RESUMO
Respiratory system cancer, encompassing lung, trachea and bronchus cancer, constitute a substantial and evolving public health challenge. Since pollution plays a prominent cause in the development of this disease, identifying which substances are most harmful is fundamental for implementing policies aimed at reducing exposure to these substances. We propose an approach based on explainable artificial intelligence (XAI) based on remote sensing data to identify the factors that most influence the prediction of the standard mortality ratio (SMR) for respiratory system cancer in the Italian provinces using environment and socio-economic data. First of all, we identified 10 clusters of provinces through the study of the SMR variogram. Then, a Random Forest regressor is used for learning a compact representation of data. Finally, we used XAI to identify which features were most important in predicting SMR values. Our machine learning analysis shows that NO, income and O3 are the first three relevant features for the mortality of this type of cancer, and provides a guideline on intervention priorities in reducing risk factors.
Assuntos
Poluição do Ar , Inteligência Artificial , Neoplasias do Sistema Respiratório , Humanos , Itália/epidemiologia , Poluição do Ar/efeitos adversos , Neoplasias do Sistema Respiratório/mortalidade , Fatores de Risco , Aprendizado de Máquina , Exposição Ambiental/efeitos adversosRESUMO
Chronic obstructive pulmonary disease (COPD) and tracheal, bronchus, and lung (TBL) cancers are among the leading causes of mortality worldwide. Many environmental factors have been linked to COPD and TBL cancers. This study examined the associations of cumulative environmental quality indices with COPD mortality and TBL cancers mortality, respectively. Environmental Quality Index (EQI) was constructed to represent cumulative environmental quality for the overall environment and 5 major environmental domains (e.g., air, water, built). Associations of each EQI indices with COPD mortality and TBL cancers mortality, across 3109 counties in the 48 contiguous states of the US, were examined using simultaneous autoregressive (SAR) models. Stratified analyses were conducted in females versus males and according to rural-urban continuum codes (RUCC) to assess the heterogeneity across the overall population. Overall poor environmental quality was associated with a percent difference (PD) of 0.75 [95% confidence intervals (95% CI), 0.46, 1.05] in COPD mortality and an PD of 1.22 (95% CI, 0.97, 1.46) in TBL cancers mortality. PDs were higher in females than in males for both COPD and TBL cancers. The built domain had the largest effect on COPD mortality (PD, 0.85; 95% CI, 0.58, 1.12) while the air domain had the largest effect on TBL cancers mortality (PD, 1.54; 95% CI, 1.31, 1.76). The EQI-mortality associations varied among different RUCCs, but no consistent trend was found. This result suggests that poor environmental quality, particularly poor air quality and built environment quality may increase the mortality risk for COPD and that for TBL cancers. Females appear to be more susceptible to the effect of cumulative environmental quality. Our findings highlight the importance of improving overall and domain-specific cumulative environmental quality in reducing COPD and TBL cancer mortalities in the United States.
Assuntos
Poluição do Ar/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/mortalidade , Neoplasias do Sistema Respiratório/mortalidade , Neoplasias Brônquicas/mortalidade , Humanos , Neoplasias Pulmonares/mortalidade , Fatores Socioeconômicos , Neoplasias da Traqueia/mortalidade , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Malignant central airway obstruction (CAO) occurs in approximately 20-30% of patients with lung cancer and is associated with debilitating symptoms and poor prognosis. Multimodality therapeutic bronchoscopy can relieve malignant CAO, though carries risk. Evidence to guide clinicians regarding which patients may benefit from such interventions is sparse. We aimed to assess the clinical and radiographic predictors associated with therapeutic bronchoscopy success in relieving malignant CAO. METHODS: We reviewed all cases of therapeutic bronchoscopy performed for malignant CAO at our institution from January 2010-February 2017. Therapeutic bronchoscopy success was defined as establishing airway patency of > 50%. Patient demographics and baseline characteristics, oncology history, degree of airway obstruction, procedural interventions, and complications were compared between successful and unsuccessful groups. Univariate and multivariate logistic regression identified the significant clinical and radiographic predictors for therapeutic success. The corresponding simple and conditional odds ratio were calculated. A time-to-event analysis with Kaplan-Meier plots was performed to estimate overall survival. RESULTS: During the study period, 301 therapeutic bronchoscopies were performed; 44 (14.6%) were considered unsuccessful. Factors associated with success included never vs current smoking status (OR 5.36, 95% CI:1.45-19.74, p = 0.010), patent distal airway on CT imaging (OR 15.11, 95% CI:2.98-45.83, p < 0.0001) and patent distal airway visualized during bronchoscopy (OR 10.77, 95% CI:3.63-31.95, p < 0.001) in univariate analysis. Along with patent distal airway on CT imaging, increased time from radiographic finding to therapeutic bronchoscopy was associated with lower odds of success in multivariate analysis (OR 0.96, 95% CI:0.92-1.00, p = 0.048). Median survival was longer in the successful group (10.2 months, 95% CI:4.8-20.2) compared to the unsuccessful group (6.1 months, 95% CI:2.1-10.8, log rank p = 0.015). CONCLUSIONS: Predictors associated with successful therapeutic bronchoscopy for malignant CAO include distal patent airway visualized on CT scan and during bronchoscopy. Odds of success are higher in non-smokers, and with decreased time from radiographic finding of CAO to intervention.
Assuntos
Obstrução das Vias Respiratórias/cirurgia , Broncoscopia , Qualidade de Vida , Neoplasias do Sistema Respiratório/cirurgia , Idoso , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/mortalidade , Dispneia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias do Sistema Respiratório/complicações , Neoplasias do Sistema Respiratório/mortalidade , Estudos Retrospectivos , Análise de Sobrevida , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
OBJECTIVES: To assess the rate of second (or more) primaries after treatment for head and neck squamous cell carcinoma (HNSCC), and survival compared to patients with a single head and neck cancer. MATERIAL AND METHOD: A single-center retrospective study was performed in a University Hospital Center in 541 patients between 2002 and 2010. RESULTS: One hundred and forty-one patients (26.06%) presented 172 metachronous cancers. Overall 5-year survival was 20.3% with and 38.1% without metachronous cancer. Median and mean survival were respectively 21.9 and 51 months in patients with a single cancer, versus 13.9 and 26.5 months in case of metachronous cancer. Specific survival was comparable to overall survival. All-cause and specific survival were significantly poorer in metachronous cancer (P=0.001; log-rank α=0.05). CONCLUSION: At least a quarter of HNSCC patients go on to develop a metachronous second primary. These are of poor prognosis, whatever their location.
Assuntos
Carcinoma de Células Escamosas/mortalidade , Neoplasias de Cabeça e Pescoço/mortalidade , Segunda Neoplasia Primária/mortalidade , Carcinoma de Células Escamosas/patologia , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Feminino , França/epidemiologia , Neoplasias de Cabeça e Pescoço/patologia , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/patologia , Prevalência , Neoplasias do Sistema Respiratório/mortalidade , Neoplasias do Sistema Respiratório/patologia , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologiaRESUMO
The risk of second malignant neoplasms (SMN) in chronic myeloid leukemia (CML) survivors remains unclear. We utilized the Surveillance, Epidemiology and End Results 18 (SEER 18) registries to evaluate the risk and subsequent outcomes of SMN in CML survivors. There were 3407 patients included. Of these, 170 (4.99%) developed a SMN with SIR of 1.40 (95% C.I. 1.19-1.62). An increased risk was noted for cancers of the respiratory tract, genitourinary (GU) tract and skin excluding basal cell and squamous cell carcinoma. Using 3:1 matching (3 de novo malignancies to 1 post-CML SMN case), we compared survival data for cancers of the respiratory, GU and gastrointestinal (GI) tract. Patients with GU malignancies developing after CML had worse overall survival than patients without prior CML diagnosis (P = 0.018). There was no difference in survival between post-CML and non-post-CML patients with respiratory or GI malignancies.
Assuntos
Leucemia Mielogênica Crônica BCR-ABL Positiva/mortalidade , Segunda Neoplasia Primária/mortalidade , Neoplasias do Sistema Respiratório/mortalidade , Neoplasias Cutâneas/mortalidade , Neoplasias Urogenitais/mortalidade , Adulto , Idoso , Feminino , Humanos , Incidência , Leucemia Mielogênica Crônica BCR-ABL Positiva/diagnóstico , Leucemia Mielogênica Crônica BCR-ABL Positiva/patologia , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/diagnóstico , Neoplasias do Sistema Respiratório/diagnóstico , Neoplasias do Sistema Respiratório/secundário , Fatores de Risco , Programa de SEER , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/secundário , Análise de Sobrevida , Sobreviventes , Estados Unidos/epidemiologia , Neoplasias Urogenitais/diagnóstico , Neoplasias Urogenitais/secundárioRESUMO
BACKGROUND: In 2014, the European Environment Agency estimated 59 630 premature deaths in Italy attributable to long-term exposure to PM2.5, 17 290 to NO2 and 2900 to O3. The aim of this study was to test an approach for assessing health impact of the above pollutants analyzing possible associations between annual municipal concentrations, estimated by the national dispersion model developed by ENEA, and mortality rates for trachea, bronchus and lung (TBL) cancer, total respiratory diseases (RD) and chronic obstructive pulmonary diseases (COPD). Tuscany was selected as test case. METHODS: For the 287 municipalities, 2009-13 standardized mortality rates (SMRates) for each cause of death were calculated by the ENEA epidemiological database. The SMRates of municipalities, aggregated on the basis of the 2003 or 2010 estimated pollutant concentration tertiles, were also computed. RESULTS: TBL cancer SMRate in municipalities with 2003 PM2.5 levels >15.2 µg/m3 was significantly higher than the SMRates of the two lowest tertiles and COPD SMRates in the two highest O3 tertiles were significantly higher than that of the lower tertile. No association between PM2.5 or NO2 concentrations and RD and COPD was detected. Approximately 625 TBL cancer deaths attributable to PM2.5 levels above 10 µg/m3 in 2003 were estimated in the region. Smoking habits and deprivation index were homogeneously distributed among municipalities. CONCLUSION: This methodological approach allowed detecting associations between mortality and specific air pollutants even at levels below the Italian normative limits and could be employed to evaluate the potential health impact of air pollution in areas where direct measures of concentration are unavailable.
Assuntos
Poluição do Ar/efeitos adversos , Mortalidade , Dióxido de Nitrogênio/toxicidade , Ozônio/toxicidade , Material Particulado/toxicidade , Adulto , Poluição do Ar/estatística & dados numéricos , Humanos , Itália/epidemiologia , Dióxido de Nitrogênio/análise , Ozônio/análise , Material Particulado/análise , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doenças Respiratórias/mortalidade , Neoplasias do Sistema Respiratório/mortalidadeRESUMO
BACKGROUND: While therapeutic bronchoscopy has been used to treat malignant central (CAO) airway obstruction for >25 years, there are no studies quantifying the impact of therapeutic bronchoscopy on long-term quality-adjusted survival. METHODS: We conducted a prospective observational study of consecutive patients undergoing therapeutic bronchoscopy for CAO. Patients had follow-up at 1 week and monthly thereafter until death. Outcomes included technical success (ie, relief of anatomic obstruction), dyspnoea, health-related quality of life (HRQOL) and quality-adjusted survival. RESULTS: Therapeutic bronchoscopy was performed on 102 patients with malignant CAO. Partial or complete technical success was achieved in 90% of patients. At 7 days postbronchoscopy, dyspnoea improved (mean ∆Borg-day-7=-1.8, 95% CI -2.2 to -1.3, p<0.0001) and HRQOL improved (median prebronchoscopy 0.618 utiles, 25%-75% IQR 0.569 to 0.699, mean ∆utility-day-7+0.047 utiles, 95% CI +0.023 to 0.071, p=0.0002). Improvements in dyspnoea and HRQOL were maintained long-term. Compared with the prebronchoscopy baseline, HRQOL per day of life postbronchoscopy improved (mean ∆utility-long-term+0.036 utiles, 95% CI +0.014 to 0.057, p=0.002). Median quality-adjusted survival was 109 quality-adjusted life-days (QALDs) (95% CI 74 to 201 QALDs). Factors associated with longer quality-adjusted survival included better functional status, treatment-naïve tumour, endobronchial disease, less dyspnoea, shorter time from diagnosis to bronchoscopy, absence of cardiac disease, bronchoscopic dilation and receiving chemotherapy. CONCLUSIONS: Therapeutic bronchoscopy improves HRQOL as compared with baseline, resulting in approximately a 5.8% improvement in HRQOL per day of life. The risk-benefit profile in these carefully selected patients was very favourable. TRIAL REGISTRATION NUMBER: Results; NCT03326570.
Assuntos
Obstrução das Vias Respiratórias/cirurgia , Broncoscopia/métodos , Qualidade de Vida , Neoplasias do Sistema Respiratório/cirurgia , Idoso , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/mortalidade , Dispneia/etiologia , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Neoplasias do Sistema Respiratório/complicações , Neoplasias do Sistema Respiratório/mortalidade , Análise de Sobrevida , Resultado do TratamentoRESUMO
OBJECTIVES: to estimate the health impact of asbestos fibres naturally occurring in Mount Pollino area (Basilicata Region, Southern Italy). DESIGN: geographic mortality, hospitalization, and incidence study. Setting and participant s: population resident in 12 Municipalities of Mount Pollino area with naturally occurring asbestos fibres. MAIN OUTCOME MEASURES: standardized mortality ratio (SMR) and standardized hospitalization rate (SHR) for asbestos-related diseases; standardized incidence ratio (SIR) for mesotheliomas. Result s: in the area of Mount Pollino, where asbestos fibres naturally occur, especially in the sub-area in which fibres are close to dwellings and settlements, it was observed: ⢠a significant excess of mesothelioma incidence (SIR: 208; CI95% 111-355; 13 observed); ⢠a non-significant excess of hospitalization for malignant pleural neoplasms (SHR: 176; CI95% 93-335; 9 observed); ⢠a significant excess for mortality and hospitalization for pneumoconiosis (SMR: 534; CI95% 345-824; 20 observed - SHR: 245; CI95% 149-405; 15 observed); ⢠a significant excess for hospitalization (SHR: 852; CI95% 290-2,506; 3 observed) for asbestosis. CONCLUSION: it is necessary to continue environmental monitoring and environmental remediation in the area with higher asbestos exposure. It is suggested to implement a permanent process of epidemiological surveillance in this same area. A communication plan with local administrators, general practitioners, school teachers, media, and the resident population at large should be realized.
Assuntos
Amianto/toxicidade , Asbestose/etiologia , Poluentes Ambientais/toxicidade , Idoso , Idoso de 80 Anos ou mais , Asbestose/mortalidade , Exposição Ambiental , Monitoramento Ambiental , Feminino , Geografia Médica , Fenômenos Geológicos , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Itália , Masculino , Mesotelioma/etiologia , Mesotelioma/mortalidade , Fibras Minerais/toxicidade , Neoplasias Ovarianas/mortalidade , Vigilância da População , Neoplasias do Sistema Respiratório/etiologia , Neoplasias do Sistema Respiratório/mortalidadeRESUMO
BACKGROUND: Granular cell tumors (GCTs) are rare lesions occurring almost anywhere in the body. Multiple case reports have been published. However, there are very few large-scale studies regarding GCT. The aim of this study was to define characteristics, treatment patterns and outcomes of patients with GCT. METHODS: An institutional review board-approved retrospective chart review was performed. Descriptive statistics, chi-square analyses, and Kaplan-Meier survival estimates were produced. RESULTS: Fifty patients were treated for GCT at our institution between 1992 and 2015. The median age was 47 y; 62% of patients were female and 64% were whites. Median tumor size was 0.8 cm. Four percent of patients had malignant tumors, 10.0% had atypical tumors, and 86.0% had benign tumors. The most frequent location of tumors was the gastrointestinal tract (n = 30; 60%), followed by skin/subcutaneous tissues (n = 19; 38%), then respiratory tract (n = 1; 2%). Most patients underwent surgical excision or endoscopic removal of their tumors without prior biopsy. Three patients (6%) had multifocal tumors; they were more likely to experience recurrence than patients with unifocal tumors (33.3% versus 10.6%, respectively; P = 0.05). Six patients (12.0%) experienced recurrence, with a median time to recurrence of 13.5 mo. Overall cancer-specific 5-y survival was 98.0%. Overall recurrence-free 5-y survival was 86.4%. Patients with atypical tumors had a lower recurrence-free 5-y survival rate than those with benign tumors (75.0% versus 89.7%, respectively; P = 0.04). CONCLUSIONS: Patients with GCT fair well, particularly when tumors are benign. Patients with multifocal tumors are more likely to experience recurrence and should be closely monitored.
Assuntos
Institutos de Câncer/estatística & dados numéricos , Neoplasias Gastrointestinais/cirurgia , Tumor de Células Granulares/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Neoplasias do Sistema Respiratório/cirurgia , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Biópsia , Endoscopia/métodos , Endoscopia/estatística & dados numéricos , Feminino , Neoplasias Gastrointestinais/mortalidade , Neoplasias Gastrointestinais/patologia , Tumor de Células Granulares/mortalidade , Tumor de Células Granulares/patologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Neoplasias do Sistema Respiratório/mortalidade , Neoplasias do Sistema Respiratório/patologia , Estudos Retrospectivos , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/patologia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Objective: To study the clinical characteristics, strategy of treatment and prognosis of multiple primary cancers(MPC) diagnosed of digestive system malignant tumor firstly. Methods: From January, 2000 to December, 2015, the clinical, follow-up and prognostic data of 138 MPC patients diagnosed of digestive system malignant tumor firstly were retrospectively analyzed. Results: 138 cases were found in 10 580 cases with malignant tumors, and the incidence was 1.30%. There were 129 cases of duplex primary cancers, 8 cases of triple primary cancers and 1 case of quintuple primary cancers. The repetitive primary cancer was occurred in digestive system (61cases, 44.2%) most frequently, with the next in respiratory system (46 cases, 33.3%). 52.2% (72 cases) suffered second primary cancer in 2 years after first primary cancer diagnosed, and 75.4% (104 cases) in 5 years. The median overall survival in patients with all cancer lesions radically treated was 168 months, better than any other treatment (68 months, P<0.05). Conclusions: The second primary cancers of MPC cases initially diagnosed of digestive system malignant tumor most frequently occurred in the digestive system and respiratory system. More concern should be attracted in follow-up, especially in the first 5 years. The key to improve patient' prognosis was radical treatment to every primary cancer.
Assuntos
Neoplasias Gastrointestinais/epidemiologia , Neoplasias Primárias Múltiplas/epidemiologia , Neoplasias do Sistema Respiratório/epidemiologia , Sistema Digestório , Neoplasias Gastrointestinais/mortalidade , Neoplasias Gastrointestinais/terapia , Humanos , Incidência , Neoplasias Primárias Múltiplas/mortalidade , Neoplasias Primárias Múltiplas/terapia , Segunda Neoplasia Primária/epidemiologia , Prognóstico , Neoplasias do Sistema Respiratório/mortalidade , Neoplasias do Sistema Respiratório/terapia , Estudos Retrospectivos , Fatores de RiscoRESUMO
In a previous analysis of a cohort of shipyard workers, we found excess mortality from all causes, lung cancer, and mesothelioma for longer work durations and in specific occupations. Here, we expand the previous analyses by evaluating mortality associated with 5 chemical exposures: asbestos, solvents, lead, oils/greases, and wood dust. Data were gathered retrospectively for 4,702 workers employed at the Coast Guard Shipyard, Baltimore, MD (1950-1964). The cohort was traced through 2001 for vital status. Associations between mortality and these 5 exposures were calculated via standardized mortality ratios (SMRs). We found all 5 substances to be independently associated with mortality from mesothelioma, cancer of the respiratory system, and lung cancer. Findings from efforts to evaluate solvents, lead, oils/greases, and wood dust in isolation of asbestos suggested that the excesses from these other exposures may be due to residual confounding from asbestos exposure.
Assuntos
Indústria da Construção/estatística & dados numéricos , Poluentes Ambientais/toxicidade , Neoplasias Pulmonares/mortalidade , Mesotelioma/mortalidade , Doenças Profissionais/mortalidade , Exposição Ocupacional , Neoplasias do Sistema Respiratório/mortalidade , Navios , Adulto , Baltimore/epidemiologia , Estudos de Coortes , Feminino , Humanos , Neoplasias Pulmonares/induzido quimicamente , Neoplasias Pulmonares/epidemiologia , Masculino , Mesotelioma/induzido quimicamente , Mesotelioma/epidemiologia , Mesotelioma Maligno , Pessoa de Meia-Idade , Doenças Profissionais/induzido quimicamente , Doenças Profissionais/epidemiologia , Neoplasias do Sistema Respiratório/induzido quimicamente , Neoplasias do Sistema Respiratório/epidemiologia , Estudos Retrospectivos , Adulto JovemRESUMO
Falconara Marittima (Marche Region, Central Italy) is declared to be an area at high risk of environmental crisis, due to the presence of a refinery plant. In 2004, Marche Region funded an epidemiological survey to assess atmospheric risks linked to the refinery. This survey was conducted by the Italian National Cancer Institute of Milan, and citizens actively contributed. An excess for leukaemias and an increase in non-Hodgkin lymphomas were showed. These results were confirmed also by the Regional Environmental Protection Agency and the Regional Health Authority. But Marche Region and the Municipalities chose to not report the situation: the same Institutions, which at the beginning sided the citizens, became an opponent for health protection.
Assuntos
Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Órgãos Governamentais/legislação & jurisprudência , Resíduos Industriais/efeitos adversos , Leucemia/mortalidade , Linfoma não Hodgkin/mortalidade , Instalações Industriais e de Manufatura/legislação & jurisprudência , Indústria de Petróleo e Gás/legislação & jurisprudência , Neoplasias do Sistema Respiratório/mortalidade , Revelação da Verdade , Poluição do Ar/legislação & jurisprudência , Benzeno/toxicidade , Estudos de Casos e Controles , Participação da Comunidade , Humanos , Itália , Leucemia/induzido quimicamente , Linfoma não Hodgkin/induzido quimicamente , Imperícia , Sistema de Registros , Neoplasias do Sistema Respiratório/induzido quimicamenteRESUMO
BACKGROUND: Prognostic significance of adiposity, at the time of cancer diagnosis, on survival is not clear. Body mass index (kg m-2) does not provide an appropriate assessment of body composition; therefore, the concept of the 'obesity paradox' needs to be investigated based on the prognostic significance of fat and muscle. Independent prognostic significance of adipose tissue in predicting mortality, importance of visceral and subcutaneous adiposity in the presence and absence of sarcopenia on survival, was investigated. METHODS: Adiposity markers including total adipose index (TATI), visceral adipose tissue index (VATI) and subcutaneous adipose tissue index (SATI) were estimated for 1473 gastrointestinal and respiratory cancer patients and 273 metastatic renal cell carcinoma patients using computed tomography. Univariate and multivariate analysis to determine mortality hazard ratios (HR) were conducted using cox proportional hazard models. RESULTS: Low SATI (SATI <50.0 cm2 m-2 in males and <42.0 cm2 m-2 in females) independently associated with increased mortality (HR: 1.26; 95% CI: 1.11-1.43; P<0.001) and shorter survival (13.1 months; 95% CI, 11.4-14.7) compared to patients with high SATI (19.3 months; 95% CI, 17.6-21.0; P<0.001). In the presence of sarcopenia, the longest survival was observed in patients with high subcutaneous adiposity. CONCLUSIONS: Subcutaneous adipose tissues appear to associate with reduction in mortality risk demonstrating the prognostic importance of fat distribution. The effect of sarcopenia on survival was more pronounced in patients with low subcutaneous adiposity.
Assuntos
Gordura Intra-Abdominal/diagnóstico por imagem , Neoplasias/mortalidade , Obesidade Abdominal/epidemiologia , Sarcopenia/epidemiologia , Gordura Subcutânea/diagnóstico por imagem , Adiposidade , Idoso , Alberta/epidemiologia , Carcinoma de Células Renais/mortalidade , Feminino , Neoplasias Gastrointestinais/mortalidade , Humanos , Neoplasias Renais/mortalidade , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Obesidade Abdominal/diagnóstico por imagem , Prognóstico , Modelos de Riscos Proporcionais , Fatores de Proteção , Neoplasias do Sistema Respiratório/mortalidade , Fatores de Risco , Sarcopenia/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: The aim of this study was to examine mortality causes and cancer incidence in a population cohort that have resided in close proximity to highly metal-contaminated sources, characterized by contamination of, in particular, arsenic (As), cadmium (Cd), and lead (Pb). METHODS: Data from Swedish registers were used to calculate standardized mortality and cancer incidence ratios. An attempt to relate cancer incidence to metal contamination levels was made. RESULTS: Significantly elevated cancer incidences were observed for overall malignant cancers in both genders, cancer in the digestive system, including colon, rectum, and pancreas, and cancers in prostate among men. Dose-response relationships between Cd and Pb levels in soil and cancer risks were found. CONCLUSIONS: Cancer observations made, together with previous studies of metal uptake in local vegetables, may imply that exposure to local residents have occurred primarily via oral intake of locally produced foodstuffs.
Assuntos
Neoplasias do Sistema Digestório/epidemiologia , Exposição Ambiental/efeitos adversos , Metais Pesados/toxicidade , Neoplasias da Próstata/epidemiologia , Neoplasias do Sistema Respiratório/mortalidade , Doenças Cardiovasculares/mortalidade , Causas de Morte , Neoplasias do Sistema Digestório/induzido quimicamente , Neoplasias do Sistema Digestório/mortalidade , Exposição Ambiental/análise , Feminino , Vidro , Humanos , Incidência , Masculino , Instalações Industriais e de Manufatura , Neoplasias da Próstata/induzido quimicamente , Sistema de Registros , Doenças Respiratórias/mortalidade , Fatores Sexuais , Solo/química , Suécia/epidemiologiaRESUMO
The Life Span Study (LSS) of Japanese atomic bomb survivors is comprised of a large, population-based cohort offering one of the best opportunities to study the relationship between exposure to radiation and incidence of respiratory cancers. Risks of lung, laryngeal and other cancers of the respiratory system were evaluated among 105,444 LSS subjects followed from 1958 to 2009. During this period, we identified 2,446 lung, 180 laryngeal and 115 other respiratory (trachea, mediastinum and other ill-defined sites) first primary incident cancer cases. Ten additional years of follow-up, improved radiation dose estimates, revised smoking data, and updated migration information were used to investigate the joint effects of radiation and smoking using Poisson regression methods. For nonsmokers, the sex-averaged excess relative risk per Gy (ERR/Gy) for lung cancer (at age 70 after radiation exposure at age 30) was estimated as 0.81 (95% CI: 0.51, 1.18) with a female-to-male ratio of 2.83. There was no evidence of curvature in the radiation dose-response relationship overall or by sex. Lung cancer risks increased with pack-years of smoking and decreased with time since quitting smoking at any level of radiation exposure. Similar to the previously reported study, which followed cohort members through 1999, the ERR/Gy for lung cancer was significantly higher for low-to-moderate smokers than for heavy smokers, with little evidence of any radiation-associated excess risk in heavy smokers. Of 2,446 lung cancer cases, 113 (5%) could be attributed to radiation exposure. Of the 1,165 lung cancer cases occurring among smokers, 886 (76%) could be attributed to smoking. While there was little evidence of a radiation effect for laryngeal cancer, a nonsignificantly elevated risk of other respiratory cancers was observed. However, significant smoking effects were observed for both laryngeal (ERR per 50 pack-years = 23.57; 95% CI: 8.44, 71.05) and other respiratory cancers (ERR per 50 pack-years = 1.21; 95% CI: 0.10, 3.25).
Assuntos
Expectativa de Vida/tendências , Neoplasias Induzidas por Radiação/mortalidade , Armas Nucleares/estatística & dados numéricos , Exposição à Radiação/estatística & dados numéricos , Neoplasias do Sistema Respiratório/mortalidade , Sobreviventes/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Distribuição por Sexo , Análise de Sobrevida , Adulto JovemRESUMO
Respiratory cancer mortality and incidence were examined in an updated cohort of >56,000 Canadian nickel mining and refining workers. There was little evidence to suggest increased lung cancer risk in workers who had no experience in high-risk sintering operations that were closed by 1972, apart from that which would be expected from probable increased smoking prevalence relative to the comparison population. There was no substantive evidence of increased laryngeal cancer risk in the cohort, nor was there evidence of increased pharyngeal cancer risk in nonsinter workers. Nasal cancer incidence was elevated in nonsinter workers, but excess risks appeared to be confined to those hired prior to 1960. These findings lead us to tentatively conclude that occupationally-related respiratory risks in workers hired over the past 45 years are either very low or nonexistent.
Assuntos
Metalurgia , Níquel/toxicidade , Exposição Ocupacional , Neoplasias do Sistema Respiratório/epidemiologia , Adolescente , Adulto , Idoso , Estudos de Coortes , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Neoplasias do Sistema Respiratório/induzido quimicamente , Neoplasias do Sistema Respiratório/mortalidade , Estudos Retrospectivos , Adulto JovemRESUMO
AIM: To identify the relationship between HbA1c and cancers in people with or without diabetes. BACKGROUND: Cancer is a major public health problem, accounting for 8.2 million deaths worldwide in 2012. HbA1c level has been associated with the risk of developing certain cancers, although the existing evidence is conflicting. METHODS: EMBASE, MEDLINE, CINAHL and the Cochrane Library were searched. Eligible articles included randomized controlled trials, cohort studies, case-control studies, systematic reviews and meta-analyses. Participants of either sex, with or without Type 1 or 2 diabetes, were included. The studies were assessed using the Scottish Intercollegiate Guidelines Network (SIGN) criteria by two independent assessors. No meta-analysis was performed because of the heterogeneity of results. RESULTS: A total of 19 studies from 1006 met the inclusion criteria, of which 14 were cohort studies and five were nested case-control studies. Eight studies investigated outcomes for all cancer sites. Four of these studies reported that higher HbA1c levels were associated with higher incidence and/or mortality risk for all cancers. One study observed a U-shaped relationship between HbA1c and cancer incidence and mortality. Increasing HbA1c levels were associated with increasing risk of developing colorectal, pancreatic, respiratory and female genital tract cancers. No increased risk was observed for breast cancer, gastrointestinal or urological malignancies. CONCLUSION: HbA1c appears to be associated with cancer incidence and/or cancer mortality, but further studies are needed to fully understand the complex relationship between HbA1c and cancer.
Assuntos
Diabetes Mellitus/epidemiologia , Hemoglobinas Glicadas/metabolismo , Neoplasias/epidemiologia , Estudos de Casos e Controles , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/metabolismo , Neoplasias Colorretais/mortalidade , Diabetes Mellitus/metabolismo , Feminino , Neoplasias dos Genitais Femininos/epidemiologia , Neoplasias dos Genitais Femininos/metabolismo , Neoplasias dos Genitais Femininos/mortalidade , Humanos , Incidência , Masculino , Neoplasias/metabolismo , Neoplasias/mortalidade , Neoplasias Pancreáticas/epidemiologia , Neoplasias Pancreáticas/metabolismo , Neoplasias Pancreáticas/mortalidade , Prognóstico , Neoplasias do Sistema Respiratório/epidemiologia , Neoplasias do Sistema Respiratório/metabolismo , Neoplasias do Sistema Respiratório/mortalidadeRESUMO
BACKGROUND: Cancer of unknown primary origin (CUP) is defined by the presence of pathologically identified metastatic disease without clinical or radiological evidence of a primary tumour. Our objective was to identify incident cases of CUP in Ontario, Canada, and determine the influence of histology and sites of metastases on overall survival (OS). MATERIAL AND METHODS: We used the Ontario Cancer Registry (OCR) and the Same-Day Surgery and Discharge Abstract Database (SDS/DAD) to identify patients diagnosed with CUP in Ontario between 1 January 2000, and 31 December 2005. Patient diagnostic information, including histology and survival data, was obtained from the OCR. We cross-validated CUP diagnosis and obtained additional information about metastasis through data linkage with the SDS/DAD database. OS was assessed using Cox regression models adjusting for histology and sites of metastases. RESULTS: We identified 3564 patients diagnosed with CUP. Patients without histologically confirmed disease (n = 1821) had a one-year OS of 10.9%, whereas patients with confirmed histology (n = 1743) had a one-year OS of 15.6%. The most common metastatic sites were in the respiratory or digestive systems (n = 1603), and the most common histology was adenocarcinoma (n = 939). Three-year survival rates were 3.5%, 5.3%, 41.6% and 3.6% among adenocarcinoma, unspecified carcinoma, squamous cell carcinoma and undifferentiated histology, respectively. Three-year survival rates were 40%, 2.4%, 8.0% and 4.6% among patients with metastases localised to lymph nodes, the respiratory or digestive systems, other specified sites, and unspecified sites, respectively. CONCLUSION: CUP patients in Ontario have a poor prognosis. Some subgroups may have better survival rates, such as patients with metastases localised to lymph nodes and patients with squamous cell histology.
Assuntos
Adenocarcinoma/mortalidade , Carcinoma de Células Escamosas/mortalidade , Neoplasias do Sistema Digestório/mortalidade , Neoplasias Primárias Desconhecidas/mortalidade , Neoplasias do Sistema Respiratório/mortalidade , Adenocarcinoma/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/secundário , Neoplasias do Sistema Digestório/secundário , Feminino , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Desconhecidas/patologia , Ontário/epidemiologia , Modelos de Riscos Proporcionais , Sistema de Registros , Neoplasias do Sistema Respiratório/secundário , Taxa de SobrevidaRESUMO
BACKGROUND: Interventional bronchoscopy is effective in the management of patients with symptomatic airway obstruction for both malignant and benign conditions. The main aim of this study is to report our experience with emergency interventional bronchoscopy in patients with symptomatic airway obstruction and identify prognostic factors for survival. METHODS: This is a retrospective observational study of patients undergoing emergency interventional bronchoscopy over a 4-year period. Survival times were analyzed separately for patients with benign and malignant airway obstruction by the Kaplan-Meier method. RESULTS: Between June 2009 and July 2013, 168 emergency interventional bronchoscopies were performed in 112 patients for airway obstruction. The median age was 63 years (range, 20 to 86), and 91 patients (54%) patients were female. Seventy-two cases (43%) had airway obstruction due to malignant disease. There were 3 in-hospital deaths (2.7%). Median survival of the study population was 5.6 months (range, 0 to 51) with a median follow-up of 7.3 months (range, 0 to 51). Median survival for patients with malignant airway obstruction was 3.5 months (range, 0 to 21), and 9.8 months (range, 0.1 to 51) for those with benign disease. Airway intervention facilitated palliative chemotherapy in 32 patients (44%) of those with malignant airway obstruction. At multivariate analysis in patients with malignant airway obstruction, presence of stridor (hazard ratio 1.919, 95% confidence interval: 1.082 to 3.404, p = 0.026) and not receiving postprocedure chemotherapy (hazard ratio 2.05, 95% confidence interval: 1.156 to 3.636, p = 0.014) were independent prognostic factors for death. CONCLUSIONS: Emergency interventional bronchoscopy for airway obstruction is safe, relieved symptoms, and facilitated palliative chemotherapy, which improved survival.
Assuntos
Obstrução das Vias Respiratórias/cirurgia , Broncopatias/cirurgia , Broncoscopia , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias do Sistema Respiratório/patologia , Estenose Traqueal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/mortalidade , Obstrução das Vias Respiratórias/patologia , Broncopatias/etiologia , Broncopatias/mortalidade , Constrição Patológica/etiologia , Constrição Patológica/mortalidade , Emergências , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Neoplasias do Sistema Respiratório/mortalidade , Neoplasias do Sistema Respiratório/terapia , Estudos Retrospectivos , Taxa de Sobrevida , Estenose Traqueal/etiologia , Estenose Traqueal/mortalidade , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: Determine whether select cause of death mortality disparities in four Appalachian regions is associated with coal mining or other factors. METHODS: We calculated direct age-adjusted mortality rates and associated 95% confidence intervals by sex and study group for each cause of death over 5-year time periods from 1960 to 2009 and compared mean demographic and socioeconomic values between study groups via two-sample t tests. RESULTS: Compared with non-coal-mining areas, we found higher rates of poverty in West Virginia and Virginia (VA) coal counties. All-cause mortality rates for males and females were higher in coal counties across all time periods. Virginia coal counties had statistically significant excesses for many causes of death. CONCLUSIONS: We found elevated mortality and poverty rates in coal-mining compared with non-coal-mining areas of West Virginia and VA. Future research should examine these findings in more detail at the individual level.