The incidence and associations of malignancy in a large cohort of patients with biopsy-determined idiopathic inflammatory myositis.

The South Australian (SA) myositis database has registered all patients with biopsy-proven inflammatory myositis in SA from 1980 to 2009. We determined the incidence and associations of malignancy in myositis by linking this database with the SA cancer registry. Standardized incidence ratios (SIR) for malignancy were determined using the total SA population over the same time period, stratified by age and gender. The SIR for cancer in the myositis population (n = 373) was 1.39, p = 0.047. There was a trend towards an increased SIR in dermatomyositis but no increased risk of malignancy in polymyositis or inclusion body myositis. Malignancies of the lung and prostate were the commonest and 28 % of malignancies occurred within one year of IIM diagnosis. The odds of developing cancer were significantly raised in the presence of a shawl sign, male gender, and in patients with overlap syndrome or rheumatoid arthritis whilst myalgia was a significant protective factor. HLA-A28 allele was overrepresented in patients with malignancy (11 vs 2 %, p = 0.006). Patients in SA with myositis are at modestly increased risk for malignancy. We report clinical and genetic risk factors allowing the identification of patients at greatest risk for malignancy.

Outcomes of lymphoma in South Australia, 1977-2007.

OBJECTIVE: To determine survival rates of patients with lymphoma in South Australia. DESIGN AND SETTING: De-identified data from the SA Cancer Registry on all patients with lymphoma were analysed, as well as the subgroup treated at the Royal Adelaide Hospital (RAH). For non-Hodgkin lymphoma (NHL), we used the International Working Formulation (IWF) grading. SA and RAH data on survival rates were compared with those for the whole of Australia and the United States. PATIENTS: All patients diagnosed with lymphoma and treated in SA in 1977-2007. OUTCOME MEASURES: 5-year survival rates for patients with lymphoma, by type of lymphoma and age. RESULTS: Of the total of 8651 patients with lymphoma, 939 were classified as having Hodgkin lymphoma (HL) and 7712 as having NHL. Of those with NHL, 1805 had low-grade, 3576 intermediate-grade, and 510 high-grade NHL. In another 1821 patients, the data were insufficient to make an IWF grading. There was a substantial increase in 5-year survival rates for patients with lymphoma between 1977 and 2007 in SA. While the increase in 5-year survival rates for HL was 7.6 percentage points, survival rates peaked at 88%. For NHL, there was an 18.7 percentage points increase in 5-year survival rates. The first significant increase of 7 percentage points was associated with the introduction of bone marrow transplantation; this was maintained with the increase in 5-year survival rates reaching 14 percentage points by 1995-1999. Since 1999, there has been a further increase of 5 percentage points in 5-year survival rates with the introduction of rituximab. CONCLUSION: Outcomes in patients with NHL have improved significantly, most likely because of the use of bone marrow transplantation and rituximab. Hospital- and state-based cancer registry data reflect the reality of population outcomes and the impact of new technologies.

Epidemiology of neuroendocrine cancers in an Australian population.

OBJECTIVE: The aim was to explore incidence, mortality and case survivals for invasive neuroendocrine cancers in an Australian population and consider cancer control implications. METHODS: Directly age-standardised incidence and mortality rates were investigated from 1980 to 2006, plus disease-specific survivals. RESULTS: Annual incidence per 100,000 increased from 1.7 in 1980-1989 to 3.3 in 2000-2006. A corresponding mortality increase was not observed, although numbers of deaths were low, reducing statistical power. Increases in incidence affected both sexes and were more evident for female lung, large bowel (excluding appendix), and unknown primary site. Common sites were lung (25.9%), large bowel (23.3%) (40.9% were appendix), small intestine (20.6%), unknown primary (15.0%), pancreas (6.5%), and stomach (3.7%). Site distribution did not vary by sex (p = 0.260). Younger ages at diagnosis applied for lung (p = 0.002) and appendix (p < 0.001) and older ages for small intestine (p < 0.001) and unknown primary site (p < 0.001). Five-year survival was 68.5% for all sites combined, with secular increases (p < 0.001). After adjusting for age and diagnostic period, survivals were higher for appendix and lower for unknown primary site, pancreas, and colon (excluding appendix). CONCLUSIONS: Incidence rates are increasing. Research is needed into possible aetiological factors for lung and large-bowel sites, including tobacco smoking, and excess body weight and lack of exercise, respectively; and Crohn's disease as a possible precursor condition.

Metastatic carcinoid tumor: changing patterns of care over two decades.

BACKGROUND: Metastatic carcinoid tumors (MCTs), an important subgroup of neuroendocrine tumors, occur infrequently and often have an indolent course, limiting data on long-term treatment outcomes. We aimed to assess treatment trends at a single center over time and the impact on the outcome. STUDY: Patients diagnosed with carcinoid tumors in the North West Adelaide Health Service between January 1, 1985 and March 1, 2007 were identified from the South Australian Cancer Registry. RESULTS: We identified 92 patients with carcinoid tumors; 49 had MCT. Although treatment options increased over time, the most significant change was to access octreotide therapy, with 24 receiving long-acting somatostatin analogs. Survival improved over time and the median overall survival for patients receiving long-acting somatostatin analogs was 112 months compared with 53 months for those who did not (P=0.021, hazard ratio: 2.46). Ten year survival was 40% and 22%, respectively. About 75% of evaluable patients had a biochemical response to initial therapy and a measurable response occurred in 3 of 24 (13%) patients. CONCLUSIONS: This single center experience has provided insight into current treatment options for MCT, and suggests the use of long-acting somatostatin analogs may impact on disease control and survival. However, the uptake of other treatment options seems limited and there is a need for agents that target tumor progression.

Bladder cancer survivals in New South Wales, Australia: why do women have poorer survival than men?

OBJECTIVE: To investigate factors that most influenced survival from bladder cancer in New South Wales, Australia (NSW) and to consider the impact of changes in coding practices on the reporting the of bladder cancer outcomes. PATIENTS AND METHODS: All NSW cases of bladder cancer diagnosed between 1980 and 2003 were followed to the end of 2004 (17 923 cases). Survival analysis was undertaken using Kaplan-Meier unadjusted disease-specific survival and adjusted disease-specific survival using Cox proportional hazards regression modelling. This analysis was unique in that it modelled the effect of sex, age, country of birth, socio-economic status (SES), histological type, extent of disease and period of diagnosis on survival from bladder cancer in NSW. RESULTS: After adjusting for sex, age, extent of disease, SES, period of diagnosis and histological type, the likelihood of death was 11% (95% confidence interval, CI 5-18%) higher in females than in males, with case fatality most influenced by age at diagnosis, extent of disease, and histological type. When the analysis was repeated for cases with a method 6 (i.e. coding undertaken in the registry after examination of the pathology report, which would enhance accuracy), the likelihood of death was 13% (95% CI 5-21%) higher in females than in males. CONCLUSIONS: The NSW analysis controls for variability in coding, extent of disease at diagnosis and histological type of cancer. The analysis shows significantly lower survival from bladder cancer in NSW women compared with men, with no improvement in survival from 1980 to 2003. Possible reasons for the lower survivals in women, the lack of improvement in survival and coding differences in jurisdictions are discussed.

Exploring the epidemiological characteristics of cancers of unknown primary site in an Australian population: implications for research and clinical care.

OBJECTIVES: To investigate incidence, mortality and case survival trends for cancer of unknown primary site (CUP) and consider clinical implications. METHOD: South Australian Cancer Registry data were used to calculate age-standardised incidence and mortality rates from 1977 to 2004. Disease-specific survivals, socio-demographic, histological and secular predictors of CUP, compared with cancers of known primary site, and of CUP histological types, using multivariable logistic regression were investigated. RESULTS: Incidence and mortality rates increased approximately 60% between 1977--80 and 1981--84. Rates peaked in 1993--96. Male to female incidence and mortality rate ratios approximated 1.3:1. Incidence and mortality rates increased with age. The odds of unspecified histological type, compared with the more common adenocarcinomas, were higher for males than females, non-metropolitan residents, low socio-economic areas, and for 1977--88 than subsequent diagnostic periods. CUP represented a higher proportion of cancers in Indigenous patients. Case survival was 7% at 10 years from diagnosis. Factors predictive of lower case survival included older age, male sex, Indigenous status, lower socio-economic status, and unspecified histology type. CONCLUSION: Results point to poor CUP outcomes, but with a modest improvement in survival. The study identifies socio-demographic groups at elevated risk of CUP and of worse treatment outcomes where increased research and clinical attention are required.

Retrospective study of survival and treatment pattern in a cohort of patients with oral and oropharyngeal tongue cancers from 1987 to 2004.

This is a retrospective study of patients with oral and oropharyngeal tongue cancers who presented to the Royal Adelaide Hospital (RAH) from 1987 to 2004. The aims of this study were to determine sociodemographic and tumour characteristics, treatment patterns and five-year disease-specific survival of the disease. All cases of tongue cancers, including untreated and palliative cases, were identified through the Royal Adelaide Hospital Cancer Registry and were included in statistical analysis. A total of 212 cases of tongue cancer were identified. Patients less than 45 years of age accounted for 15% of cases and had a tendency to present with advanced stage disease. Squamous cell carcinoma was the most common histological type. Almost 30% of recorded cases were oropharyngeal or base of tongue cancers. Nearly half of the patients had advanced stage (III and IV) disease at presentation, which was significantly associated with rural area of residence, base of tongue sub-site and early diagnostic period. Treatment involved a multidisciplinary approach and majority of patients were treated with a curative intent. Palliative treatment was more likely to be given to patient with oropharyngeal tongue cancers or advance stage disease. There was no significant improvement of five-year disease-specific survival over the 18-year period. Poorer survival was significantly associated with age 45 years or older, oropharyngeal tongue cancers and advanced stage disease. Tongue cancer is an important health issue associated with poor survival. Early detection and diagnosis is important in order to improve survival rate for this malignancy.

Benchmarking epidemiological characteristics of cervical cancer in advance of change in screening practice and commencement of vaccination.

OBJECTIVES: To investigate trends in cervical cancer incidence, mortality and survival by histology for benchmarking purposes ahead of practice change and the introduction of Human Papilloma Virus (HPV) vaccine. METHODS: Using data from the South Australian Cancer Registry, age-standardised rates are presented for four-year periods from 1977 to 2004. Socio-demographic and secular predictors of glandular as opposed to squamous cancers are investigated, using multivariable logistic regression. Disease-specific survivals are analysed using Kaplan-Meier product-limit estimates and Cox proportional hazards regression. RESULTS: Incidence and mortality rates reduced by 55.1% and 59.3% respectively between 1977-80 and 2001-04, with larger reductions for squamous than glandular cancers. The ratio of squamous to glandular cancer incidence reduced from 5.4:1 in 1977-88 to 2.8:1 in 1993-2004, with a corresponding reduction from 5.2:1 to 3.0:1 for mortality. Compared with squamous cancers, glandular lesions were more common in patients from higher socio-economic areas, but less common in those over 70 years of age, Aboriginal patients, and those born in Southern Europe. CONCLUSION: The proportion of cancers comprising glandular lesions has increased, possibly reflecting prevention of squamous cancers through treatment of screen-detected preinvasive lesions. Additional mortality reductions from screening may be limited where the proportion of glandular lesions is high, with vaccination offering the best prospects for gains in the long term. Priority should be given to Aboriginal and Torres Strait Islander women in vaccination programs in view of their high death rate from cervical cancer.

Treatment and survival from breast cancer: the experience of patients at South Australian teaching hospitals between 1977 and 2003.

RATIONALE: Treatment guidelines recommend a more conservative surgical approach than mastectomy for early stage breast cancer and a stronger emphasis on adjuvant therapy. Registry data at South Australian teaching hospitals have been used to monitor survivals and treatment in relation to these guidelines. AIMS AND OBJECTIVES: To use registry data to: (1) investigate trends in survival and treatment; and (2) compare treatment with guidelines. METHODS: Registry data from three teaching hospitals were used to analyse trends in primary courses of treatment of breast cancers during 1977-2003 (n=4671), using univariate analyses and multiple logistic regression. Disease-specific survivals were analysed using Kaplan-Meier product limit estimates and multivariable Cox proportional hazards regression. RESULTS: The 5-year survival was 79.9%, but with a secular increase, reaching 83.6% in 1997-2003. The relative risk of death (95% confidence limits) was 0.74 (0.62, 0.88) for 1997-2003, compared with previous diagnoses, after adjusting for tumour node metastasis stage, grade, age and place of residence. Treatment changes included an increase in conservative surgery (as opposed to mastectomy) from 51.7% in 1977-1990 to 76.8% in 1997-2003 for stage I (P<0.001) and from 31.1% to 52.2% across these periods for stage II (P<0.001). Adjuvant radiotherapy also became more common (P<0.001), with 20.6% of patients receiving this treatment in 1977-1990 compared with 60.7% in 1997-2003. Radiotherapy generally was more prevalent when conservative surgery was provided, although also relatively common in mastectomy patients when tumour diameters exceeded 50 mm or when there were four or more involved nodes. The proportion of patients receiving chemotherapy increased (P<0.001), from 19.6% in 1977-1990 to 36.9% in 1997-2003, and the proportion having hormone therapy also increased (P<0.001), from 34.3% to 59.4% between these periods. CONCLUSIONS: Survivals appear to be increasing and treatment trends are broadly consistent with guideline directions, and the earlier research on which these recommendations were based.

Prognostic importance of palpability as a feature of screen-detected breast cancers.

OBJECTIVES: To determine epidemiological characteristics of palpability as a feature of asymptomatic invasive breast cancers detected through screening mammography, and to determine whether palpability is predictive of case survival after adjusting for conventional prognostic indicators such as diameter, grade and nodal status. SETTING: The University of Adelaide, South Australian Department of Health, and The Cancer Council South Australia, Adelaide, South Australia. METHODS: Sociodemographic and clinical characteristics of 2108 screen-detected invasive breast cancers were compared by tumour palpability using univariate and multiple logistic regression analysis. Survival outcomes from breast cancer were compared using Kaplan-Meier product-limit estimates. Multivariable proportional hazard regression was employed to assess the association of palpability with survival after adjusting for conventional prognostic indicators. RESULTS: Palpability was associated with year of diagnosis, ductal histology type, and unfavourable prognostic indicators such as larger tumour diameter, higher grade and nodal involvement. After adjusting for these variables, no associations were found with age at diagnosis, place of residence or socioeconomic status, or with presence of multifocal disease or presence of an extensive in situ component. Palpability was predictive of death from breast cancer in an unadjusted analysis, the relative risk (95% confidence limits) being 1.75 (1.12, 2.74). After adjusting for nodal involvement and larger tumour size, the relative risk no longer was elevated, reducing to 0.99 (0.60, 1.64). DISCUSSION: Palpability is associated with unfavourable prognostic indicators, such as larger diameter, higher grade and nodal involvement, and is not an independent indicator of survival outcome for screen-detected female-breast cancers after accounting for nodal involvement and diameter.

Changes in incidence of in situ and invasive breast cancer by histology type following mammography screening.

OBJECTIVE: To investigate secular trends and correlates of incidence of breast cancer by histology type following the introduction of population-based mammography screening. METHODS: Analysis of age-standardised incidence rates for 1,423 in situ and 16,157 invasive carcinomas recorded on the South Australian population-based cancer registry for the 1985-2004 diagnostic period. Multiple logistic regression was undertaken to compare socio-demographic characteristics by histology. Progression from in situ disease was investigated using the Kaplan-Meier method. RESULTS: The incidence of in situ lesions increased approximately seven-fold over the 20-year period, compared with an increase of about 40% for invasive cancers. The increase for in situ lesions was due to increases for ductal carcinomas, with little change for lobular lesions. By comparison, the percentage increase in incidence for invasive cancer was greater for lobular than ductal cancers. Both for in situ and invasive cancers, percentage increases were greatest for the screening target age range of 50-69 years. One in 14 in situ cases was found to progress to invasive cancer within seven years of diagnosis, but insufficient detail was available to determine whether the invasive cancers were a progression of the in situ lesions or whether they originated separately. These invasive cancers were smaller than generally applying for other invasive cancers of the female breast. CONCLUSIONS: The larger secular increases in incidence for in situ than invasive cancers would reflect the dominant role of mammography in the detection of ductal carcinoma in situ. The lack of an increase for lobular in situ lesions may have resulted from their poorer radiological visibility. The greater percentage increase for lobular than ductal invasive lesions may have been due to an increase in imaging sensitivity for these lesions, plus real increases in incidence. The smaller sizes of invasive cancers found in women with a prior in situ diagnosis may have resulted from more intensive medical surveillance, although the possibility of biological differences cannot be discounted.

Myeloid leukaemia treatment and survival--the South Australian experience, 1977 to 2002.

OBJECTIVE: To evaluate trends in survival and treatment for myeloid leukaemia in South Australia during 1977-2002, using population-based survival data plus data on survival and treatment of patients at three teaching hospitals. METHODS: Population data were analysed using relative survival methods and hospital registry data using disease-specific survival. Univariate and multivariable analyses were undertaken. Multiple logistic regression analysis was used to investigate factors associated with first-line chemotherapy. RESULTS: South Australia recorded 1,572 new cases of acute myeloid leukaemia (AML) in 1977-2002, together with 536 cases of chronic myeloid leukaemia (CML). Of these cases, 42.6% were recorded in teaching hospital registries. The five-year survival for AML at the teaching hospitals of 14.5% was similar to the corresponding 12.0% for South Australia as a whole. The five-year survival for CML at these hospitals was higher, however, at 48.1% compared with 37.5% for all South Australian cases. Younger patients had higher survivals, both for AML and CML. An increase in survival was evident for more recently diagnosed cases for both leukaemia types, after adjusting for age. This increase in survival was accompanied by an increase over time in the proportion of patients at teaching hospitals having a primary course of chemotherapy. Cytarabine in combination with other agents was the most common induction therapy for AML. While hydroxyurea was the most common first-line treatment of CML, there were changes in clinical policies towards higher-dose treatments, plus trials of new agents and combination therapies. CONCLUSIONS: Secular gains in survival have occurred from AML and CML in association with an increased use of chemotherapy.

Cervical cancer: effect of glandular cell type on prognosis, treatment, and survival.

OBJECTIVE: To investigate survivals from cervical cancer, with special reference to effects of glandular histology and its influence on prognostic characteristics and management decisions. METHODS: Data on cervical cancers, diagnosed in 1984-2000, were obtained from the gynecologic oncology registry of hospitals of the University of Adelaide. Comparisons were made of disease-specific survival, age at diagnosis, diagnostic period, stage, grade, and primary course of treatment. RESULTS: The study included 544 squamous cell carcinomas, 43 adenosquamous carcinomas, five clear cell cancers, 136 other adenocarcinomas, and 19 cancers of "other" histological type. Overall survival was 72.2% at 5 years from diagnosis, decreasing to 67.5% at 15 years. Survival was lower for older ages, higher grades, and higher International Federation of Gynecology and Obstetrics stages, although equivalent for stages IIA and IIB. Unadjusted survivals varied by histological type (P =.001), with lower survivals suggested for adenosquamous and clear cell lesions and "other" histological types than for squamous cell carcinomas and other adenocarcinomas. After adjusting for age, stage, grade, and diagnostic period, adenocarcinomas had a higher case fatality than squamous cell lesions (relative risk 2.08, 95% confidence limit 1.35, 3.21), whereas the elevation in relative risk was lower and not statistically significant for a combined adenosquamous and clear cell category at 1.25 (0.69, 2.24). For stage II, both adenocarcinomas and the adenosquamous and clear cell group had lower survivals than squamous cell cancers. CONCLUSION: Relative to squamous cell carcinomas, adenocarcinomas and potentially adenosquamous cancers are becoming more common. This has implications for screening, treatment, and prognosis.

Time trends in lung cancer incidence by histology in South Australia: likely causes and public health implications.

OBJECTIVES: In response to reported increases in ratios of adenocarcinomas to squamous cell carcinomas of the lung in other populations, to investigate and consider public health and clinical implications of time trends in lung cancer incidence by histological type in South Australia. METHODS: 11,898 lung cancers, diagnosed during 1982-2000, were analysed to determine age-adjusted incidence rates by sex, diagnostic epoch, and histological type, and changes in histological distribution at diagnosis. RESULTS: The age-adjusted incidence of squamous cell carcinoma reduced by 47.1% in males between 1982-86 and 1997-2000, with larger reductions applying to younger age groups. A 34.1% reduction also occurred for small cell lesions in males, whereas a 55.6% incidence increase applied for large cell lesions, and in the age range of 70 years and over, a 29.9% incidence increase for adenocarcinomas. Larger increases were observed for adenocarcinomas and large cell lesions in females. There was also a 48.0% incidence increase in squamous cell carcinomas in females aged 70 years or more. In general, adverse incidence trends were less pronounced and favourable trends more pronounced in the younger age groups of both sexes. CONCLUSIONS: The more favourable incidence trends by histology in younger age groups are a positive sign that hopefully will prove to be cohort effects that extend to older ages. Incidence trends have led to an increased proportion among diagnosed cancers of adenocarcinomas and large cell lesions, but this is unlikely to have more than a marginal effect on overall survivals and treatment requirements.

Female breast cancers are getting smaller, but socio-demographic differences remain.

OBJECTIVE: To investigate trends towards early detection of infiltrating ductal carcinomas, possible effects on patients' prognosis, and characteristics of women still at high risk of late detection. METHODS: South Australian Cancer Registry data were analysed to compare breast tumour diameters for the 1980-86 and 1997-2002 diagnostic periods by age. Relative survivals for 1980-86 were compared with corresponding survival estimates for 1997-2000, obtained by weighting diameter-specific survivals for 1980-86 to equate with the diameter distribution for 1997-2002. Multivariable logistic regression was used to determine socio-demographic predictors of large diameters (> or =30 mm) in 1997-2002. RESULTS: The proportion of tumours with diameters smaller than 15 mm increased from 13.0% in 1980-86 to 36.7% in 1997-2002, whereas the proportion with large diameters reduced from 43.0% to 18.6%. Estimated changes in 20-year survivals equated with a 33% reduction in breast-cancer mortality among patients aged 50-69 years at diagnosis. Data for 1997-2002 indicate that early diagnosis is not evenly distributed, with large diameters more common in age ranges outside the 50-69 year target for mammography screening; low socio-economic areas; non-Caucasians; patients born in northern/eastern Europe and potentially Asia/Middle East; and in some country locations. CONCLUSIONS AND IMPLICATIONS: Increased emphasis on early detection should be directed at sectors of the population where delays in diagnosis and poorer prognosis are evident. Projected reductions in breast-cancer mortality among patients are indicative of effects of earlier detection on patients' prognosis, but require confirmation with follow-up data. More particularly, parallel studies of effects on population-based mortality are warranted.

Comparative epidemiological characteristics of oesophageal adenocarcinoma and other cancers of the oesophagus and gastric cardia.

Secular trends and epidemiological characteristics of 1,581 oesophageal cancers, diagnosed in South Australian residents in 1977-2000, were analysed by histological type and diagnostic period, using multivariable Poisson regression and logistic regression. The age-adjusted incidence of squamous cell carcinoma did not vary significantly by diagnostic period, either in males (p = 0.195) or females (p = 0.087). By comparison, variations were observed for adenocarcinomas in males (p<0.001) and females (p = 0.015), with an increase in age-adjusted incidence of 169% for males and 150% for females between 1977-81 and 1997-2000. Most of these increases occurred in the 1990s. Secular differences were not evident for tumours of other or unknown histological type. The ratio of adenocarcinomas to squamous cell carcinomas was higher in patients who were aged 80 years or more, male, residents of high socio-economic areas, and those born in the United Kingdom/Ireland. Conversely, relatively low ratios presented for patients born in Southern and other parts of Europe. These differences by country of origin accord with differences between the national incidence rates for these countries, as indicated by international data. Differences in secular trend and country of birth between adenocarcinomas of the oesophagus and gastric cardia suggest that they are not expressions of the same disease. Preventive implications of these results are discussed.

Are cutaneous melanomas of specified thickness showing deeper levels of invasion at diagnosis?

Secular trends in Clark level were investigated by Breslow category for 8,432 invasive cutaneous melanomas diagnosed in South Australia in 1980-2000. More recently diagnosed lesions were found to have deeper levels. After adjusting for age at diagnosis, tumour site, histology, and thickness measured in half millimetres, the relative odds (95% confidence limits) of penetration to the reticular dermis or subcutaneous fat were 1.99 (1.59, 2.50) for the 1987-93 diagnostic period, and 2.82 (2.25, 3.54) for 1994-2000, when compared with 1980-86. After adjusting for melanoma thickness, the secular trends for deeper lesions applied to a broad cross-section of socio-demographic sub-groups, tumour sites, and histological types. While this similarity in trend would be consistent with a measurement effect, a real change cannot be ruled out and increased emphasis on earlier detection may be warranted. The prognostic implications of changes in inter-relationships between measures of thickness and level require periodic re-evaluation.

Reasons for lower survival from non-Hodgkin's lymphoma among older patients.

Cancer-registry data for 710 patients, treated for non-Hodgkin's lymphoma (NHL) at a South Australian teaching hospital between 1977 and 2000, gave a five-year disease-specific survival of 53%, which was similar to population based estimates for Australia, the USA, and Europe. This figure reduced with age at diagnosis from 69% for patients less than 40 years at diagnosis to 30% for those aged 80 years or more. Multivariable analysis indicated that older age was predictive of lower survival (p<0.001), after adjusting for grade (Working Formulation), Ann Arbor stage,bulk disease, B symptoms (weight loss, unexplained fever, night sweats), extra-lymphatic site involvement, and diagnostic period. No other clinical variable, when included in the model, affected the risk coefficient for age. Even among patients gaining complete remission following chemotherapy, the relative risk of death from NHL was 2.11(95% CL: 1.24, 3.57) for patients aged 70 years or more at diagnosis when compared with younger patients. We conclude that older patients have lower survivals not explained by established risk factors and that this also applies to patients who achieve complete remission following chemotherapy.

Rechallenge with oxaliplatin and fluoropyrimidine for metastatic colorectal carcinoma after prior therapy.

OBJECTIVES: Patients with advanced colorectal cancer (CRC) who have received oxaliplatin, 5-fluoropyrimidine, and irinotecan chemotherapy (with or without bevacizumab) and antiepidermal growth factor receptor therapy (if KRAS is wild type) have no further standard treatment options. Although repeating a prior chemotherapy [in particular, oxaliplatin and fluoropyrimidine (FOX)] is an option, there is very little evidence in the literature for this approach; thus, we reviewed our registry to assess the frequency and outcome of rechallenging with FOX. METHODS: Patients who had been rechallenged with FOX were identified from the South Australian metastatic CRC database. Patient characteristics were analyzed, and tumor response was retrospectively assessed using Response Evaluation Criteria in Solid Tumors criteria. RESULTS: Twenty patients were eligible for inclusion in this analysis. The number of prior lines of therapy received for metastatic CRC was 4 lines for 2 patients, 3 lines for 6 patients, 2 lines for 7 patients, and 1 line for 3 patients, with 3 patients having received oxaliplatin as adjuvant therapy. Four patients had received bevacizumab previously, 7 patients had undergone antiepidermal growth factor receptor treatment, and 4 patients had undergone liver resection earlier. Response rate was 18%, and 47% had stable disease. The median progression-free survival was 3.7 months, median overall survival was 7.8 months, and 1-year survival was 37%. CONCLUSIONS: In this selected population, there is evidence of modest activity of rechallenge with FOX chemotherapy, although radiologic response is uncommon.

Colorectal cancer surgery 2000-2008: evaluation of a prospective database.

BACKGROUND: Colorectal cancer is a common cause of cancer death in Australia and is primarily managed operatively. Surgical databases are valuable in monitoring performance in cancer treatment and detecting problems and trends. METHODS: Diagnostic and treatment variables and short-term outcomes were gathered prospectively for patients undergoing resection for colorectal cancer over a 9-year period. Survival data were obtained by linkage to state and interstate death indices. RESULTS: Eight hundred and five patients underwent resection for colorectal cancer during the study period. Overall 5-year survival was 61%. Five-year cancer-specific survival was 73%. Five-year cancer-specific survival for Australian Clinico-Pathological Staging (ACPS) stages A, B, C and D was 96, 80, 61 and 19%, respectively (P < 0.0001). Emergency presentations showed diminished survival (59% versus 75%, P < 0.0001) after controlling for age and stage (hazard ratio (HR) 1.78, P= 0.005), as did transfusion recipients (63% versus 74%, P= 0.0014; HR 1.78, P= 0.004). Anastomotic leak did not affect survival in multivariable analysis. Non-cancer causes accounted for 26% deaths, primarily comprising cardiovascular deaths in the elderly. DISCUSSION: High case ascertainment, data completeness and accuracy can be obtained with prospective, independently gathered data linked electronically to national death records. Survival for colorectal cancer in South Australia continues to improve. Close follow-up for disease recurrence is warranted for transfusion recipients, emergencies and advanced disease. Locally managed databases with linkage to state registries and other institutions are powerful methods to improve data quality and surgical care at a national level.