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Lepage C.,University of Burgundy | Ciccolallo L.,Fondazione Istituto Nazionale Dei Tumori | De Angelis R.,Istituto Superiore di Sanita | De Angelis R.,Centro Nazionale Of Epidemiologia | And 63 more authors.
International Journal of Cancer | Year: 2010

The aim of this study was to report on malignant digestive endocrine tumours (MDET) prognosis in several European countries. We analysed survival data from 19 cancer registries in 12 European countries on 3,715 MDET diagnosed between 1985 and 1994. The overall 5-year survival rate was 47.5%. It was 58.1% for differentiated MDET and 8.1% for small-cell MDET (p < 0.001), 55.9% for patients under 65 and 37.0% for older patients. Survival rates for small intestinal and colorectal were higher than for the other sites. The 5-year relative survival rates were 60.3% in Northern Europe, 53.6% in Western Continental Europe, 42.5% in the UK, 37.6% in Eastern Europe (p < 0.001). Among well-differentiated pancreatic tumours, 5-year relative survival was 55.6% for insulinoma, 48.4% for gastrinoma, 33.4% for glucagonoma, 28.8% for carcinoïd tumours and 49.9% for non-functioning tumours. The relative excess risk of death was significantly lower in Western Continental Europe and Northern Europe and significantly higher in Easter European compared to the UK. MDET differentiation, site, geographic area, age and sex, were independent prognostic factors. Overall, in Europe approximately half of the patients with MDET survive 5 years after the initial diagnosis. Prognosis varies with tumour differentiation, anatomic site and histological type. There are significant differences in survival from MDET among European countries, independently of other prognostic factors. Source


Maringe C.,London School of Hygiene and Tropical Medicine | Walters S.,London School of Hygiene and Tropical Medicine | Butler J.,St. Bartholomews and Royal Marsden Hospitals | Coleman M.P.,London School of Hygiene and Tropical Medicine | And 16 more authors.
Gynecologic Oncology | Year: 2012

Objective: We investigate what role stage at diagnosis bears in international differences in ovarian cancer survival. Methods: Data from population-based cancer registries in Australia, Canada, Denmark, Norway, and the UK were analysed for 20,073 women diagnosed with ovarian cancer during 2004-07. We compare the stage distribution between countries and estimate stage-specific one-year net survival and the excess hazard up to 18 months after diagnosis, using flexible parametric models on the log cumulative excess hazard scale. Results: One-year survival was 69% in the UK, 72% in Denmark and 74-75% elsewhere. In Denmark, 74% of patients were diagnosed with FIGO stages III-IV disease, compared to 60-70% elsewhere. International differences in survival were evident at each stage of disease; women in the UK had lower survival than in the other four countries for patients with FIGO stages III-IV disease (61.4% vs. 65.8-74.4%). International differences were widest for older women and for those with advanced stage or with no stage data. Conclusion: Differences in stage at diagnosis partly explain international variation in ovarian cancer survival, and a more adverse stage distribution contributes to comparatively low survival in Denmark. This could arise because of differences in tumour biology, staging procedures or diagnostic delay. Differences in survival also exist within each stage, as illustrated by lower survival for advanced disease in the UK, suggesting unequal access to optimal treatment. Population-based data on cancer survival by stage are vital for cancer surveillance, and global consensus is needed to make stage data in cancer registries more consistent. © 2012 Elsevier Inc. Source


Emmett M.,Trent Cancer Registry | Goos P.,University of Antwerp | Goos P.,Erasmus University Rotterdam | Stillman E.C.,University of Sheffield
Quality and Reliability Engineering International | Year: 2011

The goal of response surface designs is typically to make precise predictions. A commonly used prediction-based design selection criterion isitV-optimality, which seeks designs that minimize the average prediction variance over the entire experimental region. We propose an alternative criterion, which seeks designs that yield small prediction variances particularly in those parts of the experimental region where a response is expected to be interesting, important, or desirable. The new criterion is a weighted V-optimality criterion, which attaches higher weights to areas with such interesting outcomes. The weights in the new criterion are derived from a logistic regression model. We illustrate the value of the new criterion using an example from the automotive industry. © 2011 John Wiley & Sons, Ltd. Source


Meechan D.,Trent Cancer Registry | Gildea C.,Trent Cancer Registry | Hollingworth L.,Trent Cancer Registry | Richards M.A.,National Cancer Action Team | And 2 more authors.
British Journal of General Practice | Year: 2012

Background: A 2-Week Wait (2WW) referral pathway for earlier diagnosis of suspected cancer was introduced in England in 2000. Nevertheless, a significant proportion of patients with cancer are diagnosed by other routes (detection rate), only a small proportion of 2WW referrals have cancer (conversion rate) and there is considerable between-practice variation. Aim: This study examined use by practices of the 2WW referral in relation to all cancer diagnoses. Design and setting: A cross-sectional analysis of data extracted from the Cancer Waiting Times Database for all 2WW referrals in 2009 and for all patients receiving a first definitive treatment in the same year. Method: The age standardised referral ratio, conversion rate, and detection rate were calculated for all practices in England and the correlation coefficient for each pair of measures. The median detection rate was calculated for each decile of practices ranked by conversion rate and vice versa, performing nonparametric tests for trend in each case. Results: Data for 8049 practices, 865 494 referrals, and 224 984 cancers were analysed. There were significant correlations between referral ratio and conversion rate (inverse) and detection rate (direct). There was also a direct correlation between conversion and detection rates. There was a significant trend in conversion rate for deciles of detection rate, and vice versa, with a marked difference between the lowest and higher deciles. Conclusion: There is a consistent relationship between 2WW referral conversion rate and detection rate that can be interpreted as representing quality of clinical practice. The 2WW referral rate should not be a measure of quality of clinical care. ©British Journal of General Practice. Source


Iyer R.,University College London | Gentry-Maharaj A.,University College London | Nordin A.,Network Intelligence | Burnell M.,University College London | And 22 more authors.
British Journal of Cancer | Year: 2015

Background:There are limited data on surgical outcomes in gynaecological oncology. We report on predictors of complications in a multicentre prospective study.Methods:Data on surgical procedures and resulting complications were contemporaneously recorded on consented patients in 10 participating UK gynaecological cancer centres. Patients were sent follow-up letters to capture any further complications. Post-operative (Post-op) complications were graded (I-V) in increasing severity using the Clavien-Dindo system. Grade I complications were excluded from the analysis. Univariable and multivariable regression was used to identify predictors of complications using all surgery for intra-operative (Intra-op) and only those with both hospital and patient-reported data for Post-op complications.Results:Prospective data were available on 2948 major operations undertaken between April 2010 and February 2012. Median age was 62 years, with 35% obese and 20.4% ASA grade ≥3. Consultant gynaecological oncologists performed 74.3% of operations. Intra-op complications were reported in 139 of 2948 and Grade II-V Post-op complications in 379 of 1462 surgeries. The predictors of risk were different for Intra-op and Post-op complications. For Intra-op complications, previous abdominal surgery, metabolic/endocrine disorders (excluding diabetes), surgical complexity and final diagnosis were significant in univariable and multivariable regression (P<0.05), with diabetes only in multivariable regression (P=0.006). For Post-op complications, age, comorbidity status, diabetes, surgical approach, duration of surgery, and final diagnosis were significant in both univariable and multivariable regression (P<0.05).Conclusions:This multicentre prospective audit benchmarks the considerable morbidity associated with gynaecological oncology surgery. There are significant patient and surgical factors that influence this risk. © 2015 Cancer Research UK. All rights reserved 0007 - 0920/15. Source

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