf, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, 51067 Cologne, Germany
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8
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Neo-adjuvant chemotherapy alone for the locally advanced rectal cancer: a systematic review. Int J Clin Oncol 2020; 25:1570-1580. [PMID: 32666388 DOI: 10.1007/s10147-020-01738-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 06/23/2020] [Indexed: 12/20/2022]
Abstract
Neo-adjuvant chemoradiation (NA-CRT) is the standard of management for the locally advanced rectal cancer (LARC), achieving very low rates of local recurrence (LR). However, NA-CRT fails to control distant recurrence and improve survival, whilst it is associated with increased postoperative morbidity and increased acute and late toxicity. In recent years, neo-adjuvant chemotherapy (NACTx) appears in the literature as an alternative to NA-CRT in patients with LARC. In the present study, the authors review all current evidence on the specific subject. Following a systematic search of the literature, 25 studies were identified reporting on short- or long-term outcomes of NACTx for LARC. Seventeen studies were prospective or retrospective series, and 8 comparative. Of the comparative studies, one was a randomized control trial (RCT) comparing NACTx to NA-CRT and to the combination of NACTx/NA-CRT, and another a non-randomized study comparing NACTx to NA-CRT. Chemotherapeutic regimens were 5-fluoropyrimidine and oxaliplatin based. In some of them, irinotecan or/and bevacizumab was added. A pooled analysis showed that NACTx is associated with a mean anastomotic leak rate of 6.8%. In the RCT, postoperative morbidity and overall toxicity was significantly less in the NACTx group. Mean T downstaging (ypStage 0-I) was 49.6%, mean N downstaging 69.6% and mean pathologic complete response (pCR) 10.7%. The RCT showed an inferior pCR rate after NACTx than after NA-CRT, but similar rates of T downstaging. Mean LR was 8.6% and mean distant recurrence 17.2%. Satisfactory survival rates are reported by several studies. NACTx seems to be an alternative to NA-CRT for patients with LARC, associated with low anastomotic leak, adequate tumour downstaging, low LR and rather high survival rates. Further data deriving from high-quality studies are necessary to assess safety and efficacy of NACTx as a substitute to NA-CRT, for at least a subset of patients with LARC.
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Ludvigsson JF, Svedberg P, Olén O, Bruze G, Neovius M. The longitudinal integrated database for health insurance and labour market studies (LISA) and its use in medical research. Eur J Epidemiol 2019; 34:423-437. [PMID: 30929112 PMCID: PMC6451717 DOI: 10.1007/s10654-019-00511-8] [Citation(s) in RCA: 579] [Impact Index Per Article: 115.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/12/2019] [Indexed: 12/17/2022]
Abstract
Education, income, and occupation are factors known to affect health and disease. In this review we describe the Swedish Longitudinal Integrated Database for Health Insurance and Labour Market Studies (LISA, Longitudinell Integrationsdatabas för Sjukförsäkrings- och Arbetsmarknadsstudier). LISA covers the adult Swedish population aged ≥ 16 years registered on December 31 each year since 1990 (since 2010 individuals aged ≥ 15 years). The database was launched in response to rising levels of sick leave in the country. Participation in Swedish government-administered registers such as LISA is compulsory, and hence selection bias is minimized. The LISA database allows researchers to identify individuals who do not work because of injury, disease, or rehabilitation. It contains data on sick leave and disability pension based on calendar year. LISA also includes information on unemployment benefits, disposable income, social welfare payments, civil status, and migration. During 2000–2017, an average of 97,000 individuals immigrated to Sweden each year. This corresponds to about 1% of the Swedish population (10 million people in 2017). Data on occupation have a completeness of 95%. Income data consist primarily of income from employment, capital, and allowances, including parental allowance. In Sweden, work force participation is around 80% (2017: overall: 79.1%; men 80.3% and women 77.9%). Education data are available in > 98% of all individuals aged 25–64 years, with an estimated accuracy for highest attained level of education of 85%. Some information on civil status, income, education, and employment before 1990 can be obtained through the Population and Housing Census data (FoB, Folk- och bostadsräkningen).
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Affiliation(s)
- Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. .,Department of Paediatrics, Örebro University Hospital, Örebro, Sweden. .,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building 2, City Hospital, Nottingham, UK. .,Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - Pia Svedberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ola Olén
- Clinical Epidemiology Unit, Department of Medicine Stockholm, Karolinska Institutet, Stockholm, Sweden
| | - Gustaf Bruze
- Clinical Epidemiology Unit, Department of Medicine Stockholm, Karolinska Institutet, Stockholm, Sweden
| | - Martin Neovius
- Clinical Epidemiology Unit, Department of Medicine Stockholm, Karolinska Institutet, Stockholm, Sweden
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Socha J, Pietrzak L, Zawadzka A, Paciorkiewicz A, Krupa A, Bujko K. A systematic review and meta-analysis of pT2 rectal cancer spread and recurrence pattern: Implications for target design in radiation therapy for organ preservation. Radiother Oncol 2019; 133:20-27. [PMID: 30935577 DOI: 10.1016/j.radonc.2018.12.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND There are no guidelines on clinical target volume (CTV) delineation for cT2 rectal cancer treated with organ preservation. MATERIALS AND METHODS A systematic review and meta-analysis were performed to determine the extent of distal mesorectal (DMS) and distal intramural spread (DIS), the risk of lateral lymph node (LLN) metastases in pT2 tumours, and regional recurrence pattern after organ preservation. RESULTS The rate of DMS > 1 cm was 1.9% (95% CI: 0.4-5.4%), maximum extent: 1.3 cm. The rate of DIS > 0.5 cm was 4.7% (95% CI: 1.3-11.5%), maximum extent: 0.8 cm. The rate of LLN metastases was 8.2% (95% CI: 6.7-9.9%) for tumours below or at peritoneal reflexion and 0% for higher tumours. Regional nodal recurrences alone were recorded in 1.0% (95% CI: 0.5-1.7%) of patients after watch-and-wait and in 2.1% (95% CI: 1.2-3.4%) after preoperative radiotherapy and local excision. Thus, the following rules for CTV delineation are proposed: caudal border 1.5 cm from the tumour to account for DMS or 1 cm to account for DIS, whichever is more caudal; cranial border at S2/S3 interspace; inclusion of LLN for tumours at or below peritoneal reflexion. A planning study was performed in eight patients to compare dose-volume parameters obtained using these rules to that obtained using current guidelines for advanced cancers. The proposed rules led to a mean 18% relative reduction of planning target volume, which resulted in better sparing of organs-at-risk. CONCLUSION This meta-analysis suggests a smaller CTV for cT2 tumours than the current guidelines designed for advanced cancers.
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Affiliation(s)
- Joanna Socha
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland; Department of Radiotherapy, Regional Oncology Center, Czestochowa, Poland.
| | - Lucyna Pietrzak
- Department of Radiotherapy I, Maria Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland
| | - Anna Zawadzka
- Medical Physics Department, Maria Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland
| | - Anna Paciorkiewicz
- Medical Physics Department, Maria Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland
| | - Anna Krupa
- Department of Radiotherapy I, Maria Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland
| | - Krzysztof Bujko
- Department of Radiotherapy I, Maria Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland
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