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Ekström Smedby K, Eloranta S, Wästerlid T, Falini V, Jerlström U, Ellin F, Papworth K, Westerberg J, Lewerin C, Andersson PO, Lind Kristjansdottir H, Brandefors L, Mörth C, Hallén K, Kuric N, Abu Sabaa A, Wahlin BE, Molin D, Enblad G, Hörstedt AS, Jerkeman M, Glimelius I. The National Swedish Lymphoma Register - a systematic validation of data quality. Acta Oncol 2024; 63:563-572. [PMID: 38988133 PMCID: PMC11332524 DOI: 10.2340/1651-226x.2024.40431] [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: 03/27/2024] [Accepted: 06/24/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND AND PURPOSE The Swedish Lymphoma Register (SLR) was initiated in the year 2000 with the aim to monitor quality of care in diagnostics, treatment and outcome of all lymphomas diagnosed nationally among adults. Here, we present the first systematic validation of SLR records as a basis for improved register quality and patient care. PATIENTS AND METHODS We evaluated timeliness and completeness of register records among patients diagnosed with lymphoma in the SLR (n = 16,905) compared with the National Cancer Register for the period 2013-2020. Comparability was assessed through evaluation of coding routines against national and international guidelines. Accuracy of 42 variables was evaluated through re-abstraction of data from medical records among 600 randomly selected patients diagnosed in 2016-2017 and treated across all six Swedish healthcare regions. Results: Completeness was high, >95% per year for the period 2013-2018, and >89% for 2019-2020 compared to the National Cancer Register. One in four patients was registered within 3 months, and 89.9% within 2 years of diagnosis. Registration instructions and coding procedures followed the prespecified guidelines. Missingness was generally low (<5%), but high for occasional variables, for example, those describing maintenance and consolidative treatment. Exact agreement of categorical variables was high overall (>80% for 24/34 variables), especially for treatment-related data (>80% for 17/19 variables). INTERPRETATION Completeness and accuracy are high in the SLR, while timeliness could be improved. Finetuning of variable registration guided by this validation can further improve reliability of register reports and advance service to lymphoma patients and health care in the future.
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Affiliation(s)
- Karin Ekström Smedby
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.
| | - Sandra Eloranta
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Tove Wästerlid
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Urban Jerlström
- Department of Oncology, Örebro University Hospital, Örebro, Sweden
| | - Fredrik Ellin
- Department of Internal Medicine, Kalmar Hospital, Kalmar, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Karin Papworth
- Department of Oncology, Umeå University Hospital, Umeå, Sweden
| | - Johanna Westerberg
- Department of Hematology, Linköping University Hospital, Linköping, Sweden
| | - Catharina Lewerin
- Section of Hematology and Coagulation, Sahlgrenska University Hospital; Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, Gothenburg, Sweden
| | - Per-Ola Andersson
- Section of Hematology and Coagulation, Sahlgrenska University Hospital; Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, Gothenburg, Sweden
| | - Hallgerdur Lind Kristjansdottir
- Section of Hematology and Coagulation, Sahlgrenska University Hospital; Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, Gothenburg, Sweden
| | - Lena Brandefors
- Department of Internal Medicine, Sunderbyn Hospital, Luleå, Sweden
| | - Charlott Mörth
- Department of Oncology, Västerås Hospital, Västerås, Sweden
| | - Karin Hallén
- Department of Oncology, Karlstad Hospital, Karlstad, Sweden
| | - Nevzeta Kuric
- Department of Internal Medicine, Halmstad Hospital, Halmstad, Sweden
| | | | - Björn E Wahlin
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Molin
- Department of Immunology, Genetics and Pathology, Cancer Immunotherapy, and Cancer Precision Medicine, Uppsala University, Uppsala, Sweden; Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Cancer Immunotherapy, and Cancer Precision Medicine, Uppsala University, Uppsala, Sweden; Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | | | - Mats Jerkeman
- Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Cancer Immunotherapy, and Cancer Precision Medicine, Uppsala University, Uppsala, Sweden; Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
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Tsilingiris D, Vallianou NG, Spyrou N, Kounatidis D, Christodoulatos GS, Karampela I, Dalamaga M. Obesity and Leukemia: Biological Mechanisms, Perspectives, and Challenges. Curr Obes Rep 2024; 13:1-34. [PMID: 38159164 PMCID: PMC10933194 DOI: 10.1007/s13679-023-00542-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE OF REVIEW To examine the epidemiological data on obesity and leukemia; evaluate the effect of obesity on leukemia outcomes in childhood acute lymphoblastic leukemia (ALL) survivors; assess the potential mechanisms through which obesity may increase the risk of leukemia; and provide the effects of obesity management on leukemia. Preventive (diet, physical exercise, obesity pharmacotherapy, bariatric surgery) measures, repurposing drugs, candidate therapeutic agents targeting oncogenic pathways of obesity and insulin resistance in leukemia as well as challenges of the COVID-19 pandemic are also discussed. RECENT FINDINGS Obesity has been implicated in the development of 13 cancers, such as breast, endometrial, colon, renal, esophageal cancers, and multiple myeloma. Leukemia is estimated to account for approximately 2.5% and 3.1% of all new cancer incidence and mortality, respectively, while it represents the most frequent cancer in children younger than 5 years. Current evidence indicates that obesity may have an impact on the risk of leukemia. Increased birthweight may be associated with the development of childhood leukemia. Obesity is also associated with worse outcomes and increased mortality in leukemic patients. However, there are several limitations and challenges in meta-analyses and epidemiological studies. In addition, weight gain may occur in a substantial number of childhood ALL survivors while the majority of studies have documented an increased risk of relapse and mortality among patients with childhood ALL and obesity. The main pathophysiological pathways linking obesity to leukemia include bone marrow adipose tissue; hormones such as insulin and the insulin-like growth factor system as well as sex hormones; pro-inflammatory cytokines, such as IL-6 and TNF-α; adipocytokines, such as adiponectin, leptin, resistin, and visfatin; dyslipidemia and lipid signaling; chronic low-grade inflammation and oxidative stress; and other emerging mechanisms. Obesity represents a risk factor for leukemia, being among the only known risk factors that could be prevented or modified through weight loss, healthy diet, and physical exercise. Pharmacological interventions, repurposing drugs used for cardiometabolic comorbidities, and bariatric surgery may be recommended for leukemia and obesity-related cancer prevention.
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Affiliation(s)
- Dimitrios Tsilingiris
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
| | - Natalia G Vallianou
- Department of Internal Medicine, Evangelismos General Hospital, 45-47 Ipsilantou str, 10676, Athens, Greece
| | - Nikolaos Spyrou
- Tisch Cancer Institute Icahn School of Medicine at Mount Sinai, 1190 One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Dimitris Kounatidis
- Department of Internal Medicine, Evangelismos General Hospital, 45-47 Ipsilantou str, 10676, Athens, Greece
| | | | - Irene Karampela
- 2nd Department of Critical Care, Medical School, University of Athens, Attikon General University Hospital, 1 Rimini Str, 12462, Athens, Greece
| | - Maria Dalamaga
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias str, 11527, Athens, Greece.
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Li Y, Zhou H, Zou L. Influence of Statins on the Survival Outcomes of Patients with Diffuse Large B Cell Lymphoma: A Systematic Review and Meta-Analysis. Int J Clin Pract 2022; 2022:5618290. [PMID: 35989867 PMCID: PMC9356894 DOI: 10.1155/2022/5618290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/27/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Previous studies evaluating the influence of statins on the survival of patients with diffuse large B cell lymphoma (DLBCL) showed inconsistent results. This systematic review and meta-analysis was conducted to investigate whether statin use is correlated with the survival of DLBCL patients. METHODS Related cohort studies were obtained by searching PubMed, Embase, Cochrane's Library, and Web of Science databases. Study characteristics and outcome data were extracted independently by two authors. The random-effect model was used for meta-analysis, considering the possible influence of between-study heterogeneity. RESULTS Eight studies involving 9927 patients with DLBCL were included. Results did not show significant associations of statins with overall survival (OS, hazard ratio [HR]: 0.88, 95% confidence interval [CI]: 0.69∼1.11, p=0.27; I 2 = 60%) or progression-free survival (PFS, HR: 0.92, 95% CI: 0.72∼1.17, p=0.49; I 2 = 23%) in these patients. Subgroup analyses suggested that statin was be associated with survival of DLBCL patients from Asia (HR for OS: 1.19, 95% CI: 0.91∼1.56, p=0.19, I 2 = 2%; HR for PFS: 1.13, 95% CI: 0.89∼1.44, p=0.33, I 2 = 0%), but was associated with significantly improved survival of patients from Western countries (HR for OS: 0.73, 95% CI: 0.66∼0.81, p < 0.001, I 2 = 0%; for PFS, HR: 0.72, 95% CI: 0.53∼0.96, p=0.03, I 2 = 0%), which fully explained the heterogeneity (p for subgroup difference <0.05). Variables such as study design, patient age, and study quality were not shown to affect the findings. CONCLUSIONS Overall, statins did not affect the survival of patients with DLBCL. However, statin use may be associated with an improved survival rate of DLBCL patients from Western countries.
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Affiliation(s)
- Yanbing Li
- Department of Medical Oncology of Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Oncology, Jiujiang No. 1 People's Hospital, Jiujiang 332000, China
| | - Huijie Zhou
- Department of Medical Oncology of Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Liqun Zou
- Department of Medical Oncology of Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
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Smyth L, Blunt DN, Cheung MC. Statins in mature B-cell lymphomas and leukaemias. Br J Haematol 2021; 195:490-492. [PMID: 34402051 DOI: 10.1111/bjh.17778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Liam Smyth
- Department of Haematology, St Vincent's University Hospital, Dublin, Ireland.,UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - Danielle N Blunt
- Department of Haematology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Matthew C Cheung
- Odette Cancer Centre, Sunnybroook Health Sciences Centre, Toronto, ON, Canada.,Division of Hematology/Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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