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Martin RM, Turner EL, Young GJ, Metcalfe C, Walsh EI, Lane JA, Sterne JAC, Noble S, Holding P, Ben-Shlomo Y, Williams NJ, Pashayan N, Bui MN, Albertsen PC, Seibert TM, Zietman AL, Oxley J, Adolfsson J, Mason MD, Davey Smith G, Neal DE, Hamdy FC, Donovan JL. Prostate-Specific Antigen Screening and 15-Year Prostate Cancer Mortality: A Secondary Analysis of the CAP Randomized Clinical Trial. JAMA 2024; 331:1460-1470. [PMID: 38581198 PMCID: PMC10999004 DOI: 10.1001/jama.2024.4011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 02/29/2024] [Indexed: 04/08/2024]
Abstract
Importance The Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP) reported no effect of prostate-specific antigen (PSA) screening on prostate cancer mortality at a median 10-year follow-up (primary outcome), but the long-term effects of PSA screening on prostate cancer mortality remain unclear. Objective To evaluate the effect of a single invitation for PSA screening on prostate cancer-specific mortality at a median 15-year follow-up compared with no invitation for screening. Design, Setting, and Participants This secondary analysis of the CAP randomized clinical trial included men aged 50 to 69 years identified at 573 primary care practices in England and Wales. Primary care practices were randomized between September 25, 2001, and August 24, 2007, and men were enrolled between January 8, 2002, and January 20, 2009. Follow-up was completed on March 31, 2021. Intervention Men received a single invitation for a PSA screening test with subsequent diagnostic tests if the PSA level was 3.0 ng/mL or higher. The control group received standard practice (no invitation). Main Outcomes and Measures The primary outcome was reported previously. Of 8 prespecified secondary outcomes, results of 4 were reported previously. The 4 remaining prespecified secondary outcomes at 15-year follow-up were prostate cancer-specific mortality, all-cause mortality, and prostate cancer stage and Gleason grade at diagnosis. Results Of 415 357 eligible men (mean [SD] age, 59.0 [5.6] years), 98% were included in these analyses. Overall, 12 013 and 12 958 men with a prostate cancer diagnosis were in the intervention and control groups, respectively (15-year cumulative risk, 7.08% [95% CI, 6.95%-7.21%] and 6.94% [95% CI, 6.82%-7.06%], respectively). At a median 15-year follow-up, 1199 men in the intervention group (0.69% [95% CI, 0.65%-0.73%]) and 1451 men in the control group (0.78% [95% CI, 0.73%-0.82%]) died of prostate cancer (rate ratio [RR], 0.92 [95% CI, 0.85-0.99]; P = .03). Compared with the control, the PSA screening intervention increased detection of low-grade (Gleason score [GS] ≤6: 2.2% vs 1.6%; P < .001) and localized (T1/T2: 3.6% vs 3.1%; P < .001) disease but not intermediate (GS of 7), high-grade (GS ≥8), locally advanced (T3), or distally advanced (T4/N1/M1) tumors. There were 45 084 all-cause deaths in the intervention group (23.2% [95% CI, 23.0%-23.4%]) and 50 336 deaths in the control group (23.3% [95% CI, 23.1%-23.5%]) (RR, 0.97 [95% CI, 0.94-1.01]; P = .11). Eight of the prostate cancer deaths in the intervention group (0.7%) and 7 deaths in the control group (0.5%) were related to a diagnostic biopsy or prostate cancer treatment. Conclusions and Relevance In this secondary analysis of a randomized clinical trial, a single invitation for PSA screening compared with standard practice without routine screening reduced prostate cancer deaths at a median follow-up of 15 years. However, the absolute reduction in deaths was small. Trial Registration isrctn.org Identifier: ISRCTN92187251.
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Affiliation(s)
- Richard M. Martin
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Emma L. Turner
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Grace J. Young
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Chris Metcalfe
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Eleanor I. Walsh
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - J. Athene Lane
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jonathan A. C. Sterne
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
- Health Data Research UK South-West, University of Bristol, Bristol, United Kingdom
| | - Sian Noble
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Peter Holding
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Naomi J. Williams
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Nora Pashayan
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Mai Ngoc Bui
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Peter C. Albertsen
- Division of Urology, University of Connecticut Health Center, Farmington
| | - Tyler M. Seibert
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla
- Department of Radiology, University of California San Diego, La Jolla
- Department of Bioengineering, University of California San Diego, La Jolla
| | - Anthony L. Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jon Oxley
- Department of Cellular Pathology, North Bristol NHS Trust, Bristol, United Kingdom
| | - Jan Adolfsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Malcolm D. Mason
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - George Davey Smith
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - David E. Neal
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Freddie C. Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Jenny L. Donovan
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Roy S, Saad F, Wallis CJD, Sun Y, Spratt DE, Akilla R, Kishan AU, Malone S, Morgan SC. Effect of Concomitant Medications on Treatment Response and Survival in De Novo Metastatic Prostate Cancer: Secondary Analysis of the LATITUDE Study. Eur J Cancer 2024; 199:113348. [PMID: 38262848 DOI: 10.1016/j.ejca.2023.113348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/02/2023] [Accepted: 09/17/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE It is unclear whether exposure to commonly prescribed medications influences survival and treatment response in patients with de novo high-risk metastatic prostate cancer (mPCa) treated with androgen receptor pathway inhibitors (ARPIs). METHODS We performed a secondary analysis of the LATITUDE trial to determine whether receipt of concomitant medications influenced the effect of abiraterone acetate and prednisone, in addition to androgen deprivation therapy (ADT), on overall survival (OS) and prostate cancer-specific mortality (PCSM) in patients with de novo mPCa. We focused on 7 commonly prescribed classes of medications: metformin, statins, proton pump inhibitors (PPIs), cyclooxygenase 2 (COX-2) inhibitors, aspirin, acetaminophen, and NSAIDs (nonselective COX inhibitors). To account for multiple testing, a two-sided p < 0.0024 was set as the threshold for statistical significance. RESULTS Overall, 1135 patients were eligible. There was some evidence of a differential treatment effect from abiraterone among patients who received concomitant NSAIDs (hazard ratio [HR] for OS: 0.54; 95% CI: 0.42-0.70) versus those who did not (HR: 0.74; 95% CI: 0.60-0.91), though this did not reach significance (interaction p = 0.05). A similar non-significant finding of heterogeneity of effect from abiraterone was noted among patients who received concomitant aspirin (HR for OS: 0.93 [0.63-1.36]) versus those who did not (HR: 0.61 [0.51-0.73]) (interaction p = 0.04). Receipt of NSAIDs was independently associated with a significantly inferior OS (HR: 1.37 [1.15-1.62]; p < 0.001) and higher relative incidence of PCSM (sHR: 1.47 [1.21-1.78]; p < 0.001). CONCLUSIONS This exploratory analysis did not find statistically significant evidence of differences in treatment effects from ADT plus abiraterone in de novo high-risk mPCa based on the receipt of concurrent medications. The receipt of NSAIDs was independently associated with increased PCSM and inferior OS.
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Affiliation(s)
- Soumyajit Roy
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, USA.
| | - Fred Saad
- Department of Surgery, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Christopher J D Wallis
- Department of Urology, Mount Sinai Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Yilun Sun
- Case Western Reserve University, Cleveland, OH, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, OH, USA
| | | | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Shawn Malone
- Department of Radiology, Radiation Oncology and Medical Physics, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Scott C Morgan
- Department of Radiology, Radiation Oncology and Medical Physics, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada.
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Valcarcel B, Schonfeld SJ, Meyer CL, Brunson A, Cooley JJP, Abrahão R, Wun T, Auletta JJ, Gadalla SM, Engels E, Albert PS, Spellman SR, Rizzo JD, Shaw BE, Muffly L, Keegan THM, Morton LM. Comparison of Vital Status, Cause of Death, and Follow-Up after Hematopoietic Cell Transplantation in Linked Center for International Blood and Marrow Transplant Research and California Cancer Registry Data, 1991 to 2018. Transplant Cell Ther 2024; 30:239.e1-239.e11. [PMID: 37981238 PMCID: PMC10872486 DOI: 10.1016/j.jtct.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/21/2023]
Abstract
Assessing outcomes following hematopoietic cell transplantation (HCT) poses challenges due to the necessity for systematic and often prolonged patient follow-up. Linking the HCT database of the Center for International Blood and Marrow Transplant Research (CIBMTR) with cancer registry data may improve long-term outcome ascertainment, but the reliability of mortality data in death certificates from cancer registries among HCT recipients remains unknown. We compared the classification of vital status and primary cause of death (COD), as well as the length of follow-up between the CIBMTR and California Cancer Registry (CCR) to assess the possibility of supplementing the CIBMTR with cancer registry data. This retrospective study leveraged a linked CIBMTR-CCR dataset. We included patients who were California residents at the time of HCT and received a first allogeneic (allo) or autologous (auto) HCT for a hematologic malignancy diagnosed during 1991-2016. Follow-up was through 2018. We analyzed 18,450 patients (alloHCT, n = 8232; autoHCT, n = 10,218). The Vital status agreement was 97.7% for alloHCT and 97.2% for autoHCT. Unknown COD was higher in CIBMTR (12.9%) than in CCR (1.6%). After excluding patients with unknown COD information, the overall agreement of primary COD (cancer versus noncancer) was 53.7% for alloHCT and 83.2% for autoHCT. This agreement was lower within the first 100 days post-HCT (alloHCT, 31.0%; autoHCT, 54.6%). Compared with CIBMTR, deaths due to cancer were higher in CCR (alloHCT, 90.0%; autoHCT, 90.1% versus alloHCT, 47.3%; autoHCT, 82.5% in CIBMTR). CIBMTR reports more frequently noncancer-related deaths, including graft-versus-host disease and infections. The cumulative incidence of cancer-specific mortality at 20 years differed, particularly for alloHCT (CCR, 53.7%; CIBMTR, 27.6%). The median follow-up among alive patients was longer in CCR (alloHCT, 6.0 years; autoHCT, 4.7 years) than in CIBMTR (alloHCT, 5.0 years; autoHCT, 3.8 years). Our findings highlight the completeness of vital status data in CIBMTR but reveal substantial disagreement in primary COD. Consequently, caution is required when interpreting HCT studies that use only death certificates to estimate cause-specific mortality outcomes. Improving the accuracy of COD registration and follow-up completeness by developing communication pathways between cancer registries and hospital-based cohorts may enhance our understanding of late effects and long-term outcomes among HCT survivors.
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Affiliation(s)
- Bryan Valcarcel
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland.
| | - Sara J Schonfeld
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Christa L Meyer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Ann Brunson
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Julianne J P Cooley
- California Cancer Reporting and Epidemiologic Surveillance Program, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Renata Abrahão
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Jeffery J Auletta
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; Divisions of Hematology/Oncology/BMT and Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio
| | - Shahinaz M Gadalla
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Eric Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Paul S Albert
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Stephen R Spellman
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - J Douglas Rizzo
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lori Muffly
- Division of Blood and Marrow Transplantation and Cellular Therapy, Stanford University, Stanford, California
| | - Theresa H M Keegan
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Lindsay M Morton
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
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Rashid T, Bennett JE, Muller DC, Cross AJ, Pearson-Stuttard J, Asaria P, Daby HI, Fecht D, Davies B, Ezzati M. Mortality from leading cancers in districts of England from 2002 to 2019: a population-based, spatiotemporal study. Lancet Oncol 2024; 25:86-98. [PMID: 38096890 PMCID: PMC7615518 DOI: 10.1016/s1470-2045(23)00530-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/28/2023] [Accepted: 10/10/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Cancers are the leading cause of death in England. We aimed to estimate trends in mortality from leading cancers from 2002 to 2019 for the 314 districts in England. METHODS We did a high-resolution spatiotemporal analysis of vital registration data from the UK Office for National Statistics using data on all deaths from the ten leading cancers in England from 2002 to 2019. We used a Bayesian hierarchical model to obtain robust estimates of age-specific and cause-specific death rates. We used life table methods to calculate the primary outcome, the unconditional probability of dying between birth and age 80 years by sex, cancer cause of death, local district, and year. We reported Spearman rank correlations between the probability of dying from a cancer and district-level poverty in 2019. FINDINGS In 2019, the probability of dying from a cancer before age 80 years ranged from 0·10 (95% credible interval [CrI] 0·10-0·11) to 0·17 (0·16-0·18) for women and from 0·12 (0·12-0·13) to 0·22 (0·21-0·23) for men. Variation in the probability of dying was largest for lung cancer among women, being 3·7 times (95% CrI 3·2-4·4) higher in the district with the highest probability than in the district with the lowest probability; and for stomach cancer for men, being 3·2 times (2·6-4·1) higher in the district with the highest probability than in the one with the lowest probability. The variation in the probability of dying was smallest across districts for lymphoma and multiple myeloma (95% CrI 1·2 times [1·1-1·4] higher in the district with the highest probability than the lowest probability for women and 1·2 times [1·0-1·4] for men), and leukaemia (1·1 times [1·0-1·4] for women and 1·2 times [1·0-1·5] for men). The Spearman rank correlation between probability of dying from a cancer and district poverty was 0·74 (95% CrI 0·72-0·76) for women and 0·79 (0·78-0·81) for men. From 2002 to 2019, the overall probability of dying from a cancer declined in all districts: the reductions ranged from 6·6% (95% CrI 0·3-13·1) to 30·1% (25·6-34·5) for women and from 12·8% (7·1-18·8) to 36·7% (32·2-41·2) for men. However, there were increases in mortality for liver cancer among men, lung cancer and corpus uteri cancer among women, and pancreatic cancer in both sexes in some or all districts with posterior probability greater than 0·80. INTERPRETATION Cancers with modifiable risk factors and potential for screening for precancerous lesions had heterogeneous trends and the greatest geographical inequality. To reduce these inequalities, factors affecting both incidence and survival need to be addressed at the local level. FUNDING Wellcome Trust, Imperial College London, UK Medical Research Council, and the National Institute of Health Research.
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Affiliation(s)
- Theo Rashid
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, Imperial College London, London, UK
| | - James E Bennett
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, Imperial College London, London, UK
| | - David C Muller
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jonathan Pearson-Stuttard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, Imperial College London, London, UK; Health Analytics, Lane Clark and Peacock, London, UK
| | - Perviz Asaria
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, Imperial College London, London, UK; Department of Cardiology, Imperial College NHS Trust, London, UK
| | - Hima Iyathooray Daby
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, Imperial College London, London, UK; UK Small Area Health Statistics Unit, Imperial College London, London, UK
| | - Daniela Fecht
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, Imperial College London, London, UK; UK Small Area Health Statistics Unit, Imperial College London, London, UK
| | - Bethan Davies
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, Imperial College London, London, UK; UK Small Area Health Statistics Unit, Imperial College London, London, UK
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, Imperial College London, London, UK; Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK; Regional Institute for Population Studies, University of Ghana, Accra, Ghana.
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Jahani MA, Mahmoudi G, Nikbakht HA, Farhadi Z, Mousavi R. Qualitative analysis of the coding of pathological data of cancer registry centers: A study in North of Iran. PLoS One 2023; 18:e0291139. [PMID: 37713374 PMCID: PMC10503709 DOI: 10.1371/journal.pone.0291139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/22/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND The cancer registry system is an important part of the cancer control program. Improper coding of cancers leads to misclassification and incorrect statistical information about cancer. Therefore, in this study, the main objective of the qualitative analysis was the accuracy in assigning the codes to the pathological reports in the centers responsible for cancer registry. METHODS This study was descriptive, retrospective and applied. The data source in this study included 15,659 pathology reports received during the years 2017-2019 in the population-based cancer registry centers of Mazandaran province. Out of 1800 reports, 1765 samples of reports were selected and analysis was done on them by stratified random sampling method. A researcher-made checklist was used to collect data, and the Kappa agreement coefficient and Cohen's agreement percentage were presented to check the accuracy of the reports. STATA13 was used for data analysis. RESULTS 1150 of 1765 pathology reports (65.0%), did not have a topographic, morphological and behavioral codes and 410 (23.2%) had grade codes. The Kappa coefficient in reports with a topography code was 0.916 and with a morphology code it was 0.929, respectively. In behavior coding, the highest agreement is in the category of benign cancers at 65.2% and in grade coding in the category without grade is 100%. CONCLUSION The most reports were on carcinoma morphology, and the Kappa coefficient in morphology codes has almost complete reliability. In terms of behavior coding, there was the most agreement in the category of benign cancers. The Kappa coefficient in given behavior codes has low reliability.
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Affiliation(s)
- Mohammad-Ali Jahani
- Health Research Institute, Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Ghahraman Mahmoudi
- Hospital Administration Research Center, Sari Branch, Islamic Azad University, Sari, Iran
| | - Hossein-Ali Nikbakht
- Health Research Institute, Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Zeinab Farhadi
- Health Research Institute, Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Raziehsadat Mousavi
- Department of Health Services Management, PhD Student in Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Innos K, Paapsi K, Alas I, Baum P, Kivi M, Kovtun M, Okas R, Pokker H, Rajevskaja O, Rautio A, Saretok M, Valk E, Žarkovski M, Denissov G, Lang K. Evidence of overestimating prostate cancer mortality in Estonia: a population-based study. Scand J Urol 2022; 56:359-364. [PMID: 36073064 DOI: 10.1080/21681805.2022.2119274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Prostate cancer (PC) mortality statistics in Estonia has shown inconsistencies with incidence and survival trends. The aim of this population-based study was to assess the accuracy of reporting PC as the underlying cause of death and estimate the effect of misattribution in assigning cause of death on PC mortality rates. MATERIAL AND METHODS The Estonian Causes of Death Registry (CoDR) and Cancer Registry provided data on all men in Estonia who died in 2017 and had a mention of PC on any field of the death certificate or had a lifetime diagnosis of PC. A blinded review of medical records was conducted by an expert panel to ascertain whether the underlying cause was PC or other death. We estimated the agreement between the underlying causes of death registered at the CoDR and those ascertained by medical review and calculated corrected mortality rates. RESULTS The study population included 655 deaths. Among 277 PC deaths registered at CoDR, 164 (59%) were verified by medical review. Among 378 other deaths registered at CoDR, 17 (5%) were ascertained as PC deaths by medical review. In total, the number of PC deaths decreased from 277 to 181 and the corrected age standardized (world) mortality rate decreased from 20 to 13 per 100 000 (1.5-fold overestimation, 95% confidence interval 1.2-1.9). CONCLUSIONS PC mortality statistics in Estonia should be interpreted with caution and possible overestimation considered when making policy decisions. Quality assurance mechanisms should be reinforced in the whole death certification process.
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Affiliation(s)
- Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Keiu Paapsi
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Indrek Alas
- Urology Centre, West Tallinn Central Hospital, Tallinn, Estonia
| | - Peep Baum
- Surgery Clinic, North Estonia Medical Centre, Tallinn, Estonia
| | - Martin Kivi
- Centre of Urology, East Tallinn Central Hospital, Tallinn, Estonia
| | - Mihhail Kovtun
- Surgery Clinic, Tartu University Hospital, Tartu, Estonia
| | - Rauno Okas
- Urology Centre, West Tallinn Central Hospital, Tallinn, Estonia
| | - Helis Pokker
- Haematology and Oncology Clinic, North Estonia Medical Centre, Tallinn, Estonia
| | - Olga Rajevskaja
- Centre of Urology, East Tallinn Central Hospital, Tallinn, Estonia
| | | | - Mikk Saretok
- Haematology and Oncology Clinic, North Estonia Medical Centre, Tallinn, Estonia
| | - Elari Valk
- Surgery Clinic, North Estonia Medical Centre, Tallinn, Estonia
| | | | - Gleb Denissov
- Causes of Death Registry, National Institute for Health Development, Tallinn, Estonia
| | - Katrin Lang
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
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Factors Associated with Major Errors on Death Certificates. Healthcare (Basel) 2022; 10:healthcare10040726. [PMID: 35455903 PMCID: PMC9029766 DOI: 10.3390/healthcare10040726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/30/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022] Open
Abstract
The objective of this study was to investigate errors on death certificates and factors associated with the occurrence of major errors. A retrospective analysis was conducted for six months in 2020 at a university training hospital. Errors were judged as major and minor errors according to the contribution to the process of determining the cause of death. Death certificates were classified into two groups with major errors (ME group) and without major errors (non-ME group). General characteristics of the death certificates, the main cause of death (cancer, cardiovascular disease, cerebrovascular disease, digestive disease, respiratory disease, genitourinary disease, intentional self-harm, external causes, and other causes), the number of causes of deaths written on the death certificate, and major and minor errors were investigated. The ME group had 127 cases out of 548 death certificates. The number of causes of deaths written on the death certificates and the total number of errors were higher in the ME group than in the non-ME group. Cardiovascular disease, cerebrovascular disease, digestive disease, respiratory disease, external causes, and other diseases as causes of deaths had higher risks of major errors on death certificates than cancer as a cause of death. The group with cancer as a cause of death had the lowest incidence of major errors and fewer causes of deaths. To reduce major errors, continuous education and feedback are needed for those who are qualified to issue a death certificate.
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Intervention-related Deaths in the European Randomized Study of Screening for Prostate Cancer. EUR UROL SUPPL 2021; 34:27-32. [PMID: 34934964 PMCID: PMC8655382 DOI: 10.1016/j.euros.2021.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/22/2022] Open
Abstract
Background Identification of intervention-related deaths is important for an accurate assessment of the ratio of benefit to harm in screening trials. Objective To investigate intervention-related deaths by study arm in the European Randomized Study of Prostate Cancer Screening (ERSPC). Design, setting, and participants ERSPC is a multicenter trial initiated in the 1990s to investigate whether screening on the basis of prostate-specific antigen (PSA) can decrease prostate cancer mortality. The present study included men in the core age group (55–69 yr: screening group n = 112 553, control group n = 128 681) with 16-yr follow-up. Outcome measurements and statistical analysis Causes of death among men with prostate cancer in ERSPC were predominantly evaluated by independent national committees via review of medical records according to a predefined algorithm. Intervention-related deaths were defined as deaths caused by complications during the screening procedure, treatment, or follow-up. Descriptive statistics were used for the results. Results and limitations In total, 34 deaths were determined to be intervention-related, of which 21 were in the screening arm and 13 in the control arm. The overall risk of intervention-related death was 1.41 (95% confidence interval 0.99–1.99) per 10 000 randomized men for both arms combined and varied among centers from 0 to 7.0 per 10 000 randomized men. A limitation of this study is that differences in procedures among centers decreased the comparability of the results. Conclusions Intervention-related deaths were rare in ERSPC. Monitoring of intervention-related deaths in screening trials is important for assessment of harms. Patient summary We investigated deaths due to screening or treatment to assess harm in a trial of prostate cancer screening. Few such deaths were identified.
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9
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Uribe-Lewis S, Uribe J, Bourke V, Deering C, Higgins D, Mehta S, Mikropoulos C, Otter S, Perna C, Khaksar S, Laing R, Langley S. Long-term survival after low-dose-rate brachytherapy for prostate cancer: the Royal Surrey experience. BJU Int 2021; 129:723-730. [PMID: 34448332 DOI: 10.1111/bju.15585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/30/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the long-term treatment efficacy of low-dose-rate (LDR) brachytherapy for the treatment of localized prostate cancer. PATIENTS AND METHODS Cause-of-death annotation in our prospective database was supplemented with death certificate information obtained via an internal audit of patients treated from 1999 to 2017 with LDR prostate brachytherapy as monotherapy or as combination with androgen deprivation therapy and/or external beam radiotherapy. Overall and disease-specific survival were the primary outcomes, estimated with Kaplan-Meier and competing risks multi-state models. Clinical variables influencing mortality were assessed with Cox proportional hazards regression in a sub-analysis of men to assess the predictive value of prostate-specific antigen (PSA) level at 48 months post implant. RESULTS The audit process began in October 2017 and culminated in June 2020 with a curated series of 2936 patients. All-cause and prostate cancer-specific death prevalence were 11% and 2.9%, respectively. The median (range) follow-up time was 10 (3-21) years and the median (range) time to death from any cause was 9 (3-21) years. At 15 years post implant the overall and prostate cancer-specific survival probability were 81% and 95%, respectively. The 15-year cumulative incidence rates of death not due and due to prostate cancer were 14% and 5%, respectively. A greater risk of death due to prostate cancer was conferred by increasing age at therapy (hazard ratio [HR] 1.1, P < 0.001), advanced clinical stages relative to T1a-T2a (HR 1.9, P = 0.048 for T2b; HR 2.7, P = 0.023 for T2c-T3b) and a 48-month PSA level >1.0 ng/mL (HR 6.8, P < 0.001). CONCLUSION This study constitutes the largest retrospective analyses of long-term mortality outcomes from prospectively collected prostate brachytherapy data and confirms the excellent treatment efficacy of LDR prostate brachytherapy for localized prostate cancer. T2 clinical stage subdivisions and 48-month PSA level >1.0 ng/mL appear to be strong indicators of prostate cancer-related survival.
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Affiliation(s)
- Santiago Uribe-Lewis
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Jennifer Uribe
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Vincent Bourke
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Claire Deering
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Donna Higgins
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Sheel Mehta
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Christos Mikropoulos
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Sophie Otter
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Carla Perna
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Sara Khaksar
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Robert Laing
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Stephen Langley
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
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10
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Donkers H, McGrane J, Eleuteri A, Giamougiannis P, Bekkers R, Galaal K. The impact of socioeconomic deprivation on mortality in cervical cancer patients in Cornwall (England). Eur J Cancer Care (Engl) 2021; 30:e13463. [PMID: 34028120 DOI: 10.1111/ecc.13463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/19/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the association between risk factors, including socioeconomic deprivation, and mortality, recurrence and chemo- or radiation toxicity in cervical cancer patients. METHODS Retrospective study of cervical cancer patients diagnosed between January 2007 and July 2018. Patient characteristics and mortality data, including recurrence, were assessed, together with socioeconomic deprivation measures evaluated using the English Indices of Multiple Deprivation. Markov multi-state models were used to model mortality and recurrence, and logistic regression models were used to model chemo- or radiation toxicity. RESULTS Included were 243 women with a median age of 49 years. A total of 57 patients died (23%), of which 41 due to cervical cancer, and 21 (9%) had recurrent disease. Hazard ratios (HR) showed no evidence of association between socioeconomic deprivation and cancer-specific hazard of mortality from diagnosis or recurrence, hazard of mortality due to other causes or hazard of cancer recurrence. Furthermore, there was no evidence of association between socioeconomic deprivation and chemo- or radiation toxicity (bowel, bladder or vaginal stenosis). CONCLUSIONS No associations were found between socioeconomic deprivation and cancer mortality or recurrence in cervical cancer patients in the population of Cornwall. In addition, no association was found between socioeconomic deprivation and chemo- or radiation toxicity.
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Affiliation(s)
| | - John McGrane
- Royal Cornwall Hospital NHS Trust, Truro, Cornwall, UK
| | - Antonio Eleuteri
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Department of Physics, University of Liverpool, Liverpool, UK
| | | | - Ruud Bekkers
- Grow School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Catharina Hospital, Eindhoven, The Netherlands
| | - Khadra Galaal
- Royal Cornwall Hospital NHS Trust, Truro, Cornwall, UK
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11
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Merriel SWD, Ingle SM, May MT, Martin RM. Retrospective cohort study evaluating clinical, biochemical and pharmacological prognostic factors for prostate cancer progression using primary care data. BMJ Open 2021; 11:e044420. [PMID: 33579772 PMCID: PMC7883851 DOI: 10.1136/bmjopen-2020-044420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To confirm the association of previously reported prognostic factors with future progression of localised prostate cancer using primary care data and identify new potential prognostic factors for further assessment in prognostic model development and validation. DESIGN Retrospective cohort study, employing Cox proportional hazards regression controlling for age, prostate specific antigen (PSA), and Gleason score, was stratified by diagnostic stage. SETTING Primary care in England. PARTICIPANTS Males with localised prostate cancer diagnosedbetween 01/01/1987 and 31/12/2016 within the Clinical Practice ResearchDatalink database, with linked data from the National Cancer Registration andAnalysis Service and Office for National Statistics. PRIMARY AND SECONDARY OUTCOMES Primary outcome measure was prostate cancer mortality. Secondary outcome measures were all-cause mortality and commencing systemic therapy. Up-staging after diagnosis was not used as a secondary outcome owing to significant missing data. RESULTS 10 901 men (mean age 74.38±9.03 years) with localised prostate cancer were followed up for a mean of 14.12 (±6.36) years. 2331 (21.38%) men underwent systemic therapy and 3450 (31.65%) died, including 1250 (11.47%) from prostate cancer. Factors associated with an increased risk of prostate cancer mortality included age; high PSA; current or ex-smoker; ischaemic heart disease; high C reactive protein; high ferritin; low haemoglobin; high blood glucose and low albumin. CONCLUSIONS This study identified several new potential prognostic factors for prostate cancer progression, as well as confirming some known prognostic factors, in an independent primary care data set. Further research is needed to develop and validate a prognostic model for prostate cancer progression.
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Affiliation(s)
| | - Suzanne Marie Ingle
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Margaret T May
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Richard M Martin
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
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12
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Kalsi JK, Ryan A, Gentry-Maharaj A, Margolin-Crump D, Singh N, Burnell M, Benjamin E, Apostolidou S, Habib M, Massingham S, Karpinskyj C, Woolas R, Widschwendter M, Fallowfield L, Campbell S, Skates S, McGuire A, Parmar M, Jacobs I, Menon U. Completeness and accuracy of national cancer and death registration for outcome ascertainment in trials-an ovarian cancer exemplar. Trials 2021; 22:88. [PMID: 33494753 PMCID: PMC7831170 DOI: 10.1186/s13063-020-04968-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 12/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a trend to increasing use of routinely collected health data to ascertain outcome measures in trials. We report on the completeness and accuracy of national ovarian cancer and death registration in the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). METHODS Of the 202,638 participants, 202,632 were successfully linked and followed through national cancer and death registries of Northern Ireland, Wales and England. Women with registrations of any of 19 pre-defined ICD-10 codes suggestive of tubo-ovarian cancer or notification of ovarian/tubal/peritoneal cancer from hospital episode statistics or trial sites were identified. Copies of hospital and primary care notes were retrieved and reviewed by an independent outcomes review committee. National registration of site and cause of death as ovarian/tubal/peritoneal cancer (C56/C57/C48) obtained up to 3 months after trial censorship was compared to that assigned by outcomes review (reference standard). RESULTS Outcome review was undertaken in 3110 women on whom notification was received between 2001 and 2014. Ovarian cancer was confirmed in 1324 of whom 1125 had a relevant cancer registration. Sensitivity and specificity of ovarian/tubal/peritoneal cancer registration were 85.0% (1125/1324; 95% CI 83.7-86.2%) and 94.0% (1679/1786; 95% CI 93.2-94.8%), respectively. Of 2041 death registrations reviewed, 681 were confirmed to have a tubo-ovarian cancer of whom 605 had relevant death registration. Sensitivity and specificity were 88.8% (605/681; 95% CI 86.4-91.2%) and 96.7% (1482/1533, 95% CI 95.8-97.6%), respectively. When multiple electronic health record sources were considered, sensitivity for cancer site increased to 91.1% (1206/1324, 95% CI 89.4-92.5%) and for cause of death 94.0% (640/681, 95% CI 91.9-95.5%). Of 1232 with cancer registration, 8.7% (107/1232) were wrongly designated as ovarian/tubal/peritoneal cancers by the registry and 4.0% (47/1172) of confirmed tubo-ovarian cancers were mis-registered. In 656 with death registrations, 7.8% (51/656) were wrongly assigned as due to ovarian/tubal/peritoneal cancers while 6.2% (40/645) of confirmed tubo-ovarian cancer deaths were mis-registered. CONCLUSION Follow-up of trial participants for tubo-ovarian cancer using national registry data will result in incomplete ascertainment, particularly of the site due in part to the latency of registration. This can be reduced by using other routinely collected data such as hospital episode statistics. Central adjudication by experts though resource intensive adds value by improving the accuracy of diagnoses. TRIAL REGISTRATION ISRCTN: ISRCTN22488978 . Registered on 6 April 2000.
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Affiliation(s)
- Jatinderpal K Kalsi
- Department of Women's Cancer, Institute for Women's Health, University College London, London, WC1E 6AU, UK
| | - Andy Ryan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Aleksandra Gentry-Maharaj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Danielle Margolin-Crump
- Department of Women's Cancer, Institute for Women's Health, University College London, London, WC1E 6AU, UK
| | - Naveena Singh
- Department of Cellular Pathology, Barts Health NHS Trust, London, E1 2ES, UK
| | - Matthew Burnell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | | | - Sophia Apostolidou
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Mariam Habib
- Department of Women's Cancer, Institute for Women's Health, University College London, London, WC1E 6AU, UK
- Imperial Clinical Trials Unit, Imperial College London, London, W12 7RH, UK
| | - Susan Massingham
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Chloe Karpinskyj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Robert Woolas
- Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
| | - Martin Widschwendter
- Department of Women's Cancer, Institute for Women's Health, University College London, London, WC1E 6AU, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9RX, UK
| | | | - Steven Skates
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | | | - Max Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - Ian Jacobs
- Department of Women's Cancer, Institute for Women's Health, University College London, London, WC1E 6AU, UK
- University of New South Wales, Sydney, NSW, 2052, Australia
| | - Usha Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK.
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13
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Thorkildsen J, Norum OJ, Myklebust TA, Zaikova O. Chondrosarcoma local recurrence in the Cancer Registry of Norway cohort (1990-2013): Patterns and impact. J Surg Oncol 2020; 123:510-520. [PMID: 33314135 DOI: 10.1002/jso.26308] [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: 09/16/2020] [Revised: 10/21/2020] [Accepted: 11/07/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND There appears to be an association between local recurrence (LR) and risk of metastasis and death in central conventional chondrosarcoma (CCCS) of bone, but this has not been quantified in modern cohorts at a subtype level. METHODS We identified nonmetastatic cases of CCCS (N = 180) from the Cancer Registry of Norway. We present prognostic analysis of LR accounting for immortal time bias by descriptive statistics and multivariable Cox models. RESULTS Of 40 LR, one case demonstrated upgrading while two dedifferentiation. LR was associated with increased risk of metastasis (hazard ratio [HR] = 4.1 [confidence interval, 1.5-10.7]) and death (HR = 9.3 [5.0-17.5]) overall. LR was associated with significant increased risk of metastasis for those with a soft tissue component, axial location, malignancy grade 2, but not atypical cartilaginous tumor's, appropriately treated curettage patients, intramedullary tumors, grade 1 histology, extremity location or "Oslo low risk" group status. We found an increased risk of death for all groups except for those treated by appropriate curettage or belonging to the "Oslo low risk" group. About 50% of LR CCCS were asymptomatic and revealed by routine follow-up. CONCLUSIONS Upgrading of LR for CCCS was a seldom event. LR was associated with significant increased risk of metastasis and death overall, but not for appropriately treated curettage patients or "Oslo low risk" status.
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Affiliation(s)
- Joachim Thorkildsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Cancer Registry of Norway, Oslo, Norway
| | - Ole-Jacob Norum
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Tor A Myklebust
- Cancer Registry of Norway, Oslo, Norway.,Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Olga Zaikova
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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14
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Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P, Wade J, Noble S, Garfield K, Young G, Davis M, Peters TJ, Turner EL, Martin RM, Oxley J, Robinson M, Staffurth J, Walsh E, Blazeby J, Bryant R, Bollina P, Catto J, Doble A, Doherty A, Gillatt D, Gnanapragasam V, Hughes O, Kockelbergh R, Kynaston H, Paul A, Paez E, Powell P, Prescott S, Rosario D, Rowe E, Neal D. Active monitoring, radical prostatectomy and radical radiotherapy in PSA-detected clinically localised prostate cancer: the ProtecT three-arm RCT. Health Technol Assess 2020; 24:1-176. [PMID: 32773013 PMCID: PMC7443739 DOI: 10.3310/hta24370] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Prostate cancer is the most common cancer among men in the UK. Prostate-specific antigen testing followed by biopsy leads to overdetection, overtreatment as well as undertreatment of the disease. Evidence of treatment effectiveness has lacked because of the paucity of randomised controlled trials comparing conventional treatments. OBJECTIVES To evaluate the effectiveness of conventional treatments for localised prostate cancer (active monitoring, radical prostatectomy and radical radiotherapy) in men aged 50-69 years. DESIGN A prospective, multicentre prostate-specific antigen testing programme followed by a randomised trial of treatment, with a comprehensive cohort follow-up. SETTING Prostate-specific antigen testing in primary care and treatment in nine urology departments in the UK. PARTICIPANTS Between 2001 and 2009, 228,966 men aged 50-69 years received an invitation to attend an appointment for information about the Prostate testing for cancer and Treatment (ProtecT) study and a prostate-specific antigen test; 82,429 men were tested, 2664 were diagnosed with localised prostate cancer, 1643 agreed to randomisation to active monitoring (n = 545), radical prostatectomy (n = 553) or radical radiotherapy (n = 545) and 997 chose a treatment. INTERVENTIONS The interventions were active monitoring, radical prostatectomy and radical radiotherapy. TRIAL PRIMARY OUTCOME MEASURE Definite or probable disease-specific mortality at the 10-year median follow-up in randomised participants. SECONDARY OUTCOME MEASURES Overall mortality, metastases, disease progression, treatment complications, resource utilisation and patient-reported outcomes. RESULTS There were no statistically significant differences between the groups for 17 prostate cancer-specific (p = 0.48) and 169 all-cause (p = 0.87) deaths. Eight men died of prostate cancer in the active monitoring group (1.5 per 1000 person-years, 95% confidence interval 0.7 to 3.0); five died of prostate cancer in the radical prostatectomy group (0.9 per 1000 person-years, 95% confidence interval 0.4 to 2.2 per 1000 person years) and four died of prostate cancer in the radical radiotherapy group (0.7 per 1000 person-years, 95% confidence interval 0.3 to 2.0 per 1000 person years). More men developed metastases in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring, n = 33 (6.3 per 1000 person-years, 95% confidence interval 4.5 to 8.8); radical prostatectomy, n = 13 (2.4 per 1000 person-years, 95% confidence interval 1.4 to 4.2 per 1000 person years); and radical radiotherapy, n = 16 (3.0 per 1000 person-years, 95% confidence interval 1.9 to 4.9 per 1000 person-years; p = 0.004). There were higher rates of disease progression in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring (n = 112; 22.9 per 1000 person-years, 95% confidence interval 19.0 to 27.5 per 1000 person years); radical prostatectomy (n = 46; 8.9 per 1000 person-years, 95% confidence interval 6.7 to 11.9 per 1000 person-years); and radical radiotherapy (n = 46; 9.0 per 1000 person-years, 95% confidence interval 6.7 to 12.0 per 1000 person years; p < 0.001). Radical prostatectomy had the greatest impact on sexual function/urinary continence and remained worse than radical radiotherapy and active monitoring. Radical radiotherapy's impact on sexual function was greatest at 6 months, but recovered somewhat in the majority of participants. Sexual and urinary function gradually declined in the active monitoring group. Bowel function was worse with radical radiotherapy at 6 months, but it recovered with the exception of bloody stools. Urinary voiding and nocturia worsened in the radical radiotherapy group at 6 months but recovered. Condition-specific quality-of-life effects mirrored functional changes. No differences in anxiety/depression or generic or cancer-related quality of life were found. At the National Institute for Health and Care Excellence threshold of £20,000 per quality-adjusted life-year, the probabilities that each arm was the most cost-effective option were 58% (radical radiotherapy), 32% (active monitoring) and 10% (radical prostatectomy). LIMITATIONS A single prostate-specific antigen test and transrectal ultrasound biopsies were used. There were very few non-white men in the trial. The majority of men had low- and intermediate-risk disease. Longer follow-up is needed. CONCLUSIONS At a median follow-up point of 10 years, prostate cancer-specific mortality was low, irrespective of the assigned treatment. Radical prostatectomy and radical radiotherapy reduced disease progression and metastases, but with side effects. Further work is needed to follow up participants at a median of 15 years. TRIAL REGISTRATION Current Controlled Trials ISRCTN20141297. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 37. See the National Institute for Health Research Journals Library website for further project information.
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Affiliation(s)
- Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - J Athene Lane
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Malcolm Mason
- School of Medicine, University of Cardiff, Cardiff, UK
| | - Chris Metcalfe
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Holding
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Julia Wade
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian Noble
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Grace Young
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Davis
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim J Peters
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma L Turner
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jon Oxley
- Department of Cellular Pathology, North Bristol NHS Trust, Bristol, UK
| | - Mary Robinson
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - John Staffurth
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Eleanor Walsh
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Jane Blazeby
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Richard Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Prasad Bollina
- Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - James Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Andrew Doble
- Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| | - Alan Doherty
- Department of Urology, Queen Elizabeth Hospital, Birmingham, UK
| | - David Gillatt
- Department of Urology, Southmead Hospital and Bristol Urological Institute, Bristol, UK
| | | | - Owen Hughes
- Department of Urology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Roger Kockelbergh
- Department of Urology, University Hospitals of Leicester, Leicester, UK
| | - Howard Kynaston
- Department of Urology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Alan Paul
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Edgar Paez
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Philip Powell
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Stephen Prescott
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Derek Rosario
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Edward Rowe
- Department of Urology, Southmead Hospital and Bristol Urological Institute, Bristol, UK
| | - David Neal
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Academic Urology Group, University of Cambridge, Cambridge, UK
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15
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Lim JY, Yang KM, Lee DH. Study on death certificates and postmortem examination certificates written by Korean emergency physicians. J Forensic Leg Med 2020; 72:101960. [PMID: 32452450 DOI: 10.1016/j.jflm.2020.101960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Statistics on death are the basis of a country's health, safety, and welfare policies. Emergency physicians issue a postmortem examination certificate (PEC) for death outside the hospital as well as a death certificate (DC) for death in the hospital. This study investigated the actual conditions and criteria for writing a DC and PEC, writing environment, and doctor's experience. MATERIAL AND METHODS The physicians' DC and PEC writing experience and demographic data were analyzed. The questions focused on CPR, patient's medical certificate, time and place of death, difficulty in writing the PEC and DC, and education in certificate writing. RESULTS 229 emergency physicians were included. Physicians' opinions differed for CPR patients in terms of time of death, location, and whether or not to issue DC/PEC. The causes of death were also different. Further, 76.9% of the doctors did not have enough time to write a medical certificate and about 45% of them wrote it within 30 min; 76% had DC-related complaints, and 7.0% faced legal problems due to the DC; 93.3% of the emergency physicians stated that a coroner system is needed in South Korea. CONCLUSION Emergency physicians are responsible for writing DCs and PECs. The standards vary from physician to physician at the time of writing. Writing DCs and PECs is also burdensome. In South Korea, it is necessary to separate the DC and PEC, to develop national data management networks, and to introduce a postmortem examination system.
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Affiliation(s)
- Ji Yeon Lim
- Department of Emergency Medicine, Ewha Womans University, Seoul, Republic of Korea; Department of Emergency Medicine, Halla Hospital, Jeju, Republic of Korea.
| | - Kyung Moo Yang
- Department of Forensic Medicine, National Forensic Service, Wonju, Republic of Korea.
| | - Duk Hee Lee
- Department of Emergency Medicine, Ewha Womans University, Seoul, Republic of Korea.
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16
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Bryant RJ, Oxley J, Young GJ, Lane JA, Metcalfe C, Davis M, Turner EL, Martin RM, Goepel JR, Varma M, Griffiths DF, Grigor K, Mayer N, Warren AY, Bhattarai S, Dormer J, Mason M, Staffurth J, Walsh E, Rosario DJ, Catto JW, Neal DE, Donovan JL, Hamdy FC. The ProtecT trial: analysis of the patient cohort, baseline risk stratification and disease progression. BJU Int 2020; 125:506-514. [PMID: 31900963 PMCID: PMC7187290 DOI: 10.1111/bju.14987] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To test the hypothesis that the baseline clinico-pathological features of the men with localized prostate cancer (PCa) included in the ProtecT (Prostate Testing for Cancer and Treatment) trial who progressed (n = 198) at a 10-year median follow-up were different from those of men with stable disease (n = 1409). PATIENTS AND METHODS We stratified the study participants at baseline according to risk of progression using clinical disease stage, pathological grade and PSA level, using Cox proportional hazard models. RESULTS The findings showed that 34% of participants (n = 505) had intermediate- or high-risk PCa, and 66% (n = 973) had low-risk PCa. Of 198 participants who progressed, 101 (51%) had baseline International Society of Urological Pathology Grade Group 1, 59 (30%) Grade Group 2, and 38 (19%) Grade Group 3 PCa, compared with 79%, 17% and 5%, respectively, for 1409 participants without progression (P < 0.001). In participants with progression, 38% and 62% had baseline low- and intermediate-/high-risk disease, compared with 69% and 31% of participants with stable disease (P < 0.001). Treatment received, age (65-69 vs 50-64 years), PSA level, Grade Group, clinical stage, risk group, number of positive cores, tumour length and perineural invasion were associated with time to progression (P ≤ 0.005). Men progressing after surgery (n = 19) were more likely to have a higher Grade Group and pathological stage at surgery, larger tumours, lymph node involvement and positive margins. CONCLUSIONS We demonstrate that one-third of the ProtecT cohort consists of people with intermediate-/high-risk disease, and the outcomes data at an average of 10 years' follow-up are generalizable beyond men with low-risk PCa.
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Affiliation(s)
- Richard J. Bryant
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Jon Oxley
- Department of Cellular PathologyNorth Bristol NHS TrustBristolUK
| | - Grace J. Young
- Bristol Medical SchoolUniversity of BristolBristolUK
- The Bristol Randomised Trials CollaborationUniversity of BristolBristolUK
| | - Janet A. Lane
- Bristol Medical SchoolUniversity of BristolBristolUK
- The Bristol Randomised Trials CollaborationUniversity of BristolBristolUK
| | - Chris Metcalfe
- Bristol Medical SchoolUniversity of BristolBristolUK
- The Bristol Randomised Trials CollaborationUniversity of BristolBristolUK
| | - Michael Davis
- Bristol Medical SchoolUniversity of BristolBristolUK
| | | | | | - John R. Goepel
- Department of PathologyRoyal Hallamshire HospitalSheffieldUK
| | - Murali Varma
- Department of PathologyUniversity Hospital of WalesCardiffUK
| | | | - Ken Grigor
- Department of PathologyWestern General HospitalEdinburghUK
| | - Nick Mayer
- Department of PathologyUniversity of LeicesterLeicesterUK
| | - Anne Y. Warren
- Department of PathologyUniversity of CambridgeCambridgeUK
| | - Selina Bhattarai
- Department of PathologyLeeds Teaching Hospitals NHS TrustLeedsUK
| | - John Dormer
- Department of PathologyUniversity of LeicesterLeicesterUK
| | | | - John Staffurth
- Division of Cancer and GeneticsSchool of MedicineCardiff UniversityCardiffUK
| | - Eleanor Walsh
- Bristol Medical SchoolUniversity of BristolBristolUK
| | | | | | - David E. Neal
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
- Academic Urology GroupUniversity of CambridgeCambridgeUK
| | - Jenny L. Donovan
- Bristol Medical SchoolUniversity of BristolBristolUK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care WestUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - Freddie C. Hamdy
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
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17
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Wissing MD, O’Flaherty A, Dragomir A, Tanguay S, Kassouf W, Aprikian AG. Statins are Associated with Reduced Overall and Cancer-Specific Mortality in Patients Undergoing Radical Cystectomy for Bladder Cancer. Bladder Cancer 2020. [DOI: 10.3233/blc-190254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Existing literature provides contrasting data on statin use and bladder cancer (BC) outcome. OBJECTIVE: We evaluated whether (chronic) statin use was associated with clinical outcomes in patients with BC undergoing radical cystectomy (RC). METHODS: Using provincial health administrative databases, we retrospectively identified BC patients undergoing RC in Quebec province in 2000-2015, and collected data from two years before RC until December 2016 or death. We compared patients who chronically used statins before RC to never statin users. Survival analyses were conducted using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models. Covariates in multivariable analyses were age, sex, Charlson’s comorbidity index, year of RC, distance to hospital, hospital type, hospital’s and surgeon’s annual RC volume, and neoadjuvant chemotherapy. RESULTS: Our cohort contained 1406 chronic and 1754 never statin users. Five-year overall, BC-specific and recurrence-free survival rates were 40.5% (95% confidence interval (95% CI) 37.8–43.2%), 52.8% (95% CI 49.8–55.7%), and 50.1% (95% CI 47.2–53.0%) for chronic statin users, versus 34.9% (95% CI 32.5–37.2%), 45.5% (95% CI 42.9–48.1%), and 43.4% (95% CI 40.9–45.9%) for never statin users (p≤0.001). In multivariable analyses, hazard ratios (HR) for death, BC-specific deaths and recurrences were 0.83 (95% CI 0.75–0.91), 0.81 (95% CI 0.72–0.91), and 0.83 (95% CI 0.74–0.93) for chronic statin users, respectively. Similar observations were made in patients with diabetes and/or cardiovascular comorbidities (p≤0.001). Clinical outcome was not improved in patients who started statins in the year following surgery compared to never statin users (p > 0.4). CONCLUSIONS: Chronic statin use is associated with improved clinical outcome in BC patients undergoing RC in Quebec.
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Affiliation(s)
- Michel D. Wissing
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
- Department of Oncology, McGill University, Montreal, QC, Canada
| | - Ana O’Flaherty
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Alice Dragomir
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Simon Tanguay
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
- Department of Oncology, McGill University, Montreal, QC, Canada
| | - Wassim Kassouf
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Armen G. Aprikian
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
- Department of Oncology, McGill University, Montreal, QC, Canada
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18
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Bright CJ, Brentnall AR, Wooldrage K, Myles J, Sasieni P, Duffy SW. Errors in determination of net survival: cause-specific and relative survival settings. Br J Cancer 2020; 122:1094-1101. [PMID: 32037401 PMCID: PMC7109046 DOI: 10.1038/s41416-020-0739-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 01/07/2020] [Accepted: 01/17/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Cause-specific and relative survival estimates differ. We aimed to examine these differences in common cancers where by possible identifying the most plausible sources of error in each estimate. METHODS Ten-year cause-specific and relative survival were estimated for lung, breast, prostate, ovary, oesophagus and colorectal cancers. The cause-specific survival was corrected for misclassification of cause of death. The Pohar-Perme relative survival estimator was modified by (1) correcting for differences in deaths from ischaemic heart disease (IHD) between cancers and general population; or (2) correcting the population hazard for smoking (lung cancer only). RESULTS For all cancers except breast and prostate, relative survival was lower than cause-specific. Correction for published error rates in cause of death gave implausible results. Correction for rates of IHD death gave slightly different relative survival estimates for lung, oesophagus and colorectal cancers. For lung cancer, when the population hazard was inflated for smoking, survival estimates were increased. CONCLUSION Results agreed with the consensus that relative survival is usually preferable. However, for some cancers, relative survival might be inaccurate (e.g. lung and prostate). Likely solutions include enhancing life tables to include other demographic variables than age and sex, and to stratify relative survival calculation by cause of death.
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Affiliation(s)
- Chloe J Bright
- National Cancer Registration and Analysis Service, Public Health England, London, UK.
| | - Adam R Brentnall
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kate Wooldrage
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jonathon Myles
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Peter Sasieni
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Stephen W Duffy
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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19
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Blocking lncRNA MIR155HG/miR-155-5p/-3p inhibits proliferation, invasion and migration of clear cell renal cell carcinoma. Pathol Res Pract 2019; 216:152803. [PMID: 31889587 DOI: 10.1016/j.prp.2019.152803] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/12/2019] [Accepted: 12/23/2019] [Indexed: 01/07/2023]
Abstract
This study aimed to investigate the effect of blocking the MIR155HG/miR-155-5p/-3p axis on proliferation, invasion and migration of clear cell renal cell carcinoma. RT-qPCR was used to detect the expression of MIR155HG, miR-155-5p, miR-155-3p in clear cell renal cell carcinoma cell lines. To study the effects of blocking LncRNA MIR155HG and interfering with miR-155-5p and miR-155-3p on the biological function. The g proliferation of tumor was detected by CCK-8, and the cell invasion and migration abilities were detected by wound healing and transwell experiments. Western blot analyzed protein levels of KI67, PCNA, MMP2 and MMP9. Furthermore, TargetScan and miRDB were used to predict the co-target gene of miR-155-3p and miR-155-5p, and the functional analysis of co-target genes was performed using the DAVID. In the current research, the expression of MIR155HG was increased in ccRCC. Interference of MIR155HG inhibited the cellular functions of ccRCC cells, which was reversed by overexpression of miR-155-3p and miR-155-5p. In addition, MIR155HG interference repressed the expression of miR-155-5p and miR-155-3p in ccRCCs, while inhibition of miR-155-5p and miR-155-3p restrained the proliferation, invasion and migration of ccRCCs. Bioinformatics software analysis showed 13 co-targeting genes of miR-155-3p and miR-155-5p. Functional analysis presented that the target genes of miR-31-3p were involved in numerous of biochemical processes and pathways.Blocking lncRNA MIR155HG/miR-155-5p/-3p inhibits proliferation, invasion and migration of renal clear cell carcinoma, which provided a new method for early diagnosis and precise treatment of ccRCC.
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20
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Abrahamyan L, Huszti E, Bremner KE, Pechlivanoglou P, Mitsakakis N, Krahn M. New Insights into the Epidemiology of Prostate Cancer in Ontario. Cancer Invest 2019; 37:513-523. [PMID: 31617759 DOI: 10.1080/07357907.2019.1682154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The epidemiology of prostate cancer (PC) continues to change. We evaluated the changes in incidence, in average age at diagnosis, and in survival from 1992 to 2015 in Ontario. We compared the cumulative incidence of PC-specific and non PC-specific mortality using two algorithms for cause of death: Method 1 assigned deaths from "other cancers" to non PC-specific causes, and Method 2 assigned these cases to PC-specific mortality. There were 188,714 cases diagnosed with PC between 1992 and 2015 in Ontario. The average age at diagnosis declined from 1992 to 2008 by 0.26 year (3.1 months) annually (p < 0.001) and increased by 0.15 year (1.8 months) thereafter (p > 0.05). Between 2010 and 2015, the proportion of patients diagnosed at stage IV increased, and the proportion diagnosed at stage I decreased (p-values for trends <0.001). Overall survival significantly improved over the years. The cumulative incidence of PC-specific mortality at 5 and 10 years was 6.8 and 9.8% using Method 1, and 10.2 and 16.8% using Method 2. We observed trends toward older age and more advanced stage at PC diagnosis in Ontario. Further studies are needed to validate algorithms for estimating PC-specific mortality from administrative databases.
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Affiliation(s)
- Lusine Abrahamyan
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Ella Huszti
- Biostatistics Research Unit, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Karen E Bremner
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Petros Pechlivanoglou
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Nicholas Mitsakakis
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.,Biostatistics Research Unit, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Murray Krahn
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
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21
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Cuccia F, Mazzola R, Arcangeli S, Mortellaro G, Figlia V, Caminiti G, Di Paola G, Spera A, Iacoviello G, Alongi F, Lo Casto A, Magrini SM, Ferrera G. Moderate hypofractionated helical tomotherapy for localized prostate cancer: preliminary report of an observational prospective study. TUMORI JOURNAL 2019; 105:516-523. [PMID: 31432765 DOI: 10.1177/0300891619867846] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To report preliminary findings of a phase II study exploring the clinical outcomes of moderate hypofractionated radiotherapy performed with helical tomotherapy (HT) using computed tomography-magnetic resonance imaging-based planning for localized prostate cancer. METHODS The phase II prospective study received ethics approval from our institutional ethics committee. A dose of 60 Gy/20 fractions for low-intermediate risk prostate cancer by means of HT was explored. Primary endpoints of the study were acute and late gastrointestinal (GI) and genitourinary (GU) toxicities. Secondary endpoints were quality of life and biochemical-free survival. RESULTS A total of 35 patients were included in this interim report. At the time of the analysis, median follow-up was 36 months (range, 13-62). Acute GI toxicity was recorded as follows: grade 1 in 34% and grade 2 in 14%; acute GU toxicity was grade 1 in 71% and grade 2 in 11%. For the entire population of the study, no acute toxicities ⩾ grade 3 occurred. A single case of late grade 3 GU toxicity was registered, whereas no late GI toxicity ⩾grade 3 was recorded. At the time of the final assessment, no biochemical failure was detected. CONCLUSIONS The preliminary results of the present phase II trial, using HT for moderate hypofractionation in localized prostate cancer, are optimal. In fact, HT guaranteed an acceptable tolerability profile with low rates of GU and GI side effects and, more specifically, no acute severe adverse events were recorded. Long-term findings are warranted.
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Affiliation(s)
- Francesco Cuccia
- Radiation Oncology School, University of Palermo, Palermo, Italy
| | - Rosario Mazzola
- Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Stefano Arcangeli
- Department of Radiation Oncology, Policlinico S. Gerardo and University of Milan "Bicocca," Milan, Italy
| | | | - Vanessa Figlia
- Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Giovanni Caminiti
- Radiation Oncology, Centro di Medicina Nucleare San Gaetano, Bagheria, Palermo, Italy
| | | | - Antonio Spera
- Radiation Oncology School, University of Palermo, Palermo, Italy
| | | | - Filippo Alongi
- Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy.,Radiation Oncology, University of Brescia, Brescia, Italy
| | - Antonio Lo Casto
- Radiation Oncology School, University of Palermo, Palermo, Italy
| | - Stefano Maria Magrini
- Radiation Oncology, University of Brescia, Brescia, Italy.,Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
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22
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Sypek MP, Dansie KB, Clayton P, Webster AC, Mcdonald S. Comparison of cause of death between Australian and New Zealand Dialysis and Transplant Registry and the Australian National Death Index. Nephrology (Carlton) 2019; 24:322-329. [PMID: 29493847 DOI: 10.1111/nep.13250] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2018] [Indexed: 11/28/2022]
Abstract
AIM The aim of the present study was to understand the differences in how cause of death for patients receiving renal replacement therapy in Australia is recorded in The Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) compared to the National Death Index (NDI). METHODS Data linkage was performed between ANZDATA and NDI for all deaths in the period 1980-2013. Cause of death was classified according to ICD-10 chapter. Overall and chapter specific agreement were assessed using the Kappa statistic. Descriptive analysis was used to explore differences where there was disagreement on primary cause of death. RESULTS The analysis cohort included 28 675 patients. Ninety five percent of ANZDATA reported deaths fell within +/- 3 days of the date recorded by NDI. Circulatory death was the most common cause of death in both databases (ANZDATA 48%, NDI 32%). Overall agreement at ICD chapter level of primary cause was poor (36%, kappa 0.22). Agreement was best for malignancy (kappa 0.71). When there was disagreement on primary cause of death these were most commonly coded as genitourinary (35%) and endocrine (25.0%) in NDI, and circulatory (39%) and withdrawal (24%) in ANZDATA. Sixty-nine percent of patients had a renal related cause documented as either primary or a contributing cause of death in the NDI. CONCLUSION There is poor agreement in primary cause of death between ANZDATA and NDI which is in part explained by the absence of diabetes and renal failure as causes of death in ANZDATA and the absence of 'withdrawal' in NDI. These differences should be appreciated when interpreting epidemiological data on cause of death in the Australian end stage kidney disease population.
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Affiliation(s)
- Matthew P Sypek
- ANZDATA, Adelaide, South Australia, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | | | - Phil Clayton
- ANZDATA, Adelaide, South Australia, Australia.,University of Adelaide, Adelaide, South Australia, Australia.,Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Angela C Webster
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia
| | - Stephen Mcdonald
- ANZDATA, Adelaide, South Australia, Australia.,University of Adelaide, Adelaide, South Australia, Australia.,Royal Adelaide Hospital, Adelaide, South Australia, Australia
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23
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Roberts DJ, Njuguna HN, Fields B, Fligner CL, Zaki SR, Keating MK, Rogena E, Walong E, Gachii AK, Maleche-Obimbo E, Irimu G, Mathaiya J, Orata N, Lopokoiyit R, Michuki J, Emukule GO, Onyango CO, Gikunju S, Owuor C, Muturi PK, Bunei M, Widdowson MA, Mott JA, Chaves SS. Comparison of Minimally Invasive Tissue Sampling With Conventional Autopsy to Detect Pulmonary Pathology Among Respiratory Deaths in a Resource-Limited Setting. Am J Clin Pathol 2019; 152:36-49. [PMID: 31006817 DOI: 10.1093/ajcp/aqz016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES We compared minimally invasive tissue sampling (MITS) with conventional autopsy (CA) in detection of respiratory pathology/pathogens among Kenyan children younger than 5 years who were hospitalized with respiratory disease and died during hospitalization. METHODS Pulmonary MITS guided by anatomic landmarks was followed by CA. Lung tissues were triaged for histology and molecular testing using TaqMan Array Cards (TACs). MITS and CA results were compared for adequacy and concordance. RESULTS Adequate pulmonary tissue was obtained by MITS from 54 (84%) of 64 respiratory deaths. Comparing MITS to CA, full histologic diagnostic concordance was present in 23 (36%) cases and partial concordance in 19 (30%), an overall 66% concordance rate. Pathogen detection using TACs had full concordance in 27 (42%) and partial concordance in 24 (38%) cases investigated, an overall 80% concordance rate. CONCLUSIONS MITS is a viable alternative to CA in respiratory deaths in resource-limited settings, especially if combined with ancillary tests to optimize diagnostic accuracy.
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Affiliation(s)
| | - Henry N Njuguna
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Barry Fields
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Sherif R Zaki
- Division of High-Consequence Pathogens and Pathology, Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA
| | - M Kelly Keating
- Division of High-Consequence Pathogens and Pathology, Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | | | | | | | | | | | | | - Gideon O Emukule
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Clayton O Onyango
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Stella Gikunju
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Collins Owuor
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | | | - Marc-Alain Widdowson
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA
| | - Joshua A Mott
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sandra S Chaves
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA
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24
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Nguyen-Nielsen M, Møller H, Tjønneland A, Borre M. Causes of death in men with prostate cancer: Results from the Danish Prostate Cancer Registry (DAPROCAdata). Cancer Epidemiol 2019; 59:249-257. [PMID: 30861444 DOI: 10.1016/j.canep.2019.02.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 02/21/2019] [Accepted: 02/23/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Current knowledge of the validity of registry data on prostate cancer-specific death is limited. We aimed to determine the underlying cause of death among Danish men with prostate cancer, to estimate the level of misattribution of prostate cancer death, and to examine the risk of death from prostate cancer when accounting for competing risk of death. MATERIAL AND METHODS We investigated a nationwide cohort of 15,878 prostate cancer patients diagnosed in 2010-2014; with 3343 deaths occurring through 2016. Blinded medical chart review was carried out for 670 deaths and compared to the national cause of death registry. Five death categories were defined: 1) prostate cancer-specific death, 2) other unspecified urological cancer death, 3) other cancer death 4) cardiovascular disease death, and 5) other causes of death. Competing risk analyses compared Cox cause-specific and Fine-Gray regression models. RESULTS Chart review attributed 51.2% of deaths to prostate cancer, 17.0% to cardiovascular disease, and 16.7% to other causes. The Danish Register of Causes of Death attributed 71.7% of deaths to prostate cancer when including all registered contributing causes of death, and 57.0% of deaths when including only the primary registered cause of death. The probability of death by prostate cancer was 10% at 2-year survival. CONCLUSIONS More than half of the deceased men in our study cohort died of their prostate cancer disease within a mean of 2.4 years of follow up. Data from the death registry is prone to misclassification, potentially overestimating the proportion of deaths from prostate cancer.
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Affiliation(s)
- Mary Nguyen-Nielsen
- Department of Urology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark; Diet, Genes and Environment, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Henrik Møller
- The Danish Clinical Registries (RKKP), Olaf Palmes Allé 15, 8200, Aarhus N, Denmark; Department of Public Health, Aarhus University, Bartholins Allé 2, Building 1260, 8000, Aarhus, Denmark
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
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25
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Wissing MD, Greenwald ZR, Franco EL. Improving the reporting of cancer-specific mortality and survival in research using cancer registry data. Cancer Epidemiol 2019; 59:232-235. [PMID: 30836221 DOI: 10.1016/j.canep.2019.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 12/11/2022]
Abstract
Population-based registries are increasingly used in cancer research. In such studies, cancer-specific mortality or survival is frequently used as the primary outcome. To determine whether a putative cancer was part of the causal chain of events leading to death, cancer registries primarily rely on death certificates. Hence, they depend on the subjective interpretation of information available to medical examiners at the time of death. Misclassification may occur: studies report misclassification of cancer as a cause of death in 15%-35% of death certificates based on evaluation by expert panels and/or autopsy reports. Further misclassification may occur when coding death causes in the cancer registry. Researchers should be aware of potential misclassification bias when using cancer registry data. Differential misclassification may bias the results towards or away from the null hypothesis, depending on whether there is relative over- or under-reporting of cancer-related deaths in one group. Strategies to improve reporting of cancer-specific survival/mortality include (1) describing the procedure used to identify cancer-specific deaths; (2) considering the use of multiple definitions of cancer-related deaths (strict/liberal definitions of cancer-specific deaths, and/or addition of relative survival as an outcome); and (3) reporting cancer-specific survival/mortality together with the objectively measured parameters overall survival or all-cause mortality.
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Affiliation(s)
- Michel D Wissing
- Department of Oncology, McGill University, Montréal, QC, Canada.
| | - Zoë R Greenwald
- Department of Oncology, McGill University, Montréal, QC, Canada
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26
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Thurtle DR, Greenberg DC, Lee LS, Huang HH, Pharoah PD, Gnanapragasam VJ. Individual prognosis at diagnosis in nonmetastatic prostate cancer: Development and external validation of the PREDICT Prostate multivariable model. PLoS Med 2019; 16:e1002758. [PMID: 30860997 PMCID: PMC6413892 DOI: 10.1371/journal.pmed.1002758] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/04/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Prognostic stratification is the cornerstone of management in nonmetastatic prostate cancer (PCa). However, existing prognostic models are inadequate-often using treatment outcomes rather than survival, stratifying by broad heterogeneous groups and using heavily treated cohorts. To address this unmet need, we developed an individualised prognostic model that contextualises PCa-specific mortality (PCSM) against other cause mortality, and estimates the impact of treatment on survival. METHODS AND FINDINGS Using records from the United Kingdom National Cancer Registration and Analysis Service (NCRAS), data were collated for 10,089 men diagnosed with nonmetastatic PCa between 2000 and 2010 in Eastern England. Median follow-up was 9.8 years with 3,829 deaths (1,202 PCa specific). Totals of 19.8%, 14.1%, 34.6%, and 31.5% of men underwent conservative management, prostatectomy, radiotherapy (RT), and androgen deprivation monotherapy, respectively. A total of 2,546 men diagnosed in Singapore over a similar time period represented an external validation cohort. Data were randomly split 70:30 into model development and validation cohorts. Fifteen-year PCSM and non-PCa mortality (NPCM) were explored using separate multivariable Cox models within a competing risks framework. Fractional polynomials (FPs) were utilised to fit continuous variables and baseline hazards. Model accuracy was assessed by discrimination and calibration using the Harrell C-index and chi-squared goodness of fit, respectively, within both validation cohorts. A multivariable model estimating individualised 10- and 15-year survival outcomes was constructed combining age, prostate-specific antigen (PSA), histological grade, biopsy core involvement, stage, and primary treatment, which were each independent prognostic factors for PCSM, and age and comorbidity, which were prognostic for NPCM. The model demonstrated good discrimination, with a C-index of 0.84 (95% CI: 0.82-0.86) and 0.84 (95% CI: 0.80-0.87) for 15-year PCSM in the UK and Singapore validation cohorts, respectively, comparing favourably to international risk-stratification criteria. Discrimination was maintained for overall mortality, with C-index 0.77 (95% CI: 0.75-0.78) and 0.76 (95% CI: 0.73-0.78). The model was well calibrated with no significant difference between predicted and observed PCa-specific (p = 0.19) or overall deaths (p = 0.43) in the UK cohort. Key study limitations were a relatively small external validation cohort, an inability to account for delayed changes to treatment beyond 12 months, and an absence of tumour-stage subclassifications. CONCLUSIONS 'PREDICT Prostate' is an individualised multivariable PCa prognostic model built from baseline diagnostic information and the first to our knowledge that models potential treatment benefits on overall survival. Prognostic power is high despite using only routinely collected clinicopathological information.
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Affiliation(s)
- David R. Thurtle
- Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, United Kingdom
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - David C. Greenberg
- National Cancer Registration and Analysis Service (Eastern Region), Fulbourn, Cambridge, United Kingdom
| | - Lui S. Lee
- Department of Urology, Singapore General Hospital, Singapore
| | - Hong H. Huang
- Department of Urology, Singapore General Hospital, Singapore
| | - Paul D. Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Vincent J. Gnanapragasam
- Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, United Kingdom
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Cambridge Urology Translational Research and Clinical Trials, Cambridge, United Kingdom
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27
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Disparities in place of death for patients with hematological malignancies, 1999 to 2015. Blood Adv 2019; 3:333-338. [PMID: 30709864 PMCID: PMC6373747 DOI: 10.1182/bloodadvances.2018023051] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 12/04/2018] [Indexed: 11/20/2022] Open
Abstract
Patients with hematologic malignancies (HMs) often receive aggressive end-of-life care and less frequently use hospice. Comprehensive longitudinal reporting on place of death, a key quality indicator, is lacking. Deidentified death certificate data were obtained via the National Center for Health Statistics for all HM deaths from 1999 to 2015. Multivariate regression analysis (MVA) was used to test for disparities in place of death associated with sociodemographic variables. During the study period, there were 951 435 HM deaths. Hospital deaths decreased from 54.6% in 1999 to 38.2% in 2015, whereas home (25.9% to 32.7%) and hospice facility deaths (0% to 12.1%) increased (all P < .001). On MVA of all cancers, HM patients had the lowest odds of home or hospice facility death (odds ratio [OR], 0.55; 95% confidence interval, 0.54-0.55). Older age (40-64 years: OR, 1.34; ≥65 years: OR, 1.89), being married (OR, 1.62), and having myeloma (OR, 1.34) were associated with home or hospice facility death, whereas being black or African American (OR, 0.68), Asian (OR, 0.58), or Hispanic (OR, 0.84) or having chronic leukemia (OR, 0.83) had decreased odds of dying at home or hospice (all P < .001). In conclusion, despite hospital deaths decreasing over time, patients with HMs remained more likely to die in the hospital than at home.
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Mulkerrin G, Ní Chaoimh D, MacLoughlin C, O'Keeffe S, Mulkerrin E. Underreporting of Death Certification in a University Teaching Hospital – A Hospital Based Study in Ireland. INT J GERONTOL 2018. [DOI: 10.1016/j.ijge.2018.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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29
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Martin RM, Donovan JL, Turner EL, Metcalfe C, Young GJ, Walsh EI, Lane JA, Noble S, Oliver SE, Evans S, Sterne JAC, Holding P, Ben-Shlomo Y, Brindle P, Williams NJ, Hill EM, Ng SY, Toole J, Tazewell MK, Hughes LJ, Davies CF, Thorn JC, Down E, Davey Smith G, Neal DE, Hamdy FC. Effect of a Low-Intensity PSA-Based Screening Intervention on Prostate Cancer Mortality: The CAP Randomized Clinical Trial. JAMA 2018; 319:883-895. [PMID: 29509864 PMCID: PMC5885905 DOI: 10.1001/jama.2018.0154] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/17/2018] [Indexed: 11/14/2022]
Abstract
Importance Prostate cancer screening remains controversial because potential mortality or quality-of-life benefits may be outweighed by harms from overdetection and overtreatment. Objective To evaluate the effect of a single prostate-specific antigen (PSA) screening intervention and standardized diagnostic pathway on prostate cancer-specific mortality. Design, Setting, and Participants The Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP) included 419 582 men aged 50 to 69 years and was conducted at 573 primary care practices across the United Kingdom. Randomization and recruitment of the practices occurred between 2001 and 2009; patient follow-up ended on March 31, 2016. Intervention An invitation to attend a PSA testing clinic and receive a single PSA test vs standard (unscreened) practice. Main Outcomes and Measures Primary outcome: prostate cancer-specific mortality at a median follow-up of 10 years. Prespecified secondary outcomes: diagnostic cancer stage and Gleason grade (range, 2-10; higher scores indicate a poorer prognosis) of prostate cancers identified, all-cause mortality, and an instrumental variable analysis estimating the causal effect of attending the PSA screening clinic. Results Among 415 357 randomized men (mean [SD] age, 59.0 [5.6] years), 189 386 in the intervention group and 219 439 in the control group were included in the analysis (n = 408 825; 98%). In the intervention group, 75 707 (40%) attended the PSA testing clinic and 67 313 (36%) underwent PSA testing. Of 64 436 with a valid PSA test result, 6857 (11%) had a PSA level between 3 ng/mL and 19.9 ng/mL, of whom 5850 (85%) had a prostate biopsy. After a median follow-up of 10 years, 549 (0.30 per 1000 person-years) died of prostate cancer in the intervention group vs 647 (0.31 per 1000 person-years) in the control group (rate difference, -0.013 per 1000 person-years [95% CI, -0.047 to 0.022]; rate ratio [RR], 0.96 [95% CI, 0.85 to 1.08]; P = .50). The number diagnosed with prostate cancer was higher in the intervention group (n = 8054; 4.3%) than in the control group (n = 7853; 3.6%) (RR, 1.19 [95% CI, 1.14 to 1.25]; P < .001). More prostate cancer tumors with a Gleason grade of 6 or lower were identified in the intervention group (n = 3263/189 386 [1.7%]) than in the control group (n = 2440/219 439 [1.1%]) (difference per 1000 men, 6.11 [95% CI, 5.38 to 6.84]; P < .001). In the analysis of all-cause mortality, there were 25 459 deaths in the intervention group vs 28 306 deaths in the control group (RR, 0.99 [95% CI, 0.94 to 1.03]; P = .49). In the instrumental variable analysis for prostate cancer mortality, the adherence-adjusted causal RR was 0.93 (95% CI, 0.67 to 1.29; P = .66). Conclusions and Relevance Among practices randomized to a single PSA screening intervention vs standard practice without screening, there was no significant difference in prostate cancer mortality after a median follow-up of 10 years but the detection of low-risk prostate cancer cases increased. Although longer-term follow-up is under way, the findings do not support single PSA testing for population-based screening. Trial Registration ISRCTN Identifier: ISRCTN92187251.
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Affiliation(s)
- Richard M. Martin
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, England
| | - Jenny L. Donovan
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Trust, Bristol, England
| | - Emma L. Turner
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Chris Metcalfe
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, England
| | - Grace J. Young
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, England
| | - Eleanor I. Walsh
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - J. Athene Lane
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, England
| | - Sian Noble
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Steven E. Oliver
- Department of Health Sciences, University of York and Hull York Medical School, York, England
| | - Simon Evans
- Urology Department, Royal United Hospital, Bath, England
| | - Jonathan A. C. Sterne
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, England
| | - Peter Holding
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, England
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Trust, Bristol, England
| | - Peter Brindle
- Bristol, North Somerset, and South Gloucestershire Clinical Commissioning Group, Bristol, England
| | - Naomi J. Williams
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Elizabeth M. Hill
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Siaw Yein Ng
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Jessica Toole
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Marta K. Tazewell
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Laura J. Hughes
- Department of Oncology, Addenbrooke’s Hospital, University of Cambridge, Cambridge, England
| | - Charlotte F. Davies
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Joanna C. Thorn
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Elizabeth Down
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - George Davey Smith
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, England
| | - David E. Neal
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, England
- Department of Oncology, Addenbrooke’s Hospital, University of Cambridge, Cambridge, England
| | - Freddie C. Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, England
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Cao L, Yang YJ, Li ZW, Wu HF, Yang ZC, Liu SX, Wang P. Moderate hypofractionated radiotherapy is more effective and safe for localized prostate cancer patients: a meta-analysis. Oncotarget 2018; 8:2647-2658. [PMID: 27926521 PMCID: PMC5356830 DOI: 10.18632/oncotarget.13735] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/24/2016] [Indexed: 12/03/2022] Open
Abstract
To compare the efficacy and safety of moderate hypofractionated radiotherapy (H-RT) with those of conventional radiotherapy (C-RT) in patients with localized prostate cancer, we conducted extensive literature searches of The Web of Science, Embase, Pubmed and Cochrane Library databases. We identified nine studies with 5969 patients for a meta-analysis. We calculated pooled risk ratios (RRs) and the 95% confidence intervals (CIs) for multiple parameters and performed statistical analysis using RevMan 5.3 software. Our analysis showed that the H-RT group obtained greater improvements in the 5-year biochemical or clinical failure-free survival (RR = 1.04, 95% CI:1.01–1.08; P = 0.01) and 5-year disease-free survival(RR = 1.04, 95% CI: 1.01–1.07, P = 0.02)than the C-RT group. However, the 5-year overall survival rates were comparable in the two groups (RR = 1.02, 95% CI: 0.99–1.04; P = 0.18). Comparison of multiple secondary parameters, including grade 2-4 acute/late gastrointestinal toxicity, grade 2–4 acute/late genitourinary toxicity, biochemical failure, local failure, distant failure and prostate cancer-specific mortality between the H-RT and the C-RT groups showed no statistical differences. This meta-analysis thus indicates that in patients with localized prostate cancer, moderate H-RT exerts a great beneficial effect on the primary parameters than C-RT without enhancing adverse events.
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Affiliation(s)
- Ling Cao
- Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun 130012, People's Republic of China
| | - Yong-Jing Yang
- Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun 130012, People's Republic of China
| | - Zhi-Wen Li
- Department of Anesthesiology, The First Hospital Affiliated to Jilin University, Changchun 130012, People's Republic of China
| | - Hong-Fen Wu
- Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun 130012, People's Republic of China
| | - Zhu-Chun Yang
- Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun 130012, People's Republic of China
| | - Shi-Xin Liu
- Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun 130012, People's Republic of China
| | - Ping Wang
- Department of Radiotherapy, Cancer Institute and Hospital of Tianjin Medical University, Tianjin 300060, People's Republic of China
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Löffeler S, Halland A, Weedon-Fekjær H, Nikitenko A, Ellingsen CL, Haug ES. High Norwegian prostate cancer mortality: evidence of over-reporting. Scand J Urol 2018; 52:122-128. [DOI: 10.1080/21681805.2017.1421260] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sven Löffeler
- Department of Urology, Sykehuset I Vestfold (Vestfold Hospital Trust), Halfdan Wilhelmsens Allé, Tønsberg, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Adrian Halland
- Department of Urology, Sykehuset I Vestfold (Vestfold Hospital Trust), Halfdan Wilhelmsens Allé, Tønsberg, Norway
| | - Harald Weedon-Fekjær
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Anastasia Nikitenko
- Department of Oncology, Sykehuset I Vestfold (Vestfold Hospital Trust), Halfdan Wilhelmsens Allé, Tønsberg, Norway
| | - Christian Lycke Ellingsen
- Cause of Death Registry, Health Data and Digitalisation, Norwegian Institute of Public Health, Bergen, Norway
| | - Erik Skaaheim Haug
- Department of Urology, Sykehuset I Vestfold (Vestfold Hospital Trust), Halfdan Wilhelmsens Allé, Tønsberg, Norway
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Smith K, Byrne, Castaño JM, Chirlaque MD, Lilja H, Agudo A, Ardanaz E, Rodríguez-Barranco M, Boeing H, Kaaks R, Khaw KT, Larrañaga N, Navarro C, Olsen A, Overvad K, Perez-Cornago A, Rohrmann S, Sánchez MJ, Tjønneland A, Tsilidis KK, Johansson M, Riboli E, Key TJ, Travis RC. Vasectomy and Prostate Cancer Risk in the European Prospective Investigation Into Cancer and Nutrition (EPIC). J Clin Oncol 2017; 35:1297-1303. [PMID: 28375714 PMCID: PMC5455458 DOI: 10.1200/jco.2016.70.0062] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose Vasectomy is a commonly used form of male sterilization, and some studies have suggested that it may be associated with an increased risk of prostate cancer, including more aggressive forms of the disease. We investigated the prospective association of vasectomy with prostate cancer in a large European cohort, with a focus on high-grade and advanced-stage tumors, and death due to prostate cancer. Patients and Methods A total of 84,753 men from the European Prospective Investigation into Cancer and Nutrition (EPIC), aged 35 to 79 years, provided information on vasectomy status (15% with vasectomy) at recruitment and were followed for incidence of prostate cancer and death. We estimated the association of vasectomy with prostate cancer risk overall, by tumor subtype, and for death due to prostate cancer, using multivariable-adjusted Cox proportional hazards models. Results During an average follow-up of 15.4 years, 4,377 men were diagnosed with prostate cancer, including 641 who had undergone a vasectomy. Vasectomy was not associated with prostate cancer risk (hazard ratio [HR], 1.05; 95% CI, 0.96 to 1.15), and no evidence for heterogeneity in the association was observed by stage of disease or years since vasectomy. There was some evidence of heterogeneity by tumor grade ( P = .02), with an increased risk for low-intermediate grade (HR, 1.14; 95% CI, 1.01 to 1.29) but not high-grade prostate cancer (HR, 0.83; 95% CI, 0.64 to 1.07). Vasectomy was not associated with death due to prostate cancer (HR, 0.88; 95% CI, 0.68 to 1.12). Conclusion These findings from a large European prospective study show no elevated risk for overall, high-grade or advanced-stage prostate cancer, or death due to prostate cancer in men who have undergone a vasectomy compared with men who have not.
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Affiliation(s)
- Karl Smith
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Byrne
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Jose Maria Castaño
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Maria Dolores Chirlaque
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Hans Lilja
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Antonio Agudo
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Eva Ardanaz
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Miguel Rodríguez-Barranco
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Heiner Boeing
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Rudolf Kaaks
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Kay-Tee Khaw
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Nerea Larrañaga
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Carmen Navarro
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Anja Olsen
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Kim Overvad
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Aurora Perez-Cornago
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Sabine Rohrmann
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Maria José Sánchez
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Anne Tjønneland
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Konstantinos K. Tsilidis
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Mattias Johansson
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Elio Riboli
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Timothy J. Key
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
| | - Ruth C. Travis
- Karl Smith Byrne, Hans Lilja, Aurora Perez-Cornago, Timothy J. Key, and Ruth C. Travis, University of Oxford, Oxford; Kay-Tee Khaw, School of Clinical Medicine, University of Cambridge, Cambridge, Konstantinos K. Tsilidis and Elio Riboli, Imperial College London, London, United Kingdom; Jose Maria Castaño, Maria Dolores Chirlaque, and Carmen Navarro, Murcia Regional Health Council; Maria Dolores Chirlaque, IMIB-Arrixaca, Murcia; Jose Maria Castaño, Maria Dolores Chirlaque, Eva Ardanaz, Miguel Rodríguez-Barranco, Nerea Larrañaga, Carmen Navarro, and Maria José Sánchez, Center for Biomedical Research Network for Epidemiology and Public Health, Madrid; Antonio Agudo, Catalan Institute of Oncology-IDIBELL, Barcelona, Spain; Eva Ardanaz, Navarra Institute for Health Research, Pamplona; Miguel Rodríguez-Barranco and Maria José Sánchez, Universidad de Granada, Granada; Nerea Larrañaga, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain; Hans Lilja, Memorial Sloan Kettering Cancer Center, New York, NY; Lund University, Malmö, Sweden; Heiner Boeing, German Institute of Human Nutrition, Potsdam-Rehbrücke; Rudolf Kaaks, German Cancer Research Center, Heidelberg, Germany; Anja Olsen and Anne Tjønneland, Danish Cancer Society Research Center, Copenhagen; Kim Overvad, Aarhus University, Aarhus, Denmark; Sabine Rohrmann, University of Zurich, Zurich, Switzerland; Konstantinos K. Tsilidis, University of Ioannina School of Medicine, Ionnina, Greece, and Mattias Johansson, International Agency for Research on Cancer, Lyon, France
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Atkin W, Wooldrage K, Parkin DM, Kralj-Hans I, MacRae E, Shah U, Duffy S, Cross AJ. Long term effects of once-only flexible sigmoidoscopy screening after 17 years of follow-up: the UK Flexible Sigmoidoscopy Screening randomised controlled trial. Lancet 2017; 389:1299-1311. [PMID: 28236467 PMCID: PMC6168937 DOI: 10.1016/s0140-6736(17)30396-3] [Citation(s) in RCA: 238] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/01/2017] [Accepted: 02/02/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Colorectal cancer is the third most common cancer worldwide. Previous analyses have only reported follow-up after flexible sigmoidoscopy for a maximum of 12 years. We aimed to examine colorectal cancer incidence and mortality after a single flexible sigmoidoscopy screening and 17 years of follow-up. METHODS In this multicentre randomised trial (UK Flexible Sigmoidoscopy Screening Trial), done between Nov 14, 1994, and March 30, 1999, 170 432 eligible men and women, who had indicated on a previous questionnaire that they would probably attend screening if invited, were randomly assigned (1:2) to an intervention group (offered flexible sigmoidoscopy screening) or a control group (not contacted). Randomisation was done centrally in blocks of 12, and stratified by trial centre, general practice, and household type. The nature of the intervention did not allow the staff to be masked to arm of the trial; however, randomisation was done in batches so that the control group and participants not yet randomised were unaware of their allocation status. The primary outcomes were incidence and mortality of colorectal cancer. Hazard ratios (HRs) and 95% CIs for colorectal cancer incidence and mortality were estimated for intention-to-treat and per-protocol analyses. The trial is registered with ISRCTN, number 28352761. FINDINGS Our cohort analysis included 170 034 people: 112 936 in the control group and 57 098 in the intervention group, 40 621 (71%) of whom were screened and 16 477 (29%) were not screened. During screening and a median of 17·1 years' follow-up, colorectal cancer was diagnosed in 1230 individuals in the intervention group and 3253 in the control group, and 353 individuals in the intervention group versus 996 individuals in the control group died from colorectal cancer. In intention-to-treat analyses, colorectal cancer incidence was reduced by 26% (HR 0·74 [95% CI 0·70-0·80]; p<0·0001) in the intervention group versus the control group and colorectal cancer mortality was reduced by 30% (0·70 [0·62-0·79]; p<0·0001) in the intervention group versus the control group. In per-protocol analyses, adjusted for non-compliance, colorectal cancer incidence and mortality were 35% (HR 0·65 [95% CI 0·59-0·71]) and 41% (0·59 [0·49-0·70]) lower in the screened group. INTERPRETATION A single flexible sigmoidoscopy continues to provide substantial protection from colorectal cancer diagnosis and death, with protection lasting at least 17 years. FUNDING National Institute for Health Research Efficacy and Mechanism Evaluation.
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Affiliation(s)
- Wendy Atkin
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Kate Wooldrage
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - D Maxwell Parkin
- Clinical Trial Service Unit, The Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
| | - Ines Kralj-Hans
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Eilidh MacRae
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Urvi Shah
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephen Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London, UK
| | - Amanda J Cross
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
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Walter SD, de Koning HJ, Hugosson J, Talala K, Roobol MJ, Carlsson S, Zappa M, Nelen V, Kwiatkowski M, Páez Á, Moss S, Auvinen A. Impact of cause of death adjudication on the results of the European prostate cancer screening trial. Br J Cancer 2017; 116:141-148. [PMID: 27855442 PMCID: PMC5220145 DOI: 10.1038/bjc.2016.378] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/22/2016] [Accepted: 10/09/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The European Randomised Study of Prostate Cancer Screening has shown a 21% relative reduction in prostate cancer mortality at 13 years. The causes of death can be misattributed, particularly in elderly men with multiple comorbidities, and therefore accurate assessment of the underlying cause of death is crucial for valid results. To address potential unreliability of end-point assessment, and its possible impact on mortality results, we analysed the study outcome adjudication data in six countries. METHODS Latent class statistical models were formulated to compare the accuracy of individual adjudicators, and to assess whether accuracy differed between the trial arms. We used the model to assess whether correcting for adjudication inaccuracies might modify the study results. RESULTS There was some heterogeneity in adjudication accuracy of causes of death, but no consistent differential accuracy by trial arm. Correcting the estimated screening effect for misclassification did not alter the estimated mortality effect of screening. CONCLUSIONS Our findings were consistent with earlier reports on the European screening trial. Observer variation, while demonstrably present, is unlikely to have materially biased the main study results. A bias in assigning causes of death that might have explained the mortality reduction by screening can be effectively ruled out.
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Affiliation(s)
- Stephen D Walter
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, CRL 233, 1280 Main Street, Hamilton, Ontario, Canada L8S 4K1
| | - Harry J de Koning
- Department of Public Health, Erasmus University Medical Center, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - Jonas Hugosson
- Department of Urology, Sahlgrenska universitetssjukhuset, Bruna stråket 11b v 2 su/sahlgrenska, 41345 Göteborg, Sweden
| | - Kirsi Talala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Unioninkatu 22, FI-00130 Helsinki, Finland
| | - Monique J Roobol
- Department of Public Health, Erasmus University Medical Center, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - Sigrid Carlsson
- Department of Urology, Sahlgrenska universitetssjukhuset, Bruna stråket 11b v 2 su/sahlgrenska, 41345 Göteborg, Sweden
- Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Marco Zappa
- ISPO–Cancer Research and Prevention Institute, Clinical and Descriptive Epidemiology Unit, Via delle Oblate 2, 50141 Florence, Italy
| | - Vera Nelen
- Provinciaal Instituut Voor Hygiëne (Labo's), Kronenburgstraat 45, 2000 Antwerpen, Belgium
| | - Maciej Kwiatkowski
- Department of Urology, Kantonsspital Aarau, Aarau, Switzerland
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Álvaro Páez
- Department of Urology, Hospital Universitario de Fuenlabrada, Camino del Molino 2, 28942 FUENLABRADA (Madrid), Spain
| | - Sue Moss
- Wolfson Institute, St Mary University, Charterhouse Square, London EC1M 6BQ, UK
| | - Anssi Auvinen
- School of Health Sciences, University of Tampere, FI-33014 Tampere, Finland
| | - the ERSPC Cause of Death Committees
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, CRL 233, 1280 Main Street, Hamilton, Ontario, Canada L8S 4K1
- Department of Public Health, Erasmus University Medical Center, Postbus 2040, 3000 CA Rotterdam, The Netherlands
- Department of Urology, Sahlgrenska universitetssjukhuset, Bruna stråket 11b v 2 su/sahlgrenska, 41345 Göteborg, Sweden
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Unioninkatu 22, FI-00130 Helsinki, Finland
- Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
- ISPO–Cancer Research and Prevention Institute, Clinical and Descriptive Epidemiology Unit, Via delle Oblate 2, 50141 Florence, Italy
- Provinciaal Instituut Voor Hygiëne (Labo's), Kronenburgstraat 45, 2000 Antwerpen, Belgium
- Department of Urology, Kantonsspital Aarau, Aarau, Switzerland
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
- Department of Urology, Hospital Universitario de Fuenlabrada, Camino del Molino 2, 28942 FUENLABRADA (Madrid), Spain
- Wolfson Institute, St Mary University, Charterhouse Square, London EC1M 6BQ, UK
- School of Health Sciences, University of Tampere, FI-33014 Tampere, Finland
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Boehm K, Dell’Oglio P, Tian Z, Capitanio U, Chun FKH, Tilki D, Haferkamp A, Saad F, Montorsi F, Graefen M, Karakiewicz PI. Comorbidity and age cannot explain variation in life expectancy associated with treatment of non-metastatic prostate cancer. World J Urol 2016; 35:1031-1036. [DOI: 10.1007/s00345-016-1963-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022] Open
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Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P, Davis M, Peters TJ, Turner EL, Martin RM, Oxley J, Robinson M, Staffurth J, Walsh E, Bollina P, Catto J, Doble A, Doherty A, Gillatt D, Kockelbergh R, Kynaston H, Paul A, Powell P, Prescott S, Rosario DJ, Rowe E, Neal DE. 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. N Engl J Med 2016; 375:1415-1424. [PMID: 27626136 DOI: 10.1056/nejmoa1606220] [Citation(s) in RCA: 1800] [Impact Index Per Article: 225.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The comparative effectiveness of treatments for prostate cancer that is detected by prostate-specific antigen (PSA) testing remains uncertain. METHODS We compared active monitoring, radical prostatectomy, and external-beam radiotherapy for the treatment of clinically localized prostate cancer. Between 1999 and 2009, a total of 82,429 men 50 to 69 years of age received a PSA test; 2664 received a diagnosis of localized prostate cancer, and 1643 agreed to undergo randomization to active monitoring (545 men), surgery (553), or radiotherapy (545). The primary outcome was prostate-cancer mortality at a median of 10 years of follow-up. Secondary outcomes included the rates of disease progression, metastases, and all-cause deaths. RESULTS There were 17 prostate-cancer-specific deaths overall: 8 in the active-monitoring group (1.5 deaths per 1000 person-years; 95% confidence interval [CI], 0.7 to 3.0), 5 in the surgery group (0.9 per 1000 person-years; 95% CI, 0.4 to 2.2), and 4 in the radiotherapy group (0.7 per 1000 person-years; 95% CI, 0.3 to 2.0); the difference among the groups was not significant (P=0.48 for the overall comparison). In addition, no significant difference was seen among the groups in the number of deaths from any cause (169 deaths overall; P=0.87 for the comparison among the three groups). Metastases developed in more men in the active-monitoring group (33 men; 6.3 events per 1000 person-years; 95% CI, 4.5 to 8.8) than in the surgery group (13 men; 2.4 per 1000 person-years; 95% CI, 1.4 to 4.2) or the radiotherapy group (16 men; 3.0 per 1000 person-years; 95% CI, 1.9 to 4.9) (P=0.004 for the overall comparison). Higher rates of disease progression were seen in the active-monitoring group (112 men; 22.9 events per 1000 person-years; 95% CI, 19.0 to 27.5) than in the surgery group (46 men; 8.9 events per 1000 person-years; 95% CI, 6.7 to 11.9) or the radiotherapy group (46 men; 9.0 events per 1000 person-years; 95% CI, 6.7 to 12.0) (P<0.001 for the overall comparison). CONCLUSIONS At a median of 10 years, prostate-cancer-specific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. Surgery and radiotherapy were associated with lower incidences of disease progression and metastases than was active monitoring. (Funded by the National Institute for Health Research; ProtecT Current Controlled Trials number, ISRCTN20141297 ; ClinicalTrials.gov number, NCT02044172 .).
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Affiliation(s)
- Freddie C Hamdy
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Jenny L Donovan
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - J Athene Lane
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Malcolm Mason
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Chris Metcalfe
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Peter Holding
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Michael Davis
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Tim J Peters
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Emma L Turner
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Richard M Martin
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Jon Oxley
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Mary Robinson
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - John Staffurth
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Eleanor Walsh
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Prasad Bollina
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - James Catto
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Andrew Doble
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Alan Doherty
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - David Gillatt
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Roger Kockelbergh
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Howard Kynaston
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Alan Paul
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Philip Powell
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Stephen Prescott
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Derek J Rosario
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - Edward Rowe
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
| | - David E Neal
- From the Nuffield Department of Surgical Sciences, University of Oxford, Oxford (F.C.H., P.H., D.E.N.), the School of Social and Community Medicine (J.L.D., J.A.L., C.M., M.D., E.L.T., R.M.M., E.W.), the Bristol Randomized Trials Collaboration (J.A.L., C.M.), and School of Clinical Sciences (T.J.P.), University of Bristol, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust (J.L.D.), the Department of Cellular Pathology, North Bristol NHS Trust (J.O.), and the Department of Urology, Southmead Hospital and Bristol Urological Institute (D.G., E.R.), Bristol, the School of Medicine (M.M.) and Division of Cancer and Genetics, School of Medicine (J.S.), Cardiff University, and the Department of Urology, Cardiff and Vale University Health Board (H.K.), Cardiff, the Department of Cellular Pathology, Royal Victoria Infirmary (M.R.), and the Department of Urology, Freeman Hospital (P.P.), Newcastle-upon-Tyne, the Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh (P.B.), the Academic Urology Unit, University of Sheffield, Sheffield (J.C., D.J.R.), the Department of Urology, Addenbrooke's Hospital (A. Doble), and the Academic Urology Group, University of Cambridge (D.E.N.), Cambridge, the Department of Urology, Queen Elizabeth Hospital, Birmingham (A. Doherty), the Department of Urology, University Hospitals of Leicester, Leicester (R.K.), and the Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds (A.P., S.P.) - all in the United Kingdom
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