Carotid endarterectomy: survival rates of 227 patients.

From March 1963 to March 1974, 227 patients with carotid stenosis underwent unilateral or bilateral carotid endarterectomy at l''Hôpital de l''Enfant-Jésus in Québec. Survival during the first 7 years after operation was analysed by life-table methods based on full intervals. The observed probability of death in this group was significantly higher than the probability expected in the general population, by 6.8% in the 1st year and 3.9% in the 2nd year. In the next 3 years the differences were much smaller (0.5, 0.9 and 1.4%). The major causes of death were myocardial infarction and stroke. Women fared somewhat better than men after the 1st year of follow-up. Unexpectedly, patients who underwent unilateral endarterectomy had lower survival rates in each of the first 5 years after operation than patients who underwent staged bilateral operations, whether survival was measured from the date of the first or the second operation.     

Breast Cancer at the Ontario Cancer Clinics, 1938-1956: A Statistical Review

In Ontario, breast cancer accounts for one death in every 27 among females. In 1938-1956 some 40% of all new cases were registered at the Ontario Cancer Foundation''s regional clinics. The five-year crude survival rate for 11,393 women was 45.4%, and for 91 men, 36.3%. Survival rates were strongly affected by extent of disease; when this was allowed for, pregnancy and treatment method were also found to influence survival rate. Simple mastectomy with radiotherapy gave results that appeared comparable to those after radical mastectomy, alone or with radiotherapy. There was a 20% improvement in the crude five-year survival rate over the period of the survey. The need for great caution in interpreting these findings is stressed.     

Pharmacodynamics of mitral insufficiency in muscular subaortic stenosis.

In Ontario, ovarian cancer causes 7% of female cancer deaths, exceeding cancer of the uterine cervix or corpus in women aged 50 years and over. For 1722 patients with ovarian cancer registered at the Ontario Cancer Foundation Clinics in 1938-1958, who received some or all of their treatment at the clinics or were untreated anywhere, the crude survival rate at five years was 28%. Survival was greatly influenced by extent of disease and by histological type; survival rates remained constant or rose slightly over successive periods although an increasing proportion of advanced cases were registered. The method of choice for initial treatment was panhysterectomy with bilateral salpingo-oophorectomy and radiotherapy. Agreement on classification by histological type and extent is urgently needed.     

A Statistical Review of Carcinoma of the Lip

Among 3166 patients with microscopically confirmed squamous cell carcinoma of the lip registered at The Ontario Cancer Treatment and Research Foundation''s Regional Clinics in 1938-1955, the five-year crude survival rate was 65%, and the five-year net survival rate 89%. Survival was influenced by age, site and size of primary lesion, local and regional invasion, long delay, and treatment method. The initial treatment appeared to control the primary lesion in 84% of cases and involved lymph nodes in 58%. The net survival rates improved over the survey period. Findings confirm the usefulness of the proposed TNM staging.     

Cancer survival as a function of age at diagnosis: A study of the Surveillance,Epidemiology and End Results database

Background: Recent research suggested that cancer survival has improved in recent cohorts. Improvement in cancer survival is considered a valid indicator of the quality of care introduced to the patients. The aim of this study is to investigate the changes in the survival profile over age for patients with the most incident cancers. Methods: Survival data of 3.94 million patients diagnosed with 23 primary-site cancers within the periods of 1979–1983, 1989–1993, and 1999–2003 were adopted from the Surveillance, Epidemiology and End Results database. Gender and cause-specific survival probabilities were estimated at one, three, and five years after diagnosis using the Kaplan–Meier survival estimate. Survival was presented for each of the studied cancers, cohorts, and sexes in the form of line graphs as a function of age at diagnosis. Error bars demonstrated the probability of error at 95% confidence level. Results: The graphs demonstrated that cancer survival was improved over the successive cohorts for most cancers, with several exceptions such as brain and lung cancers. The relation between survival and the age at diagnosis was generally described in the form of a gradual decline phase and a rapid fall-off phase at 70–80 years of age, with few exceptions as in leukemia and Hodgkin lymphoma. Patients who survived for three years were more likely to live for five years after diagnosis, but this prediction could not be extrapolated to the one-year survivors. Conclusion: Further studies on tumor-specific characteristics and treatment modalities of these patients are suggested for clarification of the possible causes of variations in patient's survival profile over age.     

Improvements in survival from childhood cancer: results of a population based survey over 30 years

Survival from cancer of children whose cancer was diagnosed during the 30 years 1954-83 was analysed. The study was population based with nearly 3000 cases covering about 30 million child years at risk. When survival during the three decades 1954-63, 1964-73, and 1974-83 was compared striking improvements were observed. For all childhood cancer five year survival increased from 21% in the first decade to 49% in the third decade. During the first and third decades five year survival rates for acute lymphocytic leukaemia increased from 2% to 47%, Hodgkin''s disease from 44% to 91%, non-Hodgkin''s lymphoma from 18% to 45%, Wilms''s tumour from 31% to 85%, and germ cell tumours from 10% to 64%. Twenty patients developed second primary tumours, but otherwise there were few late deaths. Less than 1% of children who survived without a relapse for 10 years subsequently died of their initial cancer.Survival from childhood cancer is no longer rare, and people who have been cured of cancer during childhood should be accepted as normal members of society.     

Late recurrence of localized cutaneous melanoma: its influence on follow-up policy

This paper reports 11 cases of recurrence 10 years or more after primary treatment of clinically local cutaneous melanoma at the Peter MacCallum Cancer Institute. Using the product-limit method for estimating recurrence-free survival, two late recurrence rates have been calculated. The estimated late recurrence rate among all treated patients is 5 percent (95 percent confidence interval: 2 to 8 percent), and the estimated late recurrence rate for the group who survived the first 10 years without recurrence is 7 percent (95 confidence interval: 3 to 11 percent). No prognostic factors were found that could identify a patient subgroup significantly at risk of late recurrence. Recurrence-free survival curves show that most recurrences have presented by the end of 6 years, but later recurrences are seen, the latest in this series being 18.2 years following treatment. While patients probably do not require long-term follow-up in specialist clinics provided they are adequately educated in the nature of their disease, this paper shows the value of long-term statistical surveillance.     

The role of surgery in the management of thyroid cancer.

This is a review of one surgeon''s personal experience with 85 patients with thyroid cancer treated over a 20-year period. The data confirm that for papillary thyroid tumours, with rare exceptions, the prognosis is excellent. Anaplastic lesions, however, are consistently lethal. Follicular carcinoma and medullary carcinoma fall between these extremes. A simple clinical classification is offered as a guide to operative management and a reliable index of prognosis. Patients with clinically apparent, "manifest cancer" have serious, life-threatening disease; many such patients die of their disease. Patients with "neck lumps not yet diagnosed" usually have papillary carcinoma; their prognosis is excellent. Patients whose thyroid tumours fall into the category of "malignant nodule" or "pathologist''s cancer" are particularly fortunate: in this series no such patient has died. The importance of age in relation to thyroid cancer is also confirmed: non of the patients first treated before the age of 40 years has died of cancer. For young patients with favourable disease the author recommends conservative surgical treatment, which avoids cosmetic deformity or functional disability, to be followed by administration of levothyroxine to suppress production of thyroid=stimulating hormone. For patients with "unfavourable" thyroid cancer valuable palliation can often be achieved by a combination of surgery and irradiation. Survival rates for the total series are 76% at 5 years and 60% at 10 years.     

Survival rate of microbes after freeze-drying and long-term storage

The survival rates of 10 species of microorganisms were investigated after freeze-drying and preserving in a vacuum at 5 degrees C. The survival rates varied with species. The survival rates immediately after freeze-drying were different among yeast, gram-positive bacteria, and gram-negative bacteria, and the change in the 10-year survival rate was species-specific. The survival rate of yeast, Saccharomyces cerevisiae, was about 10% immediately after drying, and the rate did not decrease significantly during the 10-year storage period. Survival rates after the drying of gram-positive bacteria, i.e., Brevibacterium flavum, B. lactofermentum, Corynebacterium acetoacidophilum, C. gultamicum, and Streptococcus mutans, were around 80%. The survival rate of Brevibacterium and Corynebacterium did not decrease greatly during the storage period, whereas the rate of S. mutans decreased to about 20% after 10 years. Survival rates after the drying of gram-negative bacteria, i.e., Escherichia coli, Pseudomonas putida, Serratia marcescens, and Alcaligenes faecalis, were around 50%. The survival rate decreased for the first 5 years and then stabilized to around 10% thereafter.     

Body image disturbance and surgical decision making in egyptian post menopausal breast cancer patients

Background

Proximal major limb amputations due to malignant tumors have become rare but are still a valuable treatment option in palliation and in some cases can even cure. The aim of this retrospective study was to analyse outcome in those patients, including the postoperative course, survival, pain, quality of life, and prosthesis usage.

Methods

Data of 45 consecutive patients was acquired from patient's charts and contact to patients, and general practitioners. Patients with interscapulothoracic amputation (n = 14), shoulder disarticulation (n = 13), hemipelvectomy (n = 3) or hip disarticulation (n = 15) were included.

Results

The rate of proximal major limb amputations in patients treated for sarcoma was 2.3% (37 out of 1597). Survival for all patients was 42.9% after one year and 12.7% after five years. Survival was significantly better in patients with complete tumor resections. Postoperative chemotherapy and radiation did not prolong survival. Eighteen percent of the patients with malignant disease developed local recurrence. In 44%, postoperative complications were observed. Different modalities of postoperative pain management and the site of the amputation had no significant influence on long-term pain assessment and quality of life. Eighty-seven percent suffered from phantom pain, 15.6% considered their quality of life worse than before the operation. Thirty-two percent of the patients who received a prosthesis used it regularly.

Conclusion

Proximal major limb amputations severely interfere with patients' body function and are the last, albeit valuable, option within the treatment concept of extremity malignancies or severe infections. Besides short survival, high complication rates, and postoperative pain, patients' quality of life can be improved for the time they have remaining.     

Socio-economic inequalities in testicular cancer survival within two clinical studies

Background: Testicular cancer is the most common cancer in men under 35 years of age, and has the highest survival for adult male malignancies. Despite the fact that survival is very high, there is evidence that survival differs between socio-economic groups. Methods: We analysed survival patterns for 1606 testicular cancer patients diagnosed during 1984–2001 and recruited to one of two clinical studies. The first was a surveillance study to determine relapse-free survival after orchidectomy in 865 patients with stage I nonseminomatous germ-cell testicular cancer diagnosed during 1984–1991 (TE04). The second study was a trial in which 1174 men with stage I seminomatous germ-cell tumours were randomised to receive radiotherapy or one injection of carboplatin between 1996 and 2001 (TE19). The number of men available for analysis from these two studies was 578 and 1028, respectively. We followed these patients up for their vital status, and assigned them an ecological measure of deprivation. Crude and relative survival were estimated at 5 and 10 years by socio-economic deprivation. Results: No significant socio-economic gradient was seen: 1.3% (95% CI ?0.3% to 3.1%) at 5 years and 2.1% (95% CI ?0.5% to 4.7%) at 10 years. Conclusion: We conclude that, given equal treatment at a given stage of disease, survival from testicular cancer does not depend on socio-economic status. This suggests that the socio-economic gradient in testicular cancer survival in the general population is more likely to be attributable to health care system factors than to personal or socio-economic factors in the men themselves.     

Beyond the 5-year milestone: Long-term survivorship of melanoma patients treated off-trial with anti-PD-1

Little is known about the long-term outcomes of anti-PD-1 treated patients with melanoma beyond 5 years, especially for patients treated off clinical trials. This retrospective cohort study includes patients with unresectable stage III/IV nonuveal melanoma treated with anti-PD-1 off-trial at Memorial Sloan Kettering Cancer Center between 2014 and 2017 who survived at least 5 years following their first anti-PD-1 dose (N = 139). We characterized overall survival (OS), melanoma-specific survival (MSS) estimates, treatment-free survival rates, and subsequent treatment courses. Median follow-up among 5-plus year survivors (N = 125) was 78.4 months (range 60.0–96.3). OS at year 7 (2 years post 5-year landmark) was 90.1% (95% CI: 83.0%–94.3%). Fourteen deaths occurred, seven due to melanoma. MSS at year 7 (2 years post 5-year landmark) was 95.0% (95% CI: 33.5%–95.2%). In patients who completed anti-PD-1 based therapy and did not require subsequent treatment by 5 years (N = 80), the probability of not requiring additional treatment for an additional 2 years was 95.7% (95% CI: 91.0%–100%). Patients treated with anti-PD-1 regimens off clinical trials who survive at least 5 years from initial anti-PD-1 treatment can be reassured of their excellent long-term prognosis, particularly if they did not require additional melanoma treatment during the first 5 years.     

A Bayesian estimate of harbour seal survival using sparse photo-identification data

Survival rates have rarely been estimated for pinniped populations due to the constraints of obtaining unbiased sample data. In this paper, we present an approach for estimating survival probabilities from individual recognition data in the form of photographic documentation of pelage patterns. This method was applied to estimate adult (age 2+) survival for harbour seals in the Moray Firth, NE Scotland. An astronomical telescope was used to obtain digital images of individual seals, and high-quality images were used to document the annual presence or absence of individuals at a single haul-out site over a 4-year period. A total of 95 females, 10 males and 57 individuals of unknown sex were photographically documented during the study period. Survival and recapture probabilities were estimated using Jolly–Seber mark–recapture models in a Bayesian statistical framework. Computer-intensive Markov Chain Monte Carlo methods were used to estimate the probability distributions for the survival and recapture probabilities, conveying the full extent of the uncertainty resulting from unavoidably sparse observational data. The deviance information criterion was used to identify a best-fitting model that accounted for variation in the probability of capture between sexes, with constant survival. The model estimated adult survival as 0.98 (95% probability interval of 0.94–1.00) using our photo-identification data alone, and 0.97 (0.92–0.99) with the use of an informative prior distribution based on previously published estimates of harbour seal survival. This paper represents the first survival estimate for harbour seals in the UK, and the first survival estimate using photo-identification data in any species of pinniped.     

ICDs at higher age and clinical risk factors

Background

The implantable cardioverter defibrillator (ICD) is effective in preventing sudden cardiac death. However, in elderly patients (aged 75 years or older) the role of ICDs is still not well-defined and controversial.

Methods

We retrospectively analysed all clinical and survival data of all ICD patients who were ≥75 years at the date of implantation in the Erasmus MC, Rotterdam, the Netherlands and the University Hospital, Basel, Switzerland. Kaplan-Meier survival analysis was performed, and mortality predictors were identified. Mortality of the cohort was compared with a random sample of patients aged 60–70 years originating from the same database and to an age- and sex-matched cohort of Dutch persons.

Results

The study cohort consisted of 179 patients aged 75 years or older who were implanted between February 1999 and July 2008. The median follow-up time was 2.0 (IQR 2.8) years. Survival rates after 1, 2 and 3 years were 87, 82, 75 %, respectively. Survival was similar for primary and secondary prevention. Mortality in this study population could be predicted by combining four clinical risk factors: QRS duration >120 ms, NYHA class > II, renal failure and atrial fibrillation (AF). Survival was worse compared with the group of ICD patients aged 60–70 years and to the age- and sex-matched group of elderly persons. However, survival was not significantly worse when comparing elderly ICD patients without additional risk factors to the general population.

Conclusions

Elderly patients still have an acceptable survival probability independent of prevention indication, certainly if there are no additional clinical risk factors. The presence or absence of additional clinical risk factors should be taken into account when making the decision for implantation, since they strongly correlate with survival.     

Effects of flipper bands and injected transponders on the survival of adult Little Penguins Eudyptula minor

Tagging is essential for many types of ecological and behavioural studies, and it is generally assumed that it does not affect the fitness of the individuals being examined. However, the tagging of birds has been shown to have negative effects on some aspects of their lives. Here we investigate the influence of tagging on apparent survival. We examined the effects of flipper bands and injected transponders on the apparent survival of adult Little Penguins by comparing the survival probabilities of 2483 Little Penguins marked at Phillip Island, Australia, between 1995 and 2001 in one of three ways: with bands, with transponders or with both. The design of the study and our method of analysis allowed us to estimate tag loss and ensured that tag loss did not bias the survival estimates. Birds marked with flipper bands had lower survival probabilities than those marked with transponders (with apparent survival probabilities in the first year after tagging of 75% for banded birds and 80% for birds fitted with transponders, and in subsequent years of 87% for banded birds and 91% for birds fitted with transponders). We estimated both band and transponder loss probabilities for the first time, and found that transponder loss probabilities were substantially higher than band loss probabilities, particularly in the first year after marking when the tag loss probability was 5% for transponders and 0.7% for bands. Survival probabilities were lower in the first year after marking than in subsequent years for all birds. Studies of penguins that have used flipper bands to identify individuals may have underestimated annual adult survival probabilities, as banded penguins were likely to have lower than average survival probabilities than those of unbanded birds. The higher annual survival probabilities of individuals marked with transponders indicate that this should be the preferred marking technique for Little Penguins. However, future studies will, like ours, need to consider the higher rates of transponder loss when estimating survival, possibly by double‐tagging some birds.     

Fertilité et aneuploïdies spermatiques après traitement par radiothérapie et/ou chimiothérapie pour cancer du testicule ou lymphome

Improvements in cancer therapy have considerably modified patient survival rates over recent years. However, the side effects of these treatments especially the effects on fertility, must be taken into account. Anticancer therapy can transiently inhibit spermatogenesis. Factors such as pretreatment semen parameters and the type of chemotherapy or radiotherapy may influence recovery of spermatogenesis, but it is still impossible to predict the probability of and time to recovery for each patient. Sperm banking remains the only way to prevent the effects of cancer treatment on male fertility. Another possible effect of chemotherapy or radiotherapy is genetic damage to germ cells. For instance, chromosomal abnormalities in viable sperm produced by these patients after recovery of spermatogenesis may result in fetal death or congenital abnormalities in their offspring. It has been fairly well documented that, during the first three months after treatment, DNA breaks and abnormal chromosomal segregation induced by chemotherapy/radiotherapy lead to structural and numerical chromosomal abnormalities in spermatozoa, respectively. However, the long-term effects on genetic sperm content have not been clearly established. The results of published studies are contradictory and are based on limited numbers of patients (maximum of 6). We present the preliminary results of a retrospective study concerning patients treated for testicular cancer or lymphoma between 1995 and 2000. Fluorescence in situ hybridization (FISH) analysis of chromosomes X, Y and 18 was performed on sperm collected one to five years after treatment and compared to the data obtained for non-affected fertile men. For four out of 13 patients, we found a significantly increased frequency of aneuploidy rates (mainly XY disomy and diploidy), and these results did not appear to be correlated with sperm count, sperm morphology or post-treatment duration. In conclusion, increased sperm aneuploidy rates appear to only concern a small number of patients, to varying degrees and without any predictive factors. According to published data and our preliminary results, we recommend waiting at least two years before starting ART (Assisted Reproduction Therapy) for patients treated for testicular cancer or lymphoma. Moreover, FISH analysis could be helpful to choose between ART with post-treatment sperm or cryopreserved sperm.     

Radiation Therapy in the Treatment of Carcinoma of the Lung

In Ontario in the past 25 years, the death rate from cancer of the lung has shown a substantial increase, ninefold for males and twofold for females. The male:female ratio varied from an average of 8.5:1 to as high as 11.7:1 at the ages 65 to 69. From 1938 to 1958, one-quarter of the total cases (2457) were treated in Ontario Cancer Clinics. Survival rates were: for one year, 20%; three years, 6.5%, and for five years, 3.8%. Fifty-four per cent of surgically treated patients and 63% treated by resection and radiotherapy were alive one year after treatment. Of 821 cases treated with orthovoltage the one-year survival rate was 14%, and of 862 cases treated with cobalt therapy, 23%. It was concluded that this improvement in results may be attributed to the difference in treatment.     

Evidence that treatment with vaccinia melanoma cell lysates (VMCL) may improve survival of patients with stage II melanoma

Summary A total of 80 patients with melanoma metastases in regional lymph nodes were treated by i.d. injections with a vaccine prepared from a vaccinia virus-infected allogeneic melanoma cell line; 39 patients have been followed for a 2-year period. Interim results from comparison of the treated group with 151 historical controls treated without the vaccine from September 1978 to December 1981 at the same institution and 56 non-randomized concurrent controls suggest that survival was significantly prolonged in the vaccinated group. At the 2-year period overall survival was 75% in the treated compared to 57% in the historical control group. Subset analysis showed a greater apparent benefit of vaccine therapy among patients who had metastases detected at the time of treatment of the primary melanoma (synchronous metastases), while therapy appeared less effective in patients with metastases detected at some time after treatment of the primary (delayed metastases). In the latter only those with one lymph node appeared to benefit from the treatment whereas in patients with synchronous metastases patients with three or more nodes as well as one node appeared to have improved survival. The survival rates at 2 years for treated patients with synchronous metastases in one, two, three or more lymph nodes was 100%, 83% and 79% respectively compared with that of 82%, 86% and 47% respectively in the equivalent control groups. Survival rates in treated patients with delayed metastases in one, two, three or more lymph nodes was 70%, 70% and 65% compared with 47%, 42% and 35% in the equivalent control groups. Treatment and control groups appeared well matched for a number of known prognostic features, including number and size of involved nodes, sex and thickness of primary tumor. Multivariate analysis indicated the effect of treatment was independent of these factors. Despite the empiricism of this approach the present results suggest that this form of therapy warrants further evaluation in a randomized controlled trial.     

Effects of Nematicides,Lime, and Herbicide on Peach Tree Short Life in Georgia

Peach tree mortality was 75% five years after planting on a site associated with peach tree short life and receiving no nematicide treatment, no lime, and with cultivation for weed control. Mortality was reduced to 29% by preplanting plus postplanting applications of DBCP (1,2-dibromo-3-chloropropane) and with herbicidal weed control. Preplanting applications of nematicides alone did not effectively reduce tree mortality or increase yield. Lime applications increased yield but did not affect tree growth or survival. Survival was higher with weed control by a herbicide than with control by disk cultivation. Populations of Macroposthonia xenoplax were correlated positively with tree mortality and negatively with yield. The other nematode consistently present at the site, Tylenchorhynchus claytoni, was not associated with either tree mortality or yield.