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Grudeva-Popova J.,Medical university-Plovdiv | Nenova I.,Medical university-Plovdiv | Mateva N.,Medical university-Plovdiv | Ananoshtev N.,Comprehensive Oncology Center | And 2 more authors.
Journal of B.U.ON. | Year: 2013

Purpose: To establish the characteristics and prognosis of newly diagnosed patients with non-Hodgkin lymphoma (NHL), who were carriers of hepatitis B (HBV) and C (HCV) viral infection. Methods: 542 patients with NHL, diagnosed and treated in the University Hospital "Sv. Georgi", Plovdiv, were retrospectively analysed. Two NHL patient groups were created - the study group, consisting of 33 patients with NHL positive for HBV and HCV, and the control group, consisting of 40 randomly assigned patients with NHL and negative serology for hepatitis. Study and control groups were compared for basic characteristics and survival. Results: The prevalence of hepatitis B surface antigen (HBsAg) among newly diagnosed patients was 5.72% and of HCV 1.84%. Association with hepatitis viruses was more frequent in indolent than in aggressive NHLs (p=0.044). Liver dysfunction was registered more often in the study group (p=0.002). Reactivation of HBV infection was registered in 5 patients (12.19%) from the study group. There was no statistically significant difference between survival rate of patients in the study group and in the control group (p=0.738). Conclusion: Hepatitis virus carrier state did not alter significantly the clinical course and disease prognosis (remission rates and survival) in our patient group. We recommend the routine testing for hepatitis infection in patients newly diagnosed with NHL in order to collect more data needed for the establishment of a possible causal relationship between hepatitis viruses and NHL. Since antiviral prophylaxis could positively impact the course of lymphoma treatment, national guidelines for the management of patients with hepatitis infection and NHL will prove to be necessary for the clinical practice.

Davies C.,University of Oxford | Pan H.,University of Oxford | Godwin J.,Glasgow Caledonian University | Gray R.,University of Oxford | And 34 more authors.
The Lancet | Year: 2013

Background For women with oestrogen receptor (ER)-positive early breast cancer, treatment with tamoxifen for 5 years substantially reduces the breast cancer mortality rate throughout the first 15 years after diagnosis. We aimed to assess the further effects of continuing tamoxifen to 10 years instead of stopping at 5 years. Methods In the worldwide Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) trial, 12 894 women with early breast cancer who had completed 5 years of treatment with tamoxifen were randomly allocated to continue tamoxifen to 10 years or stop at 5 years (open control). Allocation (1:1) was by central computer, using minimisation. After entry (between 1996 and 2005), yearly follow-up forms recorded any recurrence, second cancer, hospital admission, or death. We report effects on breast cancer outcomes among the 6846 women with ER-positive disease, and side-effects among all women (with positive, negative, or unknown ER status). Long-term follow-up still continues. This study is registered, number ISRCTN19652633. Findings Among women with ER-positive disease, allocation to continue tamoxifen reduced the risk of breast cancer recurrence (617 recurrences in 3428 women allocated to continue vs 711 in 3418 controls, p=0•002), reduced breast cancer mortality (331 deaths vs 397 deaths, p=0•01), and reduced overall mortality (639 deaths vs 722 deaths, p=0•01). The reductions in adverse breast cancer outcomes appeared to be less extreme before than after year 10 (recurrence rate ratio [RR] 0•90 [95% CI 0•79-1•02] during years 5-9 and 0•75 [0•62-0•90] in later years; breast cancer mortality RR 0•97 [0•79-1•18] during years 5-9 and 0•71 [0•58-0•88] in later years). The cumulative risk of recurrence during years 5-14 was 21•4% for women allocated to continue versus 25•1% for controls; breast cancer mortality during years 5-14 was 12•2% for women allocated to continue versus 15•0% for controls (absolute mortality reduction 2•8%). Treatment allocation seemed to have no effect on breast cancer outcome among 1248 women with ER-negative disease, and an intermediate effect among 4800 women with unknown ER status. Among all 12 894 women, mortality without recurrence from causes other than breast cancer was little affected (691 deaths without recurrence in 6454 women allocated to continue versus 679 deaths in 6440 controls; RR 0•99 [0•89-1•10]; p=0•84). For the incidence (hospitalisation or death) rates of specific diseases, RRs were as follows: pulmonary embolus 1•87 (95% CI 1•13-3•07, p=0•01 [including 0•2% mortality in both treatment groups]), stroke 1•06 (0•83-1•36), ischaemic heart disease 0•76 (0•60-0•95, p=0•02), and endometrial cancer 1•74 (1•30-2•34, p=0•0002). The cumulative risk of endometrial cancer during years 5-14 was 3•1% (mortality 0•4%) for women allocated to continue versus 1•6% (mortality 0•2%) for controls (absolute mortality increase 0•2%). Interpretation For women with ER-positive disease, continuing tamoxifen to 10 years rather than stopping at 5 years produces a further reduction in recurrence and mortality, particularly after year 10. These results, taken together with results from previous trials of 5 years of tamoxifen treatment versus none, suggest that 10 years of tamoxifen treatment can approximately halve breast cancer mortality during the second decade after diagnosis. Funding Cancer Research UK, UK Medical Research Council, AstraZeneca UK, US Army, EU-Biomed.

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