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Syriopoulou E, Osterman E, Miething A, Nordenvall C, Andersson TML. Income disparities in loss in life expectancy after colon and rectal cancers: a Swedish register-based study. J Epidemiol Community Health 2024:jech-2024-221916. [PMID: 38514169 DOI: 10.1136/jech-2024-221916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/15/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Differences in the prognosis after colorectal cancer (CRC) by socioeconomic position (SEP) have been reported previously; however, most studies focused on survival differences at a particular time since diagnosis. We quantified the lifetime impact of CRC and its variation by SEP, using individualised income to conceptualise SEP. METHODS Data included all adults with a first-time diagnosis of colon or rectal cancers in Sweden between 2008 and 2021. The analysis was done separately for colon and rectal cancers using flexible parametric models. For each cancer and income group, we estimated the life expectancy in the absence of cancer, the life expectancy in the presence of cancer and the loss in life expectancy (LLE). RESULTS We found large income disparities in life expectancy after a cancer diagnosis, with larger differences among the youngest patients. Higher income resulted in more years lost following a cancer diagnosis. For example, 40-year-old females with colon cancer lost 17.64 years if in the highest-income group and 13.68 years if in the lowest-income group. Rectal cancer resulted in higher LLE compared with colon cancer. Males lost a larger proportion of their lives. All patients, including the oldest, lost more than 30% of their remaining life expectancy. Based on the number of colon and rectal cancer diagnoses in 2021, colon cancer results in almost double the number of years lost compared with rectal cancer (24 669 and 12 105 years, respectively). CONCLUSION While our results should be interpreted in line with what individualised income represents, they highlight the need to address inequalities.
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Affiliation(s)
- Elisavet Syriopoulou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Erik Osterman
- Department of Surgery, Gävle Hospital, Gävle, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Miething
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Caroline Nordenvall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Colorectal Surgery Unit, Karolinska University Hospital, Stockholm, Sweden
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Osterman E, Syriopoulou E, Martling A, Andersson TML, Nordenvall C. Despite multi-disciplinary team discussions the socioeconomic disparities persist in the oncological treatment of non-metastasized colorectal cancer. Eur J Cancer 2024; 199:113572. [PMID: 38280280 DOI: 10.1016/j.ejca.2024.113572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND The introduction of national guidelines should eliminate previously observed associations between socioeconomic status (SES) and colorectal cancer treatment. The aim of the study was to investigate whether inequalities remain. METHODS CRCBaSe, a register-linkage originating from the Swedish Colorectal Cancer Registry, was used to identify information on patient and tumour characteristics, for 83,460 patients with stage I-III disease diagnosed 2008-2021. SES was measured as disposable income (quartiles) and the highest level of education. Outcomes of interest were emergency surgery, multidisciplinary team (MDT) conference discussion, and oncological treatment. Differences in treatment between SES groups were explored using multivariable logistic regression adjusted for year of diagnosis, age at diagnosis, sex, civil status, comorbidities, tumour location and stage. RESULTS Patients in the highest income quartile had a lower risk of emergency surgery (OR 0.73 95%CI 0.68-0.80), a higher chance of being discussed at the preoperative (OR 1.39 95%CI 1.28-1.51) and postoperative MDT (OR 1.41 95%CI 1.30-1.53), receiving neoadjuvant (OR 1.15 95%CI 1.06-1.25) and adjuvant treatment (OR 2.04 95%CI 1.88-2.20). Higher education level increased the odds of MDT discussion but was not associated with oncological treatment. The proportion of patients discussed at the MDT increased, with almost all patients discussed since 2016. Despite this, treatment differences remained when patients diagnosed since 2016 were analysed separately. CONCLUSION There were significant differences in how patients with different SES were treated for colorectal cancer. Further action is required to investigate the drivers of these differences as well as their impact on mortality and, ultimately, eliminate the inequalities.
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Affiliation(s)
- Erik Osterman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden; Department of Surgery, Gävle Hospital, Sweden.
| | - Elisavet Syriopoulou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Anna Martling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden; Department of Pelvic Cancer, Colorectal Surgery Unit, Karolinska University Hospital, Sweden
| | | | - Caroline Nordenvall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden; Department of Pelvic Cancer, Colorectal Surgery Unit, Karolinska University Hospital, Sweden
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Osterman E, Syriopoulou E, Martling A, Andersson TML, Nordenvall C. Corrigendum to "Despite multi-disciplinary team discussions the socioeconomic disparities persist in the oncological treatment of non-metastasized colorectal cancer" [Eur J Cancer 199 (2024) 113572]. Eur J Cancer 2024:113940. [PMID: 38383167 DOI: 10.1016/j.ejca.2024.113940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Affiliation(s)
- Erik Osterman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden; Department of Surgery, Gävle Hospital, Sweden.
| | - Elisavet Syriopoulou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Anna Martling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden; Department of Pelvic Cancer, Colorectal Surgery Unit, Karolinska University Hospital, Sweden
| | | | - Caroline Nordenvall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden; Department of Pelvic Cancer, Colorectal Surgery Unit, Karolinska University Hospital, Sweden
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Osterman E, Jakobsson S, Larsson C, Linder F. Effect of the COVID-19 pandemic on the care for acute cholecystitis: a Swedish multicentre retrospective cohort study. BMJ Open 2023; 13:e078407. [PMID: 38035739 PMCID: PMC10689379 DOI: 10.1136/bmjopen-2023-078407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/08/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVES The present study aimed to investigate if and how the panorama of acute cholecystitis changed in 2020 in Sweden. Seven aspects were identified, the incidence of cholecystitis, the Tokyo grade, the timing of diagnosis and treatment, the proportion treated with early surgery, the proportion of patients treated with delayed surgery, and new complications from gallstones. DESIGN Retrospective multicentre cohort study. SETTING 3 hospitals in Sweden, covering 675 000 inhabitants. PARTICIPANTS 1634 patients with cholecystitis. OUTCOMES The incidence, treatment choice and diagnostic and treatment delay were investigated by comparing prepandemic and pandemic patients. RESULTS Patients diagnosed with cholecystitis during the pandemic were more comorbid (American Society of Anesthesiologists 2-5, 86% vs 81%, p=0.01) and more often had a diagnostic CT (67% vs 59%, p=0.01). There were variations in the number of patients corresponding with the pandemic waves, but there was no overall increase in the number of patients with cholecystitis (78 vs 76 cases/100 000 inhabitants, p=0.7) or the proportion of patients treated with surgery during the pandemic (50% vs 50%, p=0.4). There was no increase in time to admission from symptoms (both median 1 day, p=0.7), or surgery from admission (both median 1 day, p=0.9). The proportion of grades 2-3 cholecystitis was not higher during the pandemic (46% vs 44%, p=0.9). The median time to elective surgery increased (184 days vs 130 days, p=0.04), but there was no increase in new gallstone complications (35% vs 39%, p=0.3). CONCLUSION Emergency surgery for cholecystitis was not impacted by the pandemic in Sweden. Patients were more comorbid but did not have more severe cholecystitis nor was there a delay in seeking care. Fewer patients non-operatively managed had elective surgery within 6 months of their initial diagnosis but there was no corresponding increase in gallstone complications.
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Affiliation(s)
- Erik Osterman
- CKF Gävleborg, Uppsala University, Gävle, Sweden
- Department of Surgery, Gävle Sjukhus, Gävle, Sweden
| | - Sofia Jakobsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Fredrik Linder
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Surgery, Uppsala University Hospital, Uppsala, Sweden
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Osterman E, Helenius L, Larsson C, Jakobsson S, Majumder T, Blomberg A, Wickenberg J, Linder F. Surgery for acute cholecystitis in severely comorbid patients: a population-based study on acute cholecystitis. BMC Gastroenterol 2022; 22:371. [PMID: 35927715 PMCID: PMC9354429 DOI: 10.1186/s12876-022-02453-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/28/2022] [Indexed: 12/07/2022] Open
Abstract
Background International guidelines recommend emergency cholecystectomy for acute cholecystitis in patients who are healthy or have mild systemic disease (ASA1-2). Surgery is also an option for patients with severe systemic disease (ASA3) in clinical practice. The study aimed to investigate the risk of complications in ASA3 patients after surgery for acute cholecystitis.
Method 1 634 patients treated for acute cholecystitis at three Swedish centres between 2017 and 2020 were included in the study. Data was gathered from electronic patient records and the Swedish registry for gallstone surgery, Gallriks. Logistic regression was used to assess the risk of complications adjusted for confounding factors: sex, age, BMI, Charlson comorbidity index, cholecystitis grade, smoking and time to surgery. Results 725 patients had emergency surgery for acute cholecystitis, 195 were ASA1, 375 ASA2, and 152 ASA3. Complications occurred in 9% of ASA1, 13% of ASA2, and 24% of ASA3 patients. There was no difference in 30-day mortality. ASA3 patients stayed on average 2 days longer after surgery. After adjusting for other factors, the risk of complications was 2.5 times higher in ASA3 patients than in ASA1 patients. The risk of complications after elective surgery was 5% for ASA1, 13% for ASA2 and 14% for ASA3 patients. Regardless of ASA 18% of patients treated non-operatively had a second gallstone complication within 3 months. Conclusion Patients with severe systemic disease have an increased risk of complications but not death after emergency surgery. The risk is lower for elective procedures, but a substantial proportion will have new gallstone complications before elective surgery. Trial registration: Not applicable. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02453-0.
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Affiliation(s)
- Erik Osterman
- Department of Surgery, Gävle Hospital, 80187, Gävle, Gävleborg Region, Sweden. .,Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden. .,Centre for Research and Development, Gävle, Gävleborg Region, Sweden.
| | - Louise Helenius
- Department of Surgery, Gävle Hospital, 80187, Gävle, Gävleborg Region, Sweden
| | - Christina Larsson
- Department of Surgery, Gävle Hospital, 80187, Gävle, Gävleborg Region, Sweden
| | - Sofia Jakobsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tamali Majumder
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Blomberg
- Department of Surgery, Gävle Hospital, 80187, Gävle, Gävleborg Region, Sweden
| | - Jennie Wickenberg
- Department of Surgery, Gävle Hospital, 80187, Gävle, Gävleborg Region, Sweden
| | - Fredrik Linder
- Department of Surgery, Uppsala University Hospital, Uppsala, Uppsala Region, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Osterman E, Ekström J, Sjöblom T, Kørner H, Myklebust TÅ, Guren MG, Glimelius B. Accurate population-based model for individual prediction of colon cancer recurrence. Acta Oncol 2021; 60:1241-1249. [PMID: 34279175 DOI: 10.1080/0284186x.2021.1953138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Prediction models are useful tools in the clinical management of colon cancer patients, particularly when estimating the recurrence rate and, thus, the need for adjuvant treatment. However, the most used models (MSKCC, ACCENT) are based on several decades-old patient series from clinical trials, likely overestimating the current risk of recurrence, especially in low-risk groups, as outcomes have improved over time. The aim was to develop and validate an updated model for the prediction of recurrence within 5 years after surgery using routinely collected clinicopathologic variables. MATERIAL AND METHODS A population-based cohort from the Swedish Colorectal Cancer Registry of 16,134 stage I-III colon cancer cases was used. A multivariable model was constructed using Cox proportional hazards regression. Three-quarters of the cases were used for model development and one quarter for internal validation. External validation was performed using 12,769 stage II-III patients from the Norwegian Colorectal Cancer Registry. The model was compared to previous nomograms. RESULTS The nomogram consisted of eight variables: sex, sidedness, pT-substages, number of positive and found lymph nodes, emergency surgery, lymphovascular and perineural invasion. The area under the curve (AUC) was 0.78 in the model, 0.76 in internal validation, and 0.70 in external validation. The model calibrated well, especially in low-risk patients, and performed better than existing nomograms in the Swedish registry data. The new nomogram's AUC was equal to that of the MSKCC but the calibration was better. CONCLUSION The nomogram based on recently operated patients from a population registry predicts recurrence risk more accurately than previous nomograms. It performs best in the low-risk groups where the risk-benefit ratio of adjuvant treatment is debatable and the need for an accurate prediction model is the largest.
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Affiliation(s)
- E. Osterman
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Department of Surgery, Region Gävleborg, Gävle, Sweden
| | - J. Ekström
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - T. Sjöblom
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - H. Kørner
- Institute of Clinical Science, University of Bergen, Bergen, Norway
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - T. Å. Myklebust
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - M. G. Guren
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - B. Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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Osterman E, Hammarström K, Imam I, Osterlund E, Sjöblom T, Glimelius B. Completeness and accuracy of the registration of recurrences in the Swedish Colorectal Cancer Registry (SCRCR) and an update of recurrence risk in colon cancer. Acta Oncol 2021; 60:842-849. [PMID: 33689551 DOI: 10.1080/0284186x.2021.1896033] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The completeness and accuracy of the registration of synchronous metastases and recurrences in the Swedish Colorectal Cancer Registry has not been investigated. Knowing how accurate these parameters are in the registry is a prerequisite to adequately measure the current recurrence risk. METHODS All charts for patients diagnosed with stage I-III colorectal cancer (CRC) in two regions were reviewed. In one of the regions, all registrations of synchronous metastases were similarly investigated. After the database had been corrected, recurrence risk in colon cancer was calculated stratified by risk group as suggested by ESMO in 2020. RESULTS In patients operated upon more than five years ago (N = 1235), there were 20 (1.6%) recurrences not reported. In more recent patients, more recurrences were unreported (4.0%). Few synchronous metastases were wrongly registered (3.6%) and, likewise, few synchronous metastases were not registered (about 1%). The five-year recurrence risk in stage II was 6% for low-risk, 11% for intermediate risk, and 23% for high-risk colon cancer patients. In stage III, it was 25% in low- and 45% in high-risk patients. Incorporation of risk factors in stage III modified the risks substantially even if this is not considered by ESMO. Adjuvant chemotherapy lowered the risk in stage III but not to any relevant extent in stage II. CONCLUSION The registration of recurrences in the registry after 5 years is accurate to between 1 and 2% but less accurate earlier. A small number of unreported recurrences and falsely reported recurrences were discovered in the chart review. The recurrence risk in this validated and updated patient series matches what has been recently reported, except for the risk of recurrence in stage II low risk colon cancers which seem to be even a few percentage points lower (6 vs. 9%).
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Affiliation(s)
- Erik Osterman
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Department of Surgery, Region Gävleborg, Gävle Hospital, Gävle, Sweden
| | - Klara Hammarström
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Israa Imam
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Emerik Osterlund
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Tobias Sjöblom
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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Bannon D, Moen E, Schwartz M, Borba E, Kudo T, Greenwald N, Vijayakumar V, Chang B, Pao E, Osterman E, Graf W, Van Valen D. Publisher Correction: DeepCell Kiosk: scaling deep learning-enabled cellular image analysis with Kubernetes. Nat Methods 2021; 18:219. [PMID: 33437045 DOI: 10.1038/s41592-021-01059-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Dylan Bannon
- Department of Computing and Mathematical Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Erick Moen
- Division of Biology and Bioengineering, California Institute of Technology, Pasadena, CA, USA
| | - Morgan Schwartz
- Division of Biology and Bioengineering, California Institute of Technology, Pasadena, CA, USA
| | - Enrico Borba
- Department of Computing and Mathematical Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Takamasa Kudo
- Department of Chemical and Systems Biology, Stanford University, Stanford, CA, USA
| | - Noah Greenwald
- Department of Cancer Biology, Stanford University, Stanford, CA, USA
| | - Vibha Vijayakumar
- Department of Computing and Mathematical Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Brian Chang
- Division of Biology and Bioengineering, California Institute of Technology, Pasadena, CA, USA
| | - Edward Pao
- Division of Biology and Bioengineering, California Institute of Technology, Pasadena, CA, USA
| | | | - William Graf
- Division of Biology and Bioengineering, California Institute of Technology, Pasadena, CA, USA
| | - David Van Valen
- Division of Biology and Bioengineering, California Institute of Technology, Pasadena, CA, USA.
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Glimelius B, Osterman E. Adjuvant Chemotherapy in Elderly Colorectal Cancer Patients. Cancers (Basel) 2020; 12:cancers12082289. [PMID: 32823998 PMCID: PMC7464071 DOI: 10.3390/cancers12082289] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022] Open
Abstract
The value of adjuvant chemotherapy in elderly patients has been the subject of many overviews, with opinions varying from “not effective”, since randomized trials have not been performed, to “as effective as in young individuals”, based upon many retrospective analyses of randomized trials that have included patients of all ages. In the absence of randomized trials performed specifically with elderly patients, retrospective analyses demonstrate that the influence on the time to tumour recurrence (TTR) may be the same as in young individuals, but that endpoints that include death for any reason, such as recurrence-free survival (RFS), disease-free survival (DFS), and overall survival (OS), are poorer in the elderly. This is particularly true if oxaliplatin has been part of the treatment. The need for adjuvant chemotherapy after colorectal cancer surgery in elderly patients is basically the same as that in younger patients. The reduction in recurrence risks may be similar, provided the chosen treatment is tolerated but survival gains are less. Adding oxaliplatin to a fluoropyrimidine is probably not beneficial in individuals above a biological age of approximately 70 years. If an oxaliplatin combination is administered to elderly patients, three months of therapy is in all probability the most realistic goal.
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Affiliation(s)
- Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, SE-75185 Uppsala, Sweden;
- Correspondence: ; Tel.: +46-18-611-24-32
| | - Erik Osterman
- Department of Immunology, Genetics and Pathology, Uppsala University, SE-75185 Uppsala, Sweden;
- Department of Surgery, Gävle Hospital, Region Gävleborg, SE-80187 Gävle, Sweden
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Osterman E, Mezheyeuski A, Sjöblom T, Glimelius B. Beyond the NCCN Risk Factors in Colon Cancer: An Evaluation in a Swedish Population-Based Cohort. Ann Surg Oncol 2020; 27:1036-1045. [PMID: 31893351 PMCID: PMC7060230 DOI: 10.1245/s10434-019-08148-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Indexed: 01/22/2023]
Abstract
Background The purpose of this study was to investigate whether pT3–4 and pN-subclassifications, lymph-node ratio (LNR), tumour deposits, pre- and postoperative carcinoembryonic antigen (CEA), and C-reactive protein (CRP)—all parameters commonly collected in clinical management—add information about recurrence risk against a background of routine clinicopathological parameters as defined by the NCCN. Methods The prospective cohort consisted of all 416 patients diagnosed with colon cancer stage I–III in Uppsala County between 2010 and 2015. Cox proportional hazard models were used to calculate hazard ratios for time to recurrence and overall survival. The results were compared with the entire Swedish population concerning parameters recorded in the national quality registry, SCRCR, during the same time period. Results The Uppsala cohort was representative of the entire Swedish cohort. In unadjusted analyses, pT3-subclassification, pN-subclassification, LNR, tumour deposits, elevated postoperative CEA, and preoperative CRP correlated with recurrence. After adjusting for T-, N-stage, and NCCN risk factors, pN-subclassification, sidedness, and elevated postoperative CEA levels correlated with recurrence. Survival correlated with parameters associated with recurrence, LNR, and elevated postoperative CRP. Conclusions Additional information on recurrence risk is available from several routinely recorded parameters, but most of the risk is predicted by the commonly used clinicopathological parameters. Electronic supplementary material The online version of this article (10.1245/s10434-019-08148-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Erik Osterman
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden. .,Department of Surgery, Gävle Hospital, Gävle, Sweden.
| | - Artur Mezheyeuski
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Tobias Sjöblom
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
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Osterman E, Glimelius B. ASO Author Reflections: Emerging Risk Factors in Colon Cancer-End of the Line for Clinomics? Ann Surg Oncol 2019; 27:1046-1047. [PMID: 31884560 PMCID: PMC7060154 DOI: 10.1245/s10434-019-08149-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Erik Osterman
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden. .,Department of Surgery, Gävle Hospital, Gävle, Sweden.
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
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Osterman E, Mezheyeuski A, Sjöblom T, Glimelius B. Emerging risk factors of recurrence and overall survival in a Swedish stage I-III colon cancer cohort. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Höglund J, Ljungström BL, Nilsson O, Lundquist H, Osterman E, Uggla A. Occurrence of Gasterophilus intestinalis and some parasitic nematodes of horses in Sweden. Acta Vet Scand 1997. [PMID: 9257451 DOI: 10.1186/bf03548495] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A survey was performed on the occurrence of some internal parasites in 461 horses (1-30 years old) slaughtered from October 1992 to September 1993 at the Linköping abattoir in central Sweden. Macroscopical examination was carried out specifically for parasites of the tear ducts and conjunctival sacs of the eyes, and of selected parts of the alimentary tract and cardio-vascular system. The following parasites were found in selected parts of the large intestine: encapsulated cyathostome larvae (in 35.6% of the horses), and mature strongyle worms (17.4%); in the stomach: Gasterophilus intestinalis (12.3% during October-June) and Habronema muscae (1.1%); and in the conjunctival sac: Thelazia lacrymalis (3.1%). Significantly more encapsulated cyathostome larvae were found during January to June than during other times of the year, and horses aged 1-5 years harboured significantly more larvae than older horses. Severe damage to the cranial mesenteric artery and its main branches was noticed in 16 (6.1%) out of 263 horses specifically examined. However, the 4th stage larva of Strongylus vulgaris was only recovered in 6 (2.3%) of the horses. Quantitative and qualitative faecal egg counts were done on 412 and 384 of the horses, respectively. Eggs of strongyles, Parascaris equorum and Strongyloides westeri were found in 78.1%, 1.9% and 0.2% of the faecal samples, respectively. Highest prevalence of strongyle eggs was found during July to September. Third stage larvae of the following nematodes were recovered from faecal cultures: subfamily Cyathostomum sensu lato (78.1%) Triodontophorus spp. (6.5%), Strongylus vulgaris (3.6%), Trichostrongylus axei (1.3%), while Gyalocephalus sp., Oesophagodontus sp., Poteriostomum sp. and Strongylus edentatus each comprised less than 0.5%.
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Höglund J, Ljungström BL, Nilsson O, Lundquist H, Osterman E, Uggla A. Occurrence of Gasterophilus intestinalis and some parasitic nematodes of horses in Sweden. Acta Vet Scand 1997; 38:157-65. [PMID: 9257451 PMCID: PMC8057032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A survey was performed on the occurrence of some internal parasites in 461 horses (1-30 years old) slaughtered from October 1992 to September 1993 at the Linköping abattoir in central Sweden. Macroscopical examination was carried out specifically for parasites of the tear ducts and conjunctival sacs of the eyes, and of selected parts of the alimentary tract and cardio-vascular system. The following parasites were found in selected parts of the large intestine: encapsulated cyathostome larvae (in 35.6% of the horses), and mature strongyle worms (17.4%); in the stomach: Gasterophilus intestinalis (12.3% during October-June) and Habronema muscae (1.1%); and in the conjunctival sac: Thelazia lacrymalis (3.1%). Significantly more encapsulated cyathostome larvae were found during January to June than during other times of the year, and horses aged 1-5 years harboured significantly more larvae than older horses. Severe damage to the cranial mesenteric artery and its main branches was noticed in 16 (6.1%) out of 263 horses specifically examined. However, the 4th stage larva of Strongylus vulgaris was only recovered in 6 (2.3%) of the horses. Quantitative and qualitative faecal egg counts were done on 412 and 384 of the horses, respectively. Eggs of strongyles, Parascaris equorum and Strongyloides westeri were found in 78.1%, 1.9% and 0.2% of the faecal samples, respectively. Highest prevalence of strongyle eggs was found during July to September. Third stage larvae of the following nematodes were recovered from faecal cultures: subfamily Cyathostomum sensu lato (78.1%) Triodontophorus spp. (6.5%), Strongylus vulgaris (3.6%), Trichostrongylus axei (1.3%), while Gyalocephalus sp., Oesophagodontus sp., Poteriostomum sp. and Strongylus edentatus each comprised less than 0.5%.
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Affiliation(s)
- J Höglund
- Department of Parasitology, National Veterinary Institute, Uppsala, Sweden.
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Osterman E. [Psychic disorders of gestation. Comparison between 2 series of research concerning schizophrenic manifestations during pregnancy and following childbirth]. Encephale 1965; 54:140-54. [PMID: 5836928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Affiliation(s)
- E Osterman
- Department of Bacteriology, Yale University
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Affiliation(s)
- E Osterman
- Department of Bacteriology, Yale University
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Hoffstadt RE, Osterman E, Pilcher KS. THE CULTIVATION OF VIRUSES ON THE CHORIOALLANTOIC MEMBRANES OF CHICK EMBRYOS. Science 1937; 86:356. [PMID: 17751241 DOI: 10.1126/science.86.2233.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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