scholarly journals A population-based study of pulmonary monitoring and toxicity for patients with testicular cancer treated with bleomycin

2020 ◽  
Vol 27 (6) ◽  
Author(s):  
M.J. Raphael ◽  
M.D. Lougheed ◽  
X. Wei ◽  
S. Karim ◽  
A.G. Robinson ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Pulmonary Toxicity ◽  
Pulmonary Function Tests ◽  
Population Based ◽  
Primary Objective ◽  
Administrative Databases ◽  
Chest Imaging ◽  
Physician Visits ◽  
Ontario Cancer Registry ◽  
Incident Cases

Background Bleomycin is commonly used to treat advanced testicular cancer and can be associated with severe pulmonary toxicity. The primary objective of the present study was to describe the use of pulmonary function tests (pfts) and chest imaging before, during, and after treatment with bleomycin. Methods To identify all incident cases of testicular cancer treated with bleomycin-based chemotherapy in the Canadian province of Ontario during 2005–2010, the Ontario Cancer Registry was linked with chemotherapy treat­ment records. Health administrative databases were used to describe use of pfts, chest imaging, and physician visits for respiratory complaints. Results Of 394 patients treated with orchiectomy and chemotherapy who received at least 1 dose of bleomycin, 93% had complete chemotherapy records available. In the 4 weeks before, during, and within 2 years after finishing bleomycin-based chemotherapy, pfts were performed in 17%, 17%, and 29% of patients respectively. Chest imaging was performed in 68%, 62%, and 98% of patients in the same time periods. In the 2 years after bleomycin-based chemotherapy, 23% of treated patients had a physician visit for respiratory symptoms. That rate was substantially higher for men with greater exposure to bleomycin: 40% (24 of 60) for 10–12 doses bleomycin compared with 21% (53 of 250) for 7–9 doses and with 14% (8 of 58) for 1–6 doses (p = 0.002). Conclusions Quality improvement initiatives are needed to increase baseline rates of chest imaging within 4 weeks of starting chemotherapy for testicular cancer; to understand why such a high proportion of men have chest imaging during bleomycin-based chemotherapy; and to mitigate the excess pulmonary toxicity seen with increasing expos­ure to bleomycin.

Delivery of bleomycin among patients with testicular cancer: A population-based study of pulmonary monitoring and toxicity.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16056-e16056
Author(s):  
Christopher M. Booth ◽  
Michael J. Raphael ◽  
Xuejiao Wei ◽  
Andrew George Robinson ◽  
Philippe L. Bedard ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Pulmonary Toxicity ◽  
Respiratory Symptoms ◽  
Pulmonary Function Tests ◽  
Administrative Databases ◽  
Medical Attention ◽  
Routine Practice ◽  
Chest Imaging ◽  
Physician Visits ◽  
Incident Cases

e16056 Background: Bleomycin is commonly used to treat testicular cancer and can be associated with severe pulmonary toxicity. There is limited information about how clinicians monitor patients during treatment and the incidence of pulmonary toxicity in routine practice. Methods: The Ontario Cancer Registry was linked to electronic records of treatment to identify all incident cases of testicular cancer treated with orchiectomy and bleomycin, etoposide, and cisplatin (BEP) chemotherapy in the province of Ontario during 2005-2010. Health-administrative databases were used to describe use of pulmonary function tests (PFTs), chest imaging and physician visits. Results: 475 patients were treated with orchiectomy and chemotherapy. Complete chemotherapy records were available for 93% (368/394) of men treated with BEP. Bleomycin was omitted among 32% (116/368) of patients. PFTs were performed in 17% (63/368), 17% (61/368) and 29% (106/368) of patients before BEP, during BEP, and within 2 years of finishing BEP, respectively. During chemotherapy, 62% of patients (227/368) had chest imaging. In the two years following BEP, 23% (85/368) had a physician visit for respiratory symptoms; this rate was substantially higher among men with greater exposure to bleomycin; 40% (24/60) for 10-12 doses bleomycin vs 21% (53/250) for 7-9 doses vs 14% (8/58) for 1-6 doses (p = 0.002). Two percent of men (8/368) had visit codes for pulmonary fibrosis. Conclusions: A substantial proportion of men treated with BEP will seek medical attention after chemotherapy for respiratory symptoms and this is associated with cumulative dose of bleomycin. Use of PFTs and chest imaging during treatment is common. Whether PFT test results or clinical symptoms are leading to bleomycin dose omission is uncertain.

scholarly journals Utilization of imaging for active surveillance in testicular cancer: Is real-world practice concordant with guidelines?

2021 ◽  
Vol 16 (2) ◽  
Author(s):  
Bishal Gyawali ◽  
Rebecca Griffiths ◽  
Andrew G. Robinson ◽  
Matthew D.F. McInnes ◽  
Philippe L. Bedard ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Active Surveillance ◽  
Early Stage ◽  
Multivariable Analysis ◽  
Germ Cell Tumors ◽  
Population Based ◽  
Chest Imaging ◽  
Imaging Data ◽  
Period Range ◽  
Ontario Cancer Registry

Introduction: Imaging is an integral component of active surveillance following orchiectomy for stage 1 non-seminoma (NSGCT) and seminoma germ cell tumors. In this population-based study, we describe use of imaging among patients with early-stage testicular cancer and evaluate whether they are concordant with guideline recommendations. Methods: This is a population-based, retrospective cohort study to describe utilization of imaging among all patients with early-stage testicular cancer treated with active surveillance in the Canadian province of Ontario. The Ontario Cancer Registry was linked to electronic records of treatment to identify use of chest and abdomen/pelvis imaging. Data from 2000–-2010 were included with followup for up to five years for patients with non-seminoma and 10 years for patients with seminoma. The key outcome of interest was the frequency of imaging at temporal milestones following orchiectomy. Compared to the most contemporaneous guidelines in Ontario, any discordant frequency of imaging was defined as underutilization or overutilization. Substantial under- or overutilization was defined as >1 imaging test less/more than what was recommended during a 12-month period. Results: The study population included 569 patients with NSGCT (median age 28) and 1107 with seminoma (median age 37). Among patients with NSGCT, adherence with body imaging was low in years 1–3 of surveillance (range 26–37%, predominantly underuse) and higher in years 4–5 (63–67%, predominantly overuse). Adherence with chest imaging was even lower (range 11–34% during years 1–5). Among patients with seminoma, adherence with abdominal and chest imaging was relatively stable and comparable throughout the 10-year followup period (range 23–47% abdomen and 28–47% chest). Multivariable analysis confirmed that underutilization of imaging was more common in recent years. NSGCT histology was associated with underutilization in years 1–2 but overutilization in years 3–5. Conclusions: In routine clinical practice, patients with testicular cancer commonly receive imaging discordant to the protocol for active surveillance, with a substantial proportion receiving both under- and overutilization at various times during surveillance followup.

Epidemiology of pheochromocytoma and paraganglioma: population-based cohort study

2021 ◽  
Vol 184 (1) ◽  
pp. 19-28
Author(s):  
Alexander A Leung ◽  
Janice L Pasieka ◽  
Martin D Hyrcza ◽  
Danièle Pacaud ◽  
Yuan Dong ◽  
...  
Keyword(s):  
Cohort Study ◽  
Administrative Data ◽  
Laboratory Data ◽  
Population Based ◽  
Incidence Rates ◽  
Primary Objective ◽  
Administrative Databases ◽  
Secondary Objective ◽  
True Frequency ◽  
Clinical Records

Objective Despite the significant morbidity and mortality associated with pheochromocytoma and paraganglioma, little is known about their epidemiology. The primary objective was to determine the incidence of pheochromocytoma and paraganglioma in an ethnically diverse population. A secondary objective was to develop and validate algorithms for case detection using laboratory and administrative data. Design Population-based cohort study in Alberta, Canada from 2012 to 2019. Methods Patients with pheochromocytoma or paraganglioma were identified using linked administrative databases and clinical records. Annual incidence rates per 100 000 people were calculated and stratified according to age and sex. Algorithms to identify pheochromocytoma and paraganglioma, based on laboratory and administrative data, were evaluated. Results A total of 239 patients with pheochromocytoma or paraganglioma (collectively with 251 tumors) were identified from a population of 5 196 368 people over a period of 7 years. The overall incidence of pheochromocytoma or paraganglioma was 0.66 cases per 100 000 people per year. The frequency of pheochromocytoma and paraganglioma increased with age and was highest in individuals aged 60–79 years (8.85 and 14.68 cases per 100 000 people per year for males and females, respectively). An algorithm based on laboratory data (metanephrine >two-fold or normetanephrine >three-fold higher than the upper limit of normal) closely approximated the true frequency of pheochromocytoma and paraganglioma with an estimated incidence of 0.54 cases per 100 000 people per year. Conslusion The incidence of pheochromocytoma and paraganglioma in an unselected population of western Canada was unexpectedly higher than rates reported from other areas of the world.

Retrospective cohort study of real-world treatment patterns and overall survival in patients with chronic lymphocytic leukemia (CLL) diagnosed between 2010 to 2017 in Ontario, Canada.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e20003-e20003
Author(s):  
Shazia Hassan ◽  
Manjusha Hurry ◽  
Soo Jin Seung ◽  
Ryan Walton ◽  
Ashlie Elnoursi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Real World ◽  
Population Based ◽  
Treatment Patterns ◽  
Lymphocytic Leukemia ◽  
Administrative Databases ◽  
Probability Of Survival ◽  
Ontario Cancer Registry ◽  
Time To Initiation ◽  
Line Of Therapy

e20003 Background: With recent advances in treatment of CLL, it is important to understand emerging treatment patterns and associated outcomes. A population-based study was undertaken to describe the management and survival of CLL patients in Ontario, Canada. Methods: Patients diagnosed with CLL between January 1, 2010 and December 31, 2017 were identified in the Ontario Cancer Registry and linked to provincial administrative databases. Treatment patterns by line of therapy were characterized, including analyses of time to initiation and between therapies. Overall survival was calculated. Results: 2,887 CLL patients were identified (median age 68yr; 67% male). The mean time from diagnosis to first line (1L) treatment was 651 days with 35% of patients receiving fludarabine-cyclophosphamide-rituximab (FCR) based treatment. During the study period, 71% of patients did not yet receive second line (2L) therapy and did not have subsequent follow up, while 19% received 2L ibrutinib. Median time to 2L initiation from 1L treatment discontinuation was 636 days. The table summarizes 1L and 2L therapies. Of the 827 patients on 2L therapy, 65% received ibrutinib. After the introduction of publicly funded novel agents in 2015, a shift in treatment patterns away from FCR and chlorambucil based regimens was observed. Overall mean survival for the cohort from diagnosis was 6.8yrs, and mean 5 year probability of survival was 72.4%. Conclusions: A shift in treatment patterns for CLL can be seen with the introduction of newer therapies, such as ibrutinib. The results can support healthcare decision-makers by characterizing the size of this patient population, real world treatment patterns and survival outcomes for patients with CLL. [Table: see text]

scholarly journals Trends in prevalence, incidence and mortality of diagnosed and silent coronary heart disease in Quebec

2015 ◽  
Vol 35 (10) ◽  
pp. 184-193 ◽  
Author(s):  
C. Blais ◽  
L. Rochette
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Disease Surveillance ◽  
Population Based ◽  
Administrative Databases ◽  
Case Definitions ◽  
Disease Surveillance System ◽  
Incidence And Mortality ◽  
Causes Of Mortality ◽  
Incident Cases

Introduction Of all cardiovascular causes of mortality, coronary heart disease (CHD) remains the leading cause of death. Our objectives were to establish trends in the prevalence and incidence of CHD in the province of Quebec, and to determine the proportion of CHD mortality that had no previous CHD diagnosis. Methods Trends in prevalence, incidence and mortality were examined with a population-based study using the Quebec Integrated Chronic Disease Surveillance System, which links several health administrative databases. Data are presented using two case definitions for Quebecers aged 20 years and over: 1) a validated definition, and 2) CHD causes of death codes added to estimate the proportion of deaths that occurred without any previous CHD diagnosis as a proxy for sudden cardiac death (SCD). Results In 2012/2013, the crude prevalence of CHD was 9.4% with the first definition (593 000 people). Between 2000/2001 and 2012/2013, the age-standardized prevalence increased by 14%, although it has been decreasing slightly since 2009/2010. Agestandardized incidence and mortality rates decreased by 46% and 26% respectively, and represented a crude rate of 6.9 per 1000 and 5.2% in 2012/2013. The proportion identified only by CHD mortality, our SCD proxy, was only significant for the incident cases (0.38 per 1000 in 2009/2010) and declined over the study period. Conclusion The prevalence of CHD has tended to decrease in recent years, and incidence and mortality have been declining in Quebec. Most CHD mortality occurs in previously diagnosed patients and only a small proportion of incident cases were not previously identified.

Is Access to Care Associated With Stage at Presentation and Survival for Melanoma Patients?

2019 ◽  
Vol 23 (6) ◽  
pp. 586-594 ◽  
Author(s):  
Lacey D. Pitre ◽  
Geordie Linford ◽  
Gregory R. Pond ◽  
Elaine McWhirter ◽  
Hsien Seow
Keyword(s):  
Primary Care ◽  
Socioeconomic Status ◽  
Overall Survival ◽  
Access To Care ◽  
Population Based ◽  
Administrative Databases ◽  
Cancer Center ◽  
Physician Visits ◽  
Melanoma Prognosis ◽  
Melanoma Patients

Background Melanoma incidence increases with socioeconomic status but the effect of rurality and access to primary care or dermatology on patient outcomes is unclear. Objectives The objectives of this study were to determine whether access to care, rurality, or socioeconomic status are associated with melanoma stage at presentation and prognosis. Methods Linked administrative databases from Ontario, Canada, were retrospectively analyzed to identify a population-based cohort of patients diagnosed with melanoma between 2004 and 2012. Rurality was assessed using the rural index of Ontario (RIO) score, and the number of visits to dermatology and primary care was used to evaluate access to care. Results We identified 18 776 melanoma patients, of whom 9591 had completed pathological staging. Patients with higher RIO scores, living further from a cancer center or in a rural community, were less likely to see a dermatologist in the year prior to diagnosis ( P < .001 for all). Patients seen by a dermatologist within 365 days prior to diagnosis were less likely to present with stage III or IV disease (odds ratio 0.63, P < .001) and had improved overall survival (hazard ratio [HR] for death 0.77, P < .001). There was a nonlinear association between number of family physician visits and melanoma prognosis, with patients who had 3 to 5 visits per year having the best overall survival (HR 0.88, P = .003). Conclusion Our findings strengthen the known association between access to dermatology and melanoma outcomes by linking individual patients’ prediagnosis access to care to pathological stage at diagnosis and overall survival.

scholarly journals Psychiatric comorbidity is associated with disability progression in multiple sclerosis

Neurology ◽  
2018 ◽  
Vol 90 (15) ◽  
pp. e1316-e1323 ◽  
Author(s):  
Kyla A. McKay ◽  
Helen Tremlett ◽  
John D. Fisk ◽  
Tingting Zhang ◽  
Scott B. Patten ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Anxiety Disorder ◽  
Psychiatric Comorbidity ◽  
Population Based ◽  
Administrative Databases ◽  
Linear Regression Models ◽  
Disability Progression ◽  
Psychiatric Comorbidities ◽  
Neurologic Disability ◽  
Incident Cases

ObjectiveEmerging evidence suggests that comorbidity may influence disability outcomes in multiple sclerosis (MS); we investigated the association between psychiatric comorbidity and MS disability progression in a large multiclinic population.MethodsThis retrospective cohort study accessed prospectively collected information from linked clinical and population-based health administrative databases in the Canadian provinces of British Columbia and Nova Scotia. Persons with MS who had depression, anxiety, or bipolar disorder were identified using validated algorithms using physician and hospital visits. Multivariable linear regression models fitted using an identity link with generalized estimating equations were used to determine the association between psychiatric comorbidity and disability using all available Expanded Disability Status Scale (EDSS) scores.ResultsA total of 2,312 incident cases of adult-onset MS were followed for a mean of 10.5 years, during which time 35.8% met criteria for a mood or anxiety disorder. The presence of a mood or anxiety disorder was associated with a higher EDSS score (β coefficient = 0.28, p = 0.0002, adjusted for disease duration and course, age, sex, socioeconomic status, physical comorbidity count, and disease-modifying therapy exposure). Findings were statistically significant among women (β coefficient = 0.31, p = 0.0004), but not men (β coefficient 0.22, p = 0.17).ConclusionPresence of psychiatric comorbidities, which were common in our incident MS cohort, increased the severity of subsequent neurologic disability. Optimizing management of psychiatric comorbidities should be explored as a means of potentially mitigating disability progression in MS.

Factors associated with referral to medical oncology (MO) and subsequent use of adjuvant chemotherapy (ACT) among patients with resected non-small cell lung cancer (NSCLC): A population-based study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1583-1583
Author(s):  
Janarthanan Kankesan ◽  
Frances A. Shepherd ◽  
Yingwei Peng ◽  
Gail Elizabeth Darling ◽  
Gavin Li ◽  
...  
Keyword(s):  
Geographic Variation ◽  
Population Based ◽  
Stage I ◽  
Stage Ii ◽  
Multivariate Logistic Regression Model ◽  
Factors Associated ◽  
Resected Nsclc ◽  
Ontario Cancer Registry ◽  
Co Morbidity ◽  
Incident Cases

1583 Background: ACT for NSCLC is associated with improved survival in the general population but may be underutilized. Underutilization may relate to lack of referral from surgeon to MO, MO not offering ACT, or patient declining ACT. Here we explore factors associated with referral to MO and use of ACT among patients with resected NSCLC in Ontario Canada. Methods: The Ontario Cancer Registry was used to identify all incident cases of NSCLC diagnosed in Ontario 2004-2006. We linked electronic records of treatment to identify surgery, ACT, and MO consultation. Co-morbidity was classified using the Charlson Comorbidity Index modified for administrative data. A multivariate logistic regression model was used to evaluate factors associated with referral to MO and use of ACT. Results: 3354 cases of NSCLC were resected in Ontario 2004-2006, 1830 (55%) were seen post-operatively by MO and 1032 (31%) were treated with ACT. Cases younger than 70 were more likely to have MO consultation (age 60-69 OR 1.6; 50-59 OR 2.3; 20-49 OR 2.2, p<0.001) as were cases with stage II/III (ORs 2.7 and 2.0, p<0.01) compared to stage I disease. There was substantial geographic variation in the proportion of surgical cases referred to MO (range 32-88%, p<0.001). Among cases seen by MO, patients younger than 70 were more likely to have ACT (age 60-69 OR 3.1; 50-59 OR 4.7; 20-49 OR 6.7, p<0.001) as were cases with stage II/III (ORs 2.7 and 3.0, p<0.001) compared to stage I disease. Less co-morbidity (OR 2.1, p=0.02) and shorter post-operative stay (OR 1.4, p=0.001) were also associated with use of ACT. Among cases seen by MO, there was some geographic variation (range 46-63%, p<0.001) in rates of ACT utilization. Conclusions: The upstream decision to refer to MO is associated with age and stage of disease and these factors have an even greater effect on ACT utilization once patients are seen by MO. While co-morbidity and post-operative length of stay are not associated with referral to MO, they are associated with use of ACT among cases seen by MO. There is substantial geographic variation in referral patterns to MO and less variation in ACT utilization once patients are seen by MO.

Incidence of diabetes among patients with colorectal cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 393-393
Author(s):  
Simron Singh ◽  
Paula Rochon ◽  
Geoffrey Anderson ◽  
Craig Earle ◽  
Hadas Fischer ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Multivariable Analysis ◽  
Population Based ◽  
Administrative Databases ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Ontario Cancer Registry ◽  
Few Data

393 Background: Emerging data show an increasingly recognized risk of colorectal cancer (CRC) in patients with type 2 diabetes (DM) likely due to common biologic pathways. Few data are available on DM incidence among patients with CRC. Our objective was to determine whether patients with CRC have a higher incidence of DM compared to those without CRC. Methods: We conducted a population-based retrospective cohort study in Ontario, Canada, using administrative databases comparing the incidence of DM among all CRC patients identified in the Ontario Cancer registry from Jan 1, 2002 to Dec 31, 2011 with an age-matched control population without CRC. We used Cox proportional hazard to study the association. We modeled the effect of CRC on the cause-specific hazard of developing DM and censored subjects at the time of a competing event. Subgroup analysis was performed on patients receiving chemotherapy vs. not, metastatic disease vs. not and colon vs. rectal cancer. Results: We identified 39,707 persons with CRC and 198,535 controls. The mean age was 68 and 48.6% were female. We found an overall DM incidence of 8.7% over a mean follow up time of 4.8 years. On multivariable analysis, the effect of CRC on the instantaneous hazard of the DM incidence varied over time, and thus we estimated instantaneous hazard ratios (IHR) for years 1-5 of follow up. The risk of DM among CRC patients was significantly higher than controls for at least five years post CRC diagnosis. The overall DM incidence was higher in patients with no metastasis (10.6% vs 8.6%, p<0.01), and lower in patients who received chemotherapy (8.0% vs 9.0%, p<0.01). Conclusions: This is among the first study to report an increased DM incidence among CRC survivors. This association may be due to common risk factors rather than a treatment effect, as the risk remains elevated for at least five years post diagnosis. The hazard may be underestimated, as patients with advanced cancer may not be formally diagnosed with DM. These results strengthen our understanding of the common biologic pathway of both diseases and have major implications for survivorship care in patients with CRC. [Table: see text]

Surgical resection and peri-operative chemotherapy for colorectal cancer (CRC) liver metastases in routine clinical practice: A population-based outcomes study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 3632-3632
Author(s):  
Christopher M. Booth ◽  
Gavin Li ◽  
James Joseph Biagi ◽  
Monika K. Krzyzanowska ◽  
William J. Mackillop ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Surgical Resection ◽  
Case Series ◽  
High Volume ◽  
Population Based ◽  
Routine Practice ◽  
Ontario Cancer Registry ◽  
Incident Cancer ◽  
Number Of Patients ◽  
Incident Cases

3632 Background: Resection of liver metastases combined with peri-operative chemotherapy is an important treatment option for patients with advanced CRC. Most of the literature describes outcomes achieved in highly selected patients treated at a few high volume institutions. Here we report the results of a population-based study of the management and outcome of all patients who underwent resection of CRC liver metastases in Ontario, Canada. Methods: All cases of CRC in Ontario who underwent surgical resection of liver metastases in 1994-2009 were identified using the population-based Ontario Cancer Registry (OCR). The OCR captures diagnostic and demographic information on ~98% of all incident cancer cases in Ontario. We linked electronic records of treatment to the OCR to identify surgery, neoadjuvant (NACT) and adjuvant chemotherapy (ACT). We describe time trends in treatment and survival using 3 study periods: 1994-1999, 2000-2004, 2005-2009. Results: During 1994-2009, 2717 patients underwent resection of CRC liver metastases in Ontario; mean age was 65 years and 61% were male. From 1994-2009 there was a 103% increase in the number of patients undergoing resection of liver metastases (117/year to 237/year) while incident cases of CRC during this time increased by 31% (5285/year to 6956/year). Use of NACT increased over the study period: 94-99, 11% (78/700); 00-04, 15% (124/830); 05-09, 36%; (424/1187), (p<0.001). Use of ACT also increased: 94-99, 38% (263/700); 00-04, 40% (335/830); 05-09, 45% (532/1187), (p=0.006). In 2005-2009 there was substantial variation across geographic regions in use of NACT (range 19% to 46%, p=0.029) and ACT (range 31% to 56%, p=0.015). Five year overall survival during the 3 study periods was 36% (95%CI 32-39%), 40% (95%CI 36-43%), and 47% (95%CI 43-51%) (p<0.001). Conclusions: Resection of CRC liver metastases in routine practice in the general population of Ontario is associated with survival outcomes that are comparable to those reported in case series from leading comprehensive cancer centres. Survival improved over the study period despite a greater proportion of patients with CRC undergoing liver resection.

Sign in / Sign up

Export Citation Format

Share Document