Development of Pancreatic Cancer, Disease-specific Mortality, and All-Cause Mortality in Patients with Nonresected IPMNs: A Long-term Cohort Study

Abstract Background Esophagectomy for esophageal cancer is associated with a substantial risk of life-threatening complications and a limited long-term survival. This study aimed to clarify the controversial questions of how age influences short-term and long-term survival. Methods This population-based cohort study included almost all patients who underwent curatively intended esophagectomy for esophageal cancer in Sweden in 1987–2010, with follow-up through 2016. The exposure was age, analyzed both as a continuous and categorical variable. The probability of mortality was computed using a novel flexible parametric model approach. The reported probabilities are proper measures of the risk of dying, and the related odds ratios (OR) are therefore more suitable measures of association than hazard ratios. The outcomes were 90-day all-cause mortality, 5-year all-cause mortality, and 5-year disease-specific mortality. A novel flexible parametric model was used to derive the instantaneous probability of dying and the related OR along with 95% confidence intervals (CIs), adjusted for sex, education, comorbidity, tumor histology, pathological tumor stage, and resection margin status. Results Among 1737 included patients, the median age was 65.6 years. When analyzed as a continuous variable, older age was associated with slightly higher odds of 90-day all-cause mortality (OR 1.05, 95% CI 1.02–1.07), 5-year all-cause mortality (OR 1.02, 95% CI 1.01–1.03), and 5-year disease-specific mortality (OR 1.01, 95% CI 1.01–1.02). Compared with patients aged < 70 years, those aged 70–74 years had no increased risk of any mortality outcome, while patients aged ≥ 75 years had higher odds of 90-day mortality (OR 2.85, 95% CI 1.68–4.84), 5-year all-cause mortality (OR 1.56, 95% CI 1.27–1.92), and 5-year disease-specific mortality (OR 1.38, 95% CI 1.09–1.76). Conclusions Patient age 75 years or older at esophagectomy for esophageal cancer appears to be an independent risk factor for higher short-term mortality and lower long-term survival.

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Anatomic site as prognostic marker of pancreatic neuroendocrine tumors: a cohort study

Acta Endocrinologica ◽

10.1530/eje-19-0332 ◽

2019 ◽

Vol 181 (3) ◽

pp. 325-330 ◽

Cited By ~ 1

Author(s):

Muhamad Badarna ◽

Ruth Percik ◽

Genya Aharon-Hananel ◽

Inbal Uri ◽

Amit Tirosh

Keyword(s):

Cohort Study ◽

Multivariable Analysis ◽

Rank Test ◽

Pancreatic Neuroendocrine Tumors ◽

Anatomic Site ◽

Log Rank Test ◽

All Cause Mortality ◽

Specific Mortality ◽

Disease Specific Mortality ◽

Disease Specific

Objective Patients with pancreatic neuroendocrine tumors (PNET) have variable prognosis, even with comparable tumor grade and stage. In the current study we aimed to evaluate the prognostic utility of the intrapancreatic PNET anatomical site. Design Cohort study based on the Surveillance Epidemiology and End Results database. Methods Patients diagnosed with non-functioning PNET between 2004 and 2015 were compared by anatomic site for disease-specific mortality and all-cause mortality, using log-rank test and by multivariable cox regression analysis. Results Overall, 4171 patients (1839 women (44.1%), median age strata 60–64 years, range 10–14 to ≥85 years) were included in our analysis. Patients with PNETs located at the head vs body/tail of the pancreas had comparable tumor diameter, as well as ethnicity, gender and age distributions, but had higher rates of grade III and IV NET (13.2 vs 6.6% and 4.4 vs 1.9%, respectively, P < 0.001). NETs located at the head vs body/tail of pancreas were more likely to be locally advanced (32.2 vs 19.9%) with no difference in distant metastases (36.4 vs 33.5%, respectively, P < 0.001). Patients with NETs of the head vs. body/tail of the pancreas had higher disease-specific mortality risk in univariate (log-rank test, P < 0.001) and multivariable analysis (hazard ratio (HR): 1.34, 95% confidence interval: 1.10–1.65, P = 0.004). Multivariable analysis for all-cause mortality also showed increased risk for patients with pancreatic head vs. body/tail PNET (HR: 1.23, P = 0.013). Conclusions PNET anatomical location is associated with the mortality risk and should be considered as a prognostic factor, and as an additional consideration in directing patients management.

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Breast Cancer: Disease-Specific Mortality Rises With Age

Family Practice News ◽

10.1016/s0300-7073(12)70284-0 ◽

2012 ◽

Vol 42 (6) ◽

pp. 22

Author(s):

MARY ANN MOON

Keyword(s):

Breast Cancer ◽

Cancer Disease ◽

Specific Mortality ◽

Disease Specific Mortality ◽

Disease Specific

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Associations Between Handgrip Strength and Disease-Specific Mortality Including Cancer, Cardiovascular, and Respiratory Diseases in Older Adults: A Meta-Analysis

Journal of Aging and Physical Activity ◽

10.1123/japa.2018-0348 ◽

2020 ◽

Vol 28 (2) ◽

pp. 320-331

Author(s):

Junga Lee

Keyword(s):

Older Adults ◽

Older Women ◽

Respiratory Diseases ◽

Handgrip Strength ◽

Meta Analysis ◽

Adult Participants ◽

All Cause Mortality ◽

Specific Mortality ◽

Disease Specific Mortality ◽

Disease Specific

Several controversial studies linking handgrip strength and health have suggested that low handgrip strength in older adults may be related to health problems and have investigated whether there is a minimum handgrip strength level associated with reduced mortality. Thus, by meta-analysis, the authors identified an association between handgrip strength in older adults and disease-specific mortality and all-cause mortality. Thirty studies with a total of 194,767 older adult participants were included in this meta-analysis. Higher handgrip strength was associated with an 18% decrease in all-cause mortality. Lower handgrip strength was associated with increased all-cause mortality. The minimum handgrip strength in older women that did not increase all-cause mortality was 18.21 kg. Increased handgrip strength showed a decreased all-cause mortality, whereas decreased handgrip strength was associated with increased all-cause mortality. Strengthening the handgrip may help improve disease-specific mortality in older adults.

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Mediating-Moderating Effect of Allostatic Load on the Association between Dietary Approaches to Stop Hypertension Diet and All-Cause and Cause-Specific Mortality: 2001–2010 National Health and Nutrition Examination Surveys

Nutrients ◽

10.3390/nu11102311 ◽

2019 ◽

Vol 11 (10) ◽

pp. 2311 ◽

Cited By ~ 1

Author(s):

Hind A. Beydoun ◽

Shuyan Huang ◽

May A. Beydoun ◽

Sharmin Hossain ◽

Alan B. Zonderman

Keyword(s):

Cardiovascular Disease ◽

Allostatic Load ◽

Moderating Effects ◽

Dash Diet ◽

Health And Nutrition ◽

All Cause Mortality ◽

Specific Mortality ◽

Disease Specific Mortality ◽

Cancer Specific Mortality ◽

Disease Specific

This secondary analysis of survey data examined mediating-moderating effects of allostatic load score (calculated using the Rodriquez method) on the association between nutrient-based Dietary Approaches to Stop Hypertension (DASH) diet score (Mellen Index) and the all-cause and cause-specific mortality risks among 11,630 adults ≥ 30 years of age from the 2001–2010 National Health and Nutrition Examination Surveys with no history of cardiovascular disease or cancer at baseline, and who were followed-up for ~9.35 years. Multivariable models were adjusted for demographic, socioeconomic, lifestyle, and health characteristics. All-cause, cardiovascular disease, and cancer-specific mortality rates were estimated at 6.5%, 1.1%, and 1.9%, respectively. The median DASH total score was 3.0 (range: 1–8) (with 78.3% scoring < 4.5), whereas the median allostatic load score was 3 (range: 0–9). The DASH diet, fiber, and magnesium were negatively correlated with allostatic load, whereas allostatic load predicted higher all-cause mortality, irrespective of the DASH diet. Whereas protein was protective, potassium increased all-cause mortality risk, irrespective of allostatic load. Potassium was protective against cardiovascular disease-specific mortality but was a risk factor for cancer-specific mortality. Although no moderating effects were observed, mediation by the allostatic load on cardiovascular disease-specific mortality was observed for DASH total score and selected component scores. Direct (but not indirect) effects of DASH through the allostatic load were observed for all-cause mortality, and no direct or indirect effects were observed for cancer-specific mortality. From a public health standpoint, the allostatic load may be a surrogate for the preventive effects of the DASH diet and its components on cardiovascular disease-specific mortality risk.

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Association Between 6-Minute Walk Test and All-Cause Mortality, Coronary Heart Disease–Specific Mortality, and Incident Coronary Heart Disease

Journal of Aging and Health ◽

10.1177/0898264314525665 ◽

2014 ◽

Vol 26 (4) ◽

pp. 583-599 ◽

Cited By ~ 17

Author(s):

Ali Yazdanyar ◽

Michael M. Aziz ◽

Paul L. Enright ◽

Daniel Edmundowicz ◽

Robert Boudreau ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Walk Test ◽

Incident Coronary Heart Disease ◽

All Cause Mortality ◽

Specific Mortality ◽

Disease Specific Mortality ◽

6 Minute Walk Test ◽

Minute Walk ◽

Disease Specific

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Surgical Proficiency Gain and Survival After Esophagectomy for Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2015.65.2875 ◽

2016 ◽

Vol 34 (13) ◽

pp. 1528-1536 ◽

Cited By ~ 43

Author(s):

Sheraz R. Markar ◽

Hugh Mackenzie ◽

Pernilla Lagergren ◽

George B. Hanna ◽

Jesper Lagergren

Keyword(s):

Esophageal Cancer ◽

Resection Margin ◽

Change Points ◽

Specific Mortality ◽

Disease Specific Mortality ◽

Short And Long Term ◽

Esophagectomy For Cancer ◽

Disease Specific ◽

Long Term Mortality

Purpose We aimed to identify the presence and length of esophagectomy proficiency gain curves in terms of short- and long-term mortality for esophageal cancer. Patients and Methods Patients who underwent esophagectomy for esophageal cancer between 1987 and 2010 with follow-up until 2014 were identified from a well-established, population-based, nationwide Swedish cohort study. Proficiency gain curves were created by using risk-adjusted cumulative sum analysis for 30-day, 90-day, 1-year, 3-year, and 5-year all-cause and disease-specific mortality measures. Similarly, the proficiency gain curves for lymph node harvest, resection margin status, and reoperation incidence were assessed as performance-contributing factors to the observed changes in long-term survival. Results Esophagectomies in 1,821 patients with esophageal cancer were conducted by 139 surgeons. The change-point in proficiency gain curve for all-cause 30-day mortality was early, at 15 cases, when mortality decreased from 7.9% to 3.1% (P < .001). Later change-points, which ranged from 35 to 59 cases, were observed for 1-, 3- and 5-year mortality rates, for which all-cause mortality decreased from 34.9% to 27.7% (P = .011), from 47.4% to 41.5% (P = .049), and from 31.4% to 19.1% (P = .009), respectively. Similar change-points were observed in disease-specific mortality at 1 and 3 years. There was a continuous increase in lymph node harvest, which did not plateau. Also, change-points were observed for resection margin with tumor involvement at 17 cases, with a reduction from 20.9% to 15.2% (P = .004), and for reoperation rate at 55 cases, with a reduction from 12.6% to 5.0% (P < .001). Conclusion The gain of proficiency in esophagectomy for cancer is associated with measurable changes in short- and long-term mortality results. These findings indicate a need for structured national training and mentorship programs for esophageal cancer surgery.

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