A Statistical Review of Malignant Testicular Tumours Based on the Experience of the Ontario Cancer Foundation Clinics, 1938-1961

For the 827 patients with malignant testicular tumours registered at the Ontario Cancer Foundation''s regional clinics in the period 1938-1961, the probability of surviving for five years after treatment was 59.8%; for the 731 patients who received all or part of their initial treatment at the clinics or were not treated anywhere, five-year survival probability was 62.7%. Most deaths from testicular cancer took place in the first two years after treatment, and 90% of recorded recurrences were diagnosed before the third anniversary. Survival rates were strongly influenced by histological type and extent of disease, and to some degree by age. Survival did not seem to be closely correlated with delay after first symptom, site or size of primary lesion, ectopia, surgical treatment of the abdominal nodes, site or dosage of radiation, or chemotherapy. The survival rates in this series of cases compare favourably with those of other large series.     

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.     

A Statistical Survey of Leukemia in Ontario and at the Ontario Cancer Foundation Clinics, 1938-1958

In Ontario, leukemia causes about 4% of all cancer deaths, ranging from nearly 50% at under 5 years of age to 1-3% at age 50 and over. Age-specific death rates are highest among older people; at all ages, male deaths exceed female deaths. Only about 20% of all leukemia patients in Ontario are registered at Ontario Cancer Clinics; the proportion changed sharply with the advent of chemotherapy. For 1258 patients registered in 1938-1963, the crude one-year survival rate was 50%, ranging from 9% for acute leukemia to about 60% for non-acute lymphatic and myeloid leukemia. The long-term outlook was much better for non-acute lymphatic leukemia than for non-acute myeloid leukemia. For acute leukemia, the treatment of choice was chemotherapy; for non-acute lymphatic leukemia, radiotherapy was used, followed, if required, by chemotherapy or further radiotherapy. For non-acute myeloid leukemia, the advantage of chemotherapy over radiotherapy was not established.     

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.     

Canadian survey of thyroid cancer

We report the results of a multicentre retrospective chart review of 2214 patients with thyroid cancer registered at 13 radiotherapy centres between 1958 and 1978. The data analysed included sex, age at the time of diagnosis, pathological diagnosis, extent of disease before treatment, types of treatment and their complications, and the rates of recurrence and survival up to 24 years after diagnosis. Although papillary cancers were most common, anaplastic and miscellaneous tumours were more frequent than expected, which reflects the type of patients referred by endocrinologists and surgeons to radiotherapy centres. There were marked differences in patterns of referral to the centres. Some patients with papillary and follicular thyroid cancers died of these cancers up to 20 years after diagnosis. The clinical manifestations, treatment and outcome of the rarer types of thyroid malignant tumours were of particular interest. The influence of age at the time of diagnosis on survival rates for patients with papillary or follicular thyroid cancer was highly significant, indicating much more aggressive behaviour of these cancers in older patients, particularly those beyond the age of 60 years. A more detailed analysis of tumour subtypes should provide new information on their natural history and lead to better management.     

Systematic evaluation of candidate blood markers for detecting ovarian cancer

Background

Epithelial ovarian cancer is a significant cause of mortality both in the United States and worldwide, due largely to the high proportion of cases that present at a late stage, when survival is extremely poor. Early detection of epithelial ovarian cancer, and of the serous subtype in particular, is a promising strategy for saving lives. The low prevalence of ovarian cancer makes the development of an adequately sensitive and specific test based on blood markers very challenging. We evaluated the performance of a set of candidate blood markers and combinations of these markers in detecting serous ovarian cancer.

Methods and Findings

We selected 14 candidate blood markers of serous ovarian cancer for which assays were available to measure their levels in serum or plasma, based on our analysis of global gene expression data and on literature searches. We evaluated the performance of these candidate markers individually and in combination by measuring them in overlapping sets of serum (or plasma) samples from women with clinically detectable ovarian cancer and women without ovarian cancer. Based on sensitivity at high specificity, we determined that 4 of the 14 candidate markers-MUC16, WFDC2, MSLN and MMP7-warrant further evaluation in precious serum specimens collected months to years prior to clinical diagnosis to assess their utility in early detection. We also reported differences in the performance of these candidate blood markers across histological types of epithelial ovarian cancer.

Conclusions

By systematically analyzing the performance of candidate blood markers of ovarian cancer in distinguishing women with clinically apparent ovarian cancer from women without ovarian cancer, we identified a set of serum markers with adequate performance to warrant testing for their ability to identify ovarian cancer months to years prior to clinical diagnosis. We argued for the importance of sensitivity at high specificity and of magnitude of difference in marker levels between cases and controls as performance metrics and demonstrated the importance of stratifying analyses by histological type of ovarian cancer. Also, we discussed the limitations of studies (like this one) that use samples obtained from symptomatic women to assess potential utility in detection of disease months to years prior to clinical detection.     

The histological type of endometrial cancer is not associated with menopause status at diagnosis

The latest evidence suggests that type 2 endometrial cancer may not be completely oestrogen-independent, indicating that the status of hormonal change may not be associated with the traditional classification of endometrial cancer, including the histological subtypes. However, this has not been investigated. Menopause is commonly considered a state of hormonal change in women. In the present study, we investigated the association of menopause with the histological types of endometrial cancer. Data on the histological type, menopause status at diagnosis, age at diagnosis, parity, body mass index (BMI), and overall survival rate from 2122 cases were collected. The difference in risk in developing type 1 or type 2 endometrial cancer between premenopausal and postmenopausal patients was 5.457%. A statistical difference in the association of menopause with the histological types between the two groups was seen in endometrioid and serous carcinoma, with a risk difference of 5.6 or 3.8%. A statistical difference in the association of menopause with parity between the groups was only seen in endometrioid and adenosquamous carcinoma, with a risk difference of 7.1 or 3.7%. However, BMI was not associated with histological type and the overall survival rate was not associated with menopause (P=0.764). We reported a relatively small difference in the association of menopause with type 1 or type 2, or the histological types of endometrial cancer. The survival rate was not associated with menopause. Our study suggests that menopause status at diagnosis was not strongly associated with the histological subtypes of endometrial cancer.     

Ovarian irradiation and prednisone therapy following surgery and radiotherapy for carcinoma of the breast.

Following mastectomy, patients with operable breast cancer underwent postoperative irradiation of the chest wall and regional lymph nodes. They were then assigned at random to receive no further therapy, ovarian irradiation (2000 rads in 5 days) or ovarian irradiation in the same dosage plus prednisone, 7.5 mg daily. A total of 705 patients received the randomly assigned treatment and were followed for up to 10 years. In premenopausal patients who received ovarian irradiation the recurrence of breast cancer was delayed and survival prolonged, but not significantly. In premenopausal women aged 45 years or more ovarian irradiation plus prednisone therapy significantly delayed the recurrence of breast cancer (P = 0.02) and prolonged survival (P = 0.02); the survival expectancy of these patients was similar to that of the general population of the same age from the third year after the cancer operation. No value was demonstrated for ovarian irradiation with or without prednisone therapy in postmenopausal patients.     

Status report on the chemotherapy of ovarian cancer at special cancer centers in Hungary (2002-2003)

Data on the first-line treatment of ovarian cancer in special centers of Hungary 2002 and 2003 are presented, involving 283 and 416 patients, respectively. Patients' age, clinical stage and histological type of the tumor were highly similar to literature data, while grades were different. Surgical effectiveness in case of IIIc staged tumors with >1 cm residual mass was 37%. The ratio of interval laparotomy was about 15%. Overall response rates of the first-line treatment of ovarian cancer was 82%, while the rate of complete remissions was 60%. The authors provide detailed analysis of factors that can improve the chemotherapy of ovarian cancer in Hungary.     

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.     

The prognostic significance of DNA measurements in endometrial carcinoma

DNA analysis was performed in 71 cases of endometrial carcinoma, selected from a retrospective series of 445 cases registered at the Department of Gynecology, Radiumhemmet, Karolinska Hospital, Stockholm, during 1973-1975. The histological material from 37 patients surviving more than eight years was compared with that from those who died from cancer within two years. The prognostic value of the DNA distribution pattern of the tumors in relation to the clinical stage and the histological grade of the tumors was evaluated. Patients with near-diploid or -tetraploid tumors were found to have a significantly lower death rate than those with aneuploid tumors. The DNA distribution pattern was also found to correlate better with the survival rate than the clinical stage or the histological grade of the tumors.     

A follow-up study of 105 women with breast cancer following reduction mammaplasty.

Reduction mammaplasty is one of the most common procedures performed by plastic surgeons in Canada. In a recent study of 27,500 women in the province of Ontario who underwent breast reduction surgery, 105 women were identified who developed breast cancer after reduction mammaplasty. The purpose of this study was to compare women who had breast cancer and had a previous breast reduction with women who had breast cancer but did not have a breast reduction. Specifically, we wanted to document patient demographics, cancer type, surgical and nonsurgical treatment, and eventual outcome. A comparison group of non-breast reduction women was taken from the cohort of breast cancer patients in the province of Ontario, and the two groups were matched for age, year of diagnosis, and place of diagnosis. It was found that (1) the average age at diagnosis of breast cancer is significantly younger for women who have had previous breast reduction surgery than for those who have not; (2) the median interval between breast reduction and cancer is 5 years; (3) the type, location, and side of breast cancers are similar in the two groups of women; (4) breast reduction does not significantly increase or decrease survival rate from breast cancer; and (5) women who have had breast reduction receive the same treatment for their breast cancer as women who have not had reduction mammaplasty.     

Impact of variation in cancer registration practice on observed international cancer survival differences between International Cancer Benchmarking Partnership (ICBP) jurisdictions

BackgroundInternational cancer survival comparisons use cancer registration data to report cancer survival, which informs the development of cancer policy and practice. Studies like the International Cancer Benchmarking Partnership (ICBP) have a duty to understand how registration differences impact on survival prior to drawing conclusions.MethodsKey informants reported differences in registration practice for capturing incidence date, death certificate case handling and registration of multiple primary tumours. Sensitivity analyses estimated their impact on one-year survival using baseline and supplementary cancer registration data from England and Sweden.ResultsVariations in registration practice accounted for up to a 7.3 percentage point difference between unadjusted (estimates from previous ICBP survival data) and adjusted (estimates recalculated accounting for registration differences) one-year survival, depending on tumour site and jurisdiction.One-year survival estimates for four jurisdictions were affected by adjustment: New South Wales, Norway, Ontario, Sweden. Sweden and Ontario’s survival reduced after adjustment, yet they remained the jurisdictions with the highest survival for breast and ovarian cancer respectively. Sweden had the highest unadjusted lung cancer survival of 43.6% which was adjusted to 39.0% leaving Victoria and Manitoba with the highest estimate at 42.7%. For colorectal cancer, Victoria’s highest survival of 85.1% remained unchanged after adjustment.ConclusionPopulation-based cancer survival comparisons can be subject to registration biases that may impact the reported ‘survival gap’ between populations. Efforts should be made to apply consistent registration practices internationally. In the meantime, survival comparison studies should provide acknowledgement of or adjustment for the registration biases that may affect their conclusions.     

Primary Carcinoma of the Ovary: A Review of 150 Cases,with an Appraisal of the Fallopian Tube as a Pathway of Spread

One hundred and fifty cases of primary ovarian carcinoma were reviewed to assess the relationship between survival and secondary involvement of the fallopian tube. Five-year crude survival rates were calculated according to stage of disease, histological type and method of treatment.Frequency of involvement of the tube in 30 cases so examined increased with anatomical extension of disease, but this route of spread was not considered significant. Invasion occurred chiefly in serous or peritubular lymph spaces. Intraluminal emboli of tumour cells were found in only three specimens, while submucosal spread was seen once. Invasion of the tubular musculature was never demonstrated. Endometrial deposits were rare. Postoperative radiation therapy after simple surgical procedures not only gave survival rates comparable to those obtained after radical surgery alone, but also controlled metastatic disease for at least three years and increased the five-year survival in Stage III disease.     

Esophageal squamous cell carcinoma and adenocarcinoma in Malaysia – Pooled data from upper gastrointestinal centers in a multiethnic Asian population

BackgroundEsophageal cancer is the sixth leading cause of cancer death worldwide with considerable geographical histological variation There is a paucity of data in esophageal cancer in demographics, histology, and survival among the multi-ethnic Malaysian population. This paper is a review of esophageal cancer epidemiology and survival among esophageal cancer patients from data collected by the Malaysian Upper Gastrointestinal Surgical Society.MethodsThis is a multicenter retrospective observational study of esophageal cancer patients from six upper gastrointestinal surgical centers in Malaysia between 2005 and 2019. Patient characteristics, histological type and stage were compared and survival analyzed.ResultsThere were 820 patients with esophageal cancer included, where 442 (53.9 %) cases had squamous cell carcinoma (SCC) and 378 (46.1 %) had adenocarcinomas (AC). Malays were the predominant ethnicity with AC (66.7 %) while Indians were the ethnic majority (74.6 %) with SCC. Majority of patients (56.8 %) presented as stage IV disease. Overall, the 1-, 3-, and 5-years’ survival were 35.8 %, 13.8 % and 11.0 %, respectively. Surgical resection with curative intent yielded the best 5-year survival (29.4 %). Intervention in stage IV AC yielded superior survival when compared to SCC (median survival, 7.9 months vs 4.8 months; p, 0.018) Our series demonstrated an increase in AC to SCC over the last 15 years.ConclusionsThere was an ethnic preponderance seen between different histology in this region, not previously discussed. An increase in AC was observed over the last 15 years. Late diagnosis seen in most patients imparts poor prognosis as curative surgery affords the best outcome.     

Measuring the effect of including multiple cancers in survival analyses using data from the Canadian Cancer Registry

Background: In survival analyses using cancer registry data, second and subsequent primary cancers diagnosed in individuals are typically excluded. However, this approach may lead to biased comparisons of survival between cancer registries, or over time within a single registry. Purpose: To examine the impact of including multiple primary cancers in the derivation of survival estimates using data from a population-based national cancer registry. Methods: Five-year relative survival estimates for persons aged 15–99 years at diagnosis were derived using all eligible primary cases from the Canadian Cancer Registry (CCR)—a population-based registry containing information on cases diagnosed from 1992 onward—and then again using first primary cases only. Any pre-1992 cancer history of persons on the CCR was obtained by using auxiliary information. Results: The inclusion of multiple cancers resulted in lower estimates of 5-year relative survival for virtually all cancers studied. The effect was somewhat attenuated by age-standardization (e.g., from 1.3% to 1.0% for all cancers combined), and was greatest for bladder cancer (?2.4%) followed by oral cancer (?1.9%)—cancers that had the first and third lowest proportions of first cancers, respectively. For the majority of cancers the difference was less than 1.0%. Cancers for which there was virtually no difference (e.g., lung, pancreatic, ovarian and liver) tended to be those with a poor prognosis. Conclusion: Inclusion of second and subsequent primary cancers in the analysis tended to lower estimates of relative survival, the extent of which varied by cancer and age and depended in part on the proportion of first primary cancers.     

Prevalence screening for ovarian cancer in postmenopausal women by CA 125 measurement and ultrasonography.

OBJECTIVE--To assess the performance of the sequential combination of serum CA 125 measurement and ultrasonography in screening for ovarian cancer. DESIGN--The serum CA 125 concentration of each subject was determined and those with a concentration > or = 30 U/ml were recalled for abdominal ultrasonography. If ultrasonography gave abnormal results surgical investigation was arranged. Volunteers were followed up by annual postal questionnaire. SETTING--General practice, occupational health departments, ovarian cancer screening clinic. SUBJECTS--22,000 women volunteers who were postmenopausal and aged over 45 years. MAIN OUTCOME MEASURES--Apparent sensitivity, specificity, positive predictive value, years of cancer detected. RESULTS--41 women had a positive screening result and were investigated surgically. 11 had ovarian cancer (true positive result) and 30 had other disorders or no abnormality (false positive result). Of the 21,959 volunteers with a negative screening result, eight subsequently presented clinically with ovarian cancer (false negative result) and 21,951 had not developed ovarian cancer during follow up (apparent true negative result). The screening protocol achieved a specificity of 99.9%, a positive predictive value of 26.8%, and an apparent sensitivity of 78.6% and 57.9% at one year and two year follow up respectively. The estimated number of years of cancer detected by the prevalence screen was 1.4 years. CONCLUSIONS--This screening protocol is highly specific for ovarian cancer and can detect a substantial proportion of cases at a preclinical stage. Further investigation is required to determine the effect of the screening protocol on the ratio of early to late stage disease detected and on mortality from ovarian cancer.     

Comparison of breast carcinomas diagnosed in the 1980s with those diagnosed in the 1940s to 1960s.

OBJECTIVE--To find out if breast carcinomas diagnosed in the 1980s differ from those diagnosed a few decades ago. DESIGN--Retrospective comparative cohort study. SETTING--City of Turku, south western Finland. PATIENTS--439 patients with breast carcinoma diagnosed in 1945-65 with a median follow up of 27 years (95% of all those histologically diagnosed in Turku); and 370 patients with breast carcinoma diagnosed in 1980-4 with a median follow up of 6 years (94% of all those histologically diagnosed in Turku). MAIN OUTCOME MEASURES--Breast cancer incidence, mortality from breast cancer, age at diagnosis, stage of cancer, seven histological factors, DNA ploidy. RESULTS--Age adjusted incidence of breast cancer increased from 30.8/100,000 person years in 1953-7 to 62.2/100,000 in 1983-7; mortality in breast cancer increased from 16.7 to 17.2/100,000 person years. Survival of patients with stages II to IV (but not with stage I) improved. The mean age at diagnosis increased from 55.5 years in 1945-55 to 62.5 years in 1980-4 (p less than 0.0001); the proportion of patients with T0-1 carcinomas increased from 13% to 41% (p less than 0.0001) and with pN0 carcinomas from 43% to 55% (p = 0.003) from 1945-65 to 1980-4. There was no change in histological type or DNA ploidy of breast cancer, but in the 1980-4 cohort carcinomas were more often well differentiated, had lower mitotic counts and less nuclear pleomorphism, more often had a well defined tumour margin, and had less tumour necrosis. There was, however, no difference between the two cohorts in these histological characteristics except for tumour necrosis when they were compared in a multivariate log linear model at a given size of primary tumour. CONCLUSION--Improved survival with breast cancer can at least partially be explained by detection of increased numbers of small carcinomas with favourable histological characteristics.     

静脉联合腹腔热灌注化疗对老年复发卵巢癌的临床效果

目的:对比分析静脉联合腹腔热灌注化疗与全身静脉化疗治疗老年复发卵巢癌的临床效果。方法:以2010年1月至2010年12月我院收治的80例老年复发卵巢癌患者为研究对象,行随机数字表法均分为观察组和对照组。观察组(n=40)行静脉联合腹腔热灌注化疗对照组(n=40)仅行全身静脉化疗。持续四个周期后统计疗效、不良反应,治疗前后CD3~+、CD4~+、CD4~+/CD8~+;持续随访,统计1年生存率、2年生存率、3年生存率、平均生存时间。结果觌察组总有效率(75.0%vs 52.5%)显著高于对照组;不良反应发生率(22.5%vs 80.0%)明显低于对照组;CD3~+、CD4~+、CD4~+/CD8~+均显著高于对照组;1年生存率(72.5%vs 55.0%)、2年生存率(27.5%vs 7.5%)均显著高于对照组;平均生存时间(16.8±2.1)月vs(13.8±1.8)月显著长于对照组。结论:静脉联合腹腔热灌注化疗治疗老年复发卵巢癌疗效显著,值得推广。