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Razenberg LGEM, van Gestel YRBM, de Hingh IHJT, Loosveld OJL, Vreugdenhil G, Beerepoot LV, Creemers GJ, Lemmens VEPP. Bevacizumab for metachronous metastatic colorectal cancer: a reflection of community based practice. BMC Cancer 2016; 16:110. [PMID: 26882902 PMCID: PMC4754889 DOI: 10.1186/s12885-016-2158-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 09/04/2015] [Accepted: 02/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the efficacy of bevacizumab has been established in patients with metastatic colorectal cancer (mCRC), population-based studies are needed to gain insight into the actual implementation of bevacizumab in daily practice. Since these studies are lacking for patients with metachronous metastases, the aim of this study is to evaluate the current role of bevacizumab in the treatment of metachronous metastases of CRC. METHODS Data on the use of bevacizumab as palliative treatment of metachronous metastases were collected for patients diagnosed with M0 CRC between 2003 and 2008 in the Eindhoven Cancer Registry (n = 361). Median follow up was 5.3 years. RESULTS One hundred eighty-five patients received bevacizumab in addition to first-line palliative chemotherapy (51%), ranging from 36% to 80% between hospitals of diagnosis (p < 0.0001). Combined cytostatic regimens (CAPOX/FOLFOX in 97%) were prescribed in the majority of patients (63%) and were associated with a higher odds for additional treatment with bevacizumab than single-agent cytostatic regimens (OR 9.9, 95% CI 5.51-18.00). Median overall survival (OS) rates were 21.6 and 13.9 months with and without the addition of bevacizumab to palliative systemic treatment respectively (p < 0.0001). The addition of bevacizumab to palliative chemotherapy was associated with a reduced hazard ratio for death (HR 0.6, 95% CI 0.45-0.73) after adjustment for patient- and tumor characteristics and the prescribed chemotherapeutic regimen. CONCLUSION Bevacizumab is adopted as a therapeutic option for metachronous metastasized CRC mainly in addition to first-line oxaliplatin-based regimens, and was associated with a reduced risk of death. The presence of inter-hospital differences in the prescription of bevacizumab reflected important differences in attitude and policies in clinical practice. Ongoing efforts should be made to further define the position of targeted agents in the treatment of metastatic colorectal cancer.
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Affiliation(s)
- L G E M Razenberg
- Department of Oncology, Catharina Hospital, Michelangelolaan 2, 5623, EJ, Eindhoven, The Netherlands. .,Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511, DT, Utrecht, The Netherlands.
| | - Y R B M van Gestel
- Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511, DT, Utrecht, The Netherlands.
| | - I H J T de Hingh
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623, EJ, Eindhoven, The Netherlands.
| | - O J L Loosveld
- Department of Oncology, Amphia Hospital, Langendijk 75, 4819, EV, Breda, The Netherlands.
| | - G Vreugdenhil
- Department of Oncology, Maxima Medical Centre, De Run 4600, 5504, DB, Veldhoven, The Netherlands.
| | - L V Beerepoot
- Department of Oncology, Elisabeth-TweeSteden Hospital, Hilvarenbeekse Weg 60, 5022, GC, Tilburg, The Netherlands.
| | - G J Creemers
- Department of Oncology, Catharina Hospital, Michelangelolaan 2, 5623, EJ, Eindhoven, The Netherlands.
| | - V E P P Lemmens
- Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511, DT, Utrecht, The Netherlands. .,Department of Public Health, Erasmus MC University Medical Centre, Wytemaweg 8, 3015, CN, Rotterdam, The Netherlands.
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Bos ACRK, van Erning FN, van Gestel YRBM, Creemers GJM, Punt CJA, van Oijen MGH, Lemmens VEPP. Timing of adjuvant chemotherapy and its relation to survival among patients with stage III colon cancer. Eur J Cancer 2015; 51:2553-61. [PMID: 26360411 DOI: 10.1016/j.ejca.2015.08.016] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [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: 06/04/2015] [Revised: 07/28/2015] [Accepted: 08/15/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Currently available data suggest that delaying the start of adjuvant chemotherapy in colon cancer patients has a detrimental effect on survival. We analysed which factors impact on the timing of adjuvant chemotherapy and evaluated the influence on overall survival (OS). PATIENTS AND METHODS Stage III colon cancer patients who underwent resection and received adjuvant chemotherapy between 2008 and 2013 were selected from the Netherlands Cancer Registry. Timing of adjuvant chemotherapy was subdivided into: ⩽ 4, 5-6, 7-8, 9-10, 11-12 and 13-16 weeks post-surgery. Multivariable regressions were performed to assess the influence of several factors on the probability of starting treatment within 8 weeks post-surgery and to evaluate the association of timing of adjuvant chemotherapy with 5-year OS. RESULTS 6620 patients received adjuvant chemotherapy, 14% commenced after 8 weeks. Factors associated with starting treatment after 8 weeks were older age (Odds ratio (OR) 65-74 versus < 65 years 1.3 (95% confidence interval (CI): 1.14-1.58); OR ⩾ 75 versus < 65 years 1.6 (1.25-1.94)), emergency resection (OR 1.8 (1.41-2.32)), anastomotic leakage (OR 8.1 (6.14-10.62)), referral to another hospital for adjuvant chemotherapy (OR 1.9 (1.36-2.57)) and prolonged postoperative hospital admission (OR 4.7 (3.30-6.68)). Starting 5-8 weeks post-surgery showed no decrease in OS compared to initiation within 4 weeks (Hazard ratio (HR) 5-6 weeks 0.9 (0.79-1.11); HR 7-8 weeks 1.1 (0.91-1.30)). However, commencing beyond 8 weeks was associated with decreased OS compared to initiation within 8 weeks (HR 9-10 weeks 1.4 (1.21-1.68); HR 11-12 weeks 1.3 (1.06-1.59); HR 13-16 weeks 1.7 (1.23-2.23)). CONCLUSION Our data support initiating adjuvant chemotherapy in stage III colon cancer patients within 8 weeks post-surgery.
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Affiliation(s)
- A C R K Bos
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
| | - F N van Erning
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Y R B M van Gestel
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - G J M Creemers
- Department of Internal Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - C J A Punt
- Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M G H van Oijen
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - V E P P Lemmens
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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Speelman AD, van Gestel YRBM, Rutten HJT, de Hingh IHJT, Lemmens VEPP. Changes in gastrointestinal cancer resection rates. Br J Surg 2015; 102:1114-22. [DOI: 10.1002/bjs.9862] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/11/2015] [Accepted: 04/20/2015] [Indexed: 12/19/2022]
Abstract
Abstract
Background
Many developments in medicine are likely to have influenced the treatment of gastrointestinal cancer, including rates of resection. This study sought to investigate changes in surgical resection rates over time among patients with gastrointestinal cancer.
Methods
Patients diagnosed between 1995 and 2012 in the Eindhoven Cancer Registry area were included. Multivariable logistic regression analysis was used to determine the independent influence of interval of diagnosis on the likelihood of having a resection.
Results
Among 43 370 patients, crude resection rates decreased between 1995 and 2012 for gastric, colonic and rectal cancer, most notably for patients aged at least 85 years with gastric cancer (from 37·3 to 13·3 per cent), and patients aged 75–84 years and 85 years or more with rectal cancer (from 80·5 to 64·4 per cent, and from 58·9 to 36·0 per cent respectively). After adjustment for patient and tumour characteristics, patients diagnosed between 2008 and 2012 with gastric (odds ratio (OR) 0·71, 95 per cent c.i. 0·55 to 0·92), colonic (OR 0·52, 0·44 to 0·62), rectal (OR 0·39, 0·33 to 0·48) and periampullary (OR 0·42, 0·27 to 0·66) cancers were less likely to undergo resection than those diagnosed between 1995 and 1998. Patients diagnosed with pancreatic cancer were more likely to undergo resection in recent periods (OR 4·13, 2·57 to 6·64).
Conclusion
Resection rates have fallen over time for several gastrointestinal cancers. This might reflect increased availability of other treatments, better selection of patients as a result of improved diagnostic accuracy, risk-avoiding behaviour and transparency related to surgical outcomes at hospital and surgeon level.
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Affiliation(s)
- A D Speelman
- Department of Oncology, Netherlands Comprehensive Cancer Organisation, Eindhoven, The Netherlands
| | - Y R B M van Gestel
- Department of Research, Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organisation, Eindhoven, The Netherlands
| | - H J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
- Research Institute Growth and Development, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - I H J T de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - V E P P Lemmens
- Department of Research, Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organisation, Eindhoven, The Netherlands
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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Razenberg LGEM, van Gestel YRBM, Creemers GJ, Verwaal VJ, Lemmens VEPP, de Hingh IHJT. Trends in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for the treatment of synchronous peritoneal carcinomatosis of colorectal origin in the Netherlands. Eur J Surg Oncol 2015; 41:466-71. [PMID: 25680955 DOI: 10.1016/j.ejso.2015.01.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [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: 11/18/2014] [Revised: 01/14/2015] [Accepted: 01/22/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Population-based data on the percentage of colorectal cancer (CRC) patients with synchronous peritoneal carcinomatosis (PC) being treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are currently lacking. The current population-based study describes trends in the use of CRS-HIPEC in the Netherlands, one of the first countries where CRS and HIPEC was introduced. METHODS All patients diagnosed with synchronous PC of CRC between 2005 and 2012 were extracted from the Netherlands Cancer Registry (n = 4623). Patients with primary appendiceal cancer were excluded resulting in a study population of 4430 patients. Trends in the use of CRS-HIPEC over time were analyzed by means of a Cochrane-Armitage trend test. Survival proportions were calculated as the time between diagnosis and date of death or last follow-up (January 2014). RESULTS Of the total 4430 patients with synchronous PC, 297 (6.4%) underwent treatment with CRS-HIPEC. The proportion of colorectal PC patients receiving CRS-HIPEC increased significantly over time from 3.6% in 2005-2006 to 9.7% in 2011-2012 (p < 0.0001). Overall median survival (MS) for patients treated with CRS-HIPEC was 32.3 months, whereas MS rates were respectively 12.6, 6.1 and 1.5 for months palliative chemotherapy with/without surgery, palliative surgery and best supportive care. CONCLUSION The proportion of patients diagnosed with synchronous PC from CRC treated with CRS-HIPEC has increased significantly over time and currently almost 10% of PC patients are treated with CRS-HIPEC. Median survival in this population based group is 32.3 months.
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Affiliation(s)
- L G E M Razenberg
- Department of Oncology, Catharina Hospital, Eindhoven, The Netherlands; Eindhoven Cancer Registry/Netherlands Comprehensive Cancer Organisation (IKNL), Eindhoven, The Netherlands
| | - Y R B M van Gestel
- Eindhoven Cancer Registry/Netherlands Comprehensive Cancer Organisation (IKNL), Eindhoven, The Netherlands
| | - G-J Creemers
- Department of Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - V J Verwaal
- Department of Surgical Oncology, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - V E P P Lemmens
- Eindhoven Cancer Registry/Netherlands Comprehensive Cancer Organisation (IKNL), Eindhoven, The Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - I H J T de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
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Kuiper JG, van Herk-Sukel MPP, van Gestel YRBM, Voogd AC, Lemmens VEPP, Siesling S. Systemic Treatment of Metachronous Metastases After Curative Treatment of Breast Cancer. Value Health 2014; 17:A663. [PMID: 27202415 DOI: 10.1016/j.jval.2014.08.2438] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- J G Kuiper
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | | | - Y R B M van Gestel
- Comprehensive Cancer Centre the Netherlands (IKNL), Eindhoven, The Netherlands
| | - A C Voogd
- Comprehensive Cancer Centre the Netherlands (IKNL), Eindhoven, The Netherlands
| | - V E P P Lemmens
- Comprehensive Cancer Centre the Netherlands (IKNL), Eindhoven, The Netherlands
| | - S Siesling
- Comprehensive Cancer Centre the Netherlands (IKNL), Utrecht, The Netherlands
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van Gestel YRBM, Thomassen I, Lemmens VEPP, Pruijt JFM, van Herk-Sukel MPP, Rutten HJT, Creemers GJ, de Hingh IHJT. Metachronous peritoneal carcinomatosis after curative treatment of colorectal cancer. Eur J Surg Oncol 2013; 40:963-9. [PMID: 24183168 DOI: 10.1016/j.ejso.2013.10.001] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [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: 04/15/2013] [Revised: 09/25/2013] [Accepted: 10/02/2013] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Population-based data on metachronous peritoneal carcinomatosis (PC) after curative resection of colorectal origin are scarce. The aim of this study was to investigate the incidence of and risk factors for developing metachronous PC from colorectal cancer as well as survival since diagnosis of PC. METHODS Data on metachronous metastases were collected between 2010 and 2011 for all patients diagnosed with M0 colorectal cancer between 2003 and 2008 in the Dutch Eindhoven Cancer Registry. Median follow-up was 5.0 years. Survival was defined as time from metastases diagnosis to death. RESULTS Of the 5671 colorectal cancer patients, 1042 (18%) were diagnosed with metachronous metastases of whom 197 (19%) developed metachronous PC. The peritoneal surface was the only site of metastasis in 81 (41%) patients while 116 (59%) patients were diagnosed with both PC and metastases elsewhere. Median survival after diagnosis of PC was 6 months compared to 15 months for patients with distant metastases in other organs. Patients with an advanced primary tumour stage, positive lymph nodes at initial diagnosis, primary mucinous adenocarcinoma, positive resection margin and a primary tumour located in the colon were at increased risk of developing metachronous PC. CONCLUSION Of the colorectal cancer patients who developed metachronous metastases, approximately one fifth is diagnosed with PC. Prognosis of these patients is poor with a median survival of 6 months after diagnosis. Identifying patients at high risk for developing metachronous PC is important as it may contribute to more accurate patient information, tailor-made follow-up schemes, and more adequate treatment.
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Affiliation(s)
- Y R B M van Gestel
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), P.O. Box 231, 5600 AE Eindhoven, The Netherlands.
| | - I Thomassen
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), P.O. Box 231, 5600 AE Eindhoven, The Netherlands; Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands
| | - V E P P Lemmens
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), P.O. Box 231, 5600 AE Eindhoven, The Netherlands; Department of Public Health, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - J F M Pruijt
- Department of Internal Medicine, Jeroen Bosch Hospital, P.O. Box 90153, 5200 ME 's-Hertogenbosch, The Netherlands
| | - M P P van Herk-Sukel
- PHARMO Institute for Drug Outcome Research, P.O. Box 85222, 3508 AE Utrecht, The Netherlands
| | - H J T Rutten
- Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; Research Institute Growth & Development, P.O. Box 616, Maastricht University Medical Centre, 6200 MD, The Netherlands
| | - G J Creemers
- Department of Internal Medicine, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands
| | - I H J T de Hingh
- Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands
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7
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van Gestel YRBM, Rutten HJT, de Hingh IHJT, van den Broek E, Nieuwenhuijzen GAP, Coebergh JWW, Lemmens VEPP. The standardised mortality ratio is unreliable for assessing quality of care in rectal cancer. Neth J Med 2013; 71:209-214. [PMID: 23723118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The standardised mortality ratio (SMR) for rectal or anal cancer was above average in a large tertiary referral centre for locally advanced rectal cancer in the Netherlands. The aim of this study was to investigate whether the increased SMR was indeed related to poor quality of care or whether it could be explained by inadequate adjustment for case-mix factors. METHODS Between 2006 and 2008, 381 patients were admitted for rectal or anal cancer. The SMR score of this diagnostic group was 230 (95% CI 140 to 355), corresponding with 20 in-hospital deaths. The hospital dataset was merged with data from the Eindhoven Cancer Registry to obtain more detailed information. RESULTS Patients admitted for palliative care only accounted for 45% (9/20) of the in-hospital mortality. In contrast to the high SMR, postoperative mortality was low, i.e. 2.6%. The majority of the rectal or anal cancer patients were diagnosed in and referred from another hospital. Referred patients more often had an advanced tumour stage, more often underwent resection and were more frequently treated with chemotherapy and/or radiotherapy than non-referred patients (p<0.01). Postoperative mortality rates for referred and non-referred patients were 2.9% and 1.9%, respectively. CONCLUSIONS The increased SMR appeared to be caused by the admission of patients who received palliative care only. Consequently, the SMR is unreliable for the assessment of quality of care in patients with rectal or anal cancer.
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Affiliation(s)
- Y R B M van Gestel
- Eindhoven Cancer Registry÷ Comprehensive Cancer Centre South, Eindhoven, the Netherlands.
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van Gestel YRBM, Hoeks SE, Sin DD, Huzeir V, Stam H, Mertens FW, van Domburg RT, Bax JJ, Poldermans D. COPD and cancer mortality: the influence of statins. Thorax 2009; 64:963-7. [DOI: 10.1136/thx.2009.116731] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Welten GMJM, Chonchol M, Hoeks SE, Schouten O, Bax JJ, Dunkelgrün M, van Gestel YRBM, Feringa HHH, van Domburg RT, Poldermans D. β-Blockers improve outcomes in kidney disease patients having noncardiac vascular surgery. Kidney Int 2007; 72:1527-34. [PMID: 17882146 DOI: 10.1038/sj.ki.5002554] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Beta-blockers are known to improve postoperative outcome after major vascular surgery. We studied the effects of beta-blockers in 2126 vascular surgery patients with and without kidney disease followed for 14 years. Creatinine clearance was calculated using the Cockcroft-Gault equation, and kidney function was categorized as Stage 1 for a reference group of 550 patients, Stage 2 with 808 patients, Stage 3 with 627 patients, and combined Stages 4 and 5 with 141 patients. Outcome measures were 30-day and long-term all-cause mortality with a mean follow-up of 6 years. Cox proportional hazards models were used to control cardiovascular risk factors, including propensity for beta-blocker use. In all, 129 (6%) and 1190 (56%) patients died respectively. Mortality rates were three- and two-fold higher, respectively, for patients at Stages 3-5 compared to the reference group for the two outcomes. beta-Blocker use was significantly associated with a lower risk of mortality after surgery. The overall adjusted hazard ratio was 0.35 and 0.62, respectively, for individuals at Stages 3-5 compared to the reference group for 30-day and long-term mortality. This study shows that kidney function is a predictor of all-cause mortality and beta-blocker use is associated with a lower risk of death in kidney disease patients undergoing elective vascular surgery.
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Affiliation(s)
- G M J M Welten
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
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10
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Welten GMJM, Schouten O, van Domburg RT, Feringa HHH, Hoeks SE, Dunkelgrün M, van Gestel YRBM, Goei D, Bax JJ, Poldermans D. The Influence of Aging on the Prognostic Value of the Revised Cardiac Risk Index for Postoperative Cardiac Complications in Vascular Surgery Patients. Eur J Vasc Endovasc Surg 2007; 34:632-8. [PMID: 17587611 DOI: 10.1016/j.ejvs.2007.05.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Accepted: 05/05/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The Lee-risk index [Lee-index] was developed to predict major adverse cardiac events [MACE]. However, age is not included as a risk factor. The aim was to assess the value of the Lee-index in vascular surgery patients among different age categories. METHODS Of 2642 patients cardiovascular risk factors were noted to calculate the Lee-index. Patients were divided into four age categories; < or = 55 (n=396), 56-65 (n=650), 66-75 (n=1058) and > 75 years (n=538). Outcome measures were postoperative MACE (cardiac death, MI, coronary revascularization and heart failure). The performance of the Lee-index was determined using C-statistics within the four age groups. RESULTS The incidence of MACE was 10.9%, for Lee-index 1, 2 and > or = 3; 6%, 13% and 20%, respectively. However, the prognostic value differed among age groups. The predictive value for MACE was highest among patients under 55 year (0.76 vs 0.62 of patients aged > 75). The prediction of MACE improved in elderly (aged > 75) after adjusting the Lee-index with age, revised risk of operation (low, low-intermediate, high-intermediate and high-risk procedures) and hypertension (0.62 to 0.69). CONCLUSION The prognostic value of the Lee-index is reduced in elderly vascular surgery patients, adjustment with age, risk of surgical procedure, and hypertension improves the Lee-index significantly.
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Affiliation(s)
- G M J M Welten
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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11
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van Gestel YRBM, Voogd AC, Vingerhoets AJJM, Mols F, Nieuwenhuijzen GAP, van Driel OJR, van Berlo CLH, van de Poll-Franse LV. A comparison of quality of life, disease impact and risk perception in women with invasive breast cancer and ductal carcinoma in situ. Eur J Cancer 2006; 43:549-56. [PMID: 17140788 DOI: 10.1016/j.ejca.2006.10.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Revised: 10/03/2006] [Accepted: 10/23/2006] [Indexed: 11/22/2022]
Abstract
We compared the health-related quality of life, impact of the disease, risk perception of recurrence and dying of breast cancer, and understanding of diagnosis of patients with ductal carcinoma in situ (DCIS) and invasive breast cancer 2-3 years after treatment. We included all women (N=211) diagnosed with DCIS or invasive breast cancer TNM stage I (T1, N0, and M0) in three community hospitals in the southern part of The Netherlands in the period 2002-2003. After verifying the medical files, 180 disease free patients proved eligible for study entry, 47 of whom had DCIS and 133 stage I invasive breast cancer. One-hundred and thirty-five patients returned a completed questionnaire (75% response). No significant differences were found between women with DCIS and invasive breast cancer on the physical and mental component scale of the RAND SF-36, nor on the WHO-5, which assesses well-being. In contrast, women with DCIS reportedly had a better physical health, better sex life and better relationships with friends/acquaintances than women with invasive breast cancer. Despite their better prognosis, the DCIS-group had comparable perceptions of the risk of recurrence and dying of breast cancer as women with invasive breast cancer. However, this did not appear to affect their well-being significantly.
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Affiliation(s)
- Y R B M van Gestel
- Institute for Health Sciences, Faculty of Earth and Life Sciences, Free University Amsterdam, and Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
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