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  • 1. Andren, O.
    et al.
    Widmark, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Falt, A.
    Ulvskog, E.
    Davidsson, S.
    Thellenberg Karlsson, Camilla
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Hjalm-Eriksson, M.
    Cabazitaxel followed by androgen deprivation therapy (ADT) significantly improves time to progression in patients with newly diagnosed metastatic hormone sensitive prostate cancer (mHSPC): A randomized, open label, phase III, multicenter trial2017In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 28Article in journal (Other academic)
  • 2. Bergström, S.
    et al.
    Christensen, H. Nordahl
    Wiklund, F.
    Bergqvist, Michael
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    EGFR tyrosine kinase inhibitors in non-small cell lung cancer: Nationwide register-based cohort study in Sweden2018In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 29, p. 526-526Article in journal (Other academic)
  • 3. Bossi, A.
    et al.
    Dearnaley, D.
    McKenzie, M.
    Baskin-Bey, E.
    Tyler, R.
    Tombal, B.
    Freedland, S. J.
    Roach, M. , I I I
    Widmark, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Dicker, A. P.
    Wiegel, T.
    Shore, N.
    Smith, M.
    Yu, M.
    Kheoh, T.
    Thomas, S.
    Sandler, H. M.
    ATLAS: A phase 3 trial evaluating the efficacy of apalutamide (ARN-509) in patients with high-risk localized or locally advanced prostate cancer receiving primary radiation therapy2016In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 27Article in journal (Refereed)
  • 4. Chadeau-Hyam, M.
    et al.
    Vermeulen, R. C. H.
    Hebels, D. G. A. J.
    Castagne, R.
    Campanella, G.
    Portengen, L.
    Kelly, R. S.
    Bergdahl, Ingvar
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Faculty of Medicine, Department of Biobank Research.
    Melin, Beatrice
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Biobank Research. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Palli, D.
    Krogh, V.
    Tumino, R.
    Sacerdote, C.
    Panico, S.
    de Kok, T. M. C. M.
    Smith, M. T.
    Kleinjans, J. C. S.
    Vineis, P.
    Kyrtopoulos, S. A.
    Prediagnostic transcriptomic markers of Chronic lymphocytic leukemia reveal perturbations 10 years before diagnosis2014In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 25, no 5, p. 1065-1072Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    B-cell lymphomas are a diverse group of hematological neoplasms with differential etiology and clinical trajectories. Increased insights in the etiology and the discovery of prediagnostic markers have the potential to improve the clinical course of these neoplasms.

    METHODS:

    We investigated in a prospective study global gene expression in peripheral blood mononuclear cells of 263 incident B-cell lymphoma cases, diagnosed between 1 and 17 years after blood sample collection, and 439 controls, nested within two European cohorts.

    RESULTS:

    Our analyses identified only transcriptomic markers for specific lymphoma subtypes; few markers of multiple myeloma (N = 3), and 745 differentially expressed genes in relation to future risk of chronic lymphocytic leukemia (CLL). The strongest of these associations were consistently found in both cohorts and were related to (B-) cell signaling networks and immune system regulation pathways. CLL markers exhibited very high predictive abilities of disease onset even in cases diagnosed more than 10 years after blood collection.

    CONCLUSIONS:

    This is the first investigation on blood cell global gene expression and future risk of B-cell lymphomas. We mainly identified genes in relation to future risk of CLL that are involved in biological pathways, which appear to be mechanistically involved in CLL pathogenesis. Many but not all of the top hits we identified have been reported previously in studies based on tumor tissues, therefore suggesting that a mixture of preclinical and early disease markers can be detected several years before CLL clinical diagnosis.

  • 5. Chajes, V.
    et al.
    Assi, N.
    Biessy, C.
    Ferrari, P.
    Rinaldi, S.
    Slimani, N.
    Lenoir, G. M.
    Baglietto, L.
    His, M.
    Boutron-Ruault, M. C.
    Trichopoulou, A.
    Lagiou, P.
    Katsoulis, M.
    Kaaks, R.
    Kuehn, T.
    Panico, S.
    Pala, V.
    Masala, G.
    Bueno-de-Mesquita, H. B.
    Peeters, P. H.
    van Gils, C.
    Hjartaker, A.
    Olsen, K. Standahl
    Barnung, R. Borgund
    Barricarte, A.
    Redondo-Sanchez, D.
    Menendez, V.
    Amiano, P.
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Key, T.
    Khaw, K. T.
    Merritt, M. A.
    Riboli, E.
    Gunter, M. J.
    Romieu, I.
    A prospective evaluation of plasma phospholipid fatty acids and breast cancer risk in the EPIC study2017In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 28, no 11, p. 2836-2842Article in journal (Refereed)
    Abstract [en]

    Background: Intakes of specific fatty acids have been postulated to impact breast cancer risk but epidemiological data based on dietary questionnaires remain conflicting.

    Materials and methods: We assessed the association between plasma phospholipid fatty acids and breast cancer risk in a case–control study nested within the European Prospective Investigation into Cancer and Nutrition study. Sixty fatty acids were measured by gas chromatography in pre-diagnostic plasma phospholipids from 2982 incident breast cancer cases matched to 2982 controls. Conditional logistic regression models were used to estimate relative risk of breast cancer by fatty acid level. The false discovery rate (q values) was computed to control for multiple comparisons. Subgroup analyses were carried out by estrogen receptor (ER) and progesterone receptor expression in the tumours.

    Results: A high level of palmitoleic acid [odds ratio (OR) for the highest quartile compared with the lowest OR (Q4–Q1) 1.37; 95% confidence interval (CI), 1.14–1.64; P for trend = 0.0001, q value = 0.004] as well as a high desaturation index (DI16) (16:1n–7/16:0) [OR (Q4–Q1), 1.28; 95% C, 1.07–1.54; P for trend = 0.002, q value = 0.037], as biomarkers of de novo lipogenesis, were significantly associated with increased risk of breast cancer. Levels of industrial trans-fatty acids were positively associated with ER-negative tumours [OR for the highest tertile compared with the lowest (T3–T1)=2.01; 95% CI, 1.03–3.90; P for trend = 0.047], whereas no association was found for ER-positive tumours (P-heterogeneity =0.01). No significant association was found between n-3 polyunsaturated fatty acids and breast cancer risk, overall or by hormonal receptor.

    Conclusion: These findings suggest that increased de novo lipogenesis, acting through increased synthesis of palmitoleic acid, could be a relevant metabolic pathway for breast tumourigenesis. Dietary trans-fatty acids derived from industrial processes may specifically increase ER-negative breast cancer risk.

  • 6. Fedirko, V.
    et al.
    Lukanova, A.
    Bamia, C.
    Trichopolou, A.
    Trepo, E.
    Noethlings, U.
    Schlesinger, S.
    Aleksandrova, K.
    Boffetta, P.
    Tjonneland, A.
    Johnsen, N. F.
    Overvad, K.
    Fagherazzi, G.
    Racine, A.
    Boutron-Ruault, M. C.
    Grote, V.
    Kaaks, R.
    Boeing, H.
    Naska, A.
    Adarakis, G.
    Valanou, E.
    Palli, D.
    Sieri, S.
    Tumino, R.
    Vineis, P.
    Panico, S.
    Bueno-de-Mesquita, H. B(as).
    Siersema, P. D.
    Peeters, P. H.
    Weiderpass, E.
    Skeie, G.
    Engeset, D.
    Quiros, J. R.
    Zamora-Ros, R.
    Sanchez, M. J.
    Amiano, P.
    Huerta, J. M.
    Barricarte, A.
    Johansen, D.
    Lindkvist, B.
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Werner, Mårten
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Crowe, F.
    Khaw, K. T.
    Ferrari, P.
    Romieu, I.
    Chuang, S. C.
    Riboli, E.
    Jenab, M.
    Glycemic index, glycemic load, dietary carbohydrate, and dietary fiber intake and risk of liver and biliary tract cancers in Western Europeans2013In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 24, no 2, p. 543-553Article in journal (Refereed)
    Abstract [en]

    The type and quantity of dietary carbohydrate as quantified by glycemic index (GI) and glycemic load (GL), and dietary fiber may influence the risk of liver and biliary tract cancers, but convincing evidence is lacking. The association between dietary GI/GL and carbohydrate intake with hepatocellular carcinoma (HCC; N = 191), intrahepatic bile duct (IBD; N = 66), and biliary tract (N = 236) cancer risk was investigated in 477 206 participants of the European Prospective Investigation into Cancer and Nutrition cohort. Dietary intake was assessed by country-specific, validated dietary questionnaires. Hazard ratios and 95% confidence intervals were estimated from proportional hazard models. HBV/HCV status was measured in a nested case-control subset. Higher dietary GI, GL, or increased intake of total carbohydrate was not associated with liver or biliary tract cancer risk. For HCC, divergent risk estimates were observed for total sugar = 1.43 (1.17-1.74) per 50 g/day, total starch = 0.70 (0.55-0.90) per 50 g/day, and total dietary fiber = 0.70 (0.52-0.93) per 10 g/day. The findings for dietary fiber were confirmed among HBV/HCV-free participants [0.48 (0.23-1.01)]. Similar associations were observed for IBD [dietary fiber = 0.59 (0.37-0.99) per 10 g/day], but not biliary tract cancer. Findings suggest that higher consumption of dietary fiber and lower consumption of total sugars are associated with lower HCC risk. In addition, high dietary fiber intake could be associated with lower IBD cancer risk.

  • 7. Fedirko, V
    et al.
    Trichopolou, A
    Bamia, C
    Duarte-Salles, T
    Trepo, E
    Aleksandrova, K
    Nöthlings, U
    Lukanova, A
    Lagiou, P
    Boffetta, P
    Trichopoulos, D
    Katzke, VA
    Overvad, K
    Tjønneland, A
    Hansen, L
    Boutron-Ruault, MC
    Fagherazzi, G
    Bastide, N
    Panico, S
    Grioni, S
    Vineis, P
    Palli, D
    Tumino, R
    Bueno-de-Mesquita, HB
    Peeters, PH
    Skeie, G
    Engeset, D
    Parr, CL
    Jakszyn, P
    Sánchez, MJ
    Barricarte, A
    Amiano, P
    Chirlaque, M
    Quirós, JR
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Werner, Mårten
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Sonestedt, E
    Ericson, U
    Key, TJ
    Khaw, KT
    Ferrari, P
    Romieu, I
    Riboli, E
    Jenab, M
    Consumption of fish and meats and risk of hepatocellular carcinoma: the European Prospective Investigation into Cancer and Nutrition (EPIC)2013In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 24, no 8, p. 2166-2173Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: While higher intake of fish and lower consumption of red/processed meats have been suggested to play a protective role in the etiology of several cancers, prospective evidence for hepatocellular carcinoma (HCC) is limited, particularly in Western European populations.

    METHODS: The associations of fish and meats with HCC risk were analyzed in the EPIC cohort. Between 1992 and 2010, 191 incident HCC were identified among 477 206 participants. Baseline diet was assessed using validated dietary questionnaires. A single 24-h diet recall from a cohort subsample was used for calibration. Multivariable proportional hazard regression was utilized to estimate hazard ratios (HR) and 95% confidence intervals (CI). In a nested case-control subset (HCC = 122), HBV/HCV status and liver function biomarkers were measured.

    RESULTS: HCC risk was inversely associated with intake of total fish (per 20 g/day increase, HR = 0.83, 95% CI 0.74-0.95 and HR = 0.80, 95% CI 0.69-0.97 before and after calibration, respectively). This inverse association was also suggested after adjusting for HBV/HCV status and liver function score (per 20-g/day increase, RR = 0.86, 95% CI 0.66-1.11 and RR = 0.74, 95% CI 0.50-1.09, respectively) in a nested case-control subset. Intakes of total meats or subgroups of red/processed meats, and poultry were not associated with HCC risk.

    CONCLUSIONS: In this large European cohort, total fish intake is associated with lower HCC risk.

  • 8. Gonzalez, C. A.
    et al.
    Megraud, F.
    Buissonniere, A.
    Lujan Barroso, L.
    Agudo, A.
    Duell, E. J.
    Boutron-Ruault, M. C.
    Clavel-Chapelon, F.
    Palli, D.
    Krogh, V.
    Mattiello, A.
    Tumino, R.
    Sacerdote, C.
    Quiros, J. R.
    Sanchez-Cantalejo, E.
    Navarro, C.
    Barricarte, A.
    Dorronsoro, M.
    Khaw, K. -T
    Wareham, N.
    Allen, N. E.
    Tsilidis, K. K.
    Bueno-de-Mesquita, H. Bas
    Jeurnink, S. M.
    Numans, M. E.
    Peeters, P. H. M.
    Lagiou, P.
    Valanou, E.
    Trichopoulou, A.
    Kaaks, R.
    Lukanova-McGregor, A.
    Bergman, M. M.
    Boeing, H.
    Manjer, J.
    Lindkvist, B.
    Stenling, Roger
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Mortensen, L. M.
    Overvad, K.
    Olsen, A.
    Tjonneland, A.
    Bakken, K.
    Dumeaux, V.
    Lund, E.
    Jenab, M.
    Romieu, I.
    Michaud, D.
    Mouw, T.
    Carneiro, F.
    Fenge, C.
    Riboli, E.
    Helicobacter pylori infection assessed by ELISA and by immunoblot and noncardia gastric cancer risk in a prospective study: the Eurgast-EPIC project2012In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 23, no 5, p. 1320-1324Article in journal (Refereed)
    Abstract [en]

    In epidemiological studies, Helicobacter pylori infection is usually detected by enzyme-linked immunosorbent assay (ELISA). However, infection can spontaneously clear from the mucosa during the progression of atrophy and could lead to substantial under-detection of infection and underestimation of its effect on gastric cancer (GC) risk. Antibodies detected by western blot are known to persist longer after the loss of the infection. In a nested case-control study from the Eurogast-EPIC cohort, including 88 noncardia GC cases and 338 controls, we assessed the association between noncardia GC and H. pylori infection comparing antibodies detected by western blot (HELICOBLOT2.1) to those detected by ELISA (Pyloriset EIA-GIII((R))). By immunoblot, 82 cases (93.2%) were H. pylori positive, 10 of these cases (11.4%) were negative by ELISA and only 6 cases (6.8%) were negative by both ELISA and immunoblot. Multivariable odds ratio (OR) for noncardia GC comparing immunoglobulin G positive versus negative by ELISA was 6.8 [95% confidence interval (CI) 3.0-15.1], and by immunoblot, the OR was 21.4 (95% CI 7.1-64.4). Using a western blot assay, nearly all noncardia GC were classified as H. pylori positive and the OR was more than threefold higher than the OR assessed by ELISA, supporting the hypothesis that H. pylori infection is a necessary condition for noncardia GC.

  • 9. Gray, M.
    et al.
    Naredi, Peter
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Bacon, N.
    Kerr, D. J.
    Better value cancer care for the 21st century2011In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 22, no 12, p. 2541-2545Article in journal (Other (popular science, discussion, etc.))
  • 10. Holte, H.
    et al.
    Leppa, S.
    Bjorkholm, M.
    Fluge, O.
    Jyrkkio, S.
    Delabie, J.
    Sundstrom, C.
    Karjalainen-Lindsberg, M. -L
    Erlanson, Martin
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Kolstad, A.
    Fossa, A.
    Ostenstad, B.
    Lofvenberg, E.
    Nordstrom, M.
    Janes, R.
    Pedersen, L. M.
    Anderson, H.
    Jerkeman, M.
    Eriksson, M.
    Dose-densified chemoimmunotherapy followed by systemic central nervous system prophylaxis for younger high-risk diffuse large B-cell/follicular grade 3 lymphoma patients: results of a phase II Nordic Lymphoma Group study2013In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 24, no 5, p. 1385-1392Article in journal (Refereed)
    Abstract [en]

    Background: Many patients with aggressive B-cell lymphomas and high clinical risk score still die of lymphoma after conventional R-CHOP chemoimmunotherapy. We hypothesized that intensified chemoimmunotherapy including systemic central nervous system (CNS) prophylaxis improves outcome and reduces the incidence of CNS-related events. Patients and methods: Inclusion criteria were age 18-65 years, primary diffuse large B-cell lymphoma or grade III follicular lymphoma without clinical signs of CNS disease and negative cerebrospinal fluid cytology, age-adjusted International Prognostic Index 2-3 and WHO performance score 0-3. Treatment consisted of six courses of R-CHOEP-14 followed by a course of high-dose cytarabine and a course of high-dose methotrexate. Primary end point was failure-free survival (FFS) at 3 years. Results: A total of 156 eligible patients with a median age of 54 years (range 20-64) were included. Three toxic deaths were observed. Three-year overall survival (OS) and FFS rates (median observation time 52 months for survivors) were 81% and 65%, respectively. Seven patients experienced CNS relapse, all within 6 months. Conclusions: The results are promising with favorable 3-year OS and FFS rates, a low toxic death rate and a lower than expected number of CNS events. CNS progression might be further reduced by earlier CNS prophylaxis. CinicalTrials.gov.identifier: NCT01502982.

  • 11. Hussain, S. K.
    et al.
    Lenner, Per
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Sundquist, J.
    Hemminki, K.
    Influence of education level on cancer survival in Sweden2008In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 19, no 1, p. 156-162Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    While cancer survival at several sites has historically been shown to vary by education level, a current comprehensive assessment of survival following a cancer diagnosis in Sweden, a country with universal health care and cancer screening, has yet to be carried out.

    METHODS:

    Using the 2006 update of the Swedish Family-Cancer Database and Cox's proportional hazards regression methods, we calculate the adjusted hazard ratio (HR) and 95% confidence interval to estimate the influence of education level on site-specific cancer survival.

    RESULTS:

    Significant positive associations between education level and cancer survival were observed following a diagnosis of upper aerodigestive track cancer, colon cancer, pancreatic cancer, lung cancer, kidney cancer, urinary bladder cancer, melanoma, non-Hodgkin's lymphoma, breast cancer, endometrial cancer, cervical cancer, prostate cancer, and testicular cancer. Although the HRs differed between cancer sites, compared with women and men completing <9 years of education, university graduates were associated with a significant 40% improved survival for all cancer sites combined.

    CONCLUSIONS:

    Survival differences by education level were observed for both indolent and aggressive malignancies.

  • 12. Klintman, M.
    et al.
    Nilsson, Fredrik
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Bendahl, P. -O
    Ferno, M.
    Liljegren, G.
    Emdin, Stefan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Malmstrom, P.
    A prospective, multicenter validation study of a prognostic index composed of S-phase fraction, progesterone receptor status, and tumour size predicts survival in node-negative breast cancer patients: NNBC, the node-negative breast cancer trial2013In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 24, no 9, p. 2284-2291Article in journal (Refereed)
    Abstract [en]

    In a retrospective study on node-negative breast cancer, a prognostic index consisting of a proliferation factor, S-phase fraction (SPF), progesterone receptor status (PR), and tumour size identified one-third of patients as high risk, with a sixfold increased risk of breast cancer death. This prospective multicenter cohort study was set up to validate the index. In 576 T1-2N0 patients < 60 years, prospective analyses of PR and SPF were carried out. High risk was defined as >= 2 of the following: size > 20 mm, PR-negativity, and high SPF (in the absence of SPF, Bloom-Richardson grade 3). Median follow-up was 17.8 years. Thirty-one percent were high risk. In univariate analysis, the index was prognostic for breast cancer-specific survival after 5 years [hazard ratio (HR) = 4.7, 95% confidence interval (95% CI) 2.5-8.9], 10 years (HR = 2.2, 95% CI 1.5-3.3), and 15 years (HR = 1.7, 95% CI 1.2-2.5), and remained significant after adjustment for adjuvant medical treatment and age. In the 37% of patients with no risk factors, only one patient died of breast cancer the first 5 years. This prospective study validates a prognostic index consisting of a proliferation factor, PR-status, and tumour size. The index may be helpful for prognostic considerations and for selection of patients in need of adjuvant therapy.

  • 13. Krug, S.
    et al.
    Beyer, G.
    Javed, M. A.
    Le, N.
    Vinci, A.
    Morgan, R. D.
    Hubner, R.
    Valle, J. W.
    Wong, H.
    Chowdhury, S.
    Ma, Y. Ting
    Palmer, D.
    Maisonneuve, P.
    Neesse, A.
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Schober, M.
    Intensified chemotherapy for metastatic pancreatic cancer: interim analysis of a large retrospective pan-European database and real life evaluation2016In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 27Article in journal (Refereed)
  • 14. Le Rhun, E.
    et al.
    Weller, M.
    Brandsma, D.
    Van den Bent, M.
    de Azambuja, E.
    Henriksson, Roger
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology. Regional Cancer Center, Stockholm.
    Boulanger, T.
    Peters, S.
    Watts, C.
    Wick, W.
    Wesseling, P.
    Ruda, R.
    Preusser, M.
    EANO-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with leptomeningeal metastasis from solid tumours2017In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 28, p. 84-99Article in journal (Refereed)
  • 15. Muller, D. C.
    et al.
    Hodge, A. M.
    Fanidi, A.
    Albanes, D.
    Mai, X. M.
    Shu, X. O.
    Weinstein, S. J.
    Larose, T. L.
    Zhang, X.
    Han, J.
    Stampfer, M. J.
    Smith-Warner, S. A.
    Ma, J.
    Gaziano, J. M.
    Sesso, H. D.
    Stevens, V. L.
    McCullough, M. L.
    Layne, T. M.
    Prentice, R.
    Pettinger, M.
    Thomson, C. A.
    Zheng, W.
    Gao, Y. T.
    Rothman, N.
    Xiang, Y. B.
    Cai, H.
    Wang, R.
    Yuan, J. M.
    Koh, W. P.
    Butler, L. M.
    Cai, Q.
    Blot, W. J.
    Wu, J.
    Ueland, P. M.
    Midttun, O.
    Langhammer, A.
    Hveem, K.
    Johansson, M.
    Hultdin, Johan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Grankvist, Kjell
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Arslan, A. A.
    Le Marchand, L.
    Severi, G.
    Brennan, P.
    No association between circulating concentrations of vitamin D and risk of lung cancer: an analysis in 20 prospective studies in the Lung Cancer Cohort Consortium (LC3)2018In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 29, no 6, p. 1468-1475Article in journal (Refereed)
    Abstract [en]

    Background: There is observational evidence suggesting that high vitamin D concentrations may protect against lung cancer. To investigate this hypothesis in detail, we measured circulating vitamin D concentrations in prediagnostic blood from 20 cohorts participating in the Lung Cancer Cohort Consortium (LC3).

    Patients and methods: The study included 5313 lung cancer cases and 5313 controls. Blood samples for the cases were collected, on average, 5 years before lung cancer diagnosis. Controls were individually matched to the cases by cohort, sex, age, race/ethnicity, date of blood collection, and smoking status in five categories. Liquid chromatography coupled with tandem mass spectrometry was used to separately analyze 25-hydroxyvitamin D2 [25(OH)D2] and 25-hydroxyvitamin D3 [25(OH)D3] and their concentrations were combined to give an overall measure of 25(OH)D. We used conditional logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for 25(OH)D as both continuous and categorical variables.

    Results: Overall, no apparent association between 25(OH)D and risk of lung cancer was observed (multivariable adjusted OR for a doubling in concentration: 0.98, 95% CI: 0.91, 1.06). Similarly, we found no clear evidence of interaction by cohort, sex, age, smoking status, or histology.

    Conclusion: This study did not support an association between vitamin D concentrations and lung cancer risk.

  • 16. Nagel, G
    et al.
    Concin, H
    Bjørge, T
    Rapp, K
    Manjer, J
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Diem, G
    Häggström, Christel
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Engeland, A
    Almquist, M
    Jonsson, Håkan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Selmer, R
    Stocks, Tanja
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Tretli, S
    Ulmer, H
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Lukanova, A
    Metabolic syndrome and rare gynecological cancers in the Metabolic syndrome and Cancer project (Me-Can)2011In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 22, no 6, p. 1339-1345Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Risk factors for rare gynecological cancers are largely unknown. Initial research has indicated that the metabolic syndrome (MetS) or individual components could play a role. Materials and methods: The Metabolic syndrome and Cancer project cohort includes 288 834 women. During an average follow-up of 11 years, 82 vulvar, 26 vaginal and 43 other rare gynecological cancers were identified. Hazard ratios (HRs) were estimated fitting Cox proportional hazards regression models for tertiles and standardized z-scores [with a mean of 0 and a standard deviation (SD) of 1] of body mass index (BMI), blood pressure, glucose, cholesterol, triglycerides and MetS. Risk estimates were corrected for random error in the measurement of metabolic factors. RESULTS: The MetS was associated with increased risk of vulvar [HR 1.78, 95% confidence interval (CI) 1.30-2.41) and vaginal cancer (HR 1.87, 95% CI 1.07-3.25). Among separate MetS components, 1 SD increase in BMI was associated with overall risk (HR 1.43, 95% CI 1.23-1.66), vulvar (HR 1.36, 95% CI 1.11-1.69) and vaginal cancer (HR 1.79, 95% CI 1.30-2.46). Blood glucose and triglyceride concentrations were associated with increased risk of vulvar cancer (HR 1.98, 95% CI 1.10-3.58 and HR 2.09, 95% CI 1.39-3.15, respectively). CONCLUSION: The results from this first prospective study on rare gynecological cancers suggest that the MetS and its individual components may play a role in the development of these tumors.

  • 17. Nitter, M.
    et al.
    Norgard, B.
    de Vogel, S.
    Eussen, S. J. P. M.
    Meyer, K.
    Ulvik, A.
    Ueland, P. M.
    Nygard, O.
    Vollset, S. E.
    Bjorge, T.
    Tjonneland, A.
    Hansen, L.
    Boutron-Ruault, M.
    Racine, A.
    Cottet, V.
    Kaaks, R.
    Kuehn, T.
    Trichopoulou, A.
    Bamia, C.
    Naska, A.
    Grioni, S.
    Palli, D.
    Panico, S.
    Tumino, R.
    Vineis, P.
    Bueno-de-Mesquita, H. B.
    van Kranen, H.
    Peeters, P. H.
    Weiderpass, E.
    Dorronsoro, M.
    Jakszyn, P.
    Sanchez, M.
    Argueelles, M.
    Huerta, J. M.
    Barricarte, A.
    Johansson, Mattias
    Umeå University, Faculty of Medicine, Department of Biobank Research.
    Ljuslinder, Inger
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Khaw, K.
    Wareham, N.
    Freisling, H.
    Duarte-Salles, T.
    Stepien, M.
    Gunter, M. J.
    Riboli, E.
    Plasma methionine, choline, betaine, and dimethylglycine in relation to colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC)2014In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 25, no 8, p. 1609-1615Article in journal (Refereed)
    Abstract [en]

    Background: Disturbances in one carbon metabolism may contribute to carcinogenesis by affecting methylation and synthesis of DNA. Choline and its oxidation product betaine are involved in this metabolism and can serve as alternative methyl group donors when folate status is low. Patients and methods: We conducted a case-control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC), to investigate plasma concentrations of the methyl donors methionine, choline, betaine (trimethylglycine), and dimethylglycine (DMG) in relation to colorectal cancer (CRC) risk. Our study included 1367 incident CRC cases (965 colon and 402 rectum) and 2323 controls matched by gender, age group, and study center. Multivariate-adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for CRC risk were estimated by conditional logistic regression, comparing the fifth to the first quintile of plasma concentrations. Results: Overall, methionine (OR: 0.79, 95% CI: 0.63-0.99, P-trend = 0.05), choline (OR: 0.77, 95% CI: 0.60-0.99, P-trend = 0.07), and betaine (OR: 0.85, 95% CI: 0.66-1.09, P-trend = 0.06) concentrations were inversely associated with CRC risk of borderline significance. In participants with folate concentration below the median of 11.3 nmol/l, high betaine concentration was associated with reduced CRC risk (OR: 0.71, 95% CI: 0.50-1.00, P-trend = 0.02), which was not observed for those having a higher folate status. Among women, but not men, high choline concentration was associated with decreased CRC risk (OR: 0.62, 95% CI: 0.43-0.88, P-trend = 0.01). Plasma DMG was not associated with CRC risk. Conclusions: Individuals with high plasma concentrations of methionine, choline, and betaine may be at reduced risk of CRC.

  • 18.
    Näppä, Ulla
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology. Umeå University, Faculty of Medicine, Department of Nursing.
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rasmussen Holritz, Birgit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Axelsson, Bertil
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Palliative chemotherapy during the last month of life2011In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 22, no 11, p. 2375-2380Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study analyses the potential discriminative characteristics for patients with incurable cancer who received palliative chemotherapy during their last month of life.

    PATIENTS AND METHODS: The study includes all patients with epithelial cancer treated with palliative chemotherapy who died in 2008 in northern Sweden. Demographic parameters and care utilization data were registered. Data were analyzed using nonparametric methods.

    RESULTS: Of 374 included patients, 87 (23%) received chemotherapy during the last month of life. These patients had a significantly shorter survival time from first palliative treatment to death, were admitted more frequently to hospital, more often lacked a documented decision to cease treatment, and died less frequently at home.

    CONCLUSIONS: The results indicate covariations between palliative chemotherapy treatments in the last month of life and unfavorable patient outcomes. As almost one of four patients with incurable cancer received their last round of palliative chemotherapy <31 days before death, there is a potential for improved routines.

  • 19. Obón-Santacana, M.
    et al.
    Slimani, N.
    Lujan-Barroso, L.
    Travier, N.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Biobank Research. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Freisling, H.
    Ferrari, P.
    Boutron-Ruault, M. C.
    Racine, A.
    Clavel, F.
    Saieva, C.
    Pala, V.
    Tumino, R.
    Mattiello, A.
    Vineis, P.
    Argüelles, M.
    Ardanaz, E.
    Amiano, P.
    Navarro, C.
    Sánchez, M. J.
    Molina Montes, E.
    Key, T.
    Khaw, K.-T.
    Wareham, N.
    Peeters, P. H.
    Trichopoulou, A.
    Bamia, C.
    Trichopoulos, D.
    Boeing, H..
    Kaaks, R
    Katzke, V.
    Ye, W.
    Umeå University, Faculty of Medicine, Department of Biobank Research.
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Ericson, U.
    Wirfält, E..
    Overvad, K.
    Tjønneland, A.
    Olsen, A.
    Skeie, G.
    Asli, L. A.
    Weiderpass, E.
    Riboli, E.
    Bueno-de-Mesquita, H. B.
    Duell, EJ
    Dietary intake of acrylamide and pancreatic cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort2013In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 24, no 10, p. 2645-2651Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In 1994, acrylamide (AA) was classified as a probable human carcinogen by the International Agency for Research on Cancer. In 2002, AA was discovered at relatively high concentrations in some starchy, plant-based foods cooked at high temperatures.

    PATIENTS AND METHODS: A prospective analysis was conducted to evaluate the association between the dietary intake of AA and ductal adenocarcinoma of the exocrine pancreatic cancer (PC) risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort using Cox regression modeling. EPIC includes >500 000 men and women aged 35-75 at enrollment from 10 European countries. AA intake was estimated for each participant by combining questionnaire-based food consumption data with a harmonized AA database derived from the EU monitoring database of AA levels in foods, and evaluated in quintiles and continuously.

    RESULTS: After a mean follow-up of 11 years, 865 first incident adenocarcinomas of the exocrine pancreas were observed and included in the present analysis. At baseline, the mean dietary AA intake in EPIC was 26.22 µg/day. No overall association was found between continuous or quintiles of dietary AA intake and PC risk in EPIC (HR:0.95, 95%CI:0.89-1.01 per 10 µg/day). There was no effect measure modification by smoking status, sex, diabetes, alcohol intake or geographic region. However, there was an inverse association (HR: 0.73, 95% CI: 0.61-0.88 per 10 µg/day) between AA intake and PC risk in obese persons as defined using the body mass index (BMI, ≥30 kg/m(2)), but not when body fatness was defined using waist and hip circumference or their ratio.

    CONCLUSIONS: Dietary intake of AA was not associated with an increased risk of PC in the EPIC cohort.

  • 20. Ordóñez-Me, J. M.
    et al.
    Walter, V.
    Schöttker, B.
    Jenab, M.
    O'Doherty, M. G.
    Kee, F.
    Bueno-de-Mesquita, B.
    Peeters, P. H. M
    Stricker, B. H.
    Ruiter, R.
    Hofman, A.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Jousilahti, P.
    Kuulasmaa, K.
    Freedman, N. D.
    Wilsgaard, T.
    Wolk, A
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Arctic Research Centre at Umeå University.
    Tjønneland, A
    Quirós, J. R.
    van Duijnhoven, F. J. B.
    Siersema, P. D.
    Boffetta, P.
    Trichopoulou, A.
    Brenner, H.
    Impact of prediagnostic smoking and smoking cessation on colorectal cancer prognosis: a meta-analysis of individual patient data from cohorts within the CHANCES consortium2018In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 29, no 2, p. 472-483Article in journal (Refereed)
    Abstract [en]

    Background: Smoking has been associated with colorectal cancer (CRC) incidence and mortality in previous studies and might also be associated with prognosis after CRC diagnosis. However, current evidence on smoking in association with CRC prognosis is limited.

    Patients and methods: For this individual patient data meta-analysis, sociodemographic and smoking behavior information of 12,414 incident CRC patients (median age at diagnosis: 64.3 years), recruited within 14 prospective cohort studies among previously cancer-free adults, was collected at baseline and harmonized across studies. Vital status and causes of death were collected for a mean follow-up time of 5.1 years following cancer diagnosis. Associations of smoking behavior with overall and CRC-specific survival were evaluated using Cox regression and standard meta-analysis methodology.

    Results: A total of 5,229 participants died, 3,194 from CRC. Cox regression revealed significant associations between former (hazard ratio (HR)=1.12; 95%-confidence interval (CI)=1.04-1.20) and current smoking (HR = 1.29; 95%CI=1.04-1.60) and poorer overall survival compared with never smoking. Compared with current smoking, smoking cessation was associated with improved overall (HR<10years=0.78; 95%CI=0.69-0.88; HR≥10years=0.78; 95%CI=0.63-0.97) and CRC-specific survival (HR≥10years=0.76; 95%CI=0.67-0.85).

    Conclusion: In this large meta-analysis including primary data of incident CRC patients from 14 prospective cohort studies on the association between smoking and CRC prognosis, former and current smoking were associated with poorer CRC prognosis compared with never smoking. Smoking cessation was associated with improved survival when compared with current smokers. Future studies should further quantify the benefits of non-smoking, both for cancer prevention and for improving survival among CRC patients, in particular also in terms of treatment response.

  • 21. O'Sullivan, J. M.
    et al.
    Sartor, O.
    Parker, C.
    Hoskin, P.
    Widmark, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Mellado, B.
    Helle, S. I.
    Aksnes, A.
    Garcia-Vargas, J. E.
    Nilsson, S.
    EXTERNAL-BEAM RADIATION THERAPY (EBRT) USE AND SAFETY WITH RADIUM-223 DICHLORIDE (RA) IN PATIENTS (PTS) WITH CASTRATION-RESISTANT PROSTATE CANCER (CRPC) AND SYMPTOMATIC BONE METASTASES (METS) FROM THE ALSYMPCATRIAL2014In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 25, no suppl 4, p. 768P-Article in journal (Other academic)
  • 22.
    Saini, K S
    et al.
    Breast International Group, Brussels; Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
    Taylor, C
    Department of Supportive Cancer Care, Florence Nightingale School of Nursing and Midwifery, King’s College London, London.
    Ramirez, A-J
    Promoting Early Presentation Group, King’s College London, London.
    Palmieri, C
    Cancer Research UK Laboratories, Department of Surgery and Cancer, Division of Cancer, Imperial College, London, UK .
    Gunnarsson, Ulf
    Division of Surgery, Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden .
    Schmoll, H J
    Department of Internal Medicine IV, Oncology/Hematology, University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany .
    Dolci, S M
    Br.E.A.S.T. Data Center, Institut Jules Bordet, Brussels, Belgium.
    Ghenne, C
    Br.E.A.S.T. Data Center, Institut Jules Bordet, Brussels, Belgium.
    Metzger-Filho, O
    Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Br.E.A.S.T. Data Center, Institut Jules Bordet, Brussels, Belgium.
    Skrzypski, M
    Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland .
    Paesmans, M
    Data Centre, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles, Brussels, Belgium .
    Ameye, L
    Data Centre, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles, Brussels, Belgium .
    Piccart-Gebhart, M J
    Breast International Group, Brussels; Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
    de Azambuja, E
    Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Br.E.A.S.T. Data Center, Institut Jules Bordet, Brussels, Belgium .
    Role of the multidisciplinary team in breast cancer management: results from a large international survey involving 39 countries2012In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 23, no 4, p. 853-859Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The optimal management of patients with breast cancer (BC) requires the expertise of specialists from different disciplines. This has led to the evolution of multidisciplinary teams (MDTs), allowing all key professionals to jointly discuss individual patients and to contribute independently to clinical decisions. Data regarding BC MDTs in different regions and countries are scarce.

    METHODS: The investigators of a large global phase III adjuvant BC trial being conducted by the Breast International Group were invited to respond to a questionnaire about the extent, structure, and function of BC MDTs.

    RESULTS: One hundred and fifty-two responses from 39 countries were received, and remarkable differences were noted in different geographic regions. Sixty-five percent of the respondents from eastern Europe, 63% from western Europe, 35% from Asia, and 25% from South America declared that MDT was a mandatory part of BC care in their country. Ninety percent of the respondents from Europe stated their MDTs met weekly, compared with only half of the respondents from Asia.

    CONCLUSION: This survey is perhaps the first large-scale effort to collect information regarding BC MDTs from different parts of the world and provides objective information of frequency, composition, function, and working mechanism of BC MDTs.

  • 23.
    Salander, Pär
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Communication training in oncology needs a theoretical framework2019In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041Article in journal (Refereed)
  • 24. Sandstrom, P.
    et al.
    Sandin, R.
    Kowalski, J.
    Wahlgren, T.
    Jakobsson, M.
    Lundstam, S.
    Ljungberg, Börje
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Harmenberg, U.
    Overall survival (OS) in metastatic renal cell carcinoma (MRCC): a comparison between sorafenib (SO) and best supportive care (BSC)after first line treatment with sunitinib (SU) inSweden2012In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 23, no Suppl. 9, p. 281-281Article in journal (Other academic)
  • 25. Sartor, O.
    et al.
    Heinrich, D.
    Mariados, N.
    Mendez Vidal, M. J.
    Keizman, D.
    Thellenberg Karlsson, Camilla
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Peer, A.
    Procopio, G.
    Frank, S. J.
    Pulkkanen, K.
    Rosenbaum, E.
    Severi, S.
    Trigo Perez, J. M.
    Wagner, V.
    Li, R.
    Nordquist, L. T.
    Re-treatment with radium-223: first experience from an international, open-label, phase I/II study in patients with castration-resistant prostate cancer and bone metastases2017In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 28, no 10, p. 2464-2471Article in journal (Refereed)
    Abstract [en]

    Background: Six radium-223 injections at 4-week intervals is indicated for patients with castration-resistant prostate cancer and symptomatic bone metastases. However, patients usually develop disease progression after initial treatment. This prospective phase I/II study assessed re-treatment safety and efficacy of up to six additional radium-223 injections. Patients and methods: Patients had castration-resistant prostate cancer and bone metastases and six initial radium-223 injections with no on-treatment bone progression; all had subsequent radiologic or clinical progression. Concomitant agents were allowed at investigator discretion, excluding chemotherapy and initiation of new abiraterone or enzalutamide. The primary endpoint was safety; additional exploratory endpoints included time to radiographic bone progression, time to total alkaline phosphatase and prostate-specific antigen progression, radiographic progression-free survival, overall survival, time to first symptomatic skeletal event (SSE), SSE-free survival, and time to pain progression. Results: Among 44 patients, 29 (66%) received all six re-treatment injections. Median time from end of initial radium-223 treatment was 6 months. Forty-one (93%) reported >= 1 treatment-emergent adverse event. No grade 4-5 hematologic treatment-emergent adverse events occurred. Only one (2%) patient had radiographic bone progression; eight (18%) had radiographic soft tissue tumor progression (three lymph node and five visceral metastases). Median times to total alkaline phosphatase and prostate-specific antigen progression were not reached and 2.2 months, respectively. Median radiographic progression-free survival was 9.9 months (12.8-month maximum follow-up). Five (11%) patients died and eight (18%) experienced first SSEs. Median overall survival, time to first SSE, and SSE-free survival were not reached. Five (14%) of 36 evaluable patients (baseline worst pain score <= 7) had pain progression. After 2 years of follow-up, 28 (64%) patients died, and the median overall survival was 24.4 months. Conclusions: Re-treatment with a second course of six radium-223 injections after disease progression is well tolerated, with minimal hematologic toxicity and low radiographic bone progression rates in this small study with limited follow-up. Favorable safety and early effects on disease progression indicate that radium-223 re-treatment is feasible and warrants further evaluation in larger prospective trials.

  • 26. Scelo, G
    et al.
    Hofmann, J N
    Banks, R E
    Bigot, P
    Bhatt, R S
    Cancel-Tassin, G
    Chew, S K
    Creighton, C J
    Cussenot, O
    Davis, I J
    Escudier, B
    Frayling, T M
    Häggström, Christel
    Umeå University, Faculty of Medicine, Department of Biobank Research. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Hildebrandt, M A T
    Holcatova, I
    Johansson, M
    Linehan, W M
    McDermott, D F
    Nathanson, K L
    Ogawa, S
    Perlman, E J
    Purdue, M P
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Swanton, C
    Vasudev, N S
    Wu, X
    Znaor, A
    Brennan, P
    Chanock, S J
    International cancer seminars: a focus on kidney cancer2016In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 27, no 8, p. 1382-1385Article in journal (Refereed)
    Abstract [en]

    Recent years have seen important advances in our understanding of the etiology, biology and genetics of kidney cancer. To summarize important achievements and identify prominent research questions that remain, a workshop was organized by IARC and the US NCI. A series of 'difficult questions' were formulated, which should be given future priority in the areas of population, genomic and clinical research.Recent years have seen important advances in our understanding of the etiology, biology and genetics of kidney cancer. To summarize important achievements and identify prominent research questions that remain, a workshop was organized by IARC and the US NCI. A series of 'difficult questions' were formulated, which should be given future priority in the areas of population, genomic and clinical research.

  • 27. Schlesinger, S
    et al.
    Aleksandrova, K
    Pischon, T
    Jenab, M
    Fedirko, V
    Trepo, E
    Overvad, K
    Roswall, N
    Tjønneland, A
    Boutron-Ruault, M C
    Fagherazzi, G
    Racine, A
    Kaaks, R
    Grote, V A
    Boeing, H
    Trichopoulou, A
    Pantzalis, M
    Kritikou, M
    Mattiello, A
    Sieri, S
    Sacerdote, C
    Palli, D
    Tumino, R
    Peeters, P H
    Bueno-de-Mesquita, H B
    Weiderpass, E
    Quirós, J R
    Zamora-Ros, R
    Sánchez, M J
    Arriola, L
    Ardanaz, E
    Tormo, M J
    Nilsson, P
    Lindkvist, B
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Khaw, K T
    Wareham, N
    Travis, R C
    Riboli, E
    Nöthlings, U
    Diabetes mellitus, insulin treatment, diabetes duration, and risk of biliary tract cancer and hepatocellular carcinoma in a European cohort2013In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 24, no 9, p. 2449-2455Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Evidence on associations between self-reported diabetes mellitus, diabetes duration, age at diabetes diagnosis, insulin treatment, and risk of biliary tract cancer (BTC) and hepatocellular carcinoma (HCC), independent of general and abdominal obesity is scarce. PATIENTS AND METHODS: We conducted a prospective analysis in the EPIC-cohort study among 363 426 participants with self-reported diabetes data. Multivariable adjusted relative risks and 95% confidence intervals were estimated from Cox regression models. In a nested case-control subset, analyses were carried out in HCV/HBV-negative individuals. RESULTS: During 8.5 years of follow-up, 204 BTC cases [including 75 gallbladder cancer (GBC) cases], and 176 HCC cases were identified. Independent of body mass index and waist-to-height ratio diabetes status was associated with higher risk of BTC and HCC [1.77 (1.00-3.13) and 2.17 (1.36-3.47)]. For BTC, the risk seemed to be higher in participants with shorter diabetes duration and those not treated with insulin. Regarding cancer subsites, diabetes was only associated with GBC [2.72 (1.17-6.31)]. The risk for HCC was particularly higher in participants treated with insulin. The results were not appreciably different in HCV/HBV-negative individuals. CONCLUSION(S): This study supports the hypothesis that diabetes is a risk factor for BTC (particularly GBC) and HCC. Further research is required to establish whether diabetes treatment or duration is associated with these cancers.

  • 28. Tandstad, T.
    et al.
    Ståhl, O.
    Håkansson, U.
    Dahl, O.
    Haugnes, H. S.
    Klepp, O. H.
    Langberg, C. W.
    Laurell, A.
    Oldenburg, J.
    Solberg, A.
    Söderström, Karin
    The Cancer Clinic, Norrland University Hospital, Umeå.
    Cavallin-Ståhl, E.
    Stierner, U.
    Wahlquist, R.
    Wall, N.
    Cohn-Cedermark, G.
    One course of adjuvant BEP in clinical stage I nonseminoma mature and expanded results from the SWENOTECA group2014In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 25, no 11, p. 2167-2172Article in journal (Refereed)
    Abstract [en]

    The SWENOTECA group treated 517 clinical stage I nonseminoma patients with one course of adjuvant BEP in a prospective study. The median follow-up is 7.9 years. One course of adjuvant BEP reduced the risk of relapse by over 90%. The relapse rates were 1.6% in low-risk disease and 3.2% in high-risk disease. One course of adjuvant BEP should be considered a standard adjuvant treatment option.SWENOTECA has since 1998 offered patients with clinical stage I (CS I) nonseminoma, adjuvant chemotherapy with one course of bleomycin, etoposide and cisplatin (BEP). The aim has been to reduce the risk of relapse, sparing patients the need of toxic salvage treatment. Initial results on 312 patients treated with one course of adjuvant BEP, with a median follow-up of 4.5 years, have been previously published. We now report mature and expanded results. In a prospective, binational, population-based risk-adapted treatment protocol, 517 Norwegian and Swedish patients with CS I nonseminoma received one course of adjuvant BEP. Patients with lymphovascular invasion (LVI) in the primary testicular tumor were recommended one course of adjuvant BEP. Patients without LVI could choose between surveillance and one course of adjuvant BEP. Data for patients receiving one course of BEP are presented in this study. At a median follow-up of 7.9 years, 12 relapses have occurred, all with IGCCC good prognosis. The latest relapse occurred 3.3 years after adjuvant treatment. The relapse rate at 5 years was 3.2% for patients with LVI and 1.6% for patients without LVI. Five-year cause-specific survival was 100%. The updated and expanded results confirm a low relapse rate following one course of adjuvant BEP in CS I nonseminoma. One course of adjuvant BEP should be considered a standard treatment in CS I nonseminoma with LVI. For patients with CS I nonseminoma without LVI, one course of adjuvant BEP is also a treatment option.

  • 29. Tikk, Kaja
    et al.
    Sookthai, Disorn
    Johnson, Theron
    Rinaldi, Sabina
    Romieu, Isabelle
    Tjønneland, Anne
    Olsen, Anja
    Overvad, Kim
    Clavel-Chapelon, Francoise
    Baglietto, Laura
    Boeing, Heiner
    Trichopoulou, Antonia
    Lagiou, Pagona
    Trichopoulos, Dimitrios
    Palli, Domenico
    Pala, V
    Tumino, Rosario
    Rosso, S
    Panico, Salvatore
    Agudo, A
    Menéndez, Virginia
    Sánchez, Maria-Jose
    Amiano, Pilar
    Castaño, J M Huerta
    Ardanaz, Eva
    Bas Bueno-de-Mesquita, H
    Monninkhof, Evelyn
    Onland-Moret, C
    Andersson, Anne
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Weiderpass, Elisabete
    Khaw, Kay-Tee
    Key, Timothy J
    Travis, Ruth C
    Gunter, Marc J
    Riboli, Elio
    Dossus, Laure
    Kaaks, Rudolf
    Circulating prolactin and breast cancer risk among pre- and postmenopausal women in the EPIC cohort2014In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 25, no 7, p. 1422-1428Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Experimental and epidemiological evidence suggests that prolactin might play a role in the etiology of breast cancer. We analyzed the relationship of pre-diagnostic circulating prolactin levels with the risk of breast cancer by menopausal status, use of postmenopausal hormone replacement therapy (HRT) at blood donation, and by estrogen and progesterone receptor-status of the breast tumors. METHODS: Conditional logistic regression was used to analyze the data from a case-control study nested within the prospective European EPIC cohort, including 2250 invasive breast cancer and their matched control subjects. RESULTS: Statistically significant heterogeneity in the association of prolactin levels with breast cancer risk between women who were either pre- or postmenopausal at the time of blood donation was observed (Phet=0.04). Higher serum levels of prolactin were associated with significant increase in risk of breast cancer among postmenopausal women (ORQ4-Q1=1.29 [95%CI 1.05-1.58], Ptrend=0.09); however this increase in risk seemed to be confined to women who used postmenopausal HRT at blood donation (ORQ4-Q1=1.45 [95%CI 1.08-1.95], Ptrend=0.01), whereas no statistically significant association was found for the non-users of HRT (ORQ4-Q1 =1.11 [95%CI 0.83-1.49], Ptrend=0.80) (Phet=0.08). Among premenopausal women, a statistically non-significant inverse association was observed (ORQ4-Q1 =0.70 [95%CI 0.48-1.03], Ptrend=0.16). There was no heterogeneity in the prolactin-breast cancer association by hormone receptor status of the tumor. CONCLUSION: Our study indicates that higher circulating levels of prolactin among the postmenopausal HRT users at baseline may be associated with increased breast cancer risk.

  • 30.
    Tiselius, Catarina
    et al.
    Department of Surgery, Västmanland’s County Hospital, Centre for Clinical Research, Uppsala University, Västerås .
    Gunnarsson, Ulf
    Department of Surgery, CLINTEC, Karolinska Institutet, Stockholm.
    Smedh, Kenneth
    Department of Surgery, Västmanland’s County Hospital, Centre for Clinical Research, Uppsala University, Västerås.
    Glimelius, Bengt
    Departments of Radiology, Oncology, and Radiation Science, Uppsala University, Uppsala, Sweden.
    Påhlman, Lars
    Surgical Science, Uppsala University, Uppsala, Sweden.
    Patients with rectal cancer receiving adjuvant chemotherapy have an increased survival: a population-based longitudinal study2013In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 24, no 1, p. 160-165Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this study was to investigate whether or not the use of adjuvant chemotherapy in stage III rectal cancer varies between regions and over time, and if this has had an effect on survival rates.

    PATIENTS AND METHODS: Patients from the Uppsala/Örebro region below 75 years-of-age, operated 1995-2002 and registered in the Swedish Rectal Cancer Register, were monitored between 1995 and September 2008. A multivariate Cox proportional hazard regression model was used for analysis. Overall survival was described using the Kaplan-Meier method.

    RESULTS: Four hundred and thirty-six patients with stage III rectal cancer were included. Adjuvant chemotherapy was given to 42% of the patients (proportions varying from 13% to 77% among counties), and there were substantial increases over time. The 5-year overall survival was 65.8% [95% confidence interval (CI) 50-84] for patients having adjuvant chemotherapy compared with 45.6% (95% CI 39-52) for patients not treated with chemotherapy. The multivariate hazard ratio for death was 0.65 (95% CI 0.5-0.8) for patients treated with adjuvant chemotherapy.

    CONCLUSIONS: The use of adjuvant chemotherapy for rectal cancer has increased, but varies considerably between hospitals/counties. In this cohort, those having adjuvant chemotherapy had a longer overall survival.

  • 31. Toriola, A T
    et al.
    Grankvist, Kjell
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Agborsangaya, C B
    Lukanova, A
    Lehtinen, M
    Surcel, H M
    Changes in pre-diagnostic serum C-reactive protein concentrations and ovarian cancer risk: a longitudinal study2011In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 22, no 8, p. 1916-1921Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Evidence suggests that inflammation may be associated with increased risk of ovarian cancer but there is paucity of studies investigating this association, especially using over-time changes in inflammatory biomarkers.

    MATERIALS AND METHODS: We conducted a prospective population-based case-control study nested within the Finnish Maternity Cohort (FMC). Within the FMC, 170 women with ovarian cancer who had donated serum samples to the cohort twice, ≥1 year apart, before cancer diagnoses were identified. One control per case was matched for age, parity and sampling date.

    RESULTS: Comparing the highest with lowest tertiles, the odds ratio (OR) of ovarian cancer using the first set of serum samples (mean lag time to cancer diagnosis 9.0 years) was 1.62 [95% confidence interval (CI) 0.93-2.83]. However, analysis conducted using the second set of serum samples donated closer to cancer diagnosis (mean lag time 6.4 years) revealed a significantly increased risk of ovarian cancer comparing extreme tertiles of C-reactive protein (CRP) concentrations; OR 1.96 (95% CI 1.11-3.4). Over time, increases in individuals' CRP concentrations were also associated with increased risk; OR 1.90 (95% CI 1.12-3.23).

    CONCLUSION: The results suggest that inflammation may precede ovarian cancer since increasing CRP concentrations, both across tertiles and longitudinally at the individual level, were associated with increased risk.

  • 32. Vineis, P
    et al.
    Veglia, F
    Garte, S
    Malaveille, C
    Matullo, G
    Dunning, A
    Peluso, M
    Airoldi, L
    Overvad, K
    Raaschou-Nielsen, O
    Clavel-Chapelon, F
    Linseisen, J P
    Kaaks, R
    Boeing, H
    Trichopoulou, A
    Palli, D
    Crosignani, P
    Tumino, R
    Panico, S
    Bueno-De-Mesquita, H B
    Peeters, P H
    Lund, E
    Gonzalez, C A
    Martinez, C
    Dorronsoro, M
    Barricarte, A
    Navarro, C
    Quiros, J R
    Berglund, G
    Jarvholm, B
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Day, N E
    Key, T J
    Saracci, R
    Riboli, E
    Autrup, H
    Genetic susceptibility according to three metabolic pathways in cancers of the lung and bladder and in myeloid leukemias in nonsmokers.2007In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 18, no 7, p. 1230-42Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: We chose a set of candidate single nucleotide polymorphisms (SNPs) to investigate gene-environment interactions in three types of cancer that have been related to air pollution (lung, bladder and myeloid leukemia). PATIENTS AND METHODS: The study has been conducted as a nested case-control study within the European Prospective Investigation into Cancer and Nutrition cohort (409 cancer cases and 757 matched controls). We included never and ex-smokers. SNPs were in genes involved in oxidative stress, phase I metabolizing genes, phase II metabolizing genes and methylenetetrahydrofolate reductase (MTHFR). RESULTS: The most notable findings are: GSTM1 deletion and bladder cancer risk [odds ratio (OR) = 1.60; 95% confidence interval 1.00-2.56]; CYP1A1 and leukemia (2.22, 1.33-3.70; heterozygotes); CYP1B1 and leukemia (0.47, 0.27-0.84; homozygotes); MnSOD and leukemia (1.91, 1.08-3.38; homozygotes) and NQO1 and lung cancer (8.03, 1.73-37.3; homozygotes). Other statistically significant associations were found in subgroups defined by smoking habits (never or ex-smokers), environmental tobacco smoke or gender, with no obvious pattern. When gene variants were organized according to the three main pathways, the emerging picture was of a strong involvement of combined phase I enzymes in leukemia, with an OR of 5 (1.63-15.4) for those having three or more variant alleles. The association was considerably stronger for leukemias arising before the age of 55.

  • 33. Westerlund, A.
    et al.
    Steineck, G.
    Bälter, K
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Grönberg, H
    Hedelin, M
    Dietary supplement use patterns in men with prostate cancer: the Cancer Prostate Sweden study2011In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 22, no 4, p. 967-72Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In a European setting, we know little about the use of dietary supplements among men with prostate cancer (PCa) and to what extent lifestyle, disease or other factors influence such use.

    PATIENTS AND METHODS: We evaluated supplement use in 1127 men with incident PCa and in 900 population controls in Sweden. Age-adjusted binary regression with an identity link was carried out to estimate prevalence differences and corresponding 95% confidence intervals (CIs). Modifying effects of lifestyle- and diet-related factors were explored by statistical assessment of additive interaction.

    RESULTS: Among men with PCa, 542 individuals (48%) had used supplements, which was a 10% (95% CI: 5.9%-15%) higher prevalence than among population controls. Among individuals with high intake of fatty fish, vegetables, and phytoestrogens, but low intake of saturated fat, supplement use was 29% (95% CI: 18%-41%) more common in men with PCa than in population controls. We found no evidence of heterogeneity by categories of education, smoking history, body mass index, fiber, fruit, or phytoestrogen intake, treatment, or disease stage.

    CONCLUSION: Supplement use is common in Swedish men with PCa, especially among those with a healthy dietary pattern.

  • 34. Wilking, N
    et al.
    Lidbrink, E
    Wiklund, T
    Erikstein, B
    Lindman, H
    Malmström, P
    Kellokumpu-Lehtinen, P
    Bengtsson, N-O
    Umeå University, Faculty of Medicine, Radiation Sciences.
    Söderlund, G
    Anker, G
    Wist, E
    Ottosson, S
    Salminen, E
    Ljungman, P
    Holte, H
    Nilsson, J
    Blomqvist, C
    Bergh, J
    Long-term follow-up of the SBG 9401 study comparing tailored FEC-based therapy versus marrow-supported high-dose therapy.2007In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 18, no 4, p. 694-700Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The purpose was to investigate adjuvant marrow-supportive high-dose chemotherapy compared with an equitoxicity-tailored comparator arm. PATIENTS AND METHODS: Five hundred and twenty-five women below the age of 60 years with operated high-risk primary breast cancer were randomised to nine cycles of granulocyte colony-stimulating factor supported and individually tailored FEC (5-fluorouracil, epirubicin, cyclophosphamide), (n = 251) or standard FEC followed by marrow-supported high-dose therapy with CTCb (cyclophosphamide, thiotepa, carboplatin) therapy (n = 274), followed by locoregional radiotherapy and tamoxifen for 5 years. RESULTS: There were 104 breast cancer relapses in the tailored FEC group versus 139 in the CTCb group (double triangular method by Whitehead, P = 0.046), with a median follow-up of all included patients of 60.8 months. The event-free survival demonstrated 121 and 150 events in the tailored FEC- and CTCb group, respectively [P = 0.074, hazard ratio (HR) 0.804, 95% confidence interval (CI) 0.633-1.022]. Ten patients in the tailored FEC regimen developed acute myeloid leukaemia (AML)/myelodysplasia (MDS). One hundred deaths occurred in the tailored FEC group and 121 in the CTCb group (P = 0.287, HR 0.866, 95% CI 0.665-1.129). CONCLUSION: The update of this study shows an improved outcome linked to the tailored FEC treatment in relation to breast cancer relapse, but also an increased incidence of AML/MDS.

  • 35. Zakeri, K.
    et al.
    Rotolo, F.
    Lacas, B.
    Vitzthum, L. K.
    Le, Q-TX.
    Gregoire, V.
    Overgaard, J.
    Tobias, J.
    Zackrisson, Björn
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Parmar, M. K.
    Burtness, B. A.
    Ghi, M. G.
    Sanguineti, G.
    O'Sullivan, B.
    Fortpied, C.
    Bourhis, J.
    Shen, H.
    Harris, J.
    Pignon, J-P
    Mell, L. K.
    Predictor of effectiveness of treatment intensification on overall survival in head and neck cancer (HNC)2018In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 29Article in journal (Other academic)
  • 36. Zuo, H.
    et al.
    Ueland, P. M.
    Midttun, O.
    Tell, G. S.
    Fanidi, A.
    Zheng, W.
    Shu, X.
    Xiang, Y.
    Wu, J.
    Prentice, R.
    Pettinger, M.
    Thomson, C. A.
    Giles, G. G.
    Hodge, A.
    Cai, Q.
    Blot, W. J.
    Johansson, Mikael
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Hultdin, Johan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Grankvist, Kjell
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Stevens, V. L.
    McCullough, M. L.
    Weinstein, S. J.
    Albanes, D.
    Ziegler, R. G.
    Freedman, N. D.
    Caporaso, N. E.
    Langhammer, A.
    Hveem, K.
    Naess, M.
    Buring, J. E.
    Lee, I.
    Gaziano, J. M.
    Severi, G.
    Zhang, X.
    Stampfer, M. J.
    Han, J.
    Zeleniuch-Jacquotte, A.
    Marchand, L. L.
    Yuan, J.
    Wang, R.
    Koh, W.
    Gao, Y.
    Ericson, U.
    Visvanathan, K.
    Jones, M. R.
    Relton, C.
    Brennan, P.
    Ulvik, A.
    Vitamin B6 catabolism and lung cancer risk: results from the Lung Cancer Cohort Consortium (LC3)2019In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 30, no 3, p. 478-485Article in journal (Refereed)
    Abstract [en]

    Background: Increased vitamin B6 catabolism related to inflammation, as measured by the PAr index (the ratio of 4-pyridoxic acid over the sum of pyridoxal and pyridoxal-5'-phosphate), has been positively associated with lung cancer risk in two prospective European studies. However, the extent to which this association translates to more diverse populations is not known.

    Materials and methods: For this study, we included 5323 incident lung cancer cases and 5323 controls individually matched by age, sex, and smoking status within each of 20 prospective cohorts from the Lung Cancer Cohort Consortium. Cohort-specific odds ratios (ORs) and 95% confidence intervals (CIs) for the association between PAr and lung cancer risk were calculated using conditional logistic regression and pooled using random-effects models.

    Results: PAr was positively associated with lung cancer risk in a dose-response fashion. Comparing the fourth versus first quartiles of PAr resulted in an OR of 1.38 (95% CI: 1.19-1.59) for overall lung cancer risk. The association between PAr and lung cancer risk was most prominent in former smokers (OR: 1.69, 95% CI: 1.36-2.10), men (OR: 1.60, 95% CI: 1.28-2.00), and for cancers diagnosed within 3years of blood draw (OR: 1.73, 95% CI: 1.34-2.23).

    Conclusion: Based on pre-diagnostic data from 20 cohorts across 4 continents, this study confirms that increased vitamin B6 catabolism related to inflammation and immune activation is associated with a higher risk of developing lung cancer. Moreover, PAr may be a pre-diagnostic marker of lung cancer rather than a causal factor.

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