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  • 1. Berglund, Anders
    et al.
    Garmo, Hans
    Robinson, David
    Tishelman, Carol
    Holmberg, Lars
    Bratt, Ola
    Adolfsson, Jan
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Lambe, Mats
    Differences according to socioeconomic status in the management and mortality in men with high risk prostate cancer2012In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 48, no 1, p. 75-84Article in journal (Refereed)
    Abstract [en]

    Background: Outcomes for many cancer forms are associated with socioeconomic status (SES).We investigated if SES was associated with management and mortality in men with high risk prostate cancer.

    Material and methods: A nation-wide population-based cohort in Prostate Cancer Data Base Sweden (PCBaSe), a merged database including data on incident prostate cancer identified in the National Prostate Cancer Register (NPCR) between 1997 and 2006. High risk PCa was defined as T3 tumour, and/or Gleason score 8–10 and/or PSA 20–50 ng/mL. Use of bone scan, curative treatment, and mortality in relation to SES was assessed by logistic, Cox, and competing risk regression with hazard ratios (HR), sub-distributed HR and 95% confidence intervals (CI) adjusted for co-morbidity, age, calendar period and clinical subgroups.

    Results: Amongst 17,522 high risk prostate cancer patients, a bone scan was more often performed in higher white-collar than in blue-collar workers (OR 1.30; 95% CI 1.21–1.40). Amongst men without metastases, the likelihood of intention to treat was higher in higher white-collar workers (OR 1.43; 95% CI 1.28–1.57). In men who received curative treatment, the likelihood was higher to undergo radical prostatectomy for higher white-collar patients (OR 1.29; 95% CI 1.10–1.47). In men without metastases, not only overall mortality was lower amongst higher white-collar workers (HR, 0.76; 95% CI 0.60–0.97), but also prostate cancer-specific mortality (sHR 0.70; 95% CI, 0.49–0.99).

    Conclusions: We conclude that socioeconomic disparities in the management and mortality in men with high risk prostate cancer exist also within the setting of a National Health Care System aiming to provide care on equal terms to all residents.

  • 2. Bill-Axelson, Anna
    et al.
    Garmo, Hans
    Nyberg, Ullakarin
    Lambe, Mats
    Bratt, Ola
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Adolfsson, Jan
    Steineck, Gunnar
    Psychiatric treatment in men with prostate cancer: results from a Nation-wide, population-based cohort study from PCBaSe Sweden.2011In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 47, no 14, p. 2195-201Article in journal (Refereed)
    Abstract [en]

    Aim: To explore whether the self-reported psychological distress among men with prostate cancer was to the extent that it required psychiatric treatment.

    Methods: PCBaSe Sweden, a merged database based on the National Prostate Cancer Register including 97% of allprostate cancers registered as well as age-matched controls. We calculated relative risks and 95% confidence intervals to compare risks of psychiatric treatment due to depression, anxiety, and post-traumatic stress disordercontrolling for age and socio-economic factors. We used odds ratios to compare use or no use of antidepressants.

    Findings: In total 72,613 men with prostate cancer and 217,839 men without prostate cancer were included for analyses. Psychiatric hospitalisation due to depression, anxiety and post-traumatic stress disorder were significantly increased (RR 1.29, (95% CI 1.14–1.45), RR 1.42 (95% CI 1.12–1.80) and RR 1.61 (95% CI 1.16–2.24), respectively). However, hospitalisations due to anxiety were only increased in men with more advanced tumours RR 2.28 (95% CI 1.45–3.57). The use of antidepressants was increased for all men with prostate cancer RR 1.65 (95% CI 1.54–1.77) and treatment strategies RR 1.93 (95% CI 1.75–2.13).

    Interpretation: Men diagnosed with prostate cancer had increased risk of psychiatric treatment for depression, post-traumatic stress disorder and use of antidepressants regardless of risk group and treatment strategy compared to age-matched controls, whilst more advanced prostate cancer was associated with severe anxiety disorders.

  • 3.
    Boldrup, Linda
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Coates, Philip J
    Laurell, Göran
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Nylander, Karin
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    p63 transcriptionally regulates BNC1, a Pol I and Pol II transcription factor that regulates ribosomal biogenesis and epithelial differentiation2012In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 48, no 9, p. 1401-1406Article in journal (Refereed)
    Abstract [en]

    The p53-family member, p63 is a transcription factor that influences cellular adhesion, motility, proliferation, survival and apoptosis, and has a major role in regulating epithelial stem cells. Expression of p63 is often dysregulated in squamous cell carcinomas of the head and neck. In this study we show that p63 induces the expression of the basal epithelial transcription factor, Basonuclin 1. Basonuclin 1 is an unusual transcription factor that interacts with a subset of promoters of genes that are transcribed by both RNA polymerase-I and -II and has roles in maintaining ribosomal biogenesis and the proliferative potential of immature epithelial cells. Chromatin immunoprecipitation and reporter assays demonstrate that Basonuclin 1 is a direct transcriptional target of p63 and we also show that up-regulation of Basonuclin 1 is a common event in squamous cell carcinomas of the head and neck. These data identify a new transcriptional programme mediated by p63 regulation of the Basonuclin 1 transcription factor in squamous cell carcinomas and provide a novel link of p63 with the regulation of ribosomal biogenesis in epithelial cancer.

  • 4. Bottomley, A.
    et al.
    Henriksson, Roger
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Taphoorn, M. J. B.
    Cloughesy, T.
    Wick, W.
    Mason, W.
    Saran, F.
    Nishikawa, R.
    Ravelo, A.
    Chinot, O. L.
    Health-related quality of life (HRQoL) in AVAglio, a randomized, placebo (P)-controlled phase III study of bevacizumab (B), temozolomide (T) and radiotherapy (RI) in patients (pts) with newly diagnosed glioblastoma (GBM)2013In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 49, no Supplement 2, p. S780-S780, Meeting Abstract: 3316Article in journal (Other academic)
  • 5. Breugom, A. J.
    et al.
    Bastiaannet, E.
    Boelens, P. G.
    Iversen, L. H.
    Martling, A.
    Johansson, R.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Evans, T.
    Lawton, S.
    O'Brien, K. M.
    Van Eycken, E.
    Janciauskiene, R.
    Liefers, G. J.
    Cervantes, A.
    Lemmens, V. E. P. P.
    van de Velde, C. J. H.
    Adjuvant chemotherapy and relative survival of patients with stage II colon cancer - A EURECCA international comparison between the Netherlands, Denmark, Sweden, England, Ireland, Belgium, and Lithuania2016In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 63, p. 110-117Article in journal (Refereed)
    Abstract [en]

    Background: The aim of the present EURECCA international comparison is to compare adjuvant chemotherapy and relative survival of patients with stage II colon cancer between European countries.

    Methods: Population-based national cohort data (2004-2009) from the Netherlands (NL), Denmark (DK), Sweden (SE), England (ENG), Ireland (IE), and Belgium (BE) were obtained, as well as single-centre data from Lithuania. All surgically treated patients with stage II colon cancer were included. The proportion of patients receiving adjuvant chemotherapy was calculated and compared between countries. Besides, relative survival was calculated and compared between countries.

    Results: Overall, 59,154 patients were included. The proportion of patients receiving adjuvant chemotherapy ranged from 7.1% to 29.0% (p < 0.001). Compared with NL, a better adjusted relative survival was observed in SE (stage II: relative excess risks (RER) 0.53, 95% confidence interval (CI) 0.44-0.64; p < 0.001), and BE (stage II: RER 0.84, 95% CI 0.76-0.92; p < 0.001), and in IE for patients with stage IIA disease (RER 0.80, 95% CI 0.65-0.98; p = 0.03).

    Conclusion: The proportion of patients with stage II colon cancer receiving adjuvant chemotherapy varied largely between seven European countries. No clear linear pattern between adjuvant chemotherapy and adjusted relative survival was observed. Compared with NL, SE and BE showed an improved adjusted relative survival for stage II disease, and IE for patients with stage IIA disease only. Further research into selection criteria for adjuvant chemotherapy could eventually lead to individually tailored, optimal treatment of patients with stage II colon cancer.

  • 6. Campa, Daniele
    et al.
    Hüsing, Anika
    Chang-Claude, Jenny
    Dostal, Lucie
    Boeing, Heiner
    Kröger, Janine
    Tjønneland, Anne
    Roswall, Nina
    Overvad, Kim
    Dahm, Christina C
    Rodríguez, Laudina
    Sala, Núria
    Pérez, Maria José Sánchez
    Larrañaga, Nerea
    Chirlaque, Maria-Dolores
    Ardanaz, Eva
    Khaw, Kay-Tee
    Wareham, Nick
    Allen, Naomi E
    Travis, Ruth C
    Trichopoulou, Antonia
    Naska, Androniki
    Bamia, Christina
    Palli, Domenico
    Sieri, Sabina
    Tumino, Rosario
    Sacerdote, Carlotta
    van Kranen, Henk J
    Bas Bueno-de-Mesquita, H
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Johansson, Mattias
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. International Agency for Research on Cancer, Lyon, France.
    Chajes, Veronique
    Rinaldi, Sabina
    Romieu, Isabelle
    Siddiq, Afshan
    Norat, Teresa
    Riboli, Elio
    Kaaks, Rudolf
    Canzian, Federico
    Genetic variability of the fatty acid synthase pathway is not associated with prostate cancer risk in the European Prospective Investigation on Cancer (EPIC)2011In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 47, no 3, p. 420-427Article in journal (Refereed)
    Abstract [en]

    A western lifestyle, characterised by low rates of energy expenditure and a high-energy diet rich in animal protein, saturated fats and refined carbohydrates, is associated with high incidence of prostate cancer in men. A high-energy nutritional status results in insulin/IGF signalling in cells, which in turn stimulates synthesis of fatty acids. We investigated whether the genetic variability of the genes belonging to the fatty acid synthesis pathway is related to prostate cancer risk in 815 prostate cancer cases and 1266 controls from the European Prospective Investigation on Cancer (EPIC). Using a tagging approach and selecting 252 SNPs in 22 genes, we covered all the common genetic variation of this pathway. None of the SNPs reached statistical significance after adjusting for multiple comparisons. Common SNPs in the fatty acid synthase pathway are not major contributors to prostate cancer risk.

  • 7. Carlsson, Sigrid
    et al.
    Sandin, Fredrik
    Fall, Katja
    Lambe, Mats
    Adolfsson, Jan
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Bill-Axelson, Anna
    Risk of suicide in men with low-risk prostate cancer2013In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 49, no 7, p. 1588-1599Article in journal (Refereed)
    Abstract [en]

    Purpose: Risk of suicide is increased among men with prostate cancer. We investigated this association among men with low-risk cancer, usually detected by prostate specific antigen (PSA)-testing. Patients and Methods: Relative risk (RR) of suicide was calculated by use of Poisson regression analysis within the Prostate Cancer data Base Sweden (PCBaSe) 2.0, a nation-wide, population-based database, comparing 105,736 men diagnosed with prostate cancer between 1997-2009 to 528,658 matched prostate cancer-free men. Results: During the first 6 months after diagnosis, there were 38 suicides among men with prostate cancer; incidence rate 0.73 per 1000 person-years (PY) and 30 suicides in the comparison cohort; 0.11 per 1000 PY, corresponding to a RR of suicide of 6.5 (95% confidence interval (CI) 4.0-10). Risk was highest among men with distant metastases, incidence rate 1.25 per 1000 PY, RR 10 (95% CI 5.1-21) but risk was also increased for men with low-risk tumours, incidence rate difference 0.45 per 1000 PY and RR 5.2 (95% CI 2.3-12) and across categories of socioeconomic status and comorbidity. Eighteen months after diagnosis, risk of suicide had decreased to 0.27 per 1000 PY, RR 1.0 (95% CI 0.68-1.5) for low-risk prostate cancer but remained increased among men with metastases, 0.57 per 1000 PY, RR 1.8 (95% CI 1.1-2.9). Conclusion: Although the increase in absolute risk of suicide was modest, our findings reflect the severe psychological stress that prostate cancer patients may experience after diagnosis. The increased risk of suicide observed in men with prostate cancer, including low-risk, calls for increased awareness.

  • 8. Chinot, O.
    et al.
    Cloughesy, T.
    Henriksson, Roger
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Saran, F.
    Mason, W.
    Nishikawa, R.
    Hilton, M.
    Abrey, L.
    Wick, W.
    Efficacy and safety of bevacizumab (By) plus standard combination temozolomide (T) and radiotherapy (RT) in newly diagnosed glioblastoma: final results from AVAglio2013In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 49, no Supplement 2, p. S774-S775, Meeting Abstract: 3301AArticle in journal (Other academic)
  • 9. Chuang, Shu-Chun
    et al.
    Stolzenberg-Solomon, Rachael
    Ueland, Per Magne
    Vollset, Stein Emil
    Midttun, Oivind
    Olsen, Anja
    Tjonneland, Anne
    Overvad, Kim
    Boutron-Ruault, Marie-Christine
    Morois, Sophie
    Clavel-Chapelon, Francoise
    Teucher, Birgit
    Kaaks, Rudolf
    Weikert, Cornelia
    Boeing, Heiner
    Trichopoulou, Antonia
    Benetou, Vassiliki
    Naska, Androniki
    Jenab, Mazda
    Slimani, Nadia
    Romieu, Isabelle
    Michaud, Dominique S.
    Palli, Domenico
    Sieri, Sabina
    Panico, Salvatore
    Sacerdote, Carlotta
    Tumino, Rosario
    Skeie, Guri
    Duell, Eric J.
    Rodriguez, Laudina
    Molina-Montes, Esther
    Maria Huerta, Jose
    Larranaga, Nerea
    Barricarte Gurrea, Aurelio
    Johansen, Dorthe
    Manjer, Jonas
    Ye, Weimin
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Peeters, Petra H. M.
    Jeurnink, Suzanne
    Wareham, Nicholas
    Khaw, Kay-Tee
    Crowe, Francesca
    Riboli, Elio
    Bueno-de-Mesquita, Bas
    Vineis, Paolo
    A U-shaped relationship between plasma folate and pancreatic cancer risk in the European Prospective Investigation into Cancer and Nutrition2011In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 47, no 12, p. 1808-1816Article in journal (Refereed)
    Abstract [en]

    Folate intake has shown an inverse association with pancreatic cancer; nevertheless, results from plasma measurements were inconsistent. The aim of this study is to examine the association between plasma total homocysteine, methionine, folate, cobalamin, pyridoxal 5'-phosphate, riboflavin, flavin mononucleotide and pancreatic cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). We conducted a nested case-control study in the EPIC cohort, which has an average of 9.6 years of follow-up (1992-2006), using 463 incident pancreatic cancer cases. Controls were matched to each case by center, sex, age (+/- 1 year), date (+/- 1 year) and time (+/- 3 h) at blood collection and fasting status. Conditional logistic regression was used to calculate the odds ratios (OR) and 95% confidence intervals (CI), adjusting for education, smoking status, plasma cotinine concentration, alcohol drinking, body mass index and diabetes status. We observed a U-shaped association between plasma folate and pancreatic cancer risk. The ORs for plasma folate <= 5, 5-10, 10-15 (reference), 15-20, and > 20 nmol/L were 1.58 (95% CI = 0.72-3.46), 1.39 (0.93-2.08), 1.0 (reference), 0.79 (0.52-1.21), and 1.34 (0.89-2.02), respectively. Methionine was associated with an increased risk in men (per quintile increment: OR = 1.17, 95% CI = 1.00-1.38) but not in women (OR = 0.91, 95% CI = 0.78-1.07; p for heterogeneity < 0.01). Our results suggest a U-shaped association between plasma folate and pancreatic cancer risk in both men and women. The positive association that we observed between methionine and pancreatic cancer may be sex dependent and may differ by time of follow-up. However, the mechanisms behind the observed associations warrant further investigation.

  • 10. Chung, Sui Chu
    et al.
    Hammarsten, Peter
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Josefsson, Andreas
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Granfors, Torvald
    Egevad, Lars
    Mancini, Giacomo
    Lutz, Beat
    Bergh, Anders
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Fowler, Christopher J
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Pharmacology.
    A high cannabinoid CB(1) receptor immunoreactivity is associated with disease severity and outcome in prostate cancer2009In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 45, no 1, p. 174-182Article in journal (Refereed)
    Abstract [en]

    In the light of findings indicating that cannabinoids can affect the proliferation of a number of cancer cell types and that cannabinoid receptor expression is higher in prostate cancer cell lines than in non-malignant cells, we investigated whether the level of cannabinoid 1 receptor immunoreactivity (CB(1)IR) in prostate cancer tissues is associated with disease severity and outcome. Formalin-fixed paraffin-embedded non-malignant and tumour tissue samples from patients who were diagnosed with prostate cancer at a transurethral resection for voiding problems were used. CB(1)IR, which was scored in a total of 399 cases, was associated with the epithelial cell membranes, with little staining in the stroma. Patients with a tumour CB(1)IR score greater or equal to the median (2) had a significantly higher proportion of Gleason scores 8-10, metastases at diagnosis, tumour size and rate of cell proliferation at diagnosis than patients with a score<2. For 269 cases, tumour CB(1)IR was measured for patients who only received palliative therapy at the end stages of the disease, allowing the influence of CB(1)IR upon the disease outcome to be determined. Receiver operating characteristic (ROC) curves showed an area under the curve of 0.67 (95% confidence limits 0.59-0.74) for CB(1)IR in the tumour. CB(1)IR in non-malignant tissue was not associated with disease outcome. A tumour CB(1)IR score >or=2 was associated with a significantly lower disease specific survival. A Cox proportional hazards regression indicated that the tumour CB(1)IR score and the Gleason score were independent prognostic variables. It is concluded that a high tumour CB(1)IR score is associated with prostate cancer severity and outcome.

  • 11. Eriksson, H.
    et al.
    Lyth, J.
    Månsson-Brahme, E.
    Frohm-Nilsson, M.
    Ingvar, C.
    Lindholm, C.
    Naredi, Peter
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Stierner, U.
    Wagenius, G.
    Carstensen, J.
    Hansson, J.
    Low level of education is associated with later stage at diagnosis and reduced survival in cutaneous malignant melanoma: a nationwide population-based study in Sweden2013In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 49, no 12, p. 2705-2716Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A worse outcome has been reported for cutaneous malignant melanoma (CMM) patients with low socioeconomic status. We have investigated the association between level of education, clinical stage at diagnosis (stage at diagnosis) and CMM-specific survival in Sweden.

    METHODS: We identified 27,235 patients from the Swedish Melanoma Register diagnosed with a primary invasive CMM between 1990 and 2007 and linked data to nationwide, population-based, health and census registers with a follow-up to 2010.

    RESULTS: The odds ratio (OR) of higher disease stage at diagnosis was significantly increased in lower education groups (OR stage II versus I=1.6; 95% confidence interval (CI)=1.5-1.7. OR stage III-IV versus I=2.3; 95% CI=1.8-2.9). The risk of dying of CMM, was significantly increased in patients with low (hazard ratio (HR) low versus high=2.02; 95% CI=1.80-2.26; p<0.0001) and intermediate (HR intermediate versus high=1.35; 95% CI=1.20-1.51; p<0.0001) level of education. After adjustment for age, gender, stage at diagnosis and other known prognostic factors, the HRs remained significant for low versus high (HR=1.13; 95% CI=1.01-1.27; p=0.04) but not for intermediate versus high (HR=1.11; 95% CI=0.99-1.24; p=0.08) education. The HR associated with low level of education was significantly higher among female patients, patients <55years, patients with truncal tumours and during the first 5years after diagnosis.

    CONCLUSION: Lower level of education is associated with reduced CMM-specific survival, which may at least partially be attributed to a more advanced stage at diagnosis. These results emphasise the need for improved early detection strategies.

  • 12. Fritz, Helena K. M.
    et al.
    Lindgren, David
    Ljungberg, Börje
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Axelson, Håkan
    Dahlbäck, Björn
    The miR(21/10b) ratio as a prognostic marker in clear cell renal cell carcinoma2014In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 50, no 10, p. 1758-1765Article in journal (Refereed)
    Abstract [en]

    Purpose: Clear cell renal cell carcinoma (ccRCC) is the most common type of cancer in the adult kidney, and the prognosis of metastatic ccRCC remains poor with high mortality. In ccRCC, microRNAs (miRs) differentially expressed in tumour tissue have been identified and have been proposed to predict prognosis. The purpose of this study was to evaluate candidate miR markers identified from analysis of The Cancer Genome Atlas (TCGA) datasets in a large RCC cohort and to elucidate whether a ratio of miRs provided additional prognostic information. Experimental design: Deep sequencing data from TCGA datasets were analysed using biostatistical methods to identify candidate miRs that correlate with factors such as survival and stage of disease. Candidate miRs were analysed by reverse transcription and quantitative polymerase chain reaction (RT-qPCR) in a cohort of 198 RCC tumours (ccRCC, n = 152) and 50 normal kidney samples. Results: Four candidate miRs (miR-10b, miR-21, miR-101 and miR-223) were selected from the TCGA analysis and analysed in our cohort. Of these, miR-21 and miR-10b were differentially expressed in RCC subtypes and in ccRCC nuclear grades. Individually, the two miRs demonstrated a non-significant trend to correlate with survival. Importantly, the ratio of miR-21/miR10b (miR(21/10b),) correlated significantly with disease severity and survival, a high miR(21/10b) being associated with poor prognosis (P = 0.0095). In particular, the miR(21/10b) was found to be an independent prognostic factor in metastasis-free patients (P = 0.016; confidence interval (CI) 1.201-5.736). Conclusions: We have shown that the miR(21/10b) ratio is an independent prognostic factor for M0 ccRCC patients, which could be useful to identify high-risk M0 patients who could benefit from increased surveillance.

  • 13. Fritz, Helena K. M.
    et al.
    Lindgren, David
    Ljungberg, Börje
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Axelson, Håkan
    Dahlbäck, Björn
    The miR21/10b ratio as a prognostic marker in metastasis-free clear cell renal cell carcinoma patients2014In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 50, p. S143-S144Article in journal (Other academic)
  • 14. Funegård, Ulrika
    et al.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Odontology, Cariology.
    Malmer, B
    Henriksson, R
    Ericson, T
    Can alpha-tocopherol and beta-carotene supplementation reduce adverse radiation effects on salivary glands?1995In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 31A, no 13-14, p. 2347-2353Article in journal (Refereed)
    Abstract [en]

    In this study, we evaluated whether supplementation with antioxidant vitamins can reduce the adverse effects of irradiation on the salivary glands in the rat. Four groups of adult Sprague-Dawley rats were given a basic diet providing 0.6 mg alpha-tocopherol and no beta-carotene per day. In two groups the basic diet was supplemented with 3.4 mg alpha-tocopherol and 6 mg beta-carotene per day from 14 days before irradiation until 12 days after completed irradiation. One group of rats given basic diet and one group given supplemented diet were irradiated with 7 Gy daily for five consecutive days. Isoproterenol and pilocarpine-stimulated whole saliva was collected from all rats 2, 4 and 26 weeks after irradiation. Vitamin-supplemented irradiated rats had higher secretion rates on all three occasions compared with those of irradiated rats given basic diet. The changes in saliva composition seen in irradiated rats were less accentuated in vitamin-supplemented, irradiated rats. The proportions of acinar cells were significantly decreased both in parotid and submandibular glands 26 weeks after irradiation. Supplementation with alpha-tocopherol and beta-carotene did not alter the morphology of the glands.

  • 15. Gnekow, Astrid K.
    et al.
    Walker, David A.
    Kandels, Daniela
    Picton, Susan
    Perilongo, Giorgio
    Grill, Jacques
    Stokland, Tore
    Sandström, Per Eric
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Warmuth-Metz, Monika
    Pietsch, Torsten
    Giangaspero, Felice
    Schmidt, Rene
    Faldum, Andreas
    Kilmartin, Denise
    De Paoli, Angela
    De Salvo, Gian Luca
    A European randomised controlled trial of the addition of etoposide to standard vincristine and carboplatin induction as part of an 18-month treatment programme for childhood (<= 16 years) low grade glioma - A final report2017In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 81, p. 206-225Article in journal (Refereed)
    Abstract [en]

    Background: The use of chemotherapy to manage newly diagnosed low grade glioma (LGG) was first introduced in the 1980s. One randomised trial has studied two-versus four-drug regimens with a duration of 12 months of treatment after resection. Methods: Within the European comprehensive treatment strategy for childhood LGG, the International Society of Paediatric OncologyeLow Grade Glioma (SIOP LGG) Committee launched a randomised trial involving 118 institutions and 11 countries to investigate the addition of etoposide (100 mg/m(2), days 1, 2 & 3) to a four-course induction of vincristine (1.5 mg/m(2) x 10 wkly) and carboplatin (550 mg/m(2) q 3 weekly) as part of 18-month continuing treatment programme. Patients were recruited after imaging diagnosis, resection or biopsy with progressive disease/symptoms. Some 497 newly diagnosed patients (M/F 231/266; median age 4.26 years (interquartile range (IQR) 2.02-7.06)) were randomised to receive vincristine carboplatin (VC) (n = 249) or VC plus etoposide (VCE) during induction (n = 248), stratified by age and tumour site. Findings: No differences between the two arms were found in term of survival and radiological response. Response and non-progression rates at 24 weeks for VC and VCE, were 46% versus 41%, and 93% versus 91% respectively; 5-year Progression-Free Survival (PFS) and Overall Survival (OS) were 46% (StDev 3.5) versus 45% (StDev 3.5) and 89% (StDev 2.1) versus 89% (StDev 2.1) respectively. Age and diencephalic syndrome are adverse clinical risk factors for PFS and OS. 5-year OS for patients in early progression at week 24 were 46% (StDev 13.8) and 49% (StDev 16.5) in the two arms, respectively. Interpretation: The addition of etoposide to VC did not improve PFS or OS. High non-progression rates at 24 weeks justify retaining VC as standard first-line therapy. Infants with diencephalic syndrome and early progression need new treatments to be tested. Future trials should use neurological/visual and toxicity outcomes and be designed to discriminate between the impact on disease outcomes of 'duration of therapy' and 'age at stopping therapy'.

  • 16. Gnekow, Astrid K.
    et al.
    Walker, David A.
    Kandels, Daniela
    Picton, Susan
    Perilongo, Giorgio
    Grill, Jacques
    Stokland, Tore
    Sandström, Per Eric
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Warmuth-Metz, Monika
    Pietsch, Torsten
    Giangaspero, Felice
    Schmidt, Rene
    Faldum, Andreas
    Kilmartin, Denise
    De Paoli, Angela
    De Salvo, Gian Luca
    Corrigendum to “A European randomised controlled trial of the addition of etoposide to standard vincristine and carboplatin induction as part of an 18-month treatment programme for childhood (≤16 years) low grade glioma – A final report” [Eur J of Canc (2017) 206–225]2018In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 90, p. 156-157Article in journal (Refereed)
  • 17. Göhler, S.
    et al.
    Da Silva Filho, M. I.
    Johansson, R.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Enquist-Olsson, K.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Henriksson, R.
    Hemminki, K.
    Lenner, Per
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Försti, A.
    Functional germline variants in driver genes of breast cancer2014In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 50, p. S233-S233Article in journal (Other academic)
  • 18. Hansen, RD
    et al.
    Larsen, R
    Borre, M
    Friis, S
    Åman, P
    Steingrimsdottir, L
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Overgaard, K
    Tjonneland, A
    Nordic lifestyle intervention trial on prostate cancer progression (NILS)2012In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 48, no S5, p. S286-S286Article in journal (Other academic)
  • 19. Holgersson, Georg
    et al.
    Bergstrom, Stefan
    Bergqvist, Michael
    Nyman, Jan
    Hoye, Even
    Helsing, Martin
    Friesland, Signe
    Holgersson, Margareta
    Birath, Elisabet
    Ekrnan, Simon
    Blystad, Thomas
    Ewers, Sven-Borje
    Morth, Charlotte
    Loden, Britta
    Henriksson, Roger
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Swedish Lung Cancer Radiation Study Group: Predictive value of histology for radiotherapy response in patients with non-small cell lung cancer2011In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 47, no 16, p. 2415-2421Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to evaluate the potential predictive value of histology in non-small cell lung cancer (NSCLC) treated with curatively intended radiotherapy. In a collaborative effort among all the Swedish Oncology Departments, clinical data were collected for 1146 patients with a diagnosed non-small cell lung cancer subjected to curatively intended irradiation (>= 50 Gy) during the years 1990 to 2000. The included patients were identified based on a manual search of all medical and radiation charts at the oncology departments from which the individual patient data were collected. Only patients who did not have a histological diagnosis date and death date/last follow-up date were excluded (n = 141). Among the 1146 patients with non-small cell carcinoma eligible for analysis, 919 were diagnosed with either adenocarcinoma (n = 323) or squamous cell carcinoma (n = 596) and included in this study. The median survival for the 919 patients was 14.8 months, while the 5-year survival rate was 9.5%. Patients with adenocarcinoma had a significantly better overall survival compared with patients with squamous cell carcinoma (p = 0.0062, log-rank test). When comparing different stages, this survival benefit was most pronounced for stages IIA-IIB (p<0.0001, log-rank test). The difference in survival between the two histological groups was statistically significant in a univariate Cox analysis (p = 0.0063) as well as in two multivariate Cox analyses including demographic and treatment variables (p = 0.037 and p = 0.048, respectively). In this large population based retrospective study we describe for the first time that patients with adenocarcinoma have a better survival after curatively intended radiation therapy in comparison with squamous cell carcinoma patients, particularly those with clinical stages IIA-IIB. (C) 2011 Elsevier Ltd. All rights reserved.

  • 20. Högberg, Thomas
    et al.
    Signorelli, Mauro
    de Oliveira, Carlos Freire
    Fossati, Roldano
    Lissoni, Andrea Alberto
    Sorbe, Bengt
    Andersson, Håkan
    Grenman, Seija
    Lundgren, Caroline
    Rosenberg, Per
    Boman, Karin
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Tholander, Bengt
    Scambia, Giovanni
    Reed, Nicholas
    Cormio, Gennaro
    Tognon, Germana
    Clarke, Jackie
    Sawicki, Tomasz
    Zola, Paolo
    Kristensen, Gunnar
    Sequential adjuvant chemotherapy and radiotherapy in endometrial cancer-Results from two randomised studies.2010In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 46, no 13, p. 2422-2431Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Endometrial cancer patients with high grade tumours, deep myometrial invasion or advanced stage disease have a poor prognosis. Randomised studies have demonstrated the prevention of loco-regional relapses with radiotherapy (RT) with no effect on overall survival (OS). The possible additive effect of chemotherapy (CT) remains unclear. Two randomised clinical trials (NSGO-EC-9501/EORTC-55991 and MaNGO ILIADE-III) were undertaken to clarify if sequential combination of chemotherapy and radiotherapy improves progression-free survival (PFS) in high-risk endometrial cancer. The two studies were pooled. METHODS: Patients (n=540; 534 evaluable) with operated endometrial cancer International Federation of Obstetrics and Gynaecology (FIGO) stage I-III with no residual tumour and prognostic factors implying high-risk were randomly allocated to adjuvant radiotherapy with or without sequential chemotherapy. RESULTS: In the NSGO/EORTC study, the combined modality treatment was associated with 36% reduction in the risk for relapse or death (hazard ratio (HR) 0.64, 95%confidence interval (CI) 0.41-0.99; P=0.04); two-sided tests were used. The result from the Gynaecologic Oncology group at the Mario Negri Institute (MaNGO)-study pointed in the same direction (HR 0.61), but was not significant. In the combined analysis, the estimate of risk for relapse or death was similar but with narrower confidence limits (HR 0.63, CI 0.44-0.89; P=0.009). Neither study showed significant differences in the overall survival. In the combined analysis, overall survival approached statistical significance (HR 0.69, CI 0.46-1.03; P=0.07) and cancer-specific survival (CSS) was significant (HR 0.55, CI 0.35-0.88; P=0.01). CONCLUSION: Addition of adjuvant chemotherapy to radiation improves progression-free survival in operated endometrial cancer patients with no residual tumour and a high-risk profile. A remaining question for future studies is if addition of radiotherapy to chemotherapy improves the results.

  • 21.
    Jestin, Pia
    et al.
    The Department of Surgical Sciences, Akademiska sjukhuset, Colorectal Unit, Uppsala University, SE 751 85, Uppsala, Sweden.
    Påhlman, Lars
    The Department of Surgical Sciences, Akademiska sjukhuset, Colorectal Unit, Uppsala University, SE 751 85, Uppsala, Sweden.
    Glimelius, Bengt
    Department of Oncology, Radiology and Clinical Immunology, Akademiska sjukhuset, Uppsala University, Uppsala, Sweden.
    Gunnarsson, Ulf
    The Department of Surgical Sciences, Akademiska sjukhuset, Colorectal Unit, Uppsala University, SE 751 85, Uppsala, Sweden.
    Cancer staging and survival in colon cancer is dependent on the quality of the pathologists' specimen examination.2005In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 41, no 14, p. 2071-2078Article in journal (Refereed)
    Abstract [en]

    Correct staging of colon cancer is decisive regarding further oncological treatment, surveillance and prediction of long-term survival. This study investigated the variability in accuracy of pathology reports with focus on differences between pathology departments and their compliance to regional guidelines. Data from the colon cancer register (1997-2002) of the Uppsala/Orebro, Sweden, health care region were analysed and the seven pathology departments in this region were compared. Included were 3735 patients who had undergone resection of a colon cancer. Cumulative 5-year survival was the main end-point. For 64% (n = 2390) of the cases, the number of lymph nodes examined was given (median 8). Survival in stage II was lower when fewer than 12 nodes were examined or when the number of nodes sampled was not given (P = 0.001, log-rank test). In stage III, those with at the most 3 nodes positive (N1) had a better survival than those with 4 or more nodes positive (N2) (P < 0.001, log-rank test). An index of metastases (IM), derived from the number of nodes with metastases divided by the number of nodes examined, was calculated for stage III tumours. Examination of 12 nodes is necessary to assure stage III cases with the median IM (0.32), whereas 20 nodes are necessary to assure 90% of cases with the lower quartile of IM (0.16). Irrespective of the number of nodes investigated, overall survival was better among patients with IM < 0.33 vs. IM > or = 33 (P < 0.001, log-rank test). The prognostic information of the IM was higher than that of the N-stage. Quality of a pathology department, measured by the median number of lymph nodes investigated and by the proportion of reports where the number is given, was determined to indicate correct staging and management of the patient. An index of metastases (IM) is a possible basis for guidance in the choice of adjuvant treatments that appears superior to that of N-stage.

  • 22. Kiflemariam, S
    et al.
    Mignardi, M
    Bergh, Anders
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Nilsson, Maria
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Sjöblom, T
    Direct detection of TMPRSS2-ERG rearrangements in prostate cancer by Padlock Probes2012In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 48, no S5, p. S110-S110Article in journal (Other academic)
  • 23. Lindskog, Magnus
    et al.
    Tavelin, Björn
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Lundström, Staffan
    Old age as risk indicator for poor end-of-life care quality: a population-based study of cancer deaths from the Swedish Register of Palliative Care2015In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 51, no 10, p. 1331-1339Article in journal (Refereed)
    Abstract [en]

    Background: If patient age affects the quality of end-of-life care in cancer is unknown. Using data from a population-based register of palliative care in Sweden, we addressed this question. Methods: This nation-wide study focused on the last week of life of adults dying from cancer in 2011-2012, based on data reported to a national quality register for end-of-life care (N = 26,976). We specifically investigated if age-dependent differences were present with respect to thirteen indicators of palliative care quality. Patients were categorised in one out of five pre-defined age groups. Odds ratios (OR) with 95% confidence intervals (CIs), adjusted for type of end-of-life care unit, were calculated using logistic regression, with the oldest group as reference. Findings: Age-dependent differences in implementation rate were detected for ten out of thirteen end-of-life care quality indicators, most of which were progressively less well met with each increment in age group. Compared to elderly cancer patients, young patients were more often informed about imminent death, (OR, 3.9; 95% CI 2.5-5.9, p < 0.001), were more often systematically assessed for the presence and severity of pain (OR, 1.6; 95% CI 1.2-2.1, p < 0.001) or other symptoms (OR, 1.4; 95% CI 1.0-1.9, p = 0.044), were more likely to be assessed by palliative care consultation services (OR, 4.3; 95% CI 3.3-5.7, p < 0.001) and to have injections prescribed as needed against pain (OR, 3.4; 95% CI 1.3-9.4, p = 0.016), anxiety (OR, 3.8; 95% CI 2.0-7.1, p < 0.001) or nausea (OR, 3.6; 95% CI 2.3-5.7, p < 0.001). The families of young patients were more likely to be informed about imminent death ( OR, 2.6; 95% CI 1.5-4.3, p = 0.001) and to be offered bereavement support ( OR, 4.6; 95% CI 2.7-7.8, p < 0.001). Interpretation: Old age is a risk indicator for poor end-of-life care quality among cancer patients in Sweden. Funding: The executive committee of the National Quality Registries in Sweden.

  • 24. Lycken, Magdalena
    et al.
    Drevin, Linda
    Garmo, Hans
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Adolfsson, Jan
    Lissbrant, Ingela Franck
    Holmberg, Lars
    Bill-Axelson, Anna
    The use of palliative medications before death from prostate cancer: Swedish population-based study with a comparative overview of European data2018In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 88, p. 101-108Article in journal (Refereed)
    Abstract [en]

    Background: Symptoms of terminal cancer have previously been reported as under-treated. The aim of this study was to assess the use of palliative medications before death from prostate cancer.

    Methods: This Swedish register study included men who died from 2009 to 2012 with prostate cancer as the underlying cause of death. We assessed the proportion who collected a prescription of androgen deprivation therapy, non-steroidal anti-inflammatory drugs, paracetamol, opioids, glucocorticoids, antidepressants, anxiolytics and sedative-hypnotics and the differences in treatment related to age, time since diagnosis, educational level, close relatives and comorbidities. Data were collected from 3 years before death from prostate cancer.

    Results: We included 8326 men. The proportion who received opioids increased from 30% to 72% during the last year of life, and 67% received a strong opioid at the time of death. Antidepressants increased from 13% to 22%, anxiolytics from 9% to 27% and sedative-hypnotics from 21% to 33%. Men without close relatives and older men had lower probability to receive opioids (odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.47-0.66 for > 85 years versus < 70 years) and (OR 0.78, 95% CI: 0.66-0.92 for unmarried without children versus married with children).

    Conclusion: Our results represent robust epidemiological data from Sweden for comparison of palliative care quality between countries. The findings indicate that men without close relatives and older men are disadvantaged with respect to the treatment of cancer pain and need closer attention from health care providers and highlight the importance to identify psychological distress in terminal prostate cancer. 

  • 25. Lycken, Magdalena
    et al.
    Garmo, Hans
    Adolfsson, Jan
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Holmberg, Lars
    Bill-Axelson, Anna
    Patterns of androgen deprivation therapies among men diagnosed with localised prostate cancer: A population-based study2014In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 50, no 10, p. 1789-1798Article in journal (Refereed)
    Abstract [en]

    Aim: Many men diagnosed with localised prostate cancer will eventually be treated with androgen deprivation therapy (ADT). ADT is associated with adverse effects and its timing is controversial. Data on patterns of use are scarce. We describe patterns of ADT use, defined as castration (medical and surgical) or antiandrogen monotherapy initiated after primary treatment, in a population-based cohort. Methods and materials: Data were extracted from the population-based Prostate Cancer data Base Sweden (PCBaSe). Totally 45,147 men diagnosed between 1997 and 2009 with clinical stage T1-2, N0-NX, M0-MX and prostate specific antigen (PSA) <50 ng/ml without primary ADT were included. Outcomes in the period 2006 through 2010 were analysed using a period analysis approach. Results: The cumulative incidence of castration at 10 years after diagnosis was 11.6% (95% confidence interval (CI), 11.0-12.2%). The corresponding proportion of antiandrogen monotherapy was 10.8% (95% CI, 10.2-11.4%). Castration was the dominant therapy among men on deferred treatment. The probability of receiving castration rather than antiandrogen monotherapy increased with age. Estimated median durations of castration ranged from 4 years in the deferred treatment high-risk group to 17 years in the prostatectomy low-risk group. The main limitation was the lack of information on progression to metastatic disease and PSA at the time for initiation of ADT. Conclusion: When initiated early after curative treatment, the duration of castration can be decades. The findings indicate that more accurate tools are necessary to guide which men should be selected for ADT as secondary treatment. (C) 2014 Elsevier Ltd. All rights reserved.

  • 26. Magnusson, Marie
    et al.
    Höglund, Peter
    Johansson, Karin
    Jönsson, Charlotta
    Killander, Fredrika
    Malmström, Per
    Weddig, Anna
    Kjellén, Elisabeth
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Department of Oncology, Lund University Hospital, Lund, Sweden.
    Pentoxifylline and vitamin E treatment for prevention of radiation-induced side-effects in women with breast cancer: a phase two, double-blind, placebo-controlled randomised clinical trial (Ptx-5)2009In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 45, no 14, p. 2488-2495Article in journal (Refereed)
    Abstract [en]

    Background: A previous study has shown that pentoxifylline in combination with vitamin E can reverse radiation-induced fibrosis. The aim of the present study is to investigate if the same drugs could prevent radiation-induced side-effects in women with breast cancer.

    Patients and methods: A randomised, placebo-controlled, double-blind, parallel group trial was performed. Women with breast cancer were treated for 12 months with 400 mg pentoxifylline t.i.d. or placebo, in combination with 100 mg vitamin E t.i.d,, starting 1-3 months after the completion of radiotherapy. The primary end-point was passive abduction of the shoulder, and the secondary end-point was difference in arm volumes. The trial is registered on the ISRCTN.org website, number ISRCTN39143623.

    Results: 83 patients were included in the study; 42 in the pentoxifylline + vitamin E group and 41 in the placebo + vitamin E group. Both treatments were generally well tolerated. Seven patients were withdrawn from the treatment due to disease progression; four in the pentoxifylline group and three in the placebo group. At inclusion, patients had impaired passive abduction of the shoulder. During treatment, both the groups improved significantly. Median improvement from baseline was 3.7 degrees (p = 0.0035) on pentoxifylline and was 9.4 degrees (p = 0.0041) in the placebo group, but no difference between the groups was detected (p = 0.20). Arm volumes increased over time in the placebo group (1.04%), but not on pentoxifylline (0.50%), and differed significantly between the groups (p = 0.0172).

    Conclusions: The combination of pentoxifylline and vitamin E was safe and may be used for the prevention of some radiation-induced side-effects. (C) 2009 Elsevier Ltd. All rights reserved.

  • 27. Niclou, S. P.
    et al.
    Johansson, M.
    Tiemann, K.
    Oudin, A.
    Hedman, Håkan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Local delivery of the soluble form of the tumor suppressor and stem cell regulator LRIG1 potently inhibits in vivo growth of glioblastomas with either wildtype or mutant EGFR expression2013In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 49, no Supplement 2, p. S777-S777, Meeting Abstract: 3307Article in journal (Other academic)
  • 28. Nilsson, S.
    et al.
    Strang, P.
    Aksnes, A. K.
    Franzen, Lars
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Olivier, P.
    Pecking, A.
    Staffurth, J.
    Vasanthan, S.
    Andersson, C.
    Bruland, O. S.
    A randomized, dose-response, multicenter phase II study of radium-223 chloride for the palliation of painful bone metastases in patients with castration-resistant prostate cancer2012In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 48, no 5, p. 678-686Article, review/survey (Refereed)
    Abstract [en]

    Purpose: To investigate the dose-response relationship and pain-relieving effect of radium-223, a highly bone-targeted alpha-pharmaceutical.

    Methods: One hundred patients with castration-resistant prostate cancer (CRPC) and painful bone metastases were randomized to a single intravenous dose of 5, 25, 50 or 100 kBq/kg radium-223. The primary end-point was pain index (visual analogue scale [VAS] and analgesic use), also used to classify patients as responders or non-responders.

    Results: A significant dose response for pain index was seen at week 2 (P = .035). At week 8 there were 40%, 63%, 56% and 71% pain responders (reduced pain and stable analgesic consumption) in the 5, 25, 50 and 100 kBq/kg groups, respectively. On the daily VAS, at week 8, pain decreased by a mean of -30, -31, -27 and -28 mm, respectively (P = .008, P = .0005, P = .002, and P < .0001) in these responders (post-hoc analysis). There was also a significant improvement in the brief pain inventory functional index for all dose-groups (P = .04, .01, .002 and .02, Wilcoxon signed rank test). Furthermore, a decrease in bone alkaline phosphatase in the highest dose-group was demonstrated (P = .0067). All doses were safe and well tolerated.

    Conclusion: Pain response was seen in up to 71% of the patients with a dose response observed 2 weeks after administration. The highly tolerable side-effect profile of radium-223 previously reported was confirmed. (C) 2012 Elsevier Ltd. All rights reserved.

  • 29. Nordlund, J.
    et al.
    Backlin, C.
    Wahlberg, P.
    Forestier, Erik
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Medical and Clinical Genetics.
    Heyman, M.
    Soderhall, S.
    Schmiegelow, K.
    Lonnerholm, G.
    Gustafsson, M.
    Syvanen, A. C.
    The DNA Methylation Landscape of Paediatric Acute Lymphoblastic Leukemia2012In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 48, p. S141-S141Article in journal (Other academic)
  • 30.
    Norrback, Karl-Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Roos, Göran
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Telomeres and telomerase in normal and malignant haematopoietic cells1997In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 33, no 5, p. 774-780Article in journal (Refereed)
    Abstract [en]

    The normal haematopoietic system harbours telomerase-competent cells with a capacity to upregulate the activity to notable levels in a telomere length-independent manner. Strong telomerase activity is found in progenitor stem cells and activated lymphocytes in vitro as well as in vivo, indicating that cells with high growth requirements can readily upregulate telomerase. Despite detection of telomerase activity, a gradual telomere erosion occurs in stem cells and lymphocytes, with significantly shortened telomeres at higher ages, a phenomenon that might be of importance for developing immunosenescence and exhausted haematopoiesis. In malignant haematopoietic disorders telomerase activity is a general finding with large differences in activity levels. The strongest telomerase expression has been shown in acute leukaemias and non-Hodgkin's lymphomas, especially high grade cases. There are indications that the level of activity might parallel tumour progression and be of prognostic relevance, but studies of larger patient materials are needed. An association between the cell cycle and telomerase activity exists, especially for normal haematopoietic cells, and induction of a differentiation programme in immortalised cell lines downregulates telomerase activity. The expression of telomerase activity seems to be regulated at different levels, since for immature bone marrow cells the level of activity seemed to parallel better the phenotype than the proliferation state. The frequent expression of telomerase in leukaemias and lymphomas makes these disorders interesting targets for future anti-telomerase therapy.

  • 31. Obondo, C.
    et al.
    Karakatsanis, A.
    Eriksson, S.
    Hersi, A. F.
    Pistiolis, L.
    Shahin, A.
    Nilsson, Fredrik
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Mohammed, I.
    Wickberg, A.
    Wärnberg, F.
    SentiDose: a dose optimizing study with SiennaXP, a superparamagnetic iron oxide for sentinel node detection2018In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 92, p. S79-S79Article in journal (Other academic)
  • 32. O'Sullivan, J.
    et al.
    Johannessen, D. C.
    Widmark, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Syndikus, I.
    James, N.
    Dall'Oglio, M.
    Haugen, I.
    Cross, A.
    Garcia-Vargas, J.
    Vogelzang, N.
    Hematologic safety of radium-223 dichloride (Ra-223) in the phase 3 ALSYMPCA trial in castration-resistant prostate cancer (CRPC) patients with bone metastases: baseline prognostic factor subgroup analysis2013In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 49, no Supplement 2, p. S688-S688, Meeting Abstract: 2877Article in journal (Other academic)
  • 33. Parker, C.
    et al.
    Heinrich, D.
    Bottomley, D.
    Hoskin, P.
    Franzen, Lars
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Solberg, A.
    Pawar, V.
    Reuning-Scherer, J.
    O'Bryan-Tear, C. G.
    Nilsson, S.
    Effects of radium-223 dichloride (Ra-223) on health-related quality of life (QOL) outcomes in the phase 3 ALSYMPCA study in patients with castration-resistant prostate cancer (CRPC) and bone metastases2013In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 49, no Supplement 2, p. S689-S689, Meeting Abstract: 2878Article in journal (Other academic)
  • 34. Petit, C.
    et al.
    Pignon, J. P.
    Landais, C.
    Trotti, A.
    Gregoire, V.
    Overgaard, J.
    Tobias, J.
    Zackrisson, Björn
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Parmar, M. K.
    Lee, J. W.
    Ghi, M. G.
    Corvo, R.
    Janot, F.
    O'Sullivan, B.
    Horiuchi, M.
    Zhang, Q.
    Fortpied, C.
    Grau, C.
    Bourhis, J.
    Blanchard, P.
    What is the most effective treatment for head and neck squamous cell carcinoma?: An individual patient data network meta-analysis from the MACH-NC and MARCH collaborative groups2017In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 72, p. S101-S102Article in journal (Other academic)
  • 35. Ros, Martine M
    et al.
    Bueno-de-Mesquita, H Bas
    Kampman, Ellen
    Buchner, Frederike L
    Aben, Katja KH
    Egevad, Lars
    Overvad, Kim
    Tjonneland, Anne
    Roswall, Nina
    Clavel-Chapelon, Francoise
    Boutron-Ruault, Marie Christine
    Morois, Sophie
    Kaaks, Rudolf
    Teucher, Birgit
    Weikert, Steffen
    von Ruesten, Anne
    Trichopoulou, Antonia
    Naska, Androniki
    Benetou, Vassiliki
    Saieva, Calogero
    Pala, Valeria
    Ricceri, Fulvio
    Tumino, Rosario
    Mattiello, Amalia
    Peeters, Petra HM
    van Gils, Carla H
    Gram, Inger T
    Engeset, Dagrun
    Chirlaque, Maria-Dolores
    Ardanazx, Eva
    Rodriguez, Laudina
    Amanio, Pilar
    Gonzalez, Carlos A
    Jose Sanchez, Maria
    Ulmert, David
    Ernstrom, Roy
    Ljungberg, Börje
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Allen, Naomi E
    Key, Timothy J
    Khaw, Kee-Tee
    Wareham, Nick
    Slimani, Nadia
    Romieu, Isabelle
    Kiemeney, Lambertus A
    Riboli, Elio
    Fruit and vegetable consumption and risk of aggressive and non-aggressive urothelial cell carcinomas in the European Prospective Investigation into Cancer and Nutrition2012In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 48, no 17, p. 3267-3277Article in journal (Refereed)
    Abstract [en]

    Background: Many epidemiological studies have examined fruit and vegetable consumption in relation to the risk of urothelial cell carcinoma (UCC) of the bladder, but results are inconsistent. The association between fruit and vegetable consumption and UCC risk may vary by bladder tumour aggressiveness. Therefore, we examined the relation between fruit and vegetable consumption and the risk of aggressive and non-aggressive UCC in the European Prospective Investigation into Cancer and Nutrition (EPIC).

    Methods: After 8.9 years of follow-up, 947 UCC were diagnosed among 468,656 EPIC participants. Of these, 421 could be classified as aggressive UCC and 433 as non-aggressive UCC cases. At recruitment, fruit and vegetable consumption was assessed by validated dietary questionnaires. Multivariable hazard ratios were estimated using Cox regression stratified by age, sex and center and adjusted for smoking status, duration and intensity of smoking, and energy intake.

    Results: Total consumption of fruits and vegetables was not associated with aggressive UCC nor with non-aggressive UCC. A 25 g/day increase in leafy vegetables and grapes consumption was associated with a reduced risk of non-aggressive UCC (hazard ratio (HR) 0.88; 95% confidence interval (CI) 0.78-1.00 and HR 0.87; 95% CI 0.77-0.98, respectively), while the intake of root vegetables was inversely associated with risk of aggressive UCC (HR 0.87; 95% CI 0.77-0.98).

    Conclusion: Our study did not confirm a protective effect of total fruit and/or vegetable consumption on aggressive or non-aggressive UCC. High consumption of certain types of vegetables and of fruits may reduce the risk of aggressive or non-aggressive UCC; however chance findings cannot be excluded.

  • 36. Sadetzki, Siegal
    et al.
    Bruchim, Revital
    Oberman, Bernice
    Armstrong, Georgina N.
    Lau, Ching C.
    Claus, Elizabeth B.
    Barnholtz-Sloan, Jill S.
    Il'yasova, Dora
    Schildkraut, Joellen
    Johansen, Christoffer
    Houlston, Richard S.
    Shete, Sanjay
    Amos, Christopher I.
    Bernstein, Jonine L.
    Olson, Sara H.
    Jenkins, Robert B.
    Lachance, Daniel
    Vick, Nicholas A.
    Merrell, Ryan
    Wrensch, Margaret
    Davis, Faith G.
    McCarthy, Bridget J.
    Lai, Rose
    Melin, Beatrice S.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Bondy, Melissa L.
    Description of selected characteristics of familial glioma patients: Results from the Gliogene Consortium2013In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 49, no 6, p. 1335-1345Article in journal (Refereed)
    Abstract [en]

    Background: While certain inherited syndromes (e. g. Neurofibromatosis or LiFraumeni) are associated with an increased risk of glioma, most familial gliomas are nonsyndromic. This study describes the demographic and clinical characteristics of the largest series of non-syndromic glioma families ascertained from 14 centres in the United States (US), Europe and Israel as part of the Gliogene Consortium. Methods: Families with 2 or more verified gliomas were recruited between January 2007 and February 2011. Distributions of demographic characteristics and clinical variables of gliomas in the families were described based on information derived from personal questionnaires. Findings: The study population comprised 841 glioma patients identified in 376 families (9797 individuals). There were more cases of glioma among males, with a male to female ratio of 1.25. In most families (83%), 2 gliomas were reported, with 3 and 4 gliomas in 13% and 3% of the families, respectively. For families with 2 gliomas, 57% were among 1st-degree relatives, and 31.5% among 2nd-degree relatives. Overall, the mean (+/- standard deviation [SD]) diagnosis age was 49.4 (+/- 18.7) years. In 48% of families with 2 gliomas, at least one was diagnosed at < 40 y, and in 12% both were diagnosed under 40 y of age. Most of these families (76%) had at least one grade IV glioblastoma multiforme (GBM), and in 32% both cases were grade IV gliomas. The most common glioma subtype was GBM (55%), followed by anaplastic astrocytoma (10%) and oligodendroglioma (8%). Individuals with grades I-II were on average 17 y younger than those with grades III-IV. Interpretation: Familial glioma cases are similar to sporadic cases in terms of gender distribution, age, morphology and grade. Most familial gliomas appear to comprise clusters of two cases suggesting low penetrance, and that the risk of developing additional gliomas is probably low. These results should be useful in the counselling and clinical management of individuals with a family history of glioma. (C) 2012 Elsevier Ltd. All rights reserved.

  • 37.
    Saraste, Deborah
    et al.
    Division of Surgery, CLINTEC, Karolinska Institutet, Sweden.
    Gunnarsson, Ulf
    Division of Surgery, CLINTEC, Karolinska Institutet, Sweden.
    Janson, Martin
    Division of Surgery, CLINTEC, Karolinska Institutet, Sweden.
    Predicting lymph node metastases in early rectal cancer2013In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 49, no 5, p. 1104-1108Article in journal (Refereed)
    Abstract [en]

    AIM: In this population-based study, the aim was to investigate risk factors for lymph node metastases and to construct a risk stratification index with relevance for pre-operative planning in T1 and T2 rectal cancers.

    METHODS: Data were retrieved from The Swedish Rectal Cancer Register, a mandatory, national, prospectively collected data base. All T1 and T2 rectal cancers treated with abdominal resection surgery without neo-adjuvant or adjuvant radio-chemotherapy from 2007 to 2010 were analysed. T-stage, sm-level, histologic differentiation, mucinous tumour type, blood vessel- and perineural infiltration, tumour location (in cm from the anal verge), age and gender were evaluated as potential predictors of lymph node metastases, using uni- and multivariate logistic regression.

    RESULTS: T2-stage (odds ratio [OR]=2.0), poor differentiation (OR=6.5) and vascular infiltration (OR=4.3) were identified as significant risk-factors for lymph node metastases in the multivariate analysis. The risk stratification index shows the risk for lymph node metastases gradually increasing from 6% to 65% and 11% to 78% in T1 and T2 cancers respectively, when adding the risk factors one by one.

    CONCLUSION: There is a considerable span in the risk for lymph node metastases between low risk T1 and high risk T2 rectal cancer. Using the risk stratification-model, with the concept of local excision as a macro-biopsy with standby for subsequent immediate radical resection surgery in high-risk cases, could benefit patients by providing the advantages of local excision yet ensuring adequate oncologic outcome.

  • 38. Svensk, A. C.
    et al.
    Öster, Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Emilsson, S.
    Hedestig, Oliver
    Umeå University, Faculty of Medicine, Department of Nursing.
    Tavelin, Björn
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Parfa, A.
    Lindh, Jack
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Conversational support group participation during radiotherapy period helps women with breast cancer and men with prostate cancer2015In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 51, p. S232-S232Article in journal (Other academic)
  • 39. Thorstenson, Andreas
    et al.
    Bratt, Ola
    Akre, Olof
    Hellborg, Henrik
    Holmberg, Lars
    Lambe, Mats
    Bill-Axelson, Anna
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Adolfsson, Jan
    Incidence of fractures causing hospitalisation in prostate cancer patients: Results from the population-based PCBaSe Sweden2012In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 48, no 11, p. 1672-1681Article in journal (Refereed)
    Abstract [en]

    Background: Prostate cancer patients have an increased risk of fractures as a consequence of skeletal metastases and osteoporosis induced by endocrine treatment. Data on incidence of fractures and risks in subgroups of men with prostate cancer are sparse. Our aim with this study is to report the risk of fractures among men with prostate cancer in a nationwide population-based study. Patients and methods: We identified 76,600 Swedish men diagnosed with prostate cancer 1997-2006 in the Prostate Cancer Data Base (PCBaSe) Sweden and compared the occurrence of fractures requiring hospitalisation with the Swedish male population. Results: Only men treated with gonadotropin releasing-hormone (GnRH) agonists or orchiectomy had increased incidence and increased relative risk of fractures requiring hospitalisation. Men treated with GnRH agonists had 9.8 and 6.3/1000 person-years higher incidence of any fracture and hip fracture requiring hospitalisation than the general population. The corresponding increases in incidence for men treated with orchiectomy were 16 and 12/1000 person-years, respectively. Men treated with orchiectomy, GnRH agonists, and antiandrogen monotherapy, had SIR for hip fracture of 2.0 (95% Confidence Interval 1.8-2.2), 1.6 (95% CI 1.5-1.8) and 0.9 (95% CI 0.7-1.1), respectively. Men treated with a curative intent (radical prostatectomy or radiotherapy) or managed with surveillance had no increased risk of fractures. Older men had the highest incidence of fractures while younger men had the highest relative risk. Conclusion: Prostate cancer patients treated with GnRH agonists or orchiectomy have significantly increased risk of fractures requiring hospitalisation while patients treated with antiandrogen monotherapy had no increase in such fractures. In absolute terms the excess risk in men treated with GnRH agonists corresponded to almost 10 extra fractures leading to hospitalisation per 1000 patient-years. Effects on bone density should be considered for men on long-term endocrine treatment. Unwarranted use of orchiectomy and GnRH agonists should be avoided. (C) 2012 Elsevier Ltd. All rights reserved.

  • 40.
    Tidehag, Viktor
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Hammarsten, Peter
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Egevad, Lars
    Grantors, Torvald
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Leanderson, Tomas
    Wikström, Pernilla
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Josefsson, Andreas
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Hägglöf, Christina
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Bergh, Anders
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    High density of S100A9 positive inflammatory cells in prostate cancer stroma is associated with poor outcome2014In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 50, no 10, p. 1829-1835Article in journal (Refereed)
    Abstract [en]

    Purpose: To elucidate if the density of inflammatory cells expressing S100A9 in malignant and surrounding non-malignant prostate tissues is a prognostic marker for outcome in prostate cancer patients. Experimental design: Tissue was obtained from 358 men diagnosed with prostate cancer at transurethral resection of the prostate due to obstructive voiding problems, of which 260 were then followed with watchful waiting. Tissue microarrays of both malignant and non-malignant tissues were stained with an antibody against S100A9. The number of stained inflammatory cells was scored and related to clinical outcome and histopathological parameters of known prognostic value. Results: A high number of inflammatory cells expressing S100A9 in both malignant and surrounding non-malignant tissues were associated with significantly shorter cancer-specific survival. This association remained significant when Gleason score and local tumour stage were analysed together with S100A9 in a Cox regression model. Low number of S100A9 positive cells in non-malignant stroma was correlated to significantly longer cancer-specific survival also in patients with Gleason score 8-10 tumours. S100A9 positive cells in tumour stroma were correlated with Gleason score, hyaluronan, platelet-derived growth factor receptor beta (PDGFR-beta), and androgen receptor (inverse correlation) in tumour stroma. S100A9 positive cells in non-malignant stroma correlated with androgen receptor in this tissue compartment (inverse correlation). Conclusions: A high number of S100A9 positive inflammatory cells in tumour stroma and in non-malignant stroma were associated with shorter cancer-specific survival in prostate cancer patients.

  • 41. Tiemann, K.
    et al.
    Bernard, A.
    Fack, F.
    Johansson, Mikael
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Hedman, Håkan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Niclou, S. P.
    Endogenous Inhibitors of Tyrosine Kinase Receptors: a Therapeutic Role for Soluble LRIG1 in Malignant Glioma?2012In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 48, p. S152-S152Article in journal (Other academic)
  • 42.
    Tomic, Katarina
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Sandin, Fredrik
    Wigertz, Annette
    Robinson, David
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Lambe, Mats
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Evaluation of data quality in the National Prostate Cancer Register of Sweden2015In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 51, no 1, p. 101-111Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Data in cancer quality registers are increasingly used for quality assurance, benchmarking, and research. 

    MATERIALS AND METHODS: Data in the National Prostate Cancer Register (NPCR) of Sweden were evaluated for completeness, timeliness, comparability and validity. Completeness and timeliness were assessed by cross-linkage to the Swedish Cancer Register, comparability was examined by comparing registration routines in NPCR with national and international guidelines, and validity was assessed by re-abstraction of data from medical charts for 731 men diagnosed with prostate cancer (Pca) in 2009. Furthermore, data on treatment were validated by record linkage to the Swedish Patient Register and The Prescribed Drug Register. 

    RESULTS: NPCR captured 98% of Pca cases in the Cancer Register and the mean value for completeness of the 48 evaluated variables was 90% (range 64-100%). Timeliness increased substantially from 2008 to 2012 with 95% of cases reported within 12months after diagnosis in 2012. NPCR complied with national and international coding routines. Overall, the agreement between original data and re-abstracted data from 731 charts was high. For example, the correlation between original and re-abstracted data was 1.00 for date of surgery, and 0.97 for serum levels of prostate specific antigen and exact agreement was 97% for Gleason score at biopsy, 83% for clinical local T stage and more than 95% of the androgen deprivation therapies registered in NPCR had a corresponding filled prescription. 

    CONCLUSION: Record linkages with other data sources and re-abstraction of data showed that data quality in NPCR is high.

  • 43. Toriola, Adetunji T
    et al.
    Surcel, Helja-Marja
    Agborsangaya, Calypse
    Grankvist, Kjell
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Tuohimaa, Pentti
    Toniolo, Paolo
    Lukanova, Annekatrin
    Pukkala, Eero
    Lehtinen, Matti
    Serum 25-hydroxyvitamin D and the risk of ovarian cancer2010In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 46, no 2, p. 364-369Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Ecological and experimental studies suggest that vitamin D may be associated with a reduced risk of ovarian cancer. In this study, we sought to determine the risk of developing ovarian cancer according to serum 25-hydroxyvitamin D (25-OHD) concentrations assessed on average 5 years before the diagnosis.

    METHODS: We conducted a population-based longitudinal case-control study nested within the Finnish Maternity Cohort (FMC) which contains serum samples of virtually all pregnant women in Finland since 1983. Among them, 201 ovarian cancers diagnosed within 10 years of serum sampling were randomly selected as cases for this study. For each case, we selected two controls matched for age, parity and sampling season (+/-4 weeks) and one control matched for age and parity but for the opposite sampling season (6 months+/-4 weeks).

    RESULTS: The relative risks (estimated as odds ratio, OR) for ovarian cancer comparing the lowest quintile to the highest quintile of serum 25-OHD concentration were 1.8 (95% CI 0.9-3.5) among controls matched for the same season, and 1.1 (95% CI 0.6-2.2) among controls matched for the opposite season. The OR among women with insufficient (<75nmol/L) serum 25-OHD concentration was 2.7 (95% CI 1.0-7.9, lower limit, 0.95) compared to that among those with sufficient (75nmol/L) serum 25-OHD concentration. No differences in the point estimates were observed between serous or mucinous histological subtypes of ovarian cancer.

    CONCLUSION: Overall, we did not observe a significant association between serum 25-OHD concentrations and the risk of ovarian cancer. However, we found evidence suggestive of an increased risk among women with low to insufficient serum 25-OHD concentrations.

  • 44. Toriola, Adetunji T
    et al.
    Surcel, Helja-Marja
    Calypse, Agborsangaya
    Grankvist, Kjell
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Luostarinen, Tapio
    Lukanova, Annekatrin
    Pukkala, Eero
    Lehtinen, Matti
    Independent and joint effects of serum 25-hydroxyvitamin D and calcium on ovarian cancer risk: a prospective nested case-control study2010In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 46, no 15, p. 2799-2805Article in journal (Refereed)
    Abstract [en]

    Calcium and vitamin D act independently to reduce the risk of ovarian cancer. The decreased risk of ovarian cancer associated with pre-diagnostic serum calcium and vitamin D needs to be evaluated further for possible new insights into ovarian cancer prevention.

  • 45. Tuomisto, Jouko
    et al.
    Holl, Katsiaryna
    Rantakokko, Panu
    Koskela, Pentti
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Wadell, Göran
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Virology.
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Dillner, Joakim
    Ogmundsdottir, Helga M
    Vartiainen, Terttu
    Lehtinen, Matti
    Pukkala, Eero
    Maternal smoking during pregnancy and testicular cancer in the sons: A nested case-control study and a meta-analysis.2009In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 45, no 9, p. 1640-1648Article in journal (Refereed)
    Abstract [en]

    Some large ecological studies have noted a significant association of testicular cancer (TC) with maternal smoking during pregnancy, while several more controlled studies have been negative. It has been difficult to obtain reliable data on exposure because of the long lag time to cancer diagnosis. We performed a case-control study nested within Finnish, Swedish and Icelandic maternity cohorts exploiting early pregnancy serum samples to evaluate the role of maternal smoking in the risk of TC in the offspring. After reviewing the literature, we also performed a meta-analysis of published studies. For each index mother of the TC patient, three to nine matched control mothers with a cancer-free son born at the same time as the TC case were identified within each cohort. First trimester sera were retrieved from the 70 index mothers and 519 control mothers and were tested for cotinine level by a novel HPLC-MS-MS method developed. No statistically significant association between maternal cotinine level and risk of TC in the offspring was found (OR 0.68; 95% CI 0.35, 1.34). This is the first study based on individual exposure measurements. Its results agree with our meta-analysis of seven previous epidemiological studies (total number of 2149 cases, 2762 controls) using indirect exposure assessment (OR 1.0; 95% CI 0.88, 1.12).

  • 46. van de Velde, Cornelis J H
    et al.
    Aristei, Cynthia
    Boelens, Petra G
    Beets-Tan, Regina G H
    Blomqvist, Lennart
    Borras, Josep M
    van den Broek, Colette B M
    Brown, Gina
    Coebergh, Jan-Willem
    Cutsem, Eric Van
    Espin, Eloy
    Gore-Booth, Jola
    Glimelius, Bengt
    Haustermans, Karin
    Henning, Geoffrey
    Iversen, Lene H
    Han van Krieken, J
    Marijnen, Corrie A M
    Mroczkowski, Pawel
    Nagtegaal, Iris
    Naredi, Peter
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Ortiz, Hector
    Påhlman, Lars
    Quirke, Philip
    Rödel, Claus
    Roth, Arnaud
    Rutten, Harm J T
    Schmoll, Hans J
    Smith, Jason
    Tanis, Pieter J
    Taylor, Claire
    Wibe, Arne
    Gambacorta, Maria Antonietta
    Meldolesi, Elisa
    Wiggers, Theo
    Cervantes, Andres
    Valentini, Vincenzo
    EURECCA colorectal: Multidisciplinary Mission statement on better care for patients with colon and rectal cancer in Europe.2013In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 49, no 13, p. 2784-2790Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Care for patients with colon and rectal cancer has improved in the last twenty years however still considerable variation exists in cancer management and outcome between European countries. Therefore, EURECCA, which is the acronym of European Registration of cancer care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012 the first multidisciplinary consensus conference about colon and rectum was held looking for multidisciplinary consensus. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries. METHODS: The expert panel had delegates of the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy & Oncology (ESTRO), European Society of Pathology (ESP), European Society for Medical Oncology (ESMO), European Society of Radiology (ESR), European Society of Coloproctology (ESCP), European CanCer Organisation (ECCO), European Oncology Nursing Society (EONS) and the European Colorectal Cancer Patient Organisation (EuropaColon), as well as delegates from national registries or audits. Experts commented and voted on the two web-based online voting rounds before the meeting (between 4th and 25th October and between the 20th November and 3rd December 2012) as well as one online round after the meeting (4th-20th March 2013) and were invited to lecture on the subjects during the meeting (13th-15th December 2012). The sentences in the consensus document were available during the meeting and a televoting round during the conference by all participants was performed. All sentences that were voted on are available on the EURECCA website www.canceraudit.eu. The consensus document was divided in sections describing evidence based algorithms of diagnostics, pathology, surgery, medical oncology, radiotherapy, and follow-up where applicable for treatment of colon cancer, rectal cancer and stage IV separately. Consensus was achieved using the Delphi method. RESULTS: The total number of the voted sentences was 465. All chapters were voted on by at least 75% of the experts. Of the 465 sentences, 84% achieved large consensus, 6% achieved moderate consensus, and 7% resulted in minimum consensus. Only 3% was disagreed by more than 50% of the members. CONCLUSIONS: It is feasible to achieve European Consensus on key diagnostic and treatment issues using the Delphi method. This consensus embodies the expertise of professionals from all disciplines involved in the care for patients with colon and rectal cancer. Diagnostic and treatment algorithms were developed to implement the current evidence and to define core treatment guidance for multidisciplinary team management of colon and rectal cancer throughout Europe.

  • 47. Van Hemelrijck, M.
    et al.
    Folkvaljon, Y.
    Garmo, H.
    Holmberg, L.
    Adolfsson, J.
    Akre, O.
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Cause of death in men with localized prostate cancer: which clinico-demographic risk factors are important?2013In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 49, no Supplement 2, p. S708-S709, Meeting Abstract: 2934Article in journal (Other academic)
  • 48. Van Hemelrijck, M.
    et al.
    Garmo, H.
    Lindhagen, L.
    Bratt, O.
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Adolfsson, J.
    Quantifying the transition from active surveillance to watchful waiting in men with very low-risk prostate cancer2017In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 72, p. S188-S188Article in journal (Other academic)
  • 49. Van Hemelrijck, M.
    et al.
    Lindhagen, L.
    Robinson, D.
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Garmo, H.
    How to model temporal changes in comorbidity for cancer patients using prospective cohort data2015In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 51, p. S148-S148Article in journal (Other academic)
  • 50. van Veldhoven, Catharina M
    et al.
    Khan, Aneire E
    Teucher, Birgit
    Rohrmann, Sabine
    Raaschou-Nielsen, Ole
    Tjønneland, Anne
    Overvad, Kim
    Vigl, Matthaeus
    Boeing, Heiner
    Benetou, Vassiliki
    Trichopoulou, Antonia
    Trichopoulos, Dimitrios
    Masala, Giovanna
    Mattiello, Amalia
    Krogh, Vittorio
    Tumino, Rosario
    Vermeulen, Roel
    Monninkhof, Evelyn
    May, Anne M
    Bueno-de-Mesquita, Bas
    Lund, Eiliv
    Ardanaz, Eva
    Huerta, José Marı A
    Jakszyn, Paula
    Dorronsoro, Miren
    Argüelles, Marcial
    Sánchez, Maria-José
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Manjer, Jonas
    Borgquist, Signe
    Allen, Naomi E
    Travis, Ruth C
    Khaw, Kay Tee
    Wareham, Nick
    Boffetta, Paolo
    Vineis, Paolo
    Riboli, Elio
    Physical activity and lymphoid neoplasms in the European Prospective Investigation into Cancer and nutrition (EPIC)2011In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 47, no 5, p. 748-760Article in journal (Refereed)
    Abstract [en]

    This study provided no consistent evidence for an association between various physical activity measures and the risk of lymphoid neoplasms or any of the B-NHL subtypes.

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