The COVID-19 pandemic poses an unprecedented threat to human health, health care systems, public life, and economy around the globe. The repertoire of effective therapies for severe courses of the ...disease has remained limited. A large proportion of the world population suffers from vitamin D insufficiency or deficiency, with prevalence being particularly high among the COVID-19 high-risk populations. Vitamin D supplementation has been suggested as a potential option to prevent COVID-19 infections, severe courses, and deaths from the disease, but is not widely practiced. This article provides an up-to-date summary of recent epidemiological and intervention studies on a possible role of vitamin D supplementation for preventing severe COVID-19 cases and deaths. Despite limitations and remaining uncertainties, accumulating evidence strongly supports widespread vitamin D supplementation, in particular of high-risk populations, as well as high-dose supplementation of those infected. Given the dynamics of the COVID-19 pandemic, the benefit-risk ratio of such supplementation calls for immediate action even before results of ongoing large-scale randomized trials become available.
Numerous observational and intervention studies have suggested adverse health effects of poor vitamin D status and health benefits of vitamin D intake ....
Background.
Therapy for head and neck cancers has evolved over the past decade, but few detailed analyses of recent developments in survival on the population level have been published.
Methods.
We ...use period analysis and modeled period analysis to disclose recent trends in survival in patients with head and neck cancer. Data are derived from the Surveillance, Epidemiology, and End Results limited‐use database.
Results.
A major, statistically significant improvement in survival was observed, with the overall 5‐year relative survival rate going from 54.7% in 1992–1996 to 65.9% in 2002–2006. Subgroup analysis showed improvement in cancers of the oral cavity, tongue, tonsils, and nasopharynx, with the greatest improvements observed in tonsillar carcinoma (+22.2 percentage points) and carcinoma of the tongue (+14.4 percentage points). Further analysis of survival for oral cavity, tonsillar, and tongue carcinoma revealed improvements in survival at each stage and across all age groups except for patients aged ≥75 years, with the greatest improvement occurring in locally advanced disease and in patients aged 55–64 years for carcinoma of the tongue and tonsils and those aged 15–44 years for oral cavity cancers.
Conclusions.
Survival has substantially improved for head and neck cancer patients over the past decade. The greatest improvement was seen in tonsillar and tongue cancers.
Period analysis and modeled period analysis are used to disclose recent trends in survival in patients with head and neck cancer. The study finds that survival has substantially improved for patients with head and neck cancers over the past decade.
Colorectal cancer Brenner, Hermann, Prof; Kloor, Matthias, MD; Pox, Christian Peter, MD
The Lancet (British edition),
04/2014, Letnik:
383, Številka:
9927
Journal Article
Recenzirano
Summary More than 1·2 million patients are diagnosed with colorectal cancer every year, and more than 600 000 die from the disease. Incidence strongly varies globally and is closely linked to ...elements of a so-called western lifestyle. Incidence is higher in men than women and strongly increases with age; median age at diagnosis is about 70 years in developed countries. Despite strong hereditary components, most cases of colorectal cancer are sporadic and develop slowly over several years through the adenoma–carcinoma sequence. The cornerstones of therapy are surgery, neoadjuvant radiotherapy (for patients with rectal cancer), and adjuvant chemotherapy (for patients with stage III/IV and high-risk stage II colon cancer). 5-year relative survival ranges from greater than 90% in patients with stage I disease to slightly greater than 10% in patients with stage IV disease. Screening has been shown to reduce colorectal cancer incidence and mortality, but organised screening programmes are still to be implemented in most countries.
Highlights ► First systematic review assessing the relationship between telomere length and age. ► Standardised data from 124 cross-sectional and 5 longitudinal studies were obtained. ► Consistent ...telomere length loss was observed between and within studies. ► The estimates of yearly telomere loss were mostly between 20 and 40 BP/year. ► Yearly telomere loss magnitude is similar across age ranges, independent of gender.
A systematic review and meta-analysis was performed to summarize the available evidence on risk scores for predicting advanced colorectal neoplasia (advanced adenomas and cancer) in average-risk and ...asymptomatic populations undergoing screening colonoscopy.
PubMed, EMBASE, and Web of Science databases were searched up to 28 March 2018. Studies that developed or validated a risk score to predict the risk of advanced colorectal neoplasia were included. Two reviewers independently extracted study characteristics including diagnostic performance indicators and assessed risk of bias and applicability in the included studies. Meta-analyses were conducted to determine the overall discrimination of risk scores evaluated by more than 1 study.
A total of 22 studies including 17 original risk scores were identified. Risk scores included a median number of 5 risk factors. Factors most commonly included were age, sex, family history in first-degree relatives, body mass index and smoking. The area under the receiver operating characteristic curve of risk scores ranged from 0.62 to 0.77 in the individual studies and from 0.61 to 0.70 in the meta-analyses.
Although the majority of available risk scores had relatively weak discriminatory power, they may be of some use for risk stratification in CRC screening. Rather than developing more risk scores based on environmental risk factors, future research should focus on exploring possibilities of enhancing predictive power by combining risk factor data with novel laboratory matters, such as polygenetic risk scores.
Fecal immunochemical tests (FITs) detect the majority of colorectal cancers (CRCs), but evidence for variation in sensitivity according to the CRC stage is sparse and has not yet been systematically ...synthesized. Thus, our objective was to systematically review and summarize evidence on the stage-specific sensitivity of FITs.
We screened PubMed, Web of Science, Embase, and the Cochrane Library from inception to June 14, 2019, for English-language articles reporting on the stage-specific sensitivity of FIT for CRC detection using colonoscopy as a reference standard. Studies reporting stage-specific sensitivities and the specificity of FIT for CRC detection were included. Summary estimates of sensitivity according to the CRC stage and study setting (screening cohorts, symptomatic/diagnostic cohorts, and case-control studies) were derived from bivariate meta-analysis.
Forty-four studies (92,447 participants including 3,034 CRC cases) were included. Pooled stage-specific sensitivities were overall very similar but suffered from high levels of imprecision because of small case numbers when calculated separately for screening cohorts, symptomatic/diagnostic cohorts, and case-control studies. Pooled sensitivities (95% confidence intervals) for all studies combined were 73% (65%-79%) for stage-I-CRCs and 80% (74%-84%), 82% (77%-87%), and 79% (70%-86%) for the detection of CRC stages II, III, and IV, respectively. Even substantially larger variation was seen in sensitivity by T-stage, with summary estimates ranging from 40% (21%-64%) for T1 to 83% (68%-91%) for T3-CRC.
Although FITs detect 4 of 5 CRCs at stages II-IV, the substantially lower sensitivity for stage-I-CRC and, in particular, T1 CRC indicates both need and potential for further improvement in performance for the early detection of CRC.
Long-term survival rates for many types of cancer have substantially improved in past decades because of advances in early detection and treatment. However, much of this improvement is only seen many ...years later with traditional cohort-based methods of survival analysis. I aimed to assess achievements in cancer patients' survival by an alternative method of survival analysis, known as period analysis, which provides more up-to-date estimates of long-term survival rates than do conventional methods.
The 1973–98 database of the Surveillance, Epidemiology, and End Results (SEER) programme of the US National Cancer Institute was analysed by period analysis.
Estimates of 5-year, 10-year, 15-year, and 20-year relative survival rates for all types of cancer were 63%, 57%, 53%, and 51%, respectively, by period analysis. These estimates were 1%, 7%, 11%, and 11% higher, respectively, than corresponding estimates by cohort-based survival analysis. By period analysis, 20-year relative survival rates were close to 90% for thyroid and testis cancer, exceeded 80% for melanomas and prostate cancer, were about 80% for endometrial cancer, and almost 70% for bladder cancer and Hodgkin's disease. A 20-year relative survival rate of 65% was estimated for breast cancer, of 60% for cervical cancer, and of about 50% for colorectal, ovarian, and renal cancer.
Timely detection of improvements in long-term survival rates might help to prevent clinicians and their patients from undue discouragement or depression by outdated and often overly pessimistic survival expectations. It also adds to the value of cancer surveillance as a basis for appropriate public-health decisions.
Background.
Treatment of multiple myeloma has changed significantly over the past several years with clinical trials reporting superior survival results using newer agents. Previous work has shown ...that the survival rate has improved for younger, but not older, patients with myeloma. Here, we update survival estimates for patients with myeloma in the early 21st century to determine whether continued improvement can be seen on a population level and whether or not it now extends to older patients.
Methods.
Using period analysis to examine data from the Surveillance, Epidemiology, and End Results database, we estimate changes in the 5‐ and 10‐year relative survival rates (RSRs) from 1998–2002 to 2003–2007.
Results.
The 5‐ and 10‐year RSRs have improved for patients with myeloma overall, from 32.8% and 15% in 1998–2002 to 40.3% and 20.8%, respectively, in 2003–2007. The greatest improvements were observed for patients aged 15–44 years, with 5‐ and 10‐year RSRs reaching >70% and ∼50%, respectively, but improvements were also seen for patients aged >70 years.
Conclusion.
Overall, survival continues to improve for patients with myeloma, including older patients, suggesting that newer treatment options continue to make a population‐wide impact.
摘要
背景. 过去若干年来，随着临床试验报道新药的卓越生存率，多发性骨髓瘤的治疗显著改观。既往研究表明，年轻骨髓瘤患者，生存率可有改善，但老年患者则不然。本文更新了21世纪初多发性骨髓瘤患者的生存率估值，以确定在群体层面上能否观察到持续改善，以及此改善能否惠及老年患者。
方法. 使用时段分析，对监测、流行病学和最终结果（SEER）数据库进行研究，估算1998∼2002至2003∼2007的5年和10年相对生存率（RSRs）变化。
结果. 骨髓瘤患者5年和10年RSRs整体有所改善，1998∼2002年为32.8%和15%， 2003∼2007年增至40.3%和20.8%。15∼44岁患者改善最为显著，其5年和10年RSRs分别为>70%和约50%，但>70岁患者也有改善。
结论. 总体而言，包括老年患者在内的骨髓瘤患者生存率得到不断改善，提示新的治疗选择不断产生群体影响。
Changes in the 5‐ and 10‐year relative survival rates of multiple myeloma patients from 1998–2002 to 2003–2007 were estimated using period analysis to examine data from the Surveillance, Epidemiology, and End Results database. Survival outcomes continue to improve for these individuals and now extend to older patients as well.
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