RESUMO
BACKGROUND: Guideline recommendations for the treatment of breast cancer with low hormone receptor (HR) expression (1%-9%) are ambiguous and several studies showed more similarities with HR-negative tumors than with HR strongly positive tumors (≥10%). We used a population-based 15-year cohort to compare patient characteristics and outcome of HR low positive tumors with HR-negative and HR strongly positive tumors, respectively. PATIENTS AND METHODS: A total of 38 560 women diagnosed with early invasive breast cancer between 2004 and 2018 within the scope of the Munich Cancer Registry with 4.9 million inhabitants were included. Descriptive analyses of prognostic factors, treatment, and outcome analyses using the Kaplan-Meier method; cumulative incidence in consideration of competing risks; and multivariate analyses (Cox regression and Fine-Gray model) were conducted. Endpoints were time to local recurrence (TTLR), time to lymph node recurrence (TTLNR), time to metastasis (TTM), overall survival (OS), and relative survival (RS). RESULTS: A total of 861 patients (2%) had HR low positive, 4862 (13%) HR-negative, and 32 837 (85%) HR strongly positive tumors. Within the HER2-negative cohort (n = 33 366), survival of HR low positive tumors was significantly worse than that of HR strongly positive tumors [OS hazard ratio 0.66 (95% confidence interval 0.55-0.78)], whereas between HR low positive and HR-negative tumors no significant survival difference could be detected [OS hazard ratio 0.93 (95% confidence interval 0.78-1.11)]. TTLR, TTLNR, and TTM showed similar results. By contrast, within the HER2-positive cohort (n = 5194), no statistically significant differences between the three HR groups could be detected in multivariate analyses. CONCLUSION: Current definitions for HR positivity and its clinical relevance should be reconsidered. Patients with HR low positive/HER2-negative tumors could be regarded and treated similar to patients with triple-negative tumors.
Assuntos
Neoplasias da Mama , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/terapia , Feminino , Hormônios , Humanos , Recidiva Local de Neoplasia , Prognóstico , Receptor ErbB-2 , Receptores de ProgesteronaRESUMO
INTRODUCTION: Neuroendocrine Neoplasms are classified according to the new WHO classification in (1.) well differentiated neuroendocrine tumors G1 (NET G1, Ki67 ≤ 2 or mitosis count <2) and (2.) well differentiated neuroendocrine tumors G2 (NET G2, Ki67 3-20 or mitosis count 2-20) and (3.) poorly differentiated neuroendocrine carcinomas G3 (NEC G3, Ki67 > 20 or mitosis count >20). MATERIAL AND METHODS: In this study 310 NENs of the Ludwig-Maximilians-University in Munich were reevaluated according to the new WHO classification. RESULTS: 7% of the analyzed NENs were presented as neoplasias of the stomach. In NENs of the stomach three distinct subtypes are recognized: (1) type 1 associated with autoimmune chronic atrophic gastritis (2) type 2, associated with multiple endocrine neoplasia (MEN1) and Zollinger-Ellison Syndrom; and (3) type 3, sporadic tumors. DISCUSSION: Precursor lesions (i. e. hyperplasia of the ECL cells) are found in patients with hypergastrinaemia (type 1 and 2). This article should provide insights into the diagnosis of NENs of the stomach with emphasis on the new international standard.
Assuntos
Tumores Neuroendócrinos/classificação , Neoplasias Gástricas/classificação , Doenças Autoimunes/complicações , Doenças Autoimunes/diagnóstico , Diferenciação Celular , Gastrite/complicações , Gastrite/diagnóstico , Humanos , Hiperplasia/patologia , Antígeno Ki-67/genética , Mitose , Neoplasia Endócrina Múltipla Tipo 1/complicações , Neoplasia Endócrina Múltipla Tipo 1/diagnóstico , Organização Mundial da Saúde , Síndrome de Zollinger-Ellison/complicações , Síndrome de Zollinger-Ellison/diagnósticoRESUMO
OBJECTIVE: Function and funding of detailed clinical cancer registries (CCRs) is defined by German Social Code Book V (SGB V) and shall be implemented by the end of 2017. CONTENT: Cancer registration according to regionally defined catchment areas, feedback of results and quality assurance are the basis which determines principles of operation and use of data. Each clinical department delivers only its own findings and therapy, while compilation by the clinical cancer registry describes the patients' way through the regional network of medical care. In this way, oncological centers are not burdened by troublesome documentation of data which originate from other clinics. CONCLUSION: After successful implementation of CCRs, interested physicians and clinics are able to spend time for analysis and use of meaningful data with the objective of improving quality of care within the region, implementing innovative therapies and presenting their results, and generating new hypotheses to stimulate research.
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Neoplasias/epidemiologia , Sistema de Registros , Estudos Transversais , Atenção à Saúde , Alemanha , Humanos , Neoplasias/terapiaRESUMO
This population-based analysis aimed to describe the 12-year trend of primary surgery following the introduction of national guidelines for the management of breast cancer in Germany, thus the implementation of breast-conserving surgery (BCS) for pT1/2-tumours and the implementation of sentinel lymph node biopsy (SLNB). Cancer registry data from 72 742 breast cancer patients diagnosed between 1999 and 2010 in four different regions in Germany were used. Descriptive statistics and multivariate logistic regression analysis were conducted. Between 1999 and 2010, rates of BCS for pT1/2-tumours rose from 60.5% to 79.9%, rates of SLNB increased rapidly from 0.4% to 79.0%. Both surgical therapies were already adherent to the respective guidelines, although some regional differences could be observed: in 1999-2003, the chance of BCS was 2.6-fold higher [odds ratio (OR) 2.6] in the western regions than in the eastern regions, but this difference decreased over time (2004-2007 OR 1.6; 2008-2010 OR 1.2). A similar pattern was observable for SLNB: in 1999-2003, the chance of receiving SLNB was 4.4-fold higher in the western regions, but these rates converged (2004-2007 OR 3.7; 2008-2010 OR 1.5). The further increase of BCS- and SLNB rates after publication of guidelines and the reduction of regional differences may also be attributable to guideline implementation.
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Neoplasias da Mama/cirurgia , Mastectomia/normas , Guias de Prática Clínica como Assunto/normas , Idoso , Idoso de 80 Anos ou mais , Axila/cirurgia , Feminino , Alemanha , Fidelidade a Diretrizes , Humanos , Excisão de Linfonodo/normas , Mastectomia Segmentar/normas , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Biópsia de Linfonodo Sentinela/normasRESUMO
BACKGROUND: Rectal cancer treatment has improved considerably due to the introduction of total meso-rectal excision, radio-chemotherapy, and high-resolution imaging. The aim of this observational cohort study was to quantify the effectiveness of these advances using high-quality data from a representative cohort of patients. METHODS: 20 281 non-metastasized cases retrieved from the Munich Cancer Registry database were divided into three time periods corresponding to before (1988-1997), partial (1998-2007), and full implementation (2008-2019) of clinical advances. Early-onset (<50 yrs.), middle-aged, elderly patient subgroups (> 70 yrs.) were compared. The overall effectiveness of evidence-based guideline adherence was also examined. RESULTS: Median survival improved by 1.5 yrs. from the first to the last time period. Relative survival increased from 74.9% (5-yr 95%CI[73.3 - 76.6]) to 79.2% (95%CI[77.8 - 80.5]). The incidence of locoregional recurrences was reduced dramatically by more than half (5-yr 17.7% (95%CI[16.5 - 18.8]); 6.7% (95%CI[6.1 - 7.3])). Gains in 5-yr relative survival were limited to early-onset and middle-aged patients with no significant improvement seen in elderly patients (Female 68.6% [63.9 - 73.3] to 67.6% [64.0 - 71.2]; Male 71.7% [65.9 - 77.4] to 74.0% [70.8 - 77.2]). CONCLUSIONS: Real-world evidence suggests that recent treatment advances have lead to an increase in prognosis for rectal cancer patients. However, more effort should be made to improve the implementation of new developments in elderly patients. Especially considering, that these cases represent a growing majority of diagnosed patients.
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Neoplasias Retais , Idoso , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Estadiamento de Neoplasias , Prognóstico , Neoplasias Retais/terapia , Neoplasias Retais/patologia , Estudos de Coortes , Incidência , Resultado do TratamentoRESUMO
BACKGROUND: The incidence of melanoma is still increasing in fair-skinned populations. At least 80% of patients have localised disease and expect a 5-year relative survival of >90%. PATIENTS AND METHODS: In 2003-2004, disease-free patients with localised melanoma were recruited from the Munich Cancer Registry to answer quality-of-life (QoL) questionnaires 2 years after treatment. RESULTS: A response rate of 72% was achieved from a total of 1085 distributed questionnaires. Hundred and seventeen questionnaires had to be excluded because of updated information about secondary tumour and progression events. Thus, questionnaires from 664 patients were evaluated. QoL scores in melanoma patients were essentially similar to those of a general population. Differences were detected between women and men concerning emotional and sexual functioning. Age and number of comorbidities were the strongest factors influencing most all aspects of QoL. Fifty percent of patients referred to deficits in communication with their doctors. CONCLUSIONS: Patients who overcome melanoma do not necessarily have a reduced QoL. Strategies used by these melanoma patients resulted in similar levels of coping as previous studies in comparable general populations. Nevertheless, doctor-patient communication was correlated with emotional and social functioning and should be emphasised in treatment and care of melanoma patients.
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Melanoma/psicologia , Melanoma/terapia , Qualidade de Vida , Neoplasias Cutâneas/psicologia , Neoplasias Cutâneas/terapia , Adulto , Idoso , Progressão da Doença , Emoções/fisiologia , Feminino , Humanos , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Invasividade Neoplásica , Comportamento Sexual/fisiologia , Neoplasias Cutâneas/patologia , Inquéritos e Questionários , Carga TumoralRESUMO
For a large territorial state like Bavaria only a decentralised cancer registration structure promises successful results: in the form of regional clinical cancer registries and--using the clinical registration as a base--one population-based registry. After ten years of epidemiological cancer registration in Bavaria it can now be shown that the chosen registration concept has proved itself. Currently the completeness of cancer notifications exceeded the international recommended threshold of 90%. A largely complete data stock is available for the years of diagnosis from 2004 to 2005. The task sharing between clinical and population-based cancer registries avoids double registration of data. Both types of registries are supporting physicians and hospitals with a wide palette of services. Together they enable transparency of cancer occurrence as well as transparency of health care for tumour patients.
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Métodos Epidemiológicos , Neoplasias/epidemiologia , Sistema de Registros/estatística & dados numéricos , Alemanha/epidemiologia , HumanosRESUMO
PURPOSE: The objective was to compare the prognostic factors and outcomes among primary ovarian cancer (OC), fallopian tube cancer (FC), and peritoneal cancer (PC) patients in a population-based setting. METHODS: We analysed 5399 OC, 327 FC, and 416 PC patients diagnosed between 1998 and 2014 in the catchment area of the Munich Cancer Registry (meanwhile 4.8 million inhabitants). Tumour site differences were examined by comparing prognostic factors, treatments, the time to progression, and survival. The effect of the tumour site was additionally analysed by a Cox regression model. RESULTS: The median age at diagnosis, histology, and FIGO stage significantly differed among the tumour sites (p < 0.001); PC patients were older, more often diagnosed with a serous subtype, and in FIGO stage III or IV. The time to progression and survival significantly differed among the tumour sites. When stratified by FIGO stage, the differences in time to progression disappeared, and the differences in survival considerably weakened. The differences in the multivariate survival analysis showed an almost identical outcome in PC patients (HR 1.07 [0.91-1.25]) and an improved survival of FC patients (HR 0.63 [0.49-0.81]) compared to that of OC patients. CONCLUSION: The comparison of OC, FC, and PC patients in this large-scale population-based study showed differences in the prognostic factors. These differences primarily account for the inferior outcome of PC patients, and for the improved survival of FC compared to OC patients.
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Neoplasias das Tubas Uterinas/mortalidade , Neoplasias Ovarianas/mortalidade , Neoplasias Peritoneais/mortalidade , Resultado do Tratamento , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias das Tubas Uterinas/patologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Neoplasias Peritoneais/patologia , Prognóstico , Modelos de Riscos ProporcionaisRESUMO
The European Treatment and Outcome Study (EUTOS) population-based registry includes data of all adult patients newly diagnosed with Philadelphia chromosome-positive and/or BCR-ABL1+ chronic myeloid leukemia (CML) in 20 predefined countries and regions of Europe. Registration time ranged from 12 to 60 months between January 2008 and December 2013. Median age was 55 years and median observation time was 29 months. Eighty percent of patients were treated first line with imatinib, and 17% with a second-generation tyrosine kinase inhibitor, mostly according to European LeukemiaNet recommendations. After 12 months, complete cytogenetic remission (CCyR) and major molecular response (MMR) were achieved in 57% and 41% of patients, respectively. Patients with high EUTOS risk scores achieved CCyR and MMR significantly later than patients with low EUTOS risk. Probabilities of overall survival (OS) and progression-free survival for all patients at 12, 24 and 30 months was 97%, 94% and 92%, and 95%, 92% and 90%, respectively. The new EUTOS long-term survival score was validated: the OS of patients differed significantly between the three risk groups. The probability of dying in remission was 1% after 24 months. The current management of patients with tyrosine kinase inhibitors resulted in responses and outcomes in the range reported from clinical trials. These data from a large population-based, patient sample provide a solid benchmark for the evaluation of new treatment policies.
Assuntos
Leucemia Mielogênica Crônica BCR-ABL Positiva/epidemiologia , Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Leucemia Mielogênica Crônica BCR-ABL Positiva/diagnóstico , Masculino , Pessoa de Meia-Idade , Vigilância da População , Sistema de Registros , Análise de Sobrevida , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: The objective was to identify trends in surgery and the outcomes of squamous cell vulvar cancer in a population-based setting. METHODS: A total of 1113 patients with squamous cell vulvar cancer diagnosed between 1998 and 2013 in the catchment area of the Munich Cancer Registry (population approximately 4.6 million) were analysed. Trends in prognostic factors and treatment were examined by comparing patients diagnosed between 1998 and 2008 with those diagnosed between 2009 and 2013. Cumulative incidence was used to calculate time to local (LR) and lymph node recurrence (LNR). Survival was analysed by the Kaplan-Meier method, calculation of relative survival (RS), and a Cox model. RESULTS: The high median age at diagnosis of 75 years did not change significantly over time. In addition, no changes in the subsite of tumour or grading were noted. A decrease in patients undergoing complete vulvectomy from 27.7 to 17.8 % (p < 0.001) as well as an increase in the use of sentinel lymph node biopsy from 11.4 to 39.1 % (p < 0.001) was observed. However, time to LR (from 19 to 19 %) and time to LNR (from 9 to 9 %) as well as 5-year overall survival (from 55 to 55 %) and RS (from 66 to 63 %) were not significantly altered. After adjustment for prognostic factors, less radical locoregional surgery had no influence on survival. CONCLUSION: Less radical locoregional surgery in vulvar cancer is increasingly implemented. Locoregional recurrence and survival have not been affected by these changes and are likely accompanied by an improvement in quality of life.
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Carcinoma de Células Escamosas/cirurgia , Neoplasias Vulvares/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Feminino , Alemanha/epidemiologia , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Recidiva , Sistema de Registros , Taxa de Sobrevida , Neoplasias Vulvares/epidemiologia , Neoplasias Vulvares/patologiaRESUMO
There are about 345,000 Germans who have been diagnosed with urological cancer over the last 5 years expecting help from the health services. Even if aftercare is now a substantial part of cancer treatment, its effectiveness has been proven for only a few cancer types. For the subset of urological cancers, evidence for effective diagnostic measures in the framework of aftercare exists only for cancers of the bladder and testis. In this case, the main objective is early detection of local recurrences and providing a curative chance for small cancers. Lack of effectiveness may result from the logic of cancer itself, and is not the consequence of insufficient study designs. Therefore, the main task of aftercare is talking to the patient, to determine individual needs and to recognise treatment consequences. For asymptomatic patients, there is no indication for routine aftercare diagnostics.
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Assistência ao Convalescente/métodos , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/prevenção & controle , Garantia da Qualidade dos Cuidados de Saúde/métodos , Neoplasias Urológicas/diagnóstico , Neoplasias Urológicas/terapia , Alemanha , Humanos , Cuidados Paliativos/métodos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Assistência Terminal/métodosRESUMO
PURPOSE: In clinical routine, adjuvant systemic therapy in small node-negative (N0) BC is controversial, in particular in HER2-positive disease. We aimed to evaluate outcome of consecutive patients with small N0 BC in a population-based cancer registry and thus consequently substantiate indications for chemotherapy in those patient subgroups at increased relapse risk or poor survival. METHODS: From 2002 to 2009 (median follow-up 6 years), 9707 primary breast cancer patients with N0 tumors <2 cm (pTis, pT1N0M0) were reported to the Munich Cancer Registry. Patients with pTis tumors (n = 1870) served as internal comparator. Time to progression, observed (OS) and relative survival rates (Kaplan-Meier estimates) are presented. Cox regression analysis was used to assess the influence of tumor size, age, HR-, and HER2-status. RESULTS: 10-year-OS for pTis was 94.0%. In HR-positive tumors it was 91.9% in pT1a, 90.6% in pT1b, and 86.8% in pT1c. In HR-negative tumors, rates were 91.7%, 86.8%, and 86.8%, respectively. In HER2-positive tumors it was 81.2%, 88.1%, and 86.7%, in HER2-negative 93.1%, 90.6%, and 86.0%, respectively. In the multivariate model, age, tumor size, and HR-status showed a significant impact on OS (HRneg. vs. HRpos.: hazard ratio 1.50 (95% CI; 1.12-1.99), while HER2-status was not an independent prognostic factor. CONCLUSION: Prognosis of N0 tumors <1 cm is excellent, especially if they are HR-positive, even in HER2-positive cases. Weighing potential benefits vs. side-effects, there seems to be no need for chemotherapy in tumors <0.5 cm. In pT1b chemotherapy may be considered, if tumors are triple negative or HER2-positive and HR-negative. In pT1c guideline-based adjuvant therapy using all therapeutic options seems to be warranted.
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Neoplasias da Mama/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/química , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Quimioterapia Adjuvante , Progressão da Doença , Receptores ErbB/sangue , Feminino , Alemanha , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia/química , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Prognóstico , Modelos de Riscos Proporcionais , Receptor ErbB-2 , Receptores de Estrogênio , Receptores de Progesterona , Sistema de Registros , Taxa de SobrevidaRESUMO
This population-based registry was designed to provide robust and updated information on the characteristics and the epidemiology of chronic myeloid leukemia (CML). All cases of newly diagnosed Philadelphia positive, BCR-ABL1+ CML that occurred in a sample of 92.5 million adults living in 20 European countries, were registered over a median period of 39 months. 94.3% of the 2904 CML patients were diagnosed in chronic phase (CP). Median age was 56 years. 55.5% of patients had comorbidities, mainly cardiovascular (41.9%). High-risk patients were 24.7% by Sokal, 10.8% by EURO, and 11.8% by EUTOS risk scores. The raw incidence increased with age from 0.39/100,000/year in people 20-29 years old to 1.52 in those >70 years old, and showed a maximum of 1.39 in Italy and a minimum of 0.69 in Poland (all countries together: 0.99). The proportion of Sokal and Euro score high-risk patients seen in many countries indicates that trial patients were not a positive selection. Thus from a clinical point of view the results of most trials can be generalized to most countries. The incidences observed among European countries did not differ substantially. The estimated number of new CML cases per year in Europe is about 6370.
Assuntos
Leucemia Mielogênica Crônica BCR-ABL Positiva/epidemiologia , Sistema de Registros/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Adulto JovemRESUMO
Although ovarian cancer treatment has advanced in the last 20 years, long-term survival remains stable. The purpose of this study was to determine whether survival has improved in line with treatment advances in a population-based prospective cohort of ovarian cancer patients (1978-1997, with a follow-up through to 2000). The 10-year overall survival rate for cancer patients was similar before and after 1988: 32.2% (n=1661) and 34.4% (n=2089). For patients after 1988, a 12-month prolongation of median survival was observed. In terms of stage according to the International Federation of Gynecology and Obstetrics (FIGO), only FIGO I and FIGO II patients showed, in addition to a prolongation in survival, an absolute improvement of 12.9 and 12.6% after 5 years and of 13.2 and 8.6% after 10 years. This hardly affected the survival of the total sample. For the most frequent stage FIGO III patients and for FIGO IV patients, a prolongation in survival time, but no improvement in survival rate, was seen after five or 10 years. The progress in FIGO I and II patients may be due to more accurate staging. More effective chemotherapy may also explain some of the improvement. The prolongation in FIGO-stages III-IV may be due to more radical surgery. Patient selection criteria, not only the treatment modalities, may be responsible for the superior results reported in clinical trials. Cancer registries are important for evaluating the quality of healthcare delivery.
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Neoplasias Ovarianas/mortalidade , Idoso , Estudos de Coortes , Feminino , Alemanha/epidemiologia , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/terapia , Guias de Prática Clínica como Assunto , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Análise de Regressão , Taxa de SobrevidaRESUMO
"Because they know what they do" should be the contribution of cancer registration to prevention. The public should be informed about the successes and failures of prevention. In addition, each doctor and each hospital should know the long-term results for its patients despite the complex interdisciplinary health care provision. At the same time, the regional results should be available and contrasted with clinical studies and international standards. An important criterion is also the quality of life of the patients, whose cooperation is more than overdue. According to the possibilities of prevention, six important levels can be differentiated. On each level the outcome should be evaluated on the basis of slightly differing criteria. Primary prevention has the largest incidence-, and thus, mortality-reduction potential, essentially caused by the giving up of smoking. However, the primary prevention of the tumor depends upon what kind of tumor it is, as primary prevention is possible to different extents. Often, secondary prevention is the earliest intervention possible, that is, the early detection of cancer in prognostically favorable stages. However, early detection only offers a chance of cure, albeit a smaller one, for some kinds of tumor. The third prevention level comprises primary care according to the state-of-the-art standards, followed by posttreatment care (disease-free phase) even when the disease is running a fatal course (palliative phase). In the terminal phase, adequate tumor-pain therapy and symptom-oriented measures stand for the sixth prevention level. Even the quality of life of the dying can be optimized. At the beginning of treatment at the latest, the quality of life should also be added to the outcome criteria. In this paper, the individual levels of prevention and possible evaluation criteria for successful prevention, which a modern cancer registration should submit, are discussed and examples given. If the evaluation of the quality of treatment and its significance for health care provision becomes the central tasks of the cancer registers, they will need to be transformed into service centers for hospitals, doctors, and patients.
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Neoplasias/prevenção & controle , Sistema de Registros , Assistência ao Convalescente , Neoplasias da Mama/diagnóstico , Feminino , Humanos , Masculino , Programas de Rastreamento , Neoplasias/diagnóstico , Neoplasias/mortalidade , Cuidados Paliativos , Prevenção Primária , Qualidade de Vida , Resultado do TratamentoRESUMO
Evidence-based medicine (ebm) is the answer to the postulate to grade the basis of scientific knowledge in medical care and to protect it against proceedings of unjustifiable arbitrariness. The ranking of controlled clinical trials, the evaluation of publications, meta-analyses, and references to "levels of evidence" in medical guidelines are well established. This is not inconsistent with the fact that many diagnostic and therapeutic measures are not evidence-based and that, even in reputable scientific journals, marketing intentions come into conflict with evidence-based facts. The demand for implementing ebm is furthermore an unsustainable ethical pretension as long as ebm itself is not evidence-based. In many cases better results from ebm are not supported by outcome studies. Health services research which, amongst others, evaluates implementation of study results under everyday conditions should be seen as an essential part of ebm. In oncology, cancer registries contribute to this type of transparency. Cancer registries show to what extent ebm is established as an encouraging future programme for the daily cancer health-care delivery and whether ebm exists as a barely realisable parallel world of promising controlled clinical trials.
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Medicina Baseada em Evidências , Neoplasias/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias da Mama/mortalidade , Neoplasias da Mama/terapia , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/terapia , Terapia Combinada , Feminino , Alemanha , Humanos , Neoplasias/mortalidade , Avaliação de Processos e Resultados em Cuidados de Saúde , Prognóstico , Garantia da Qualidade dos Cuidados de SaúdeRESUMO
PURPOSE: To exclude bias of registration evidenced by relevant differences among German cancer registries in the incidence of malignant melanoma (melanocarcinoma). METHODS: Cancer registries in the Federal German states of Hamburg, Schleswig-Holstein, Bremen, Rhineland-Palatinate, Saarland, the Munich District and the County of Münster featured registration data of malignant melanoma diagnosed in 2000 A. D. Figures and incidence rates, distribution of T-stage of the primary tumour were analysed as well as the distribution of sources reporting melanoma to the registries. Details of outpatient treatment of cutaneous melanoma by dermatologists in private practice were investigated. RESULTS: Data of 2,471 malignant melanoma cases were analysed. The highest age standardised incidence rates were 15.7 per 100,000 women and 19 per 100,000 men while the lowest rates were reported as 7.8 and 6.6 per 100,000, respectively (European standard). The proportion of stage T1 tumours varied between 21.5 and 59.2 %. We observed remarkable variations in the structure of reporting sources among the registries. The proportion of reports from dermatologists in private practice varied between 2.2 and 62 %, with higher proportions associated with more T1-T2 tumours but also lower completeness of stage reports. No clear association was identified between incidence of melanoma and reporting sources. CONCLUSION: Malignant melanomas of smaller size (T1-T2) are reported more frequently in an outpatient setting but very often without data. Hospital departments of dermatology contribute high-quality data with better completeness especially for later stage melanomas. Desirable inclusion of notifications from nationwide operating dermatopathology laboratories is complicated by the Federal German structure of cancer registration. Especially in case of malignant melanoma of the skin notification reports from all sectors of the health care system are imperative for valid epidemiological results.
Assuntos
Melanoma/epidemiologia , Sistema de Registros , Neoplasias Cutâneas/epidemiologia , Estudos de Coortes , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Melanoma/mortalidade , Fatores Sexuais , Neoplasias Cutâneas/mortalidadeRESUMO
Seventy-nine patients with ovarian carcinoma stage I-III postoperatively received a whole abdominal irradiation (median dose: 22.5 Gy) followed by pelvic boost irradiation (median pelvic dose: 45 Gy) as the sole adjuvant therapy. Surgery preceding the irradiation was radical only in 59 percent of the patients. Whole abdominal irradiation was performed either in the moving-strip-technique or the open-field-technique. The median follow-up time was 57 months. The overall and the progression-free five-year survival rate of the whole group is 66 +/- 6% and 63 +/- 6%, respectively. We have not seen a clear-cut dependence of the survival rates on the completeness of the surgery, on tumor histology or grading. In a statistically significant way, the survival rates depend on the stage, the presence of tumor rests, and, above all, on the risk group. The overall five-year survival rate for the intermediate-risk patients is 78 +/- 7% and 22 +/- 11% for high risk patients. There aren't any randomized studies concerning the optimal adjuvant therapy for intermediate-risk patients. Because of the reproduceable results and the infrequent toxicity, whole abdominal irradiation seems to be a treatment equivalent to other adjuvant therapies for these patients.
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Neoplasias Ovarianas/radioterapia , Neoplasias Peritoneais/secundário , Adulto , Idoso , Terapia Combinada , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/radioterapia , Estadiamento de Neoplasias , Neoplasias Ovarianas/mortalidade , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Neoplasias Peritoneais/radioterapia , Neoplasias Peritoneais/cirurgia , Reoperação , Taxa de SobrevidaRESUMO
Among a total of 680 patients with advanced malignant melanoma, the interval between removal of the primary tumour and first manifestation of tumour progression was more than five years in 47 (6.9%: 28 women and 19 men, mean age 45 [range 27-70] years), more than 10 years in ten of them. In only eight was the thickness of the primary tumour more than 3 mm. A total of 29 patients died after the tumour progression. Survival time ranged from 1 to 120 months, mean 18 +/- 23 months. There was no correlation between manifestation-free interval and survival time after the first progression had occurred. It is concluded from these findings that patients with malignant melanoma should be followed up for at least ten years.
Assuntos
Melanoma/mortalidade , Neoplasias Cutâneas/mortalidade , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/mortalidade , Fatores Sexuais , Fatores de TempoRESUMO
In an attempt to clarify, whether the malignant potential of cervical cancer is age-dependent and whether this has changed in the last decade, we analysed the data from 1496 patients suffering from cervical cancer. The patients were treated between 1973 and 1988 at the second Universitäts-Frauenklinik, Lindwurmstrasse and at the Frauenklinik Grosshadern, both of the Ludwig-Maximilians-Universität München. After 1973, the total number of patients with cervical cancer decreased, whilst at the same time, the percentage of young patients increased. In the sub-group of surgically treated patients (n = 555), the percentage of patients with lymph node metastases increased after 1973. The increase in lymph node involvement was most pronounced in young patients with small tumours (stage Ib disease, 35 years of age). In this group, the percentage of lymph node involvement rose from 6.3% in 1973 to 38.6% in 1988. Lower stage disease was significantly more frequent in the young patients. Accordingly, the overall mean survival time was longer in the young patients. In the sub-group of surgically treated patients, however, when comparing equal stages, the survival time was shorter in the young patients. In small tumours (confined to the uterine cervix), pelvic lymph node involvement was more frequently seen in the younger patients. Secondary metastases developed more rapidly and significantly more often in the young patients. Our data supply evidence to indicate an enhanced malignancy of cervical cancer in young patients.