Background:

The number of older patients with rectal cancer is increasing. Treatment outcome discrepancies persist, despite similar treatment guidelines. To offer the oldest patients optimal individually adjusted care, further knowledge is needed regarding treatment strategy and outcome. The present study aimed to evaluate treatment, postoperative complications, and survival in older patients treated for rectal cancer.

Methods:

This retrospective study included all 666 patients (n=255 females, n=411 males) treated for rectal cancer at Levanger Hospital during 1980-2016 (n=193 <65 years, n=329 65-79 years, n=144 ≥80 years). We performed logistic regression to analyse associations between complications, 90-day mortality, and explanatory variables. We performed a relative survival analysis to identify factors associated with short- and long-term survival.

Results:

Despite a similar distribution of cancer stages across age-groups, patients aged ≥80 years were treated with a non-curative approach more frequently than younger age groups. Among patients aged ≥80 years, 42% underwent a non-curative treatment approach, compared to 25% of patients aged <65 years, and 25% of patients aged 65-79 years. The 90-day mortality was 15.3% among patients aged ≥80 years, compared to 5.7% among patients aged <65 years, and 9.4% among patients aged 65-79 years. Among 431 (65%) patients treated with a major resection with curative intent, the 90-day mortality was 5.9% among patients aged ≥80 years (n=68), compared to 0.8% among patients aged <65 years (n=126), and 3.8% among patients aged 65-79 years (n=237). The rate of postoperative complications was 47.6%. Pneumonia was the only complication that occurred more frequently in the older patient group. The severity of complications increased with three factors: age, American Society of Anaesthesiologists score, and >400 ml perioperative blood loss. Among patients that survived the first 90 days, the relative long-term survival rates, five-year local recurrence rates, and metastases rates were independent of age.

Fig. 1 Relative survival after resection with curative intent among patients that survived 90 days (N=417) in different age groups. Each column represents 2.5 years.

Conclusion: Patients aged ≥80 years were less likely to undergo a major resection with curative intent and experienced more severe complications after surgery than patients aged <80 years. When patients aged ≥80 years were treated with a major resection with curative intent, the long-term survival rate was comparable to that of younger patients.

The post The impact of age on rectal cancer treatment, complications and survival first appeared on Serene.

Introduction

Several studies have been conducted to evaluate reducing the recurrence and progression of non-muscle-invasive bladder cancer (NMIBC). Intravesical Bacille Calmette-Guérin (BCG) instillation has demonstrated greater efficacy in these patients than the chemotherapeutic agents. However, adverse effects (AEs) have been a major cause of concern resulting in therapy withdrawal. There has been a worldwide shortage of BCG and a low-dose BCG might be a better option.

Aim

This meta-analysis evaluated whether low-dose BCG could maintain efficacy and reduce AEs in patients with NMIBC.

Method

Study Design

• Systematic review and meta-analysis of randomized controlled trials (RCTs).

Treatment Strategy

• The eligible RCTs were identified after an extensive literature search of PubMed, Embase, the Cochrane Library, CINAHL, Web of Science, and Scopus databases.
• A total of 9 RCTs (n=1217) were included and the odds ratios (ORs) with 95% confidence intervals (CIs) for the low and standard doses were compared.
• A low dose was defined as a low volume of BCG compared with the standard BCG dose (Armand Frappier, 120 mg; Connaught, 81 mg; Danish 1331, 120 mg; modified Danish 1331, 120 mg; Tokyo 172, 80 mg).

Endpoints

• Rate of recurrence
• Tumor progression
• Cancer-specific survival (CSS) rate
• Overall survival (OS) rate
• AEs
• Treatment withdrawal rate

Results

• The recurrence rate was higher in the low-dose group,
• However, tumor progression, CSS and OS was similar among the groups as seen in Figure 1.

Figure 1. Comparison of endpoints

• The incidence of AEs was lower in the low-dose group (OR, 0.41; 95% CI, 0.28-0.62; p<0.0001).
• The treatment withdrawal rate was also significantly less in the low-dose group as seen in Figure 1.

Conclusion

• Although low-dose BCG had higher recurrence rate than standard-dose BCG, tumor progression, cancer-specific survival, and overall survival were similar between the doses.
• The safety profile of low-dose BCG was better than the standard-dose as demonstrated by lesser incidence of adverse effects and lower withdrawal rate.
• Low-dose BCG may be a feasible alternative in the current scenario of BCG shortage.

The post Efficacy and Safety of Low-Dose BCG vs Standard-Dose BCG in NMIBC first appeared on Serene.

Purpose

Whether preexisting sleep disorder is an independent risk factor for cancer remains unclear. Therefore, we performed this propensity score–matched population-based cohort study to compare the incidence rate ratios (IRRs) of specific cancers between patients with and without sleep disorders.

Patients and methods

Patients were categorized into two groups on the basis of the presence or absence of sleep disorders and matched at a 1:1 ratio.

Results

Propensity score matching yielded a final cohort of 289,162 patients (i.e., 144,581 and 144,581 in the sleep disorder and nonsleep disorder groups, respectively) who were eligible for further analysis. In multivariate Cox regression analysis, the adjusted hazard ratio (aHR; 95% confidence interval [CI]) of cancer risk in the sleep disorder group compared with the nonsleep disorder group was 1.07 (1.04–1.12; P = 0.0001). Furthermore, the adjusted IRRs (95% CIs) for all cancers, breast cancer, and ovarian cancer in the patients with sleep disorders were 1.08 (1.02–1.18), 1.20 (1.08–1.32), and 1.30 (1.10–1.52), respectively.

Conclusion

The results suggested that sleep disorders are a significant risk factor for all cancers, breast cancer, and ovarian cancer.

Highlights

• Whether preexisting sleep disorder is an independent risk factor for cancer remains unclear. This study investigated the effect of sleep disorders on cancer incidence.
• We determined the significant adjusted incidence rate ratios of the risks of all cancers, breast cancer, and ovarian cancer in patients with or without a diagnosis of sleep disorder before cancer.

The post Effect of sleep disorders on the risks of cancers and site-specific cancers first appeared on Serene.

Aims/hypothesis

Diabetes is associated with an increased risk of cancer. Prostasin is an epithelial sodium channel stimulator that has been associated with suppression of tumours, glucose metabolism and hyperglycaemia-associated tumour pathology. However, the association between prostasin, diabetes and cancer mortality has not been well investigated in humans. We aim to investigate the associations between plasma prostasin and diabetes, and to explore whether prostasin has an effect on cancer mortality risk in individuals with hyperglycaemia.

Methods

Plasma prostasin was measured using samples from the Malmö Diet and Cancer Study Cardiovascular Cohort, and statistical analysis was performed from both sex-specific quartiles and per 1 SD. The cross-sectional association between plasma prostasin and diabetes was first studied in 4658 participants (age 57.5 ± 5.9 years, 39.9% men). After excluding 361 with prevalent diabetes, the associations of prostasin with incident diabetes and cancer mortality risk were assessed using Cox regression analysis. The interactions between prostasin and blood glucose levels as well as other covariates were tested.

Results

The adjusted OR for prevalent diabetes in the 4th vs 1st quartile of prostasin concentrations was 1.95 (95% CI 1.39, 2.76) (p for trend <0.0001). During mean follow-up periods of 21.9 ± 7.0 and 23.5 ± 6.1 years, respectively, 702 participants developed diabetes and 651 died from cancer. Prostasin was significantly associated with the incidence of diabetes. The adjusted HR for diabetes in the 4th vs 1st quartile of prostasin concentrations was 1.76 (95% CI 1.41, 2.19) (p for trend <0.0001). Prostasin was also associated with cancer mortality There was a significant interaction between prostasin and fasting blood glucose for cancer mortality risk (p for interaction =0.022), with a stronger association observed in individuals with impaired fasting blood glucose levels at baseline (HR per 1 SD change 1.52; 95% CI 1.07, 2.16; p=0.019).

Conclusions/interpretation

Plasma prostasin levels are positively associated with diabetes risk and with cancer mortality risk, especially in individuals with high blood glucose levels, which may shed new light on the relationship between diabetes and cancer.

The post Plasma prostasin: a novel risk marker for incidence of diabetes and cancer mortality first appeared on Serene.