Is survivorship an endless experience? Dal Maso, Luigino; Serraino, Diego; Guzzinati, Stefano
Cancer,
October 2022, Letnik:
128, Številka:
20
Journal Article
Recenzirano
The study by Colonna and colleagues in this issue describes many epidemiologic investigations that have provided estimates of cancer cure. Evidence of the possibility of cancer cure grows and lays ...the groundwork to encourage clinicians to update cancer care plans and long‐term follow‐up.
Systemic inflammatory status has been reported to impact survival of prostate cancer (PCa) patients; however, evidence is lacking on whether the inflammatory potential of diet can influence prognosis ...of PCa patients. To investigate the association between a dietary inflammatory index (DII) and PCa survival, we conducted a retrospective cohort study including 726 men with PCa originally enrolled, between 1995 and 2002, in an Italian case–control study. Information on diet and Gleason score was collected at PCa diagnosis. DII was derived from a food frequency questionnaire using a validated algorithm. Adjusted hazard ratios (HRs) of death with 95% confidence intervals (CIs) were estimated using a Fine‐Gray model. DII scores were not significantly associated with all‐cause mortality of PCa patients (HR highest vs. lowest DII tertile = 1.25; 95% CI: 0.86–1.83). However, considerable heterogeneity emerged according to Gleason score (p < 0.01): no associations emerged among men with Gleason score 2–6 PCa; whereas, among patients with Gleason score 7–10 PCa, DII was directly associated with both all‐cause and PCa‐specific mortality (HR highest vs. lowest DII tertile: 2.78; 95% CI: 1.41–5.48; and 4.01; 95% CI: 1.25–12.86; respectively). Among patients with Gleason score 7–10 PCa, ten‐year all‐cause survival probabilities were 58% (95% CI: 47–67%) for highest and 78% (95% CI: 67–86%) for lowest DII tertile. Study findings support the hypothesis that diet, through its inflammatory potential, may influence the prognosis of patients with more aggressive PCa. Dietary interventions aimed at decreasing inflammation may be considered to improve survival of men with PCa.
What's new?
Systemic inflammatory status has been reported to impact survival of prostate cancer (PCa) patients; however, evidence is lacking on whether the inflammatory potential of diet can influence prognosis. Here the authors used, for the first time, a novel, validated dietary indicator of the inflammatory potential of diet to investigate the prognosis of PCa patients. Among those with more aggressive disease, dietary inflammatory index (DII) scores were strongly associated with both all‐cause and PCa‐specific mortality in a retrospective cohort study. A diet modification to diminish the consumption of pro‐inflammatory foods may represent an effective intervention to reduce mortality among PCa patients.
Thyroid cancer incidence varies greatly between and within high‐income countries (HICs), and overdiagnosis likely plays a major role in these differences. Yet, little is known about the situation in ...low‐ and middle‐income countries (LMICs). We compare up‐to‐date thyroid cancer incidence and mortality at national and subnational levels. 599,851 thyroid cancer cases in subjects aged 20–74 reported in Cancer Incidence in Five Continents volume XI from 55 countries with at least 0.5 million population, aged 20–74 years, covered by population‐based cancer registration, and 22,179 deaths from the WHO Mortality Database for 36 of the selected countries, over 2008–2012, were included. Age‐standardized rates were computed. National incidence rates varied 50‐fold. Rates were 4 times higher among women than men, with similar patterns between countries. The highest rates (>25 cases per 100,000 women) were observed in the Republic of Korea, Israel, Canada, the United States, Italy, France, and LMICs such as Turkey, Costa Rica, Brazil, and Ecuador. Incidence rates were low (<8) in a few HICs (the Netherlands, the United Kingdom, and Denmark) and lowest (3–4) in some LMICs (such as Uganda and India). Within‐country incidence rates varied up to 45‐fold, with the largest differences recorded between rural and urban areas in Canada (HIC) and Brazil, India, and China (LMICs). National mortality rates were very low (<2) in all countries and in both sexes, and highest in LMICs. The very high thyroid cancer incidence and low mortality rates in some LMICs also strongly suggest a major role of overdiagnosis in these countries.
What's new?
The rise in thyroid cancer incidence in high‐income countries (HICs) is widely documented. By comparison, trends in low‐ and middle‐income countries (LMICs) are less well‐defined. Here, analysis of population‐based cancer registry data for thyroid cancer reveals very high incidence rates in some LMICs, comparable to those of some HICs where overdiagnosis plays an important role. The highest rates occurred in urban areas and countries where diagnostic equipment is abundant and not subject to regulatory control. The findings suggest that, similar to HICs, increased surveillance and advanced diagnostic practices in some LIMCs has produced an epidemic of thyroid cancer diagnoses.
Thyroid cancer (TC) incidence is rising in many countries, but the corresponding mortality is constant or declining. Incidence increases appear largely restricted to small papillary TC in ...young/middle-age individuals. We compared age-specific incidence rates across countries and time periods in order to estimate the fraction of TC possibly attributable to increased surveillance of the thyroid gland (diagnostic changes) following the introduction of neck ultrasonography in the 1980s.
We focused on high-resource countries, including four Nordic countries, England and Scotland, France, Italy, the United States, Australia, Japan, and the Republic of Korea. Before the 1970s, TC incidence in Nordic countries increased proportionally to the second power of age, consistent with the multistage model of carcinogenesis. Using this historical observation for reference, we attributed the progressive departure from linearity of the age curves in each country to an increased detection of asymptomatic disease in young/middle-age individuals. The proportion of cases attributable to diagnostic changes was estimated from the difference between observed rates and those expected using the Nordic countries as reference.
Diagnostic changes may account for ≥60% of TC cases diagnosed in 2003-2007 in women aged under 80 years in France, Italy, the United States, Australia, and the Republic of Korea, and approximately 50% in other assessed countries, except Japan (30%). The proportions attributable to diagnostic changes were higher in countries with largest incidence increases and were consistent across sexes, although increases were smaller and delayed in men.
A large proportion of TC cases diagnosed in high-resource countries in the last two decades are likely to be due to diagnostic changes. This proportion has progressively increased over time, and it is likely to grow further in the future. Since there is evidence of harm but no proof of benefit from the intense scrutiny of the thyroid, the dangers of overdiagnosis and overtreatment of TC should be urgently addressed.
The synergistic effect of tobacco smoking and alcohol consumption on the risk of head and neck cancers has been mainly investigated as a cross-product of categorical exposure, thus leading to loss of ...information. We propose a bi-dimensional logistic spline model to investigate the interacting dose-response relationship of two continuous exposures (i.e., ethanol intake and tobacco smoking) on the risk of head and neck cancers, representing results through three-dimensional graphs. This model was applied to a pool of hospital-based case-control studies on head and neck cancers conducted in Italy and in the Vaud Swiss Canton between 1982 and 2000, including 1569 cases and 3147 controls. Among never drinkers and for all levels of ethanol intake, the risk of head and neck cancers steeply increased with increasing smoking intensity, starting from 1 cigarette/day. The risk associated to ethanol intake increased with incrementing exposure among smokers, and a threshold effect at approximately 50 g/day emerged among never smokers. Compared to abstainers from both tobacco and alcohol consumption, the combined exposure to ethanol and/or cigarettes led to a steep increase of cancer risk up to a 35-fold higher risk (95 % confidence interval 27.30-3.61) among people consuming 84 g/day of ethanol and 10 cigarettes/day. The highest risk was observed at the highest levels of alcohol and tobacco consumption. Our findings confirmed a combined effect of tobacco smoking and alcohol drinking on head and neck cancers risk, providing evidence that bi-dimensional spline models could be a feasible and flexible method to explore the pattern of risks associated to two interacting continuous-exposure variables.
To estimate net survival and cancer cure fraction (CF), i.e. the proportion of patients no longer at risk of dying from cancer progression/relapse, a clear distinction needs to be made between ...mortality from cancer and from other causes. Conventionally, CF is estimated assuming no excess mortality compared to the general population.
A new modelling approach, that corrects for patients’ extra risk of dying (RR) from causes other than the diagnosed cancer, was considered to estimate both indicators. We analysed EUROCARE-6 data on head and neck (H&N), colorectal, and breast cancer patients aged 40–79, diagnosed from 1998 to 2002 and followed-up to 31/12/2014, provided by 65 European cancer registries.
Young male H&N cancer patients have 4 times the risk of dying from other causes than their peers, this risk decreases with age to 1.6. Similar results were observed for female. We observed an absolute increase in CF of 30 % using the new model instead of the conventional one. For colorectal cancer, CF with the new model increased by a maximum of 3 % for older patients and the RR ranged from 1 to 1.2 for both sexes. CF of female breast cancer ranged from 73 % to 79 % using the new cure model, with RR between 1.2 and 1.4.
Not considering a RR> 1 leads to underestimate the proportion of patients not bound to die of their diagnosed cancer. Estimates of cancer mortality risk have an important impact on patients’ quality of life.
•A new cure model accounting for higher risk of death from other causes was applied.•We provide the proportion of patients that will not dying from cancer progression.•The impact of ignoring a relative risk of death from other causes> 1 is relevant•Cure indicators are important to decision-making and to improve patients’ awareness•Estimates of cancer mortality risk have an impact on patients’ quality of life.
Adherence to Mediterranean diet has been consistently associated with a reduced mortality in the general population, but evidence for women with breast cancer is scanty.
A cohort of 1453 women with ...breast cancer diagnosed between 1991 and 1994 in northern Italy was followed-up for vital status for 15 years after diagnosis. The pre-diagnostic habitual diet was assessed through a structured questionnaire and adherence to the Mediterranean diet was evaluated through the Mediterranean Diet Score. Hazard ratios (HR) of death with confidence intervals (CI) were estimated using Cox model, adjusting for potential confounders.
Compared to women who scarcely adhere to the Mediterranean diet (
= 332, 22.8%), those highly adherent (
= 500, 34.4%) reported higher intakes of carbohydrates, mono-unsaturated and poly-unsaturated fatty acids, vitamins, folate, and carotenoids, and lower intakes of cholesterol and animal proteins. Adherence to the Mediterranean diet was associated with a better prognosis: 15-year overall survival of 63.1% for high and 53.6% for low adherence, respectively (
= 0.013). HR for all-cause mortality was 0.72 (95% CI: 0.57-0.92) and HR for breast cancer mortality was 0.65 (95% CI: 0.43-0.98) for women 55 years and older. No significant association emerged for breast cancer mortality in the total cohort.
Although dietary habits may have changed after breast cancer diagnosis, these findings indicate that women who ate according to the Mediterranean dietary pattern prior to their diagnosis may have greater chance of a favorable prognosis after breast cancer diagnosis compared to those who did not.
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