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Bantema-Joppe E.J.,University of Groningen | De Munck L.,Comprehensive Cancer Center North East | Visser O.,Comprehensive Cancer Center Amsterdam | Willemse P.H.B.,University of Groningen | And 4 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2011

Purpose: In young women, breast-conserving therapy (BCT), i.e., lumpectomy followed by radiotherapy, has been associated with an increased risk of local recurrence. Still, there is insufficient evidence that BCT impairs survival. The aim of our study was to compare the effect of BCT with mastectomy on overall survival (OS) in young women with early-stage breast cancer. Methods and Materials: From two Dutch regional population-based cancer registries (covering 6.2 million inhabitants) 1,453 women <40 years with pathologically T1N0-1M0 breast cancer were selected. Cox regression survival analysis was used to study the effect of local treatment (BCT vs. mastectomy) stratified for nodal stage on survival and corrected for tumor size, age, period of diagnosis, and use of adjuvant systemic therapy. Results: With a median follow-up of 9.6 years, 10-year OS was 83% after BCT and 78% after mastectomy, respectively (unadjusted hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.09-1.72). In N0-patients, 10-year OS was 84% after BCT and 81% after mastectomy and local treatment was not associated with differences in OS (HR 1.19; 95% CI, 0.89-1.58; p = 0.25). Within the N1-patient group, OS was better after BCT compared with mastectomy, 79% vs. 71% at 10 years (HR 1.91; 95% CI, 1.28-2.84; p = 0.001) and in patients treated with adjuvant hormonal therapy (HR 0.34; 95% CI, 0.18-0.66; p = 0.001). Conclusions: In this large population-based cohort of early-stage young breast cancer patients, 10-year OS was not impaired after BCT compared with mastectomy. Patients with 1 to 3 positive lymph nodes had better prognosis after BCT than after mastectomy. © 2011 Elsevier Inc.


Schaapveld M.,Comprehensive Cancer Center Amsterdam | Schaapveld M.,Netherlands Cancer Institute | Visser O.,Comprehensive Cancer Center Amsterdam | Siesling S.,Comprehensive Cancer Center North East | And 2 more authors.
European Journal of Cancer | Year: 2010

This study assesses whether new treatment strategies developed in clinical trials translate into improved survival for multiple myeloma (MM) patients in the Netherlands. All patients diagnosed with MM in the Northern part of the Netherlands between 1989 and 2005 were retrieved from two regional population-based cancer registries. Information on study participation was derived from linkage with trial information systems. The effect of period of diagnosis (1989-1992, 1993-1996, 1997-2000, 2001-2005), age (<50, 50-65, 66-74, ≥75), gender, Salmon-Durie (SD) stage, trial participation and treatment on relative survival were studied. In total 4985 patients were included. When trial participation was analysed for exact periods in which trials were open, 16% of patients aged ≤65 years with SD-stage I and 38% with SD-stage II or III were enrolled compared to 2% of patients aged >65 years with SD-stage I and 5% with SD-stage II or III. Relative survival decreased with age (p < .001), with advanced stage (p < .001) and was better for patients enrolled in trials (p < .001). Five-year relative survival increased from 34% (95% confidence interval (95% CI) 28-39%) in 1989-1992 to 56% (95% CI 50-61%) in 2001-2005 for patients ≤65 years. The excess mortality was 37% lower in 2001-2005 than in 1989-1992 for these patients, adjusted for age, stage, trial participation and gender (p < .001). Survival did not improve for older patients. In conclusion: MM survival improved among younger but not among older patients since the mid-1990s. The improved survival of younger patients coincided with increasing trial participation and increasing use of high-dose chemotherapy and autologous stem-cell transplantation. © 2009 Elsevier Ltd. All rights reserved.


Mook S.,Netherlands Cancer Institute | Van 'T Veer L.J.,Netherlands Cancer Institute | Rutgers E.J.,Netherlands Cancer Institute | Ravdin P.M.,University of Texas Health Science Center at San Antonio | And 4 more authors.
Journal of the National Cancer Institute | Year: 2011

BackgroundMammographic screening has led to a proportional shift toward earlier-stage breast cancers at presentation. We assessed whether the method of detection provides prognostic information above and beyond standard prognostic factors and investigated the accuracy of predicted overall and breast cancer-specific survival by the computer tool Adjuvant! among patients with screen-detected, interval, and nonscreening-related carcinomas.MethodsWe studied 2592 patients with invasive breast cancer who were treated at the Netherlands Cancer Institute from January 1, 1990, through December 31, 2000. Overall and breast cancer-specific survival probabilities among patients with mammographically screen-detected (n = 958), interval (n = 417), and nonscreening-related (n = 1217) breast carcinomas were compared. Analyses were adjusted for clinicopathologic characteristics and adjuvant systemic therapy. Because of gradual implementation of population-based screening in the Netherlands, analyses were stratified a priori according to two periods of diagnosis. All statistical tests were two-sided.ResultsScreen detection was associated with reduced mortality (adjusted hazard ratio for all-cause mortality = 0.74, 95% confidence interval = 0.63 to 0.87, P <. 001, and adjusted hazard ratio for breast cancer-specific mortality = 0.62, 95% confidence interval = 0.50 to 0.78, P <. 001, respectively) compared with nonscreening-related detection. The absolute adjusted reduction in breast cancer-specific mortality was 7% at 10 years. The prognostic value of the method of detection was independent of the period of diagnosis and was similar across tumor size and lymph node status categories, indicating its prognostic value beyond stage migration. Adjuvant! underestimated breast cancer-specific survival in patients with screen-detected (-3.2%) and interval carcinomas (-5.4%).ConclusionsScreen detection was found to be independently associated with better prognosis for overall and breast cancer-specific survival and to provide prognostic information beyond stage migration among patients with invasive breast cancer. We propose that the method of detection should be taken into account when estimating individual prognosis. © 2011 The Author.


Asadzadeh Vostakolaei F.,Radboud University Nijmegen | Karim-Kos H.E.,Erasmus University Rotterdam | Janssen-Heijnen M.L.G.,Comprehensive Cancer Center South | Visser O.,Comprehensive Cancer Center Amsterdam | And 3 more authors.
European Journal of Public Health | Year: 2011

Background: The complement of the cancer mortality to incidence ratio [1-(M/I)] has been suggested as a valid proxy for 5-year relative survival. Whether this suggestion holds true for all types of cancer has not yet been adequately evaluated. Methods: We used publicly available databases of cancer incidence, cancer mortality and relative survival to correlate relative survival estimates and 1-(M/I) estimates from Denmark, Finland, Iceland, Norway, Sweden, the USA and the Netherlands. We visually examined for which tumour sites 5-year relative survival cannot simply be predicted by the 1-(M/I) and evaluated similarities between countries. Results: Country-specific linear regression analyses show that there is no systematic bias in predicting 5-year relative survival by 1-(M/I) in five countries. There is a small but significant systematic underestimation of survival from prognostically poor tumour sites in two countries. Furthermore, the 1-(M/I) overestimates survival from oral cavity and liver cancer with >10 in at least two of the seven countries. By contrast, the proxy underestimates survival from soft tissue, bone, breast, prostate and oesophageal cancer, multiple myeloma and leukaemia with >10 in at least two of the seven countries. Conclusion: The 1-(M/I) is a good approximation of the 5-year relative survival for most but not all tumour sites. © The Author 2010. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.


van de Schans S.A.M.,Comprehensive Cancer Center South | Issa D.E.,VU University Amsterdam | Visser O.,Comprehensive Cancer Center Amsterdam | Nooijen P.,Robert Bosch GmbH | And 6 more authors.
Annals of Oncology | Year: 2012

Background: We studied progress in the fight against non-Hodgkin's lymphoma (NHL) in the Netherlands by describing the changes in incidence, treatment, relative survival, and mortality during 1989-2007. Patients and methods: We included all adult patients with NHL [i.e. all mature B-, T-, and natural killer (NK) cell neoplasms, with the exception of plasma cell neoplasms], newly diagnosed in the period 1989-2007 and recorded in the Netherlands Cancer Registry (n = 55 069). Regular mortality data were derived from Statistics Netherlands. Followup was completed up to 1 January 2009. Annual percentages of change in incidence, mortality, and relative survival were calculated. Results: The incidence of indolent B-cell and T- and NK-cell neoplasms rose significantly (estimated annual percentage change = 1.2% and 1.3%, respectively); incidence of aggressive B-cell neoplasms remained stable. Mortality due to NHL remained stable between 1989 and 2003, and has decreased since 2003. Five-year relative survival rates rose from 67% to 75%, and from 43% to 52%, respectively, for indolent and aggressive mature B-cell neoplasms, but 5-year survival remained stable at 48% for T- and NK-cell neoplasms. Conclusions: In the Netherlands, incidence of indolent mature B-cell and mature T- and NK-cell neoplasms has increased since 1989 but remained stable for aggressive neoplasms. Survival increased for all mature B-cell neoplasms, preceding a declining mortality and increased prevalence of NHL (17 597 on 1 January 2008). © The Author 2011. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


Elferink M.A.G.,Comprehensive Cancer Center North East | Siesling S.,Comprehensive Cancer Center North East | Siesling S.,University of Twente | Visser O.,Comprehensive Cancer Center Amsterdam | And 5 more authors.
Annals of Oncology | Year: 2011

Background: Adequate lymph node (LN) evaluation is important for planning treatment in patients with colon cancer. Aims of this study were to identify factors associated with adequate nodal examination and to determine its relationship with stage distribution and survival. Patients and methods: Data from patients with colon carcinoma stages I-III who underwent surgical treatment and diagnosed in the period 2000-2006 were retrieved from the Netherlands Cancer Registry. Multilevel logistic analysis was carried out to examine the influence of relevant factors on the number of evaluated LNs. The relationship with survival was analysed using Cox regression analysis. Results: The number of examined LN was determined for 30 682 of 33 206 tumours. Median number of evaluated LN was 8, ranging from 4 to 15 between pathology laboratories. Females, younger patients, right-sided pN+ tumours with higher pT stage and patients diagnosed in an academic centre were less likely to have nine or less LN evaluated. Unexplained variation between hospitals and pathology laboratories remained, leading to differences in stage distribution. With increasing number of evaluated LN, the risk of death decreased. Conclusion: There was large diversity in nodal examination among patients with colon cancer, leading to differences in stage distribution and being associated with survival. © The Author 2010. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


Derksen J.W.,Spaarne Ziekenhuis Hoofddorp | Visser O.,Comprehensive Cancer Center Amsterdam | de la Riviere G.B.,St Lucas Andreas Hospital | Meuleman E.J.,University of Amsterdam | And 2 more authors.
World Journal of Urology | Year: 2013

Purpose: To obtain insight into demographical factors, histology and survival rates of females diagnosed with primary urethral cancer and to determine favourable treatment. Methods: Data from 91 females with primary urethral carcinoma, age varying from 15 to 85 years, registered between 1989 and 2008 at the National Cancer Registry of the Netherlands were used for this study. Demographical factors, incidence rate, morphology and tumour stage according to TNM classification were analysed. Kaplan-Meier survival curves were constructed and stratified by stage, histological type and treatment modality. Results: The overall crude annual incidence was 0. 7 per million women with a peak incidence in the age group of 80-84 years. Analysis of the morphology showed urothelial cell carcinoma (UCC) in 45 %, squamous cell carcinoma (SCC) in 19 %, adenocarcinoma (AC) in 29 %, and unknown or undifferentiated carcinoma accounted for 6 %. Almost half of patients (46 %) had advanced disease at time of diagnosis and was mainly treated with surgery and/or radiotherapy. The 5-year survival rates of stage 0-II, stage III and stage IV were 67, 53 and 17 %, respectively. The 5-year survival rates of SCC, UCC and AC were 64, 61 and 31 %, respectively. Conclusions: Female primary urethral carcinoma is a rare condition, and the majority of patients were aged above 65 years. Almost half of patients have advanced disease upon diagnosis. TNM stage and histological type of disease are the most determining factors for survival. Extended surgery with or without radiotherapy seems to be the most favourable treatment. Awareness and early diagnosis are important to improve survival. © 2012 Springer-Verlag.


Wouters M.W.J.M.,Netherlands Cancer Institute | Jansen-Landheer M.L.E.A.,Comprehensive Cancer Center Amsterdam | Van De Velde C.J.H.,Quality of Cancer Care Task Force of the Dutch Cancer Society | Van De Velde C.J.H.,Leiden University
European Journal of Surgical Oncology | Year: 2010

Background: In 2007 the Dutch Cancer Society formed a 'Quality of Cancer Care' taskforce comprising medical specialists, from all disciplines involved in the care for cancer patients. This taskforce was charged with the evaluation of quality of cancer care in the Netherlands and the development of strategies for improvement. Objective: The experts first focused on the relation between procedural volume and patient outcome and later aimed to identify other factors associated with high and low quality of the care provided in different regions and (types of) hospitals in the Netherlands. The question if cancer care in the Netherlands could be organized differently to assure high quality of care for all patients, was the main subject of investigation. Methods: An extensive review of the literature on infrastructure, volume and specialization on the one hand and outcome on the other was performed. In addition, a meta-analysis of the volume-outcome relationship for pancreatectomies, bladder, lung, colorectal and breast cancer resections was performed. Finally, variation in quality of cancer care between regions, groups of hospitals and individual hospitals in our country was investigated on data from the Netherlands Cancer Registry. Results: In the Netherlands quality of care varies by hospital and region. These differences are not limited to surgical procedures and postoperative mortality, but are also demonstrated in other parts of the care process. Differences are only partly explained by differences in infrastructure, procedural volume and specialization between hospitals. Essential information on differences in case mix between these hospitals are lacking from the Netherlands Cancer Registry. More detailed clinical data are needed to reveal the mechanisms behind the differences in quality of care between Dutch hospitals. Conclusion: On a population level, there is potential for improvement of outcome for cancer patients in the Netherlands by reducing variation in optimal treatment rates between hospitals. Not only treatment of tumours with a low incidence but also other complex or high risk cancer procedures should be provided in a specialized setting, with the right infrastructure, sufficient volume and adequate expertise. In addition, outcomes should be monitored continuously and fed back to individual caregivers. © 2010 Elsevier Ltd. All rights reserved.


Reichgelt B.A.,Netherlands Cancer Institute | Reichgelt B.A.,Leiden University | Visser O.,Comprehensive Cancer Center Amsterdam
European Journal of Cancer | Year: 2011

Background: Merkel cell carcinoma (MCC) is a rare and highly malignant neuroendocrine tumour, predominantly located on sun-exposed areas of the skin. The aim of this study was to evaluate data in the Netherlands concerning incidence, stage, age, sex, location, treatment and survival. Methods: Using nationwide data from the Netherlands Cancer Registry from 1993 to 2007, we compared 808 MCCs with European data and the US Surveillance, Epidemiology and End Results (SEER) Program. Results: The annual age standardised incidence rate per million of MCC increased from 1.7 in 1993-1997 to 3.5 in 2003-2007. Median age at diagnosis was 76 years. The most common location was the head and neck. Three quarters of patients had localised disease, 16% regional and 6% distant metastasis. Surgery was performed in 89% of patients, with adjuvant radiotherapy in 26% of them. One-, five- and ten-year relative survival was 85%, 62% and 47%, respectively. Negative predictive factors for the risk of death were male sex, increasing T-stage, regional and distant metastasis and no treatment. Survival after combined surgery and radiotherapy was borderline significantly better than surgery alone (HR 0.82, p = 0.09). Our results are comparable to SEER data except for the ratio localised/regional disease. We observed less regional cases (16% versus 31%); while ten-year survival of localised cases was lower (51% versus 71%). Conclusions: MCC incidence rates have doubled in the Netherlands over the period 1993-2007. The relatively high number of localised cases and their relatively low survival as compared to SEER data suggest that a substantial proportion is undertreated. © 2011 Published by Elsevier Ltd.


de Vries R.R.,Netherlands Cancer Institute | Visser O.,Comprehensive Cancer Center Amsterdam | Nieuwenhuijzen J.A.,Netherlands Cancer Institute | Horenblas S.,Netherlands Cancer Institute
World Journal of Urology | Year: 2010

Purpose: To evaluate the effect of volume of cystectomies in the Greater Amsterdam region on postoperative outcomes. Methods: All primary bladder tumours diagnosed between 1989 and 2003 were selected from the Amsterdam Cancer Registry, a population-based cancer registry (population 3.0 million). For all patients who underwent cystectomy during 1989-2003 at 20 participating hospitals, medical records were reviewed for information on postoperative mortality, locoregional recurrences and relative risk of death. To assess the effect of volume, outcomes at an oncology centre and low-volume hospitals were compared. Results: During 1989-2003 a total of 1,185 cystectomies were performed in 20 hospitals of the Greater Amsterdam region. Postoperative mortality was 3.2%. During 1989-1997, 8% of cystectomies were performed at the oncology centre, increasing to 30% in 1998-2003. Although postoperative mortality at this centre decreased from 4.0% in 1989-1997 to 1.1% in 1998-2003, the latter percentage was not statistically significantly different from the other hospitals during 1998-2003 (OR 0.3; P = 0.09). No statistically significant difference in locoregional recurrence rate and in the relative risk of death was observed between the oncology centre and all other hospitals combined. Conclusions: We observed a lower postoperative mortality rate in the oncology centre compared to the low-volume hospitals; however, this difference did not reach statistical significance. We could neither prove a statistically significant relation between hospital volume, local recurrence rate and survival after cystectomy. To answer the question if centralisation of cystectomies is beneficial more procedures have to be compared. © 2010 Springer-Verlag.

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