Adrenocortical carcinoma. Clinical outcome at the end of the 20th century

BACKGROUND: Adrenocortical carcinoma remains a rare and lethal neoplasm. Effective therapies have not emerged in recent decades. However, medical advances have improved diagnostic techniques and supportive measures; these changes may have a beneficial impact on the natural history of the disease. METHODS: The authors retrospectively analyzed the clinical outcomes of patients with adrenocortical carcinoma registered at the University of Texas M.D. Anderson Cancer Center focusing on patients who received their diagnosis since 1980 and comparing data from those patients with earlier reports. RESULTS: Since 1980, 139 patients have registered at M.D. Anderson Cancer Center with the diagnosis of adrenocortical carcinoma. One-third had evidence of hormone hypersecretion, and one-third had localized disease at diagnosis. Men were affected as frequently as women but tended to be older and have larger tumors at diagnosis. The 5-year survival rate was 60% (Kaplan-Meier analysis). The 30 patients with the longest survival (> 5 years) and the 30 patients with the shortest survival (< 11 months) had no significant differences in age, gender, tumor size, or functionality. However, long-term survivors had significantly less extensive disease. A comparison with patients reviewed in earlier reports from the same institution showed no significant differences in gender predilection, tumor function, or extent of disease. Despite these similarities, patients whose disease was diagnosed since 1980 lived much longer than patients observed in earlier decades. CONCLUSIONS: Despite the lack of significant improvements in early diagnosis and effective therapies, patients with adrenocortical carcinoma are living longer (5-year survival rate, 60%). It is important to revise assumptions regarding the clinical outcomes of patients with this disease.     

Long-term cancer patient survival achieved by the end of the 20th century: most up-to-date estimates from the nationwide Finnish cancer registry

A new method of survival analysis, denoted period analysis, has recently been developed, which has been shown to provide more up-to-date estimates of long-term survival rates than traditional methods of survival analysis. We applied period analysis to data from the nationwide Finnish cancer registry to provide up-to-date estimates of 5-, 10-, 15- and 20-year relative survival rates (RSR) achieved by the end of the 20th century. For most forms of cancer, period estimates of long-term survival are much higher than corresponding traditional survival estimates which suggests that for these cancers there has been ongoing major progress in survival rates in recent years which so far has remained undisclosed by traditional methods of survival analysis. For example, period analysis reveals that 10 year RSR have come close to (or even exceed) 80% for cancer of the corpus uteri and melanoma, 75% for breast cancer, 70% for bladder cancer, 65% for cancer of the cervix uteri, and 55% for cancer of the colon and prostate. Period analysis further reveals that 20 year RSR have now come close to (or even exceed) 75% for endometrial cancer and melanoma, 60% for breast cancer and cervical cancer, 55% for colon cancer and bladder cancer, and 40%-50% for cancer of the rectum, the ovaries, kidneys and nervous system.     

Up-to-date estimates of long-term cancer survival in England and Wales

Cancer survival in England and Wales has improved over the last 30 years. However, cohort survival estimates delay recognition of these improvements. Here we show that period survival estimates, based on survival in a recent time period, suggest a more optimistic pattern for England and Wales than cohort-based measures for most cancers.British Journal of Cancer (2003) 89, 74-76. doi:10.1038/sj.bjc.6600976 www.bjcancer.com     

Predicted trends in long-term breast cancer survival in England and Wales

Trends in long-term relative survival from breast cancer are examined for women diagnosed in England and Wales up to 2001, using both period and hybrid approaches. Large improvements in long-term survival are predicted. Women with breast cancer still experience persistent excess mortality up to at least 20 years after diagnosis.     

Cancer mortality in African and Caribbean migrants to England and Wales.

Cancer mortality during 1970-85 of immigrants from East and West Africa and the Caribbean to England and Wales is described. Overall cancer mortality was raised in West African males (RR 1.38, 95% CI 1.25-1.54), and non-significantly raised in West African females (RR 1.14, 0.96-1.37) compared to mortality in the England and Wales-born population. Much of the increased risk was due to very high rates of liver cancer in males (RR 31.6, 23.8-41.9), but rates were also raised for a wide range of other cancers in each sex. Only lung and brain cancer had significantly decreased mortality. In East Africans, overall cancer mortality was low in males (RR 0.63, 0.56-0.70), and in females (RR 0.80, 0.72-0.89). Mortality was significantly low for cancers of the stomach, pancreas and testis, and Hodgkin's disease in males, for cervical cancer in females, and for lung cancer and melanoma in both sexes. Cancer sites with significantly raised mortality included oropharyngeal cancer, leukaemia, and multiple myeloma in both sexes. In Caribbean immigrants overall cancer rates were significantly low in males (RR 0.71, 0.68-0.74) and in females (RR 0.76, 0.73-0.80). Mortality was significantly low for many cancers including colorectal, lung, testis and brain cancers. Mortality was significantly raised only for cancer of the prostate in males, of the placenta in females, and of the liver, non-Hodgkin's lymphoma and multiple myeloma in both sexes. Overall, mortality was high from prostatic cancer and liver cancer, and was low from brain cancer, in predominantly ethnic African immigrant groups. Both East and West African immigrants had raised rates of leukaemia. All of the migrant groups had high rates of multiple myeloma and low rates of testicular, ovarian and lung cancer. Genetic and environmental factors that may contribute to these patterns are discussed.     

Cancer incidence in migrants to New South Wales from England, Wales, Scotland and Ireland

Cancer incidence in migrants to New South Wales (NSW) from individual countries within the British Isles has been compared with that in the Australian-born population using data from the NSW Central Cancer Registry for the period 1972-84. Indirectly age-standardised incidence ratios (SIR) showed that, for cancer at all sites combined, Scottish migrants had a significantly higher, and English migrants a lower, incidence than the native-born Australians. Melanoma of skin was less common in migrants from all four countries while lung cancer was more common. In all except the Irish migrants, stomach cancer was more frequent than in the Australian-born. Raised SIRs for bladder cancer were found in men from all the countries and for breast cancer in all except the Irish women but only in the English migrants were these ratios significant. English migrants differed from those from Wales, Scotland and Ireland in that, compared with the Australian-born, they had significantly lower SIRs for cancer of the colon (both sexes), head and neck, larynx and prostate (men), gallbladder and kidney (women), and a higher SIR for ovarian cancer. Bone cancer was relatively more common in men born in Wales. 'Other genital' cancers (penis and scrotum; vulva and vagina) tended to be more frequent in migrants from each country than in the Australian-born.     

Trends and socioeconomic inequalities in cancer survival in England and Wales up to 2001

We examined national trends and socioeconomic inequalities in cancer survival in England and Wales during the 1990s, using population-based data on 2.2 million patients who were diagnosed with one of the 20 most common cancers between 1986 and 1999 and followed up to 2001. Patients were assigned to one of five deprivation categories (from 'affluent' to 'deprived') using characteristics of their electoral ward of residence at diagnosis. We estimated relative survival up to 5 years after diagnosis, adjusting separately in each deprivation category for background mortality by age, sex and calendar period. We estimated trends in survival and in the difference in survival between deprivation categories ('deprivation gap') over the periods 1986-90, 1991-95 and 1996-99. We used period analysis to examine likely survival rates in the near future. Survival improved for most cancers in both sexes during the 1990s, and appears likely to continue improving for most cancers in the near future. The deprivation gap in survival between rich and poor was wider for patients diagnosed in the late 1990s than in the late 1980s. Increases in cancer survival in England and Wales during the 1990s are shown to be significantly associated with a widening deprivation gap in survival.     

Estimating relative survival among people registered with cancer in England and Wales.

Because routinely collected survival data for cancer patients in England and Wales do not typically specify cause of death, conventional estimates of survival in cancer patients based on such data are a measure of their mortality from all causes rather than their mortality due to cancer. As a result, trends in survival over time are difficult to interpret because changes in overall survival may well reflect changes in the risk of death from other causes, rather than from the cancer of interest. One way of overcoming this problem is to use some form of 'relative survival' defined as a measure of survival corrected for the effect of other independent causes of death. Since this concept was first introduced, various methods for calculating relative survival have been proposed and this had led to some confusion as to the most appropriate choice of estimate. This paper aims to provide an introduction to the concept of relative survival and reviews some of the suggested methods of estimation. In addition, a particularly simple, but robust approach, is highlighted based on expected and observed mortality. This method is illustrated using preliminary data from the Office for National Statistics on cancer survival in patients born after 1939 and diagnosed with cancer during 1972-84. The examples presented, although limited to analyses on a small number of selected sites, highlight some encouraging trends in survival in people aged under 35 diagnosed with leukaemia, Hodgkin's disease and testicular cancer during this period.     

Cancer mortality in small areas around nuclear facilities in England and Wales.

Cancer mortality trends were examined for the small areas around fourteen nuclear and five non-nuclear facilities in England and Wales. Using routine OPCS mortality data, standardized mortality ratios (SMRs) for these areas were computed for selected causes of death. Changes in the SMRs were then sought by comparing the SMRs for the five years before the facility opened with the period 10 (in some cases 15) years after start-up, and by computing the weighted regression of the SMRs on calendar year. These analyses indicate no overall pattern of increasing cancer SMRs around nuclear facilities.     

Cancer mortality in 1970-1972 among Polish-born migrants to England and Wales

The 1970-72 cancer mortality of Polish migrants to England and Wales is compared with the cancer mortality prevailing in England and Wales and in Poland. Small numbers limit the analyses to the most frequent cancer sites only. The main findings are: (a) Compared with mortality rates in both their country of birth and of adoption, Polish migrants displayed intermediate values for cancers of the stomach, intestinal tract, and lung. For age-groups over 74 years, lung-cancer mortality among the migrants appears, however, to be higher than in both Poland and England and Wales. (b) A distinctly higher mortality among Polish migrants than either in Poland or England and Wales was apparent for lymphomas in both sexes, and for leukaemia and oesophageal cancer in males. (c) Female breast-cancer mortality among Polish migrants was much higher than in Poland, being close to the high mortality rates prevailing in England and Wales. The present findings are compared with the results of similar studies of Polish migrants to the United States and Australia and reasons for observed differences are advanced.     

Cancer incidence in England and Wales and New Zealand and in migrants between the two countries.

Risks of cancer incidence in people born in England and Wales and New Zealand (non-Maoris) living in their home countries, and after migration between the two countries, were analysed using data from their national cancer registries. Since these populations are of similar genetic origin, any real differences in cancer incidence between them are likely to reflect the action of environmental or behavioural risk factors. The greatest differences in risk between the countries were for cutaneous melanoma and lip cancer. In each sex, relative risks of these malignancies were 4 or greater for the New Zealand-born in New Zealand compared with English and Welsh natives in their home country, and risks for migrants in each direction were generally intermediate between those born in the home country in the two countries. Sizeable significantly raised risks in the New Zealand-born in New Zealand compared with English and Welsh natives in England and Wales also occurred for cancers of the mouth, small intestine, colon, thymus, eye and thyroid, and non-Hodgkin''s lymphoma in each sex, and for cancer of the prostate. For all of these sites except mouth, small intestine and colon there were also risks around or above New Zealand-born levels for English and Welsh migrants to New Zealand; for colon cancer these migrants had risks close to those in England and Wales. New Zealand migrants to England and Wales had risks of cancers of the colon and prostate that were similar to or above New Zealand levels. Risks of cancers of the stomach, lung, pleura and bladder, and Hodgkin''s disease in each sex, and cancers of the cervix, ovary and scrotum and penis, were substantially and significantly lower in the New Zealand-born living in New Zealand than in English and Welsh natives in England and Wales. In English and Welsh migrants to New Zealand risks of bladder cancer in each sex, and of scrotal and penile and pleural cancer in males, approximated to England and Wales risks; cervical cancer risk approximated to the New Zealand risk; and stomach, lung and ovarian cancers showed intermediate risks. Migrants from New Zealand to England and Wales did not gain the lung cancer or clearly the stomach cancer risk of their host country, but did have bladder cancer risks approximating to those in England and Wales.(ABSTRACT TRUNCATED AT 400 WORDS)     

Cost-effectiveness of Trifluridine/tipiracil for Previously Treated Metastatic Colorectal Cancer in England and Wales

Background

Treatment options at third-line and beyond for patients with late-line metastatic colorectal cancer (mCRC) are limited, and outcomes are poor with best supportive care (BSC). This study investigated the cost-effectiveness of trifluridine/tipiracil and regorafenib relative to BSC alone in patients with mCRC who have been previously treated with, or are not considered candidates for, standard chemotherapies.

Cancer mortality in 13 to 29-year-olds in England and Wales, 1981-2005

We examined cancer mortality at ages 13-29 years in England and Wales between 1981 and 2005, a total of 20 026 deaths over approximately 303 million person-years (mpy) at risk by sex, age group and time period. Overall, the mortality rate was 65.6 per mpy. Malignant neoplasms of the central nervous system showed the highest rate (8.5), followed by myeloid and monocytic leukaemia (6.6), lymphoid leukaemia (6.4), malignant bone tumours (5.4) and non-Hodgkin's lymphoma (5.2). These groups together accounted for almost 50% of all cancer deaths. The mortality rate for males (72.4) was 23% higher than for females (58.6) (P-value <0.0001). Males showed significantly higher mortality rates than females in almost all diagnostic groups, in general, mortality increasing with age (P-value <0.0001). There were significant decreases in mortality over time, the annual percentage change between 1981 and 2005 being minus 1.86 (95% confidence interval -2.09 to -1.62). Cancer groups with the highest mortality differed from those with the highest incidence.     

Cancer mortality in Indian and British ethnic immigrants from the Indian subcontinent to England and Wales.

Risk of cancer mortality from 1973 to 1985 in persons born in the Indian subcontinent who migrated to England and Wales was analysed by ethnicity, and compared with cancer mortality in the England and Wales native population, using data from England and Wales death certificates. There were substantial highly significant raised risks in Indian ethnic migrants for cancers of the mouth and pharynx, gall bladder, and liver in each sex, larynx and thyroid in males, and oesophagus in females. There were also substantial raised risks in these migrants of each sex for non-Hodgkin''s lymphoma and myeloma. For the mouth and pharynx, and liver in each sex, and gall bladder in females, there were also raised risks of lesser magnitude in British ethnic migrants. For colon and rectal cancer and cutaneous melanoma in each sex, ovarian cancer in women and bladder cancer in men, there were appreciable significantly reduced risks in the Indian ethnic migrants not shared by those of British ethnicity. Appreciable raised risks in British ethnic migrants not shared by those of Indian ethnicity occurred for nasopharyngeal cancer in males, soft tissue malignancy in both sexes and non-melanoma skin cancer in males. In migrants of both ethnicities there were appreciable significantly raised risks in each sex for leukaemia and decreased risks in each sex for gastric cancer, for lung cancer except in females of British ethnicity and in males for testicular cancer. The results suggest the need for public health measures to combat the high risks of oral and pharyngeal cancers and liver cancer in the Indian ethnic immigrant population of England and Wales, by prevention of betel quid chewing and hepatitis transmission respectively. The data also imply that early exposures or early acquired behaviours in India, or exposures during migration, may increase the risk of leukaemia and reduce the risks of gastric and testicular cancers in the migrants irrespective of their ethnicity. Aetiological studies would be worthwhile to investigate the reasons for the sizeable decreased risk of colon and rectal cancer and increased risk of gall bladder cancer in each sex and the increased risk of thyroid and laryngeal cancer in males and oesophageal cancer in females of Indian ethnicity but not of British ethnicity who have migrated from the Indian subcontinent.