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  • 151.
    Papworth, Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Bergh, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Grankvist, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Klinisk kemi.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Rasmuson, Torgny
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Expression of erythropoietin and its receptor in human renal cell carcinoma2009Ingår i: Tumor Biology, ISSN 1010-4283, E-ISSN 1423-0380, Vol. 30, nr 2, s. 86-92Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To investigate the prognostic impact of erythropoietin (EPO) and EPO-receptor (EPO-R) expression in tumour as well as serum EPO in patients with renal cell carcinoma (RCC).

    Methods: Using immunohistochemistry, EPO and EPO-R were assessed in tissue microarrays from 195 RCCs. RCC type, TNM stage, nuclear grade, survival, EPO and haemoglobin (Hb) levels in blood were registered.

    Results: Strong expression of EPO and EPO-R in tumour tissue was found in 83 and 56%, respectively. EPO and EPO-R expression differed between RCC types. Serum EPO and blood Hb did not correlate to the expression of EPO or EPO-R. A positive correlation was found between the expression of EPO and EPO-R (p = 0.028). Survival was not related to tumour EPO, whereas strong EPO-R expression indicated a non-significantly worse prognosis. Serum EPO correlated positively to TNM stage and nuclear grade and negatively to survival. A multivariate analysis showed that TNM stage and nuclear grade were independent prognostic factors. Tumour EPO and EPO-R expression as well as serum EPO added no independent prognostic information.

    Conclusion: No correlation between EPO or EPO-R in tumour tissue and serum EPO or blood Hb was found. Neither EPO, EPO-R in tumour tissue nor serum EPO are independent prognostic factors.

  • 152.
    Papworth, Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Bergh, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Grankvist, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Klinisk kemi.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Sandlund, Johanna
    Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden .
    Rasmuson, Torgny
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Osteopontin and parathyroid hormone-related protein in human renal cell carcinomaManuskript (preprint) (Övrigt vetenskapligt)
  • 153.
    Papworth, Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Bergh, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Grankvist, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Klinisk kemi.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Sandlund, Johanna
    Department of Clinical Microbiology, Karolinska University Hospital.
    Rasmuson, Torgny
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Osteopontin but not parathyroid hormone-related protein predicts prognosis in human renal cell carcinoma2013Ingår i: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 52, nr 1, s. 159-165Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. To evaluate the relationship between osteopontin (OPN) in serum and plasma and parathyroid hormone-related protein (PTHrP) in serum, plasma and tumour tissue, and to assess the prognostic impact of OPN and PTHrP in human renal cell carcinoma (RCC).

    Material and methods. The study included 269 patients with RCC. In 189 patients, immunohistochemical (IHC) PTHrP tumour tissue expression was evaluated, and OPN and PTHrP in serum were assessed. In 80 patients, plasma OPN and PTHrP were analysed. Tumour type, TNM stage, nuclear grade and RCC-specific survival were also registered. In a sub-group, IHC expression of CD 31 was assessed. The prognostic information of the factors was analysed using uni- and multivariate analyses.

    Results. The median OPN level was 2.3 times higher in plasma than in serum. Serum OPN was significantly higher in patients with papillary RCC compared to clear cell RCC and chromophobe RCC. Both serum and plasma OPN levels were positively correlated to TNM stage and nuclear grade. Multivariate analysis showed that serum and plasma OPN levels were independent prognostic factors for RCC-specific survival, along with TNM stage. Immunohistochemical expression of PTHrP associated to TNM stage but not to nuclear grade or serum OPN. Furthermore, IHC expression of PTHrP was positively correlated to serum PTHrP but inversely to tumour CD31 expression. Plasma PTHrP was increased in 20% of the patients and related to TNM stage but not to nuclear grade. Plasma OPN was significantly higher in patients with increased PTHrP levels, compared to those with normal levels.

    Conclusion. Plasma OPN levels differed between RCC types, and in clear cell RCC, both serum and plasma OPN levels were independent predictors of survival. We found no evidence for prognostic value related to circulating levels or the IHC expression of PTHrP.

  • 154.
    Papworth, Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Grankvist, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Klinisk kemi.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Rasmuson, Torgny
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Parathyroid hormone-related protein and serum calcium in patients with renal cell carcinoma2005Ingår i: Tumor Biology, ISSN 1010-4283, E-ISSN 1423-0380, Vol. 26, nr 4, s. 201-206Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To evaluate serum parathyroid hormone-related protein (PTHrP) in relation to serum calcium and clinical outcome of patients with renal cell carcinoma.

    Methods: Sera from 243 patients with renal cell carcinoma were collected prior to therapy. Serum PTHrP was analyzed using an immunoradiometric assay. Tumour stage, nuclear grade, corrected serum calcium, and survival were assessed.

    Results: Serum PTHrP was detectable in 37/243 sera (15%) and hypercalcaemia (≥2.60 mmol/l) in 32/220 (15%). A positive correlation between serum PTHrP and serum calcium was found (r = 0.326; p < 0.01). Following subdivision of the material, based on storage time, the frequency of detectable serum PTHrP seemed to decrease with time. Serum calcium, but not serum PTHrP, was correlated to tumour stage (p < 0.001). Survival was similar for patients with detectable and undetectable PTHrP, but those with hypercalcaemia had a significantly shorter survival time compared to those with normal serum calcium (p < 0.001). A multivariate analysis showed that tumour stage and serum calcium were independent prognostic factors, but not grade or PTHrP.

    Conclusions: A positive relation of serum PTHrP to serum calcium was demonstrated in patients with renal cell carcinoma. Hypercalcaemia but not serum PTHrP predicted a worse prognosis.

  • 155.
    Papworth, Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Sandlund, Johanna
    Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden .
    Grankvist, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Klinisk kemi.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Rasmuson, Torgny
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Soluble carbonic anhydrase IX is not an independent prognostic factor in human renal cell carcinoma2010Ingår i: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 30, nr 7, s. 2953-2957Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to evaluate the prognostic information of soluble carbonic anhydrase (CA) IX expression in renal cell carcinoma (RCC).

    PATIENTS AND METHODS: Serum CA IX was analysed in 361 patients. Tumour type, TNM stage, nuclear grade, and RCC-specific survival were assessed. Serum and immunohistochemical expression were compared.

    RESULTS: Median serum CA IX expression was 141 (range 2-4, 181) pg/ml. Levels were significantly higher in 287 patients with clear cell, compared to 40 papillary (p<0.001) and 22 oncocytoma (p=0.002), but not to 12 chromophobe RCC (p=0.35). Serum CA IX in clear cell RCC was positively correlated to TNM stage (p=0.002). There was a positive trend between serum and immunohistochemical CA IX expression. In a multivariate analysis of clear cell RCC, TNM stage and nuclear grade were independent prognostic factors.

    CONCLUSION: Serum CA IX was higher in clear cell RCC compared to other RCC types. In clear cell RCC, serum CA IX correlated to TNM stage, but not survival.

  • 156. Patschan, Oliver
    et al.
    Holmäng, Sten
    Hosseini, Abolfazl
    Jancke, Georg
    Liedberg, Fredrik
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Malmström, Per-Uno
    Rosell, Johan
    Jahnson, Staffan
    Second-look resection for primary stage T1 bladder cancer: a population-based study2017Ingår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, nr 4, s. 301-307Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: This study aimed to evaluate the use of second-look resection (SLR) in stage T1 bladder cancer (BC) in a population-based Swedish cohort.

    MATERIALS AND METHODS: All patients diagnosed with stage T1 BC in 2008-2009 were identified in the Swedish National Registry for Urinary Bladder Cancer. Registry data on TNM stage, grade, primary treatment and pathological reports from the SLR performed within 8 weeks of the primary transurethral resection were validated against patient charts. The endpoint was cancer-specific survival (CSS).

    RESULTS: In total, 903 patients with a mean age of 74 years (range 28-99 years) were included. SLR was performed in 501 patients (55%), who had the following stages at SLR: 172 (35%) T0, 83 (17%) Ta/Tis, 210 (43%) T1 and 26 (5%) T2-4. The use of SLR varied from 18% to 77% in the six healthcare regions. Multiple adjuvant intravesical instillations were given to 420 patients (47%). SLR was associated with intravesical instillations, age younger than 74 years, discussion at multidisciplinary tumour conference, G3 tumour and treatment at high-volume hospitals. Patients undergoing SLR had a lower risk of dying from BC (hazard ratio 0.62, 95% confidence interval 0.45-0.84, p < .0022). Five-year CSS rates were as follows, in patients with the indicated tumours at SLR (p = .001): 82% in those with T1, 90% in T0, 90% in Ta/Tis and 56% in T2-4.

    CONCLUSIONS: There are large geographical differences in the use of SLR in stage T1 BC in Sweden, which are presumably related to local treatment traditions. Patients treated with SLR have a high rate of residual tumour but lower age, which suggests that a selection bias affects CSS.

  • 157. Patschan, Oliver
    et al.
    Holmäng, Sten
    Hosseini, Abolfazl
    Liedberg, Fredrik
    Ljungberg, Börje
    Department of Urology, Northern University Hospital, Umeå, Sweden.
    Malmström, Per-Uno
    Rosell, Johan
    Jahnson, Staffan
    Use of bacillus Calmette-Guerin in stage T1 bladder cancer: long-term observation of a population-based cohort2015Ingår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 49, nr 2, s. 127-132Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. The aim of this study was to analyse the rate of use of bacillus Calmette-Guerin (BCG) at a population-based level, and the overall mortality and bladder cancer mortality due to stage T1 bladder cancer in a national, population-based register. Materials and methods. In total, 3758 patients with primary stage T1 bladder cancer, registered in the Swedish Bladder Cancer Register between 1997 and 2006, were included. Age, gender, tumour grade and primary treatment in the first 3-6 months were registered. High-volume hospitals registered 10 or more T1 tumours per year. Date and cause of death were obtained from the National Board of Health and Welfare Cause of Death Register. Results. BCG was given to 896 patients (24%). The use of BCG increased from 18% between 1997 and 2000, to 24% between 2001 and 2003, and to 31% between 2004 and 2006. BCG was given more often to patients with G3 tumours, patients younger than 75 years and patients attending high-volume hospitals. BCG treatment, grade 2 tumours and patient age younger than 75 years were associated with lower mortality due to bladder cancer. Hospital volume, gender and year of diagnosis were not related to bladder cancer mortality. However, selection factors might have affected the results since comorbidity, number of tumours and tumour size were unknown. Conclusions. Intravesical BCG is underused at a population-based level in stage T1 bladder cancer in Sweden, particularly in patients 75 years or older, and in those treated at low-volume hospitals. BCG should be offered more frequently to patients with stage T1 bladder cancer in Sweden.

  • 158. Pesch, Beate
    et al.
    Gawrych, Katarzyna
    Rabstein, Sylvia
    Weiss, Tobias
    Casjens, Swaantje
    Rihs, Hans-Peter
    Ding, Hui
    Angerer, Juergen
    Illig, Thomas
    Klopp, Norman
    Bueno-de-Mesquita, Bas
    Ros, Martine M.
    Kaaks, Rudolf
    Chang-Claude, Jenny
    Roswall, Nina
    Tjonneland, Anne
    Overvad, Kim
    Clavel-Chapelon, Francoise
    Boutron-Ruault, Marie-Christine
    Dossus, Laure
    Boeing, Heiner
    Weikert, Steffen
    Trichopoulos, Dimitrios
    Palli, Domenico
    Sieri, Sabina
    Tumino, Rosario
    Panico, Salvatore
    Ramon Quiros, Jose
    Gonzalez, Carlos
    Jose Sanchez, Maria
    Dorronsoro, Miren
    Navarro, Carmen
    Barricarte, Aurelio
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Johansson, Mattias
    International Agency for Research on Cancer (IARC-WHO), Lyon, France.
    Ulmert, David
    Ehrnstrom, Roy
    Khaw, Kay-Tee
    Wareham, Nick
    Key, Timothy J.
    Ferrari, Pietro
    Romieu, Isabelle
    Riboli, Elio
    Bruening, Thomas
    Vineis, Paolo
    N-acetyltransferase 2 Phenotype, Occupation, and Bladder Cancer Risk: Results from the EPIC Cohort2013Ingår i: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 22, nr 11, s. 2055-2065Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: An association between N-acetyltransferase 2 (NAT2) slow acetylation and bladder cancer has been consistently observed in epidemiologic studies. However, evidence has been mainly derived from case-control studies and was sparse from cohort studies. We evaluated the association between NAT2 slow acetylation and bladder cancer in a case-control study nested in the European Prospective Investigation into Cancer and Nutrition.

    Methods: Exposure to aromatic amines and polycyclic aromatic hydrocarbons (PAH) could be assessed for 754 cases and 833 controls for whom occupational information was documented. A semiquantitative job-exposure matrix was applied to at-risk occupations to estimate the exposure as low, medium, or high based on tertiles of the distribution of the exposure score in controls. Using a comprehensive genotyping, NAT2 acetylation status could be categorized from 6-single-nucleotide polymorphism genotypes as slow or fast in 607 cases and 695 controls with DNA from archived blood samples.

    Results: Occupational exposure to aromatic amines and PAH was associated with an increased bladder cancer risk [upper tertile of the distribution of the exposure score: OR = 1.37; 95% confidence interval (CI), 1.02-1.84, and OR = 1.50; 95% CI, 1.09-2.05, respectively]. NAT2 slow acetylation did not modify these risk estimates and was not itself associated with bladder cancer risk (OR = 1.02; 95% CI, 0.81-1.29).

    Conclusions: These findings confirm established or suspected occupational risk factors but not the anticipated role of NAT2 slow acetylation in bladder cancer. No interaction was detected between NAT2 and any exposure of interest, including smoking. Impact: Genetic testing for NAT2 would be inappropriate in occupational settings.

  • 159. Pignot, G.
    et al.
    Bahi, R.
    Bensalah, K.
    Oger, E.
    Laguna, P.
    Barwari, K.
    Rigaud, J.
    Rouprêt, M.
    Bernhard, J.
    Long, J.
    Zisman, A.
    Berger, J.
    Paparel, P.
    Lechevallier, E.
    Bertini, R.
    Salomon, L.
    Bex, A.
    Farfara, R.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Rodriguez, A.
    Patard, J.
    L’Ischémie n’est pas un facteur d’insuffisance rénale chronique après néphrectomie partielle sur rein unique2014Ingår i: Progrès en urologie (Paris), ISSN 1166-7087, Vol. 24, nr 13, s. 822-822Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectifs Déterminer l‘influence du clampage pédiculaire et de sa durée sur la fonction rénale à long terme après néphrectomie partielle (NP) pour cancer sur rein unique.

    Méthodes L’étude a inclus rétrospectivement 259 patients opérés par NP entre 1979 et 2010 dans 13 centres. L’utilisation d’un clampage, son type (pédiculaire ou parenchymateux), sa durée ainsi que les données pré-, intra- et postopératoires ont été recueillies. Les valeurs de débit de filtration glomérulaire (DFG) préopératoire et au dernier suivi ont été comparés. Une analyse multivariée selon le modèle de Cox a été réalisée afin de déterminer l’impact de l’ischémie sur le risque d’insuffisance rénale (IR) chronique postopératoire.

    Résultats La taille moyenne des tumeurs était de 4,0±2,3cm et le DFG préopératoire moyen de 60,8±18,9ml/min. Au total, 106 patients ont été opérés en ischémie chaude (40,9 %) et 53 en ischémie froide (20,5 %). Trente patients (11,6 %) ont évolué vers l’insuffisance rénale chronique. En analyse multivariée, ni le clampage pédiculaire (p=0,44), ni la durée d’ischémie chaude (p=0,1) n’étaient associés à une évolution vers l’insuffisance rénale. Les facteurs indépendants d’insuffisance rénale à long terme étaient le DFG préopératoire (p<0,0001) et les pertes sanguines (p=0,02).

    Conclusion La fonction rénale après NP sur rein unique apparaît principalement liée à des facteurs non modifiables et notamment le DFG préopératoire. Ce travail relativise l’importance du clampage pédiculaire et du temps d’ischémie qui n’étaient pas significativement liés au risque d’IR dans notre étude.

  • 160. Pischon, Tobias
    et al.
    Lahmann, Petra H
    Boeing, Heiner
    Tjønneland, Anne
    Halkjaer, Jytte
    Overvad, Kim
    Klipstein-Grobusch, Kerstin
    Linseisen, Jakob
    Becker, Nikolaus
    Trichopoulou, Antonia
    Benetou, Vassiliki
    Trichopoulos, Dimitrios
    Sieri, Sabina
    Palli, Domenico
    Tumino, Rosario
    Vineis, Paolo
    Panico, Salvatore
    Monninkhof, Evelyn
    Peeters, Petra H M
    Bueno-de-Mesquita, H Bas
    Büchner, Frederike L
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi. Urologi och andrologi.
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Berglund, Göran
    Gonzalez, Carlos Alberto
    Dorronsoro, Miren
    Gurrea, Aurelio Barricarte
    Navarro, Carmen
    Martinez, Carmen
    Quirós, J Ramón
    Roddam, Andrew
    Allen, Naomi
    Bingham, Sheila
    Khaw, Kay-Tee
    Kaaks, Rudolf
    Norat, Teresa
    Slimani, Nadia
    Riboli, Elio
    Body size and risk of renal cell carcinoma in the European Prospective Investigation into Cancer and Nutrition (EPIC).2006Ingår i: International Journal of Cancer, ISSN 0020-7136, Vol. 118, nr 3, s. 728-38Artikel i tidskrift (Refereegranskat)
  • 161. Powles, Thomas
    et al.
    Albiges, Laurence
    Staehler, Michael
    Bensalah, Karim
    Dabestani, Saeed
    Giles, Rachel H.
    Hofmann, Fabian
    Hora, Milan
    Kuczyk, Markus A.
    Lam, Thomas B.
    Marconi, Lorenzo
    Merseburger, Axel S.
    Fernández-Pello, Sergio
    Tahbaz, Rana
    Volpe, Alessandro
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Bex, Axel
    Updated European Association of Urology Guidelines: Recommendations for the Treatment of First-line Metastatic Clear Cell Renal Cancer2018Ingår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 73, nr 3, s. 311-315Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The randomised phase III clinical trial Checkmate-214 showed a survival superiority for the combination of ipilimumab and nivolumab when compared with the previous standard of care in first-line metastatic/advanced clear cell renal cell carcinoma (RCC) (Escudier B, Tannir NM, McDermott DF, et al. CheckMate 214: efficacy and safety of nivolumab plus ipilimumab vs sunitinib for treatment-naive advanced or metastatic renal cell carcinoma, including IMDC risk and PD-L1 expression subgroups. LBA5, ESMO 2017, 2017). These results change the frontline standard of care for this disease and have implications for the selection of subsequent therapies. For this reason the European Association of Urology RCC guidelines have been updated. Patient summary: The European Association of Urology guidelines will be updated based on the results of the phase III Checkmate-214 clinical trial. The trial showed superior survival for a combination of ipilimumab and nivolumab (IN), compared with the previous standard of care, in intermediate-and poor-risk patients with metastatic clear cell renal cell carcinoma. When IN is not safe or feasible, alternative agents such as sunitinib, pazopanib, and cabozantinib should be considered. Furthermore, at present, the data from the trial are immature in favourable-risk patients. Therefore, sunitinib or pazopanib remains the favoured agent for this subgroup of patients.

  • 162. Powles, Thomas
    et al.
    Staehler, Michael
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Bensalah, Karim
    Canfield, Steven E.
    Dabestani, Saeed
    Giles, Rachel H.
    Hofmann, Fabian
    Hora, Milan
    Kuczyk, Markus A.
    Lam, Thomas
    Marconi, Lorenzo
    Merseburger, Axel S.
    Volpe, Alessandro
    Bex, Axel
    European Association of Urology Guidelines for Clear Cell Renal Cancers That Are Resistant to Vascular Endothelial Growth Factor Receptor-Targeted Therapy2016Ingår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 70, nr 5, s. 705-706Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The European Association of Urology renal cancer guidelines panel recommends nivolumab and cabozantinib over the previous standard of care in patients who have failed one or more lines of vascular endothelial growth factor-targeted therapy. New data have recently become available showing a survival benefit for cabozantinib.

  • 163. Powles, Thomas
    et al.
    Staehler, Michael
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Bensalah, Karim
    Canfield, Steven E.
    Dabestani, Saeed
    Giles, Rachel
    Hofmann, Fabian
    Hora, Milan
    Kuczyk, Markus A.
    Lam, Thomas
    Marconi, Lorenzo
    Merseburger, Axel S.
    Volpe, Alessandro
    Bex, Axel
    Updated EAU Guidelines for Clear Cell Renal Cancer Patients Who Fail VEGF Targeted Therapy2016Ingår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 69, nr 1, s. 4-6Artikel i tidskrift (Övrigt vetenskapligt)
  • 164. Purdue, Mark P
    et al.
    Johansson, Mattias
    International Agency for Research on Cancer (IARC), Lyon, France.
    Zelenika, Diana
    Toro, Jorge R
    Scelo, Ghislaine
    Moore, Lee E
    Prokhortchouk, Egor
    Wu, Xifeng
    Kiemeney, Lambertus A
    Gaborieau, Valerie
    Jacobs, Kevin B
    Chow, Wong-Ho
    Zaridze, David
    Matveev, Vsevolod
    Lubinski, Jan
    Trubicka, Joanna
    Szeszenia-Dabrowska, Neonila
    Lissowska, Jolanta
    Rudnai, Péter
    Fabianova, Eleonora
    Bucur, Alexandru
    Bencko, Vladimir
    Foretova, Lenka
    Janout, Vladimir
    Boffetta, Paolo
    Colt, Joanne S
    Davis, Faith G
    Schwartz, Kendra L
    Banks, Rosamonde E
    Selby, Peter J
    Harnden, Patricia
    Berg, Christine D
    Hsing, Ann W
    Grubb, Robert L
    Boeing, Heiner
    Vineis, Paolo
    Clavel-Chapelon, Françoise
    Palli, Domenico
    Tumino, Rosario
    Krogh, Vittorio
    Panico, Salvatore
    Duell, Eric J
    Quirós, José Ramón
    Sanchez, Maria-José
    Navarro, Carmen
    Ardanaz, Eva
    Dorronsoro, Miren
    Khaw, Kay-Tee
    Allen, Naomi E
    Bueno-de-Mesquita, H Bas
    Peeters, Petra H M
    Trichopoulos, Dimitrios
    Linseisen, Jakob
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Overvad, Kim
    Tjønneland, Anne
    Romieu, Isabelle
    Riboli, Elio
    Mukeria, Anush
    Shangina, Oxana
    Stevens, Victoria L
    Thun, Michael J
    Diver, W Ryan
    Gapstur, Susan M
    Pharoah, Paul D
    Easton, Douglas F
    Albanes, Demetrius
    Weinstein, Stephanie J
    Virtamo, Jarmo
    Vatten, Lars
    Hveem, Kristian
    Njølstad, Inger
    Tell, Grethe S
    Stoltenberg, Camilla
    Kumar, Rajiv
    Koppova, Kvetoslava
    Cussenot, Olivier
    Benhamou, Simone
    Oosterwijk, Egbert
    Vermeulen, Sita H
    Aben, Katja K H
    van der Marel, Saskia L
    Ye, Yuanqing
    Wood, Christopher G
    Pu, Xia
    Mazur, Alexander M
    Boulygina, Eugenia S
    Chekanov, Nikolai N
    Foglio, Mario
    Lechner, Doris
    Gut, Ivo
    Heath, Simon
    Blanche, Hélène
    Hutchinson, Amy
    Thomas, Gilles
    Wang, Zhaoming
    Yeager, Meredith
    Fraumeni, Joseph F
    Skryabin, Konstantin G
    McKay, James D
    Rothman, Nathaniel
    Chanock, Stephen J
    Lathrop, Mark
    Brennan, Paul
    Genome-wide association study of renal cell carcinoma identifies two susceptibility loci on 2p21 and 11q13.32011Ingår i: Nature Genetics, ISSN 1061-4036, E-ISSN 1546-1718, Vol. 43, nr 1, s. 60-65Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We conducted a two-stage genome-wide association study of renal cell carcinoma (RCC) in 3,772 affected individuals (cases) and 8,505 controls of European background from 11 studies and followed up 6 SNPs in 3 replication studies of 2,198 cases and 4,918 controls. Two loci on the regions of 2p21 and 11q13.3 were associated with RCC susceptibility below genome-wide significance. Two correlated variants (r² = 0.99 in controls), rs11894252 (P = 1.8 × 10⁻⁸) and rs7579899 (P = 2.3 × 10⁻⁹), map to EPAS1 on 2p21, which encodes hypoxia-inducible-factor-2 alpha, a transcription factor previously implicated in RCC. The second locus, rs7105934, at 11q13.3, contains no characterized genes (P = 7.8 × 10⁻¹⁴). In addition, we observed a promising association on 12q24.31 for rs4765623, which maps to SCARB1, the scavenger receptor class B, member 1 gene (P = 2.6 × 10⁻⁸). Our study reports previously unidentified genomic regions associated with RCC risk that may lead to new etiological insights.

  • 165.
    Rasmuson, Torgny
    et al.
    Umeå universitet, Medicinsk fakultet, Strålningsvetenskaper, Onkologi.
    Grankvist, Kjell
    Umeå universitet, Medicinsk fakultet, Medicinsk biovetenskap, Klinisk kemi.
    Jacobsen, Jan
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Olsson, Tommy
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Medicin.
    Ljungberg, Börje
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Serum insulin-like growth factor-1 is an independent predictor of prognosis in patients with renal cell carcinoma2004Ingår i: Acta Oncologica, ISSN 0284-186X, Vol. 43, nr 8, s. 744-748Artikel i tidskrift (Refereegranskat)
  • 166. Ravaud, Alain
    et al.
    Motzer, Robert J
    Pandha, Hardev S
    George, Daniel J
    Pantuck, Allan J
    Patel, Anup
    Chang, Yen-Hwa
    Escudier, Bernard
    Donskov, Frede
    Magheli, Ahmed
    Carteni, Giacomo
    Laguerre, Brigitte
    Tomczak, Piotr
    Breza, Jan
    Gerletti, Paola
    Lechuga, Mariajose
    Lin, Xun
    Martini, Jean-Francois
    Ramaswamy, Krishnan
    Casey, Michelle
    Staehler, Michael
    Patard, Jean-Jacques
    Ljungberg, Börje
    Adjuvant Sunitinib in High-Risk Renal-Cell Carcinoma after Nephrectomy.2016Ingår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 375, nr 23, s. 2246-2254Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Sunitinib, a vascular endothelial growth factor pathway inhibitor, is an effective treatment for metastatic renal-cell carcinoma. We sought to determine the efficacy and safety of sunitinib in patients with locoregional renal-cell carcinoma at high risk for tumor recurrence after nephrectomy.

    METHODS: In this randomized, double-blind, phase 3 trial, we assigned 615 patients with locoregional, high-risk clear-cell renal-cell carcinoma to receive either sunitinib (50 mg per day) or placebo on a 4-weeks-on, 2-weeks-off schedule for 1 year or until disease recurrence, unacceptable toxicity, or consent withdrawal. The primary end point was disease-free survival, according to blinded independent central review. Secondary end points included investigator-assessed disease-free survival, overall survival, and safety.

    RESULTS: The median duration of disease-free survival was 6.8 years (95% confidence interval [CI], 5.8 to not reached) in the sunitinib group and 5.6 years (95% CI, 3.8 to 6.6) in the placebo group (hazard ratio, 0.76; 95% CI, 0.59 to 0.98; P=0.03). Overall survival data were not mature at the time of data cutoff. Dose reductions because of adverse events were more frequent in the sunitinib group than in the placebo group (34.3% vs. 2%), as were dose interruptions (46.4% vs. 13.2%) and discontinuations (28.1% vs. 5.6%). Grade 3 or 4 adverse events were more frequent in the sunitinib group (48.4% for grade 3 events and 12.1% for grade 4 events) than in the placebo group (15.8% and 3.6%, respectively). There was a similar incidence of serious adverse events in the two groups (21.9% for sunitinib vs. 17.1% for placebo); no deaths were attributed to toxic effects.

    CONCLUSIONS: Among patients with locoregional clear-cell renal-cell carcinoma at high risk for tumor recurrence after nephrectomy, the median duration of disease-free survival was significantly longer in the sunitinib group than in the placebo group, at a cost of a higher rate of toxic events. (Funded by Pfizer; S-TRAC ClinicalTrials.gov number, NCT00375674 .).

  • 167. Redig, Josefine
    et al.
    Dalen, Johan
    Harmenberg, Ulrika
    Lindskog, Magnus
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Lundstam, Sven
    Sandin, Rickard
    Wahlgren, Thomas
    Åkerborg, Örjan
    Jakobsson, Maria
    Real-world cost-effectiveness of targeted therapy in metastatic renal cell carcinoma in Sweden: a population-based retrospective analysis2019Ingår i: Cancer Management and Research, ISSN 1179-1322, Vol. 11, s. 1289-1297Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To explore cost-effectiveness of targeted therapies (TTs) in the treatment of metastatic renal cell carcinoma (mRCC) in a real-world context using a nationwide population-based approach.

    Methods: Data on patients diagnosed with mRCC between 2002 and 2012 were extracted from Swedish national health data registers. To facilitate comparisons of patients diagnosed before and after TT introduction to the market, three cohorts were derived: pre-TT introduction (preTT), patients diagnosed 2002-2005; early TT introduction (TTi), patients diagnosed 2006-2008; and late TT introduction (TTii), which was limited to patients diagnosed 2009-2010 to ensure availability of total health care resource utilization (HCRU) data. Patients were followed until end of 2012. The value of TTs across cohorts was estimated using mean HCRU costs per life-year (LY) gained. Data on HCRU were obtained through national health registers for dispensed medication and inpatient and outpatient care, and the associated costs were estimated using the Lin method to account for censoring. LYs gained were defined as the difference in mean survival over the study period.

    Results: The preTT, TTi, and TTii cohorts consisted of 1,366, 1,158, and 806 patients, respectively. Mean survival in years from mRCC diagnosis was 1.45 in the preTT cohort, 1.62 in the TTi cohort, and 1.83 in the TTii cohort. The respective mean total HCRU cost per patient over the study period was US$16,894, US$29,922, and US$30,037. The cost per LY gained per cohort was US$78,656 for TTi vs preTT, US$34,132 for TTii vs preTT, and US$523 for TTii vs TTi.

    Conclusion: Given common willingness-to-pay per LY gained thresholds, this study in a real-world population suggests the use of TTs in the Swedish mRCC population is increasingly cost-effective over time.

  • 168. Rohrmann, Sabine
    et al.
    Linseisen, Jakob
    Overvad, Kim
    Lund Würtz, Anne Mette
    Roswall, Nina
    Tjønneland, Anne
    Boutron-Ruault, Marie-Christine
    Racine, Antoine
    Bastide, Nadia
    Palli, Domenico
    Agnoli, Claudia
    Panico, Salvatore
    Tumino, Rosario
    Sacerdote, Carlotta
    Weikert, Steffen
    Steffen, Annika
    Kühn, Tilman
    Li, Kuanrong
    Khaw, Kay-Tee
    Wareham, Nicholas J
    Bradbury, Kathryn E
    Peppa, Eleni
    Trichopoulou, Antonia
    Trichopoulos, Dimitrios
    Bueno-de-Mesquita, H Bas
    Peeters, Petra H M
    Hjartåker, Anette
    Skeie, Guri
    Weiderpass, Elisabete
    Jakszyn, Paula
    Dorronsoro, Miren
    Barricarte, Aurelio
    Santiuste de Pablos, Carmen
    Molina-Montes, Esther
    Alonso de la Torre, Ramón
    Ericson, Ulrika
    Sonestedt, Emily
    Johansson, Mattias
    Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning. International Agency for Research on Cancer (IARC), Lyon, France.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Freisling, Heinz
    Romieu, Isabelle
    Cross, Amanda J
    Vergnaud, Anne-Claire
    Riboli, Elio
    Boeing, Heiner
    Meat and fish consumption and the risk of renal cell carcinoma in the European prospective investigation into cancer and nutrition2015Ingår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 136, nr 5, s. E423-E431Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Renal cell cancer (RCC) incidence varies worldwide with a higher incidence in developed countries and lifestyle is likely to contribute to the development of this disease. We examined whether meat and fish consumption were related to the risk of RCC in the European Prospective Investigation into Cancer and Nutrition (EPIC). The analysis included 493,179 EPIC participants, recruited between 1992 and 2000. Until December 2008, 691 RCC cases have been identified. Meat and fish consumption was assessed at baseline using country-specific dietary assessment instruments; 24-hour recalls were applied in an 8% subsample for calibration purposes. Cox proportional hazards regression was used to calculate multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI). Women with a high consumption of red meat (HR=1.36, 95% CI 1.14-1.62; calibrated, per 50 g/day) and processed meat (HR=1.78, 95% CI 1.05-3.03; calibrated, per 50 g/day) had a higher risk of RCC, while no association existed in men. For processed meat, the association with RCC incidence was prominent in premenopausal women and was lacking in postmenopausal women (p interaction=0.02). Neither poultry nor fish consumption were statistically significantly associated with the risk of RCC. The results show a distinct association of red and processed meat consumption with incident RCC in women but not in men. A biological explanation for these findings remains unclear. What's new? Kidney cancer strikes different populations with different frequency, with developed nations seeing more cases. In this paper, the authors investigate whether certain elements of diet might correlate with increased incidence of renal cell carcinoma. Using data from the European Prospective Investigation into Cancer and Nutrition (EPIC), they assessed the amount of meat and fish consumed in populations representing a wide range of dietary habits. They then correlated this data with renal cell carcinoma incidence. They found no effect from eating fish; consuming red and processed meats did increase risk in women, but not in men.

  • 169. Ros, Martine M
    et al.
    Bas Bueno-de-Mesquita, H B
    Büchner, Frederike L
    Aben, Katja K H
    Kampman, Ellen
    Egevad, Lars
    Overvad, Kim
    Tjønneland, Anne
    Roswall, Nina
    Clavel-Chapelon, Francoise
    Kaaks, Rudolf
    Chang-Claude, Jenny
    Boeing, Heiner
    Weikert, Steffen
    Trichopoulou, Antonia
    Orfanos, Philippos
    Stasinopulou, Georgia
    Saieva, Calogero
    Krogh, Vittorio
    Vineis, Paolo
    Tumino, Rosario
    Mattiello, Amalia
    Peeters, Petra H M
    van Duijnhoven, Fränzel J B
    Lund, Eiliv
    Gram, Inger T
    Chirlaque, Maria D
    Barricarte, Aurelio
    Rodríguez, Laudina
    Molina, Esther
    Gonzalez, Carlos
    Dorronsoro, Miren
    Manjer, Jonas
    Ehrnström, Roy
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Allen, Naomi E
    Roddam, Andrew W
    Khaw, Kay-Tee
    Wareham, Nick
    Boffetta, Paolo
    Slimani, Nadia
    Michaud, Dominique S
    Kiemeney, Lambertus A L M
    Riboli, Elio
    Fluid intake and the risk of urothelial cell carcinomas in the European Prospective Investigation into Cancer and Nutrition (EPIC)2011Ingår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 128, nr 11, s. 2695-2708Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Results from previous studies investigating the association between fluid intake and urothelial cell carcinomas (UCC) are inconsistent. We evaluated this association among 233,236 subjects in the European Prospective Investigation into Cancer and Nutrition (EPIC), who had adequate baseline information on water and total fluid intake. During a mean follow-up of 9.3 years, 513 first primary UCC occurred. At recruitment, habitual fluid intake was assessed by a food frequency questionnaire. Multivariable hazard ratios were estimated using Cox regression stratified by age, sex and center and adjusted for energy intake, smoking status, duration of smoking and lifetime intensity of smoking. When using the lowest tertile of intake as reference, total fluid intake was not associated with risk of all UCC (HR 1.12; 95%CI 0.86-1.45, p-trend = 0.42) or with risk of prognostically high-risk UCC (HR 1.28; 95%CI 0.85-1.93, p-trend = 0.27) or prognostically low-risk UCC (HR 0.93; 95%CI 0.65-1.33, p-trend = 0.74). No associations were observed between risk of UCC and intake of water, coffee, tea and herbal tea and milk and other dairy beverages. For prognostically low-risk UCC suggestions of an inverse association with alcoholic beverages and of a positive association with soft drinks were seen. Increased risks were found for all UCC and prognostically low-risk UCC with higher intake of fruit and vegetable juices. In conclusion, total usual fluid intake is not associated with UCC risk in EPIC. The relationships observed for some fluids may be due to chance, but further investigation of the role of all types of fluid is warranted.

  • 170. Ros, Martine M.
    et al.
    Bueno-de-Mesquita, H. Bas
    Kampman, Ellen
    Aben, Katja K. H.
    Buechner, Frederike L.
    Jansen, Eugene H. J. M.
    van Gils, Carla H.
    Egevad, Lars
    Overvad, Kim
    Tjonneland, Anne
    Roswall, Nina
    Boutron-Ruault, Marie Christine
    Kvaskoff, Marina
    Perquier, Florence
    Kaaks, Rudolf
    Chang-Claude, Jenny
    Weikert, Steffen
    Boeing, Heiner
    Trichopoulou, Antonia
    Lagiou, Pagona
    Dilis, Vardis
    Palli, Domenico
    Pala, Valeria
    Sacerdote, Carlotta
    Tumino, Rosario
    Panico, Salvatore
    Peeters, Petra H. M.
    Gram, Inger T.
    Skeie, Guri
    Huerta, Jose Maria
    Barricarte, Aurelio
    Quiros, Jose Ramon
    Sanchez, Maria Jose
    Buckland, Genevieve
    Larranaga, Nerea
    Ehrnstroem, Roy
    Wallstroem, Peter
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Key, Timothy J.
    Allen, Naomi E.
    Khaw, Kay-Tee
    Wareham, Nick
    Brennan, Paul
    Riboli, Elio
    Kiemeney, Lambertus A.
    Plasma carotenoids and vitamin C concentrations and risk of urothelial cell carcinoma in the European Prospective Investigation into Cancer and Nutrition2012Ingår i: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 96, nr 4, s. 902-910Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Published associations between dietary carotenoids and vitamin C and bladder cancer risk are inconsistent. Biomarkers may provide more accurate measures of nutrient status. Objective: We investigated the association between plasma carotenoids and vitamin C and risk of urothelial cell carcinoma (UCC) in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition. Design: A total of 856 patients with newly diagnosed UCC were matched with 856 cohort members by sex, age at baseline, study center, date and time of blood collection, and fasting status. Plasma carotenoids (alpha- and beta-carotene, beta-cryptoxanthin, lycopene, lutein, and zeaxanthin) were measured by using reverse-phase HPLC, and plasma vitamin C was measured by using a colorimetric assay. Incidence rate ratios (IRRs) were estimated by using conditional logistic regression with adjustment for smoking status, duration, and intensity. Results: UCC risk decreased with higher concentrations of the sum of plasma carotenoids (IRR for the highest compared with the lowest quartile: 0.64; 95% CI: 0.44, 0.93; P-trend = 0.04). Plasma beta-carotene was inversely associated with aggressive UCC (IRR: 0.51; 95% CI: 0.30, 0.88; P-trend = 0.02). Plasma lutein was inversely associated with risk of nonaggressive UCC (IRR: 0.56; 95% CI: 0.32, 0.98; P-trend = 0.05). No association was observed between plasma vitamin C and risk of UCC. Conclusions: Although residual confounding by smoking or other factors cannot be excluded, higher concentrations of plasma carotenoids may reduce risk of UCC, in particular aggressive UCC. Plasma lutein may reduce risk of nonaggressive UCC.

  • 171. 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 universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    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 Nutrition2012Ingår i: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 48, nr 17, s. 3267-3277Artikel i tidskrift (Refereegranskat)
    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.

  • 172. Roswall, Nina
    et al.
    Freisling, Heinz
    Bueno-de-Mesquita, H. B(as)
    Ros, Martine
    Christensen, Jane
    Overvad, Kim
    Boutron-Ruault, Marie-Christine
    Severi, Gianluca
    Fagherazzi, Guy
    Chang-Claude, Jenny
    Kaaks, Rudolf
    Steffen, Annika
    Boeing, Heiner
    Argueeles, Marcial
    Agudo, Antonio
    Sanchez, Maria-Jose
    Chirlaque, Maria-Dolores
    Barricarte Gurrea, Aurelio
    Amiano, Pilar
    Wareham, Nick
    Khaw, Kay-Tee
    Bradbury, Kathryn Erica
    Trichopoulou, Antonia
    Papatesta, Helen-Maria
    Trichopoulos, Dimitrios
    Palli, Domenico
    Pala, Valeria
    Tumino, Rosario
    Sacerdote, Carlotta
    Mattiello, Amalia
    Peeters, Petra H.
    Ehrnstrom, Roy
    Brennan, Paul
    Ferrari, Pietro
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Norat, Teresa
    Gunter, Marc
    Riboli, Elio
    Weiderpass, Elisabete
    Halkjaer, Jytte
    Anthropometric measures and bladder cancer risk: A prospective study in the EPIC cohort2014Ingår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 135, nr 12, s. 2918-2929Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Anthropometric measures have been related to risk of several cancers. For bladder cancer, however, evidence is sparse. Comparability of existing studies is hampered by use of different obesity-measures, inadequate control for smoking, and few female cases. This study examined associations between height, weight, waist and hip circumference, waist-hip ratio, waist-height ratio, body mass index (BMI), recalled weight at age 20 and bladder cancer, and investigated effect modification by age, tumor aggressiveness and smoking. The study was conducted in the European Prospective Investigation into Cancer and Nutrition cohort, in 390,878 participants. Associations were calculated using Cox Proportional Hazards Models. During follow-up, 1,391 bladder cancers (1,018 male; 373 female) occurred. Height was unrelated to bladder cancer in both genders. We found a small but significant positive association with weight [1.04 (1.01-1.07) per 5 kilo], BMI [1.05 (1.02-1.08) per 2 units], waist circumference [1.04 (1.01-1.08) per 5 cm], waist-hip ratio (1.07 (1.02-1.13) per 0.05 unit] and waist-height ratio [1.07 (1.01-1.13) per 0.05 unit] in men. Stratification by smoking status confined associations in men to former smokers. In never smokers, we found no significant associations, suggesting residual confounding by smoking. Results did not differ with tumor aggressiveness and age. Residual analyses on BMI/waist circumference showed a significantly higher disease risk with BMI in men (p=0.01), but no association with waist circumference. In conclusion, in this large study, height was unrelated to bladder cancer, whereas overweight was associated with a slightly higher bladder cancer risk in men. This association may, however, be distorted by residual confounding by smoking.

  • 173. Rothman, Nathaniel
    et al.
    Garcia-Closas, Montserrat
    Chatterjee, Nilanjan
    Malats, Nuria
    Wu, Xifeng
    Figueroa, Jonine D
    Real, Francisco X
    Van Den Berg, David
    Matullo, Giuseppe
    Baris, Dalsu
    Thun, Michael
    Kiemeney, Lambertus A
    Vineis, Paolo
    De Vivo, Immaculata
    Albanes, Demetrius
    Purdue, Mark P
    Rafnar, Thorunn
    Hildebrandt, Michelle A T
    Kiltie, Anne E
    Cussenot, Olivier
    Golka, Klaus
    Kumar, Rajiv
    Taylor, Jack A
    Mayordomo, Jose I
    Jacobs, Kevin B
    Kogevinas, Manolis
    Hutchinson, Amy
    Wang, Zhaoming
    Fu, Yi-Ping
    Prokunina-Olsson, Ludmila
    Burdett, Laurie
    Yeager, Meredith
    Wheeler, William
    Tardón, Adonina
    Serra, Consol
    Carrato, Alfredo
    García-Closas, Reina
    Lloreta, Josep
    Johnson, Alison
    Schwenn, Molly
    Karagas, Margaret R
    Schned, Alan
    Andriole, Gerald
    Grubb, Robert
    Black, Amanda
    Jacobs, Eric J
    Diver, W Ryan
    Gapstur, Susan M
    Weinstein, Stephanie J
    Virtamo, Jarmo
    Cortessis, Victoria K
    Gago-Dominguez, Manuela
    Pike, Malcolm C
    Stern, Mariana C
    Yuan, Jian-Min
    Hunter, David J
    McGrath, Monica
    Dinney, Colin P
    Czerniak, Bogdan
    Chen, Meng
    Yang, Hushan
    Vermeulen, Sita H
    Aben, Katja K
    Witjes, J Alfred
    Makkinje, Remco R
    Sulem, Patrick
    Besenbacher, Soren
    Stefansson, Kari
    Riboli, Elio
    Brennan, Paul
    Panico, Salvatore
    Navarro, Carmen
    Allen, Naomi E
    Bueno-de-Mesquita, H Bas
    Trichopoulos, Dimitrios
    Caporaso, Neil
    Landi, Maria Teresa
    Canzian, Federico
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Tjonneland, Anne
    Clavel-Chapelon, Francoise
    Bishop, David T
    Teo, Mark T W
    Knowles, Margaret A
    Guarrera, Simonetta
    Polidoro, Silvia
    Ricceri, Fulvio
    Sacerdote, Carlotta
    Allione, Alessandra
    Cancel-Tassin, Geraldine
    Selinski, Silvia
    Hengstler, Jan G
    Dietrich, Holger
    Fletcher, Tony
    Rudnai, Peter
    Gurzau, Eugen
    Koppova, Kvetoslava
    Bolick, Sophia C E
    Godfrey, Ashley
    Xu, Zongli
    Sanz-Velez, José I
    D García-Prats, María
    Sanchez, Manuel
    Valdivia, Gabriel
    Porru, Stefano
    Benhamou, Simone
    Hoover, Robert N
    Fraumeni, Joseph F
    Silverman, Debra T
    Chanock, Stephen J
    A multi-stage genome-wide association study of bladder cancer identifies multiple susceptibility loci2010Ingår i: Nature Genetics, ISSN 1061-4036, E-ISSN 1546-1718, Vol. 42, nr 11, s. 978-984Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We conducted a multi-stage, genome-wide association study of bladder cancer with a primary scan of 591,637 SNPs in 3,532 affected individuals (cases) and 5,120 controls of European descent from five studies followed by a replication strategy, which included 8,382 cases and 48,275 controls from 16 studies. In a combined analysis, we identified three new regions associated with bladder cancer on chromosomes 22q13.1, 19q12 and 2q37.1: rs1014971, (P = 8 × 10⁻¹²) maps to a non-genic region of chromosome 22q13.1, rs8102137 (P = 2 × 10⁻¹¹) on 19q12 maps to CCNE1 and rs11892031 (P = 1 × 10⁻⁷) maps to the UGT1A cluster on 2q37.1. We confirmed four previously identified genome-wide associations on chromosomes 3q28, 4p16.3, 8q24.21 and 8q24.3, validated previous candidate associations for the GSTM1 deletion (P = 4 × 10⁻¹¹) and a tag SNP for NAT2 acetylation status (P = 4 × 10⁻¹¹), and found interactions with smoking in both regions. Our findings on common variants associated with bladder cancer risk should provide new insights into the mechanisms of carcinogenesis.

  • 174. Ruutu, Mirja
    et al.
    Ljungberg, Börje
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Renal cell carcinoma.2004Ingår i: Scand J Surg, ISSN 1457-4969, Vol. 93, nr 2, s. 87-Artikel i tidskrift (Refereegranskat)
  • 175. Sabir, Emad F.
    et al.
    Holmäng, Sten
    Liedberg, Fredrik
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Malmström, Per-Uno
    Månsson, Wiking
    Wijkström, Hans
    Jahnson, Staffan
    Impact of hospital volume on local recurrence and distant metastasis in bladder cancer patients treated with radical cystectomy in Sweden2013Ingår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 47, nr 6, s. 483-490Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: This study evaluated the impact of hospital volume on local recurrence and distant metastasis in a population-based series of radical cystectomy patients in Sweden. Material and methods: All patients who underwent cystectomy for bladder cancer in 1997-2002 in Sweden and were reported to the National Bladder Cancer Registry were included. A high-volume hospital (HVH) was defined as one with >= 10 cystectomies/year and a low-volume hospital (LVH) as one with <10 cystectomies/year. Information on preoperative tumour, node, metastasis (TNM) classification, operative procedure, postoperative course and follow-up was obtained from medical records. Results: Of the 1126 patients, 827 (74%) were males. The mean age was 66 years and median follow-up 47 months. Of the 610 (54%) HVH patients, 68 (11%) were pT0, 123 (20%) <pT2, 177 (29%) pT2, 242 (40%) >pT2 and 69 (11%) were microscopic non-radical. Corresponding figures for the 516 (46%) LVH patients were 35 (7%), 68 (13%), 191 (37%), 222 (43%) and 96 (19%). Local recurrence was observed in 245 patients (22%): 113 (19%) at HVHs and 132 (26%) at LVHs. Distant metastasis was found in 363 (32%): 203 (33%) at HVHs and 160 (31%) at LVHs. Perioperative chemotherapy was given to 193 (17%). Multivariate Cox proportional hazards analysis showed that local recurrence was associated with LVHs and non-organ-confined disease, whereas distant metastasis was correlated with non-organ-confined disease and lymph-node metastases. Conclusions: In this retrospective analysis, local tumour recurrence after cystectomy was common, particularly in patients with non-organ-confined disease. Furthermore, local recurrence was more frequent at LVHs than HVHs, and overall survival was better at HVHs. These findings suggest that concentrating cystectomies in HVHs may improve outcomes such as local recurrence and overall survival.

  • 176. Sampson, Joshua N.
    et al.
    Wheeler, William A.
    Yeager, Meredith
    Panagiotou, Orestis
    Wang, Zhaoming
    Berndt, Sonja I.
    Lan, Qing
    Abnet, Christian C.
    Amundadottir, Laufey T.
    Figueroa, Jonine D.
    Landi, Maria Teresa
    Mirabello, Lisa
    Savage, Sharon A.
    Taylor, Philip R.
    De Vivo, Immaculata
    McGlynn, Katherine A.
    Purdue, Mark P.
    Rajaraman, Preetha
    Adami, Hans-Olov
    Ahlbom, Anders
    Albanes, Demetrius
    Amary, Maria Fernanda
    An, She-Juan
    Andersson, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Andriole, Gerald, Jr.
    Andrulis, Irene L.
    Angelucci, Emanuele
    Ansell, Stephen M.
    Arici, Cecilia
    Armstrong, Bruce K.
    Arslan, Alan A.
    Austin, Melissa A.
    Baris, Dalsu
    Barkauskas, Donald A.
    Bassig, Bryan A.
    Becker, Nikolaus
    Benavente, Yolanda
    Benhamou, Simone
    Berg, Christine
    Van Den Berg, David
    Bernstein, Leslie
    Bertrand, Kimberly A.
    Birmann, Brenda M.
    Black, Amanda
    Boeing, Heiner
    Boffetta, Paolo
    Boutron-Ruault, Marie-Christine
    Bracci, Paige M.
    Brinton, Louise
    Brooks-Wilson, Angela R.
    Bueno-de-Mesquita, H. Bas
    Burdett, Laurie
    Buring, Julie
    Butler, Mary Ann
    Cai, Qiuyin
    Cancel-Tassin, Geraldine
    Canzian, Federico
    Carrato, Alfredo
    Carreon, Tania
    Carta, Angela
    Chan, John K. C.
    Chang, Ellen T.
    Chang, Gee-Chen
    Chang, I-Shou
    Chang, Jiang
    Chang-Claude, Jenny
    Chen, Chien-Jen
    Chen, Chih-Yi
    Chen, Chu
    Chen, Chung-Hsing
    Chen, Constance
    Chen, Hongyan
    Chen, Kexin
    Chen, Kuan-Yu
    Chen, Kun-Chieh
    Chen, Ying
    Chen, Ying-Hsiang
    Chen, Yi-Song
    Chen, Yuh-Min
    Chien, Li-Hsin
    Chirlaque, Maria-Dolores
    Choi, Jin Eun
    Choi, Yi Young
    Chow, Wong-Ho
    Chung, Charles C.
    Clavel, Jacqueline
    Clavel-Chapelon, Franoise
    Cocco, Pierluigi
    Colt, Joanne S.
    Comperat, Eva
    Conde, Lucia
    Connors, Joseph M.
    Conti, David
    Cortessis, Victoria K.
    Cotterchio, Michelle
    Cozen, Wendy
    Crouch, Simon
    Crous-Bou, Marta
    Cussenot, Olivier
    Davis, Faith G.
    Ding, Ti
    Diver, W. Ryan
    Dorronsoro, Miren
    Dossus, Laure
    Duell, Eric J.
    Ennas, Maria Grazia
    Erickson, Ralph L.
    Feychting, Maria
    Flanagan, Adrienne M.
    Foretova, Lenka
    Fraumeni, Joseph F., Jr.
    Freedman, Neal D.
    Freeman, Laura E. Beane
    Fuchs, Charles
    Gago-Dominguez, Manuela
    Gallinger, Steven
    Gao, Yu-Tang
    Gapstur, Susan M.
    Garcia-Closas, Montserrat
    Garcia-Closas, Reina
    Gascoyne, Randy D.
    Gastier-Foster, Julie
    Gaudet, Mia M.
    Gaziano, J. Michael
    Giffen, Carol
    Giles, Graham G.
    Giovannucci, Edward
    Glimelius, Bengt
    Goggins, Michael
    Gokgoz, Nalan
    Goldstein, Alisa M.
    Gorlick, Richard
    Gross, Myron
    Grubb, Robert, III
    Gu, Jian
    Guan, Peng
    Gunter, Marc
    Guo, Huan
    Habermann, Thomas M.
    Haiman, Christopher A.
    Halai, Dina
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Hassan, Manal
    Hattinger, Claudia
    He, Qincheng
    He, Xingzhou
    Helzlsouer, Kathy
    Henderson, Brian
    Henriksson, Roger
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Hjalgrim, Henrik
    Hoffman-Bolton, Judith
    Hohensee, Chancellor
    Holford, Theodore R.
    Holly, Elizabeth A.
    Hong, Yun-Chul
    Hoover, Robert N.
    Horn-Ross, Pamela L.
    Hosain, G. M. Monawar
    Hosgood, H. Dean, III
    Hsiao, Chin-Fu
    Hu, Nan
    Hu, Wei
    Hu, Zhibin
    Huang, Ming-Shyan
    Huerta, Jose-Maria
    Hung, Jen-Yu
    Hutchinson, Amy
    Inskip, Peter D.
    Jackson, Rebecca D.
    Jacobs, Eric J.
    Jenab, Mazda
    Jeon, Hyo-Sung
    Ji, Bu-Tian
    Jin, Guangfu
    Jin, Li
    Johansen, Christoffer
    Johnson, Alison
    Jung, Yoo Jin
    Kaaks, Rudolph
    Kamineni, Aruna
    Kane, Eleanor
    Kang, Chang Hyun
    Karagas, Margaret R.
    Kelly, Rachel S.
    Khaw, Kay-Tee
    Kim, Christopher
    Kim, Hee Nam
    Kim, Jin Hee
    Kim, Jun Suk
    Kim, Yeul Hong
    Kim, Young Tae
    Kim, Young-Chul
    Kitahara, Cari M.
    Klein, Alison P.
    Klein, Robert J.
    Kogevinas, Manolis
    Kohno, Takashi
    Kolonel, Laurence N.
    Kooperberg, Charles
    Kricker, Anne
    Krogh, Vittorio
    Kunitoh, Hideo
    Kurtz, Robert C.
    Kweon, Sun-Seog
    LaCroix, Andrea
    Lawrence, Charles
    Lecanda, Fernando
    Lee, Victor Ho Fun
    Li, Donghui
    Li, Haixin
    Li, Jihua
    Li, Yao-Jen
    Li, Yuqing
    Liao, Linda M.
    Liebow, Mark
    Lightfoot, Tracy
    Lim, Wei-Yen
    Lin, Chien-Chung
    Lin, Dongxin
    Lindstrom, Sara
    Linet, Martha S.
    Link, Brian K.
    Liu, Chenwei
    Liu, Jianjun
    Liu, Li
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Lloreta, Josep
    Di Lollo, Simonetta
    Lu, Daru
    Lund, Eiluv
    Malats, Nuria
    Mannisto, Satu
    Le Marchand, Loic
    Marina, Neyssa
    Masala, Giovanna
    Mastrangelo, Giuseppe
    Matsuo, Keitaro
    Maynadie, Marc
    Mckay, James
    McKean-Cowdin, Roberta
    Melbye, Mads
    Melin, Beatrice S.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Michaud, Dominique S.
    Mitsudomi, Tetsuya
    Monnereau, Alain
    Montalvan, Rebecca
    Moore, Lee E.
    Mortensen, Lotte Maxild
    Nieters, Alexandra
    North, Kari E.
    Novak, Anne J.
    Oberg, Ann L.
    Offit, Kenneth
    Oh, In-Jae
    Olson, Sara H.
    Palli, Domenico
    Pao, William
    Park, In Kyu
    Park, Jae Yong
    Park, Kyong Hwa
    Patino-Garcia, Ana
    Pavanello, Sofia
    Peeters, Petra H. M.
    Perng, Reury-Perng
    Peters, Ulrike
    Petersen, Gloria M.
    Picci, Piero
    Pike, Malcolm C.
    Porru, Stefano
    Prescott, Jennifer
    Prokunina-Olsson, Ludmila
    Qian, Biyun
    Qiao, You-Lin
    Rais, Marco
    Riboli, Elio
    Riby, Jacques
    Risch, Harvey A.
    Rizzato, Cosmeri
    Rodabough, Rebecca
    Roman, Eve
    Roupret, Morgan
    Ruder, Avima M.
    de Sanjose, Silvia
    Scelo, Ghislaine
    Schned, Alan
    Schumacher, Fredrick
    Schwartz, Kendra
    Schwenn, Molly
    Scotlandi, Katia
    Seow, Adeline
    Serra, Consol
    Serra, Massimo
    Sesso, Howard D.
    Setiawan, Veronica Wendy
    Severi, Gianluca
    Severson, Richard K.
    Shanafelt, Tait D.
    Shen, Hongbing
    Shen, Wei
    Shin, Min-Ho
    Shiraishi, Kouya
    Shu, Xiao-Ou
    Siddiq, Afshan
    Sierrasesumaga, Luis
    Sihoe, Alan Dart Loon
    Skibola, Christine F.
    Smith, Alex
    Smith, Martyn T.
    Southey, Melissa C.
    Spinelli, John J.
    Staines, Anthony
    Stampfer, Meir
    Stern, Marianna C.
    Stevens, Victoria L.
    Stolzenberg-Solomon, Rachael S.
    Su, Jian
    Su, Wu-Chou
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Sung, Jae Sook
    Sung, Sook Whan
    Tan, Wen
    Tang, Wei
    Tardon, Adonina
    Thomas, David
    Thompson, Carrie A.
    Tinker, Lesley F.
    Tirabosco, Roberto
    Tjonneland, Anne
    Travis, Ruth C.
    Trichopoulos, Dimitrios
    Tsai, Fang-Yu
    Tsai, Ying-Huang
    Tucker, Margaret
    Turner, Jenny
    Vajdic, Claire M.
    Vermeulen, Roel C. H.
    Villano, Danylo J.
    Vineis, Paolo
    Virtamo, Jarmo
    Visvanathan, Kala
    Wactawski-Wende, Jean
    Wang, Chaoyu
    Wang, Chih-Liang
    Wang, Jiu-Cun
    Wang, Junwen
    Wei, Fusheng
    Weiderpass, Elisabete
    Weiner, George J.
    Weinstein, Stephanie
    Wentzensen, Nicolas
    White, Emily
    Witzig, Thomas E.
    Wolpin, Brian M.
    Wong, Maria Pik
    Wu, Chen
    Wu, Guoping
    Wu, Junjie
    Wu, Tangchun
    Wu, Wei
    Wu, Xifeng
    Wu, Yi-Long
    Wunder, Jay S.
    Xiang, Yong-Bing
    Xu, Jun
    Xu, Ping
    Yang, Pan-Chyr
    Yang, Tsung-Ying
    Ye, Yuanqing
    Yin, Zhihua
    Yokota, Jun
    Yoon, Ho-Il
    Yu, Chong-Jen
    Yu, Herbert
    Yu, Kai
    Yuan, Jian-Min
    Zelenetz, Andrew
    Zeleniuch-Jacquotte, Anne
    Zhang, Xu-Chao
    Zhang, Yawei
    Zhao, Xueying
    Zhao, Zhenhong
    Zheng, Hong
    Zheng, Tongzhang
    Zheng, Wei
    Zhou, Baosen
    Zhu, Meng
    Zucca, Mariagrazia
    Boca, Simina M.
    Cerhan, James R.
    Ferri, Giovanni M.
    Hartge, Patricia
    Hsiung, Chao Agnes
    Magnani, Corrado
    Miligi, Lucia
    Morton, Lindsay M.
    Smedby, Karin E.
    Teras, Lauren R.
    Vijai, Joseph
    Wang, Sophia S.
    Brennan, Paul
    Caporaso, Neil E.
    Hunter, David J.
    Kraft, Peter
    Rothman, Nathaniel
    Silverman, Debra T.
    Slager, Susan L.
    Chanock, Stephen J.
    Chatterjee, Nilanjan
    Analysis of Heritability and Shared Heritability Based on Genome-Wide Association Studies for 13 Cancer Types2015Ingår i: Journal of the National Cancer Institute, ISSN 0027-8874, E-ISSN 1460-2105, Vol. 107, nr 12, artikel-id djv279Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Studies of related individuals have consistently demonstrated notable familial aggregation of cancer. We aim to estimate the heritability and genetic correlation attributable to the additive effects of common single-nucleotide polymorphisms (SNPs) for cancer at 13 anatomical sites.

    Methods: Between 2007 and 2014, the US National Cancer Institute has generated data from genome-wide association studies (GWAS) for 49 492 cancer case patients and 34 131 control patients. We apply novel mixed model methodology (GCTA) to this GWAS data to estimate the heritability of individual cancers, as well as the proportion of heritability attributable to cigarette smoking in smoking-related cancers, and the genetic correlation between pairs of cancers.

    Results: GWAS heritability was statistically significant at nearly all sites, with the estimates of array-based heritability, h(l)(2), on the liability threshold (LT) scale ranging from 0.05 to 0.38. Estimating the combined heritability of multiple smoking characteristics, we calculate that at least 24% (95% confidence interval [CI] = 14% to 37%) and 7% (95% CI = 4% to 11%) of the heritability for lung and bladder cancer, respectively, can be attributed to genetic determinants of smoking. Most pairs of cancers studied did not show evidence of strong genetic correlation. We found only four pairs of cancers with marginally statistically significant correlations, specifically kidney and testes (rho = 0.73, SE = 0.28), diffuse large B-cell lymphoma (DLBCL) and pediatric osteosarcoma (rho = 0.53, SE = 0.21), DLBCL and chronic lymphocytic leukemia (CLL) (rho = 0.51, SE = 0.18), and bladder and lung (rho = 0.35, SE = 0.14). Correlation analysis also indicates that the genetic architecture of lung cancer differs between a smoking population of European ancestry and a nonsmoking Asian population, allowing for the possibility that the genetic etiology for the same disease can vary by population and environmental exposures.

    Conclusion: Our results provide important insights into the genetic architecture of cancers and suggest new avenues for investigation.

  • 177.
    Sandlund, Johanna
    et al.
    Umeå universitet, Medicinsk fakultet, Strålningsvetenskaper, Onkologi.
    Hedberg, Ylva
    Umeå universitet, Medicinsk fakultet, Medicinsk biovetenskap. Umeå universitet, Medicinsk fakultet, Medicinsk biovetenskap, Patologi. Umeå universitet, Medicinsk fakultet, Klinisk mikrobiologi. Umeå universitet, Medicinsk fakultet, Klinisk mikrobiologi, Biomedicinsk laboratorievetenskap.
    Bergh, Anders
    Umeå universitet, Medicinsk fakultet, Medicinsk biovetenskap, Patologi.
    Grankvist, Kjell
    Umeå universitet, Medicinsk fakultet, Medicinsk biovetenskap, Klinisk kemi.
    Ljungberg, Börje
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Rasmuson, Torgny
    Umeå universitet, Medicinsk fakultet, Strålningsvetenskaper, Onkologi.
    Endoglin (CD105) expression in human renal cell carcinoma2006Ingår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 97, nr 4, s. 706-710Artikel i tidskrift (Refereegranskat)
  • 178.
    Sandlund, Johanna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Hedberg, Ylva
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Bergh, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Grankvist, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Klinisk kemi.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Rasmuson, Torgny
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Evaluation of CD31 (PECAM-1) expression using tissue microarray in patients with renal cell carcinoma.2007Ingår i: Tumor Biology, ISSN 1010-4283, E-ISSN 1423-0380, Vol. 28, nr 3, s. 158-164Artikel i tidskrift (Refereegranskat)
  • 179.
    Sandlund, Johanna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Wikström, Pernilla
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Grankvist, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Klinisk kemi.
    Lindh, Gudrun
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Rasmuson, Torgny
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Hypoxia-inducible factor-2alpha mRNA expression in human renal cell carcinoma2009Ingår i: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 48, nr 6, s. 909-914Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. Hypoxia-inducible factor (HIF)-2alpha is upregulated in hypoxia or by inactivation of the von Hippel-Lindau (VHL) tumour suppressor gene. In a number of malignancies, increased HIF-2alpha expression may indicate worse prognosis. The aim of this study was to evaluate the prognostic information of HIF-2alpha mRNA expression in renal cell carcinoma (RCC). Material and methods. HIF-2alpha mRNA was quantified by real time polymerase chain reaction (rt-PCR) in tumour tissue samples from 202 patients. Samples from 50 corresponding kidney cortex tissue were analysed as controls. mRNA levels were evaluated in relation to tumour cell type, TNM stage, nuclear grade and disease specific survival. Results. The levels of HIF-2alpha mRNA were significantly higher in 168 clear cell (c)RCC than in 23 papillary (p)RCC (p<0.001) or 11 chromophobe (ch)RCC (p<0.006). Among cRCC there was an inverse correlation between HIF-2alpha mRNA levels and TNM stage I and II-IV tumours (p=0.01), and nuclear grade (p=0.006). After a median follow-up time of 99 months (range 34-247), 106 patients had died of RCC. No correlation of HIF-2alpha mRNA to survival was observed. A multivariate analysis of prognostic factors in cRCC showed that TNM stage alone was an independent predictor of prognosis; HIF-2alpha mRNA levels did not add further prognostic information. Discussion. The results demonstrated that HIF-2alpha mRNA levels were higher in cRCC compared to pRCC and chRCC. Furthermore, HIF-2alpha mRNA levels were inversely related to TNM stage and nuclear grade in cRCC.

  • 180.
    Sandlund, Johanna
    et al.
    Umeå universitet, Medicinsk fakultet, Strålningsvetenskaper, Onkologi.
    Oosterwijk, Egbert
    Grankvist, Kjell
    Umeå universitet, Medicinsk fakultet, Medicinsk biovetenskap, Klinisk kemi.
    Oosterwijk-Wakka, Jeannette
    Ljungberg, Börje
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Rasmuson, Torgny
    Umeå universitet, Medicinsk fakultet, Strålningsvetenskaper, Onkologi.
    Prognostic impact of carbonic anhydrase IX expression in human renal cell carcinoma.2007Ingår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 100, nr 3, s. 556-560Artikel i tidskrift (Refereegranskat)
  • 181. Sandstrom, P.
    et al.
    Sandin, R.
    Kowalski, J.
    Wahlgren, T.
    Jakobsson, M.
    Lundstam, S.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    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) inSweden2012Ingår i: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 23, nr Suppl. 9, s. 281-281Artikel i tidskrift (Övrigt vetenskapligt)
  • 182. Scelo, Ghislaine
    et al.
    Purdue, Mark P.
    Brown, Kevin M.
    Johansson, Mattias
    Wang, Zhaoming
    Eckel-Passow, Jeanette E.
    Ye, Yuanqing
    Hofmann, Jonathan N.
    Choi, Jiyeon
    Foll, Matthieu
    Gaborieau, Valerie
    Machiela, Mitchell J.
    Colli, Leandro M.
    Li, Peng
    Sampson, Joshua N.
    Abedi-Ardekani, Behnoush
    Besse, Celine
    Blanche, Helene
    Boland, Anne
    Burdette, Laurie
    Chabrier, Amelie
    Durand, Geoffroy
    Le Calvez-Kelm, Florence
    Prokhortchouk, Egor
    Robinot, Nivonirina
    Skryabin, Konstantin G.
    Wozniak, Magdalena B.
    Yeager, Meredith
    Basta-Jovanovic, Gordana
    Dzamic, Zoran
    Foretova, Lenka
    Holcatova, Ivana
    Janout, Vladimir
    Mates, Dana
    Mukeriya, Anush
    Rascu, Stefan
    Zaridze, David
    Bencko, Vladimir
    Cybulski, Cezary
    Fabianova, Eleonora
    Jinga, Viorel
    Lissowska, Jolanta
    Lubinski, Jan
    Navratilova, Marie
    Rudnai, Peter
    Szeszenia-Dabrowska, Neonila
    Benhamou, Simone
    Cancel-Tassin, Geraldine
    Cussenot, Olivier
    Baglietto, Laura
    Boeing, Heiner
    Khaw, Kay-Tee
    Weiderpass, Elisabete
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Sitaram, Raviprakash T.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Bruinsma, Fiona
    Jordan, Susan J.
    Severi, Gianluca
    Winship, Ingrid
    Hveem, Kristian
    Vatten, Lars J.
    Fletcher, Tony
    Koppova, Kvetoslava
    Larsson, Susanna C.
    Wolk, Alicja
    Banks, Rosamonde E.
    Selby, Peter J.
    Easton, Douglas F.
    Pharoah, Paul
    Andreotti, Gabriella
    Freeman, Laura E. Beane
    Koutros, Stella
    Albanes, Demetrius
    Mannisto, Satu
    Weinstein, Stephanie
    Clark, Peter E.
    Edwards, Todd L.
    Lipworth, Loren
    Gapstur, Susan M.
    Stevens, Victoria L.
    Carol, Hallie
    Freedman, Matthew L.
    Pomerantz, Mark M.
    Cho, Eunyoung
    Kraft, Peter
    Preston, Mark A.
    Wilson, Kathryn M.
    Gaziano, J. Michael
    Sesso, Howard D.
    Black, Amanda
    Freedman, Neal D.
    Huang, Wen-Yi
    Anema, John G.
    Kahnoski, Richard J.
    Lane, Brian R.
    Noyes, Sabrina L.
    Petillo, David
    Teh, Bin Tean
    Peters, Ulrike
    White, Emily
    Anderson, Garnet L.
    Johnson, Lisa
    Luo, Juhua
    Buring, Julie
    Lee, I-Min
    Chow, Wong-Ho
    Moore, Lee E.
    Wood, Christopher
    Eisen, Timothy
    Henrion, Marc
    Larkin, James
    Barman, Poulami
    Leibovich, Bradley C.
    Choueiri, Toni K.
    Lathrop, G. Mark
    Rothman, Nathaniel
    Deleuze, Jean-Francois
    Mckay, James D.
    Parker, Alexander S.
    Wu, Xifeng
    Houlston, Richard S.
    Brennan, Paul
    Chanock, Stephen J.
    Genome-wide association study identifies multiple risk loci for renal cell carcinoma2017Ingår i: Nature Communications, ISSN 2041-1723, E-ISSN 2041-1723, Vol. 8, artikel-id 15724Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Previous genome-wide association studies (GWAS) have identified six risk loci for renal cell carcinoma (RCC). We conducted a meta-analysis of two new scans of 5,198 cases and 7,331 controls together with four existing scans, totalling 10,784 cases and 20,406 controls of European ancestry. Twenty-four loci were tested in an additional 3,182 cases and 6,301 controls. We confirm the six known RCC risk loci and identify seven new loci at 1p32.3 (rs4381241, P = 3.1 x 10(-10)), 3p22.1 (rs67311347, P = 2.5 x 10(-8)), 3q26.2 (rs10936602, P = 8.8 x 10(-9)), 8p21.3 (rs2241261, P = 5.8 x 10(-9)), 10q24.33-q25.1 (rs11813268, P = 3.9 x 10(-8)), 11q22.3 (rs74911261, P = 2.1 x 10(-10)) and 14q24.2 (rs4903064, P = 2.2 x 10(-24)). Expression quantitative trait analyses suggest plausible candidate genes at these regions that may contribute to RCC susceptibility.

  • 183. Sherif, A. M.
    et al.
    Eriksson, E.
    Thorn, M.
    Vasko, Janos
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Öhberg, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Riklund, Katrine
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi. Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI).
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Sentinel node detection in renal cell carcinoma. A feasibility study2012Ingår i: European urology. Supplement, ISSN 1569-9056, E-ISSN 1878-1500, Vol. 11, nr 1, s. E927-U948Artikel i tidskrift (Övrigt vetenskapligt)
  • 184. Sherif, Amir M
    et al.
    Eriksson, Elisabeth
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Thörn, Magnus
    Vasko, Janos
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Riklund, Katrine
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Öhberg, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Ljungberg, Börje J
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Sentinel node detection in renal cell carcinoma. A feasibility study for detection of tumour-draining lymph nodes.2012Ingår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 109, nr 8, s. 1134-1139Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? This is the first presented results and second publication on detection of tumour-draining lymph nodes in human renal cell carcinoma. Techniques are displayed and tumour-draining patterns are presented. OBJECTIVE: •  To evaluate the feasibility of performing sentinel node detection in patients with renal cell carcinoma (RCC). MATERIALS AND METHODS: •  An open series of 13 arbitrarily selected patients with T1b-T3b RCC scheduled for radical nephrectomy at a single Tertiary Academic Centre were examined with different modalities of sentinel node detection. •  Preoperative ultrasonography-guided injection of radioactive isotope, lymphoscintigram and single photon emission computed tomography/computed tomography, followed by intraoperative gamma-probe detection and Patent Blue detection, as well as postoperative scintigram of the main specimen were the planned interventions. •  These investigations were performed in conjunction with intended open radical nephrectomy. RESULTS: •  In 10 of the 13 patients sentinel node detection was achieved with 32 sentinel nodes displayed. •  Radio-guided surgery using an intraoperative gamma-probe resulted in the highest realtive detection rate with detection of sentinel nodes in nine patients. •  In total, nine metastatic sentinel nodes were detected in three patients. •  One patient, preoperatively staged as N+, was restaged after sentinel node detection and histopathology as pN0. CONCLUSIONS: •  Sentinel node detection in renal tumours is feasible although evaluation of different modes of detection needs further refinement and standardization. •  All nodes preoperatively detected by routine computed tomography as suspicious metastatic lesions were confirmed as sentinel nodes, including two nodes considered as metastatic by preoperative routine imaging but ultimately staged as non-metastatic sentinel nodes.

  • 185.
    Sitaram, Raviprakash T
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Cairney, Claire J
    Centre for Oncology and Applied Pharmacology, University of Glasgow, Cancer Research UK Beatson Laboratories, Glasgow, Scotland.
    Grabowski, Pawel
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Keith, W Nicol
    Centre for Oncology and Applied Pharmacology, University of Glasgow, Cancer Research UK Beatson Laboratories, Glasgow, Scotland.
    Hallberg, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Roos, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    The PTEN regulator DJ-1 is associated with hTERT expression in clear cell renal cell carcinoma2009Ingår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 125, nr 4, s. 783-790Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    DJ-1 is as a novel regulator of the tumor suppressor PTEN with stimulatory effects on PI3K-AKT/PKB signaling, one possible target of which is cMyc. The catalytic unit of the telomerase complex, hTERT, can be activated at different levels, including transcriptionally by cMyc and through phosphorylation by AKT/PKB. The aim of the study was to analyze the putative signaling pathway encompassing DJ-1, cMyc and hTERT in a series of 176 renal cell carcinomas (RCC) and experimentally in cell lines. DJ-1 mRNA expression was significantly elevated in clear cell RCC (ccRCC) compared with in papillary RCC (pRCC; p = 0.005) and kidney cortex tissue (p < 0.001). ccRCC and pRCC demonstrated higher cMyc RNA levels than in kidney cortex (p < 0.001 for both) as well as increased levels of hTERT RNA (p < 0.001 and p = 0.011, respectively). DJ-1 was positively correlated to cMyc and hTERT in ccRCC (p < 0.001 and p = 0.019, respectively), but not in pRCC, indicating that this pathway could have a functional significance in ccRCC. siRNA knock down of DJ-1 induced downregulation of cMyc and hTERT mRNA associated with decreased expression of pAKT and cMyc protein levels. hTERT promoter activity was upregulated after DJ-1 transfection and this upregulation was inhibited after mutation of the cMyc binding sites. These experimental data support the functional link among DJ-1, cMyc and hTERT expression as indicated in the tumor material. Neither DJ-1, cMyc nor hTERT mRNA levels were associated with proliferation (S-phase fraction), telomere length or prognosis in ccRCC.

  • 186.
    Sitaram, Raviprakash T
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Degerman, Sofie
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Andersson, Emma
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Oji, Y
    Department of Cancer Stem Cell Biology, Osaka University Graduate School of Medicine, Osaka, Japan.
    Sugiyama, H
    Department of Functional Diagnostic Science, Osaka University Graduate School of Medicine, Osaka, Japan.
    Roos, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Li, Ai-Hong
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Klinisk kemi.
    Wilms' tumour 1 can suppress hTERT gene expression and telomerase activity in clear cell renal cell carcinoma via multiple pathways2010Ingår i: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 103, nr 8, s. 1255-1262Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Wilms' tumour 1 (WT1) gene was discovered as a tumour suppressor gene. Later findings have suggested that WT1 also can be oncogenic. This complexity is partly explained by the fact that WT1 has a number of target genes.

    METHOD: WT1 and its target gene human telomerase reverse transcriptase (hTERT) were analysed in clear cell renal cell carcinoma (ccRCC). In vitro experiments were performed to examine the functional link between WT1 and hTERT by overexpression of WT1 isoforms in the ccRCC cell line, TK-10.

    RESULTS: WT1 demonstrated lower RNA expression in ccRCC compared with renal cortical tissue, whereas hTERT was increased, showing a negative correlation between WT1 and hTERT (P=0.005). These findings were experimentally confirmed in vitro. The WT1 generated effect on hTERT promoter activity seemed complex, as several negative regulators of hTERT transcription, such as SMAD3, JUN (AP-1) and ETS1, were activated by WT1 overexpression. Downregulation of potential positive hTERT regulators, such as cMyc, AP-2α, AP-2γ, IRF1, NFX1 and GM-CSF, were also observed. Chromatin immunoprecipitation analysis verified WT1 binding to the hTERT, cMyc and SMAD3 promoters.

    CONCLUSION: The collected data strongly indicate multiple pathways for hTERT regulation by WT1 in ccRCC.

  • 187. Sjölund, Jonas
    et al.
    Boström, Anna-Karin
    Lindgren, David
    Manna, Sugata
    Moustakas, Aristidis
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Johansson, Martin
    Fredlund, Erik
    Axelson, Håkan
    The notch and TGF-β signaling pathways contribute to the aggressiveness of clear cell renal cell carcinoma2011Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 6, nr 8, s. e23057-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    An extensive cross-talk between the Notch and TGF-β signaling cascades is present in CCRCC and the functional properties of these two pathways are associated with the aggressiveness of this disease.

  • 188. Sjölund, Jonas
    et al.
    Johansson, Martin
    Manna, Sugata
    Norin, Carl
    Pietras, Alexander
    Beckman, Siv
    Nilsson, Elise
    Ljungberg, Börje
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Axelson, Håkan
    Suppression of renal cell carcinoma growth by inhibition of Notch signaling in vitro and in vivo.2008Ingår i: J Clin Invest, ISSN 0021-9738, Vol. 118, nr 1, s. 217-28Artikel i tidskrift (Refereegranskat)
  • 189.
    Strömvall, Kerstin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Sundkvist, Kristoffer
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Halin Bergström, Sofia
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Bergh, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Reduced number of CD169(+) macrophages in pre-metastatic regional lymph nodes is associated with subsequent metastatic disease in an animal model and with poor outcome in prostate cancer patients2017Ingår i: The Prostate, ISSN 0270-4137, E-ISSN 1097-0045, Vol. 77, nr 15, s. 1468-1477Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Tumor-derived antigens are captured by CD169+ (SIGLEC1+) sinus macrophages in regional lymph nodes (LNs), and are presented to effector cells inducing an anti-tumor immune response. Reduced CD169 expression in pre-metastatic regional LNs is associated with subsequent metastatic disease and a poor outcome in several tumor types, but if this is the case in prostate cancer has not been explored.

    Methods: CD169 expression was measured with immunohistochemistry in metastasis-free regional LNs from 109 prostate cancer patients treated with prostatectomy (January 1996 to April 2002). Possible associations of CD169 expression with PSA-relapse, prostate cancer death, Gleason score, and other clinical data were assessed using Kaplan-Meier survival- and Cox regression analysis. In addition, the Dunning rat prostate tumor model was used to examine CD169 expression in pre-metastatic LNs draining either highly metastatic MatLyLu- or poorly metastatic AT1-tumors.

    Results: In patients with low CD169 immunostaining in metastasis-free regional LNs, 8 of the 27 patients died from prostate cancer compared with only three of the 82 patients with high immunostaining (P < 0.001). CD169 expression in regional LNs was not associated with PSA-relapse. Rats with highly metastatic tumors had decreased CD169 immunoreactivity in pre-metastatic regional LNs compared with rats with poorly metastatic tumors.

    Conclusion: Low expression of CD169 in metastasis-free regional LNs indicates a reduced anti-tumor immune response. If verified in other studies, CD169 expression in regional LNs could, in combination with other factors, potentially be used as a marker of prostate cancer aggressiveness.

  • 190.
    Styrke, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi. Sundsvall Hospital.
    Henriksson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi. Sundsvall Hospital.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Hasan, Mudhar
    Silfverberg, Ingrid
    Einarsson, Roland
    Malmström, Per-Uno
    Sherif, Amir
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Evaluation of the diagnostic accuracy of UBC(®) Rapid in bladder cancer: a Swedish multicentre study2017Ingår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, nr 4, s. 293-300Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The aim of this study was to determine the diagnostic accuracy of UBC(®) Rapid - a urine-based marker for bladder cancer - in patients with bladder cancer and controls, and to compare the test results across risk groups.

    MATERIALS AND METHODS: This prospective phase II study was conducted at four Swedish hospitals. UBC Rapid was evaluated in four groups: A, newly diagnosed bladder cancer (n = 94); B, follow-up of non-muscle-invasive bladder cancer (n = 75); C, benign urinary tract diseases (n = 51); and D, healthy controls (n = 50). Tumours were divided into high risk (carcinoma in situ, TaG3, T1, T2 and T3) and low risk (low malignant potential, TaG1 and TaG2). Urine samples were quantitatively analysed by UBC Rapid. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated based on optimal cut-off (receiver operator characteristics curve analysis). A linear regression compared the UBC Rapid results in the different risk groups.

    RESULTS: The optimal cut-off was 8.1 μg/l. The median UBC Rapid values were 9.3 μg/l [interquartile range (IQR) 30.9] and 4.3 μg/l (IQR 7.8) in patients with positive and negative cystoscopy, respectively (p < .001). The value for group A was 15.6 μg/l (IQR 37.9), group B 5.6 μg/l (IQR 8.6), group C 5.1 μg/l (IQR 9.0) and group D 3.3 μg/l (IQR 7.1). Sensitivity was 70.8%, specificity 61.4%, PPV 71.3% and NPV 60.8%. The high-risk group had significantly higher UBC Rapid values than the low-risk group: 20.5 μg/l (IQR 42.2), sensitivity 79.2% and specificity 61.4% versus 7.0 μg/l (IQR 9.9), sensitivity 60.0% and specificity 61.4% (p = .039).

    CONCLUSIONS: The UBC Rapid urine-based marker for bladder cancer gave higher values in patients with positive than in those with negative cystoscopy. The diagnostic accuracy was better in patients with high-risk than in those with low-risk tumours, and was better during primary detection than during surveillance.

  • 191.
    Svenson, Ulrika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Grönlund, Elisabeth
    Söderström, Ingegerd
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Sitaram, Raviprakash T
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Roos, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Telomere length in relation to immunological parameters in patients with renal cell carcinoma2013Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, nr 2, artikel-id e55543Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Over the last decade, telomere length (TL) has gained attention as a potential biomarker in cancer disease. We previously reported that long blood TL was associated with a poorer outcome in patients with breast cancer and renal cell carcinoma. Based on these findings, we hypothesized that certain immunological components may have an impact on TL dynamics in cancer patients. One aim of the present study was to investigate a possible association between serum cytokines and TL of peripheral blood cells, tumors and corresponding kidney cortex, in patients with clear cell renal cell carcinoma. For this purpose, a multiplex cytokine assay was used. Correlation analysis revealed significant positive correlations between tumor TL and peripheral levels of three cytokines (IL-7, IL-8 and IL-10). In a parallel patient group with various kidney tumors, TL was investigated in whole blood and in immune cell subsets in relation to peripheral levels of regulatory T cells (Tregs). A significant positive association was found between whole blood TL and Treg levels. However, the strongest correlation was found between Tregs and TL of the T lymphocyte fraction. Thus, patients with higher Treg levels displayed longer T cell telomeres, which might reflect a suppressed immune system with fewer cell divisions and hence less telomere shortening. These results are in line with our earlier observation that long blood TL is an unfavorable prognostic factor for cancer-specific survival. In summary, we here show that immunological components are associated with TL in patients with renal cell carcinoma, providing further insight into the field of telomere biology in cancer. 

  • 192.
    Svenson, Ulrika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Roos, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Telomere length in peripheral blood predicts survival in clear cell renal cell carcinoma2009Ingår i: Cancer Research, ISSN 0008-5472, E-ISSN 1538-7445, Vol. 69, nr 7, s. 2896-2901Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Telomeres are repetitive structures located at chromosome ends. Previous studies have indicated that blood cell telomeres may serve as a biomarker for cancer risk. In addition, we recently reported that blood telomere length predicted survival in patients with breast cancer. In the present study, we examined whether blood telomere length may act as a predictor for survival in newly diagnosed patients with clear cell renal cell carcinoma. Furthermore, we analyzed telomere length in tumor samples and corresponding kidney cortex. Relative telomere length (RTL) was measured on extracted DNA using real-time PCR. Interestingly, and in line with our previous findings in breast cancer, patients with the longest blood telomeres (fourth quartile) had a significantly worse prognosis compared with patients with shorter blood RTL (P=0.005). A highly significant association was found between long blood telomeres and a poor outcome in patients with nonmetastatic disease (P<0.001), whereas patients with distant metastases had a poor survival regardless of blood RTL (P=0.432). No correlations were found between blood RTL and various clinical variables, such as erythrocyte sedimentation rate, hemoglobin, and thrombocyte count. Multivariate Cox regression analysis verified long blood RTL as an independent negative prognostic marker. In contrast, telomere length in kidney cortex and tumor tissue did not predict survival. In conclusion, our results indicate that blood RTL may predict kidney cancer survival, with implications for future treatment strategies.

  • 193.
    Thomasson, Marcus
    et al.
    Umeå universitet, Medicinsk fakultet, Strålningsvetenskaper, Onkologi.
    Hedman, Håkan
    Umeå universitet, Medicinsk fakultet, Strålningsvetenskaper, Onkologi.
    Junttila, Teemu T
    Elenius, Klaus
    Ljungberg, Börje
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Henriksson, Roger
    Umeå universitet, Medicinsk fakultet, Strålningsvetenskaper, Onkologi.
    ErbB4 is downregulated in renal cell carcinoma: a quantitative RT-PCR and immunohistochemical analysis of the epidermal growth factor receptor family2004Ingår i: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 43, nr 5, s. 453-459Artikel i tidskrift (Refereegranskat)
  • 194.
    Thomasson, Marcus
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Hedman, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Henriksson, Roger
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Gene expression pattern of the epidermal growth factor receptor family and LRIG1 in renal cell carcinoma2012Ingår i: BMC Research Notes, ISSN 1756-0500, E-ISSN 1756-0500, Vol. 5, nr 216, s. 1-5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Previous studies have revealed altered expression of epidermal growth factor receptor (EGFR)-family members and their endogenous inhibitor leucine-rich and immunoglobulin-like domains 1 (LRIG1) in renal cell carcinoma (RCC). In this study, we analyzed the gene expression levels of EGFR-family members and LRIG1, and their possible associations with clinical parameters in various types of RCC, individually.

    METHODS: Gene expression levels of EGFR-family members and LRIG1 were analyzed in 104 RCC samples, including 81 clear cell RCC (ccRCC), 15 papillary RCC (pRCC), and 7 chromophobe RCC (chRCC) by quantitative real-time RT-PCR. Associations between gene expression levels and clinical data, including tumor grade, stage, and patient survival were statistically assessed.

    RESULTS: Compared to kidney cortex, EGFR was up-regulated in ccRCC and pRCC, LRIG1 and ERBB2 were down-regulated in ccRCC, and ERBB4 was strongly down-regulated in all RCC types. ERBB3 expression did not differ between RCC types or between RCC and the kidney cortex. The expression of the analyzed genes did not correlate with patient outcome.

    CONCLUSIONS: This study revealed that the previously described up-regulation of EGFR and down-regulation of ERBB4 occurred in all analyzed RCC types, whereas down-regulation of ERBB2 and LRIG1 was only present in ccRCC. These observations illustrate the need to evaluate the different RCC types individually when analyzing molecules of interest and potential biological markers.

  • 195. Thorstenson, Andreas
    et al.
    Bergman, Martin
    Scherman-Plogell, Ann-Helen
    Hosseinnia, Soheila
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Adolfsson, Jan
    Lundstam, Sven
    Tumour characteristics and surgical treatment of renal cell carcinoma in Sweden 2005-2010: a population-based study from the National Swedish Kidney Cancer Register2014Ingår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 48, nr 3, s. 231-238Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. Tumour characteristics, preoperative work-up and surgical treatment in patients diagnosed with renal cell carcinoma (RCC) between 2005 and 2010, and changes over time were studied in a national population-based cohort. Material and methods. The National Swedish Kidney Cancer Register (NSKCR) contains information on histopathology, Fuhrman grade and clinical stage at presentation, and on the preoperative work-up and surgical treatment of patients with RCC. Between 2005 and 2010, 5553 RCC patients were registered in the NSKCR, 99% of those registered in the National Cancer Registry. Results. During the study period the mean tumour size decreased from 70 to 64 mm (p = 0.024) and the frequency of metastatic RCC decreased from 22% to 15% (p < 0.001). The use of preoperative chest computed tomography increased from 59% to 84%. In total, 4229 (76%) patients were treated with curative intent, 3453 (82%) underwent radical nephrectomy, 606 (14%) partial nephrectomy (PN) and 170 (4%) cryotherapy or radiofrequency ablation. In tumours up to 4 cm, PN was performed in 33% of the surgically treated patients. PN irrespective of size increased from 8% to 20% and laparoscopic nephrectomy increased from 6% to 17% during the period. In patients with metastatic RCC, 55% underwent cytoreductive nephrectomy. Conclusions. The NSKCR explores population-based data on the clinical handling of patients with RCC. This study, between 2005 and 2010, shows significant decrease in tumour size and metastatic RCC at presentation, a more complete preoperative work-up, and significantly increased use of PN and laparoscopic nephrectomy in Sweden.

  • 196. Thorstenson, Andreas
    et al.
    Hagberg, Oskar
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Liedberg, Fredrik
    Jancke, Georg
    Holmäng, Sten
    Malmström, Per-Uno
    Hosseini, Abolfazl
    Jahnson, Staffan
    Gender-related differences in urothelial carcinoma of the bladder: a population-based study from the Swedish National Registry of Urinary Bladder Cancer2016Ingår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, nr 4, s. 292-297Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The aim of this investigation was to describe tumour characteristics, treatments and survival in patients with urinary bladder cancer (UBC) in a national population-based cohort, with special reference to gender-related differences. Material and methods: All primary UBC patients with urothelial pathology reported to the Swedish National Registry of Urinary Bladder Cancer (SNRUBC) from 1997 to 2011 were included in the study. Groups were compared regarding tumour, node, metastasis classification, primary treatment and survival. Results: In total, 30,310 patients (74.9% male, 25.1% female) with UBC were analysed. A larger proportion of women than men had stage T2-T4 (p<0.001), and women also had more G1 tumours (p<0.001). However, compared to women, a larger proportion of men with carcinoma in situ or T1G3 received intravesical treatment with bacillus Calmette-Guerin or intravesical chemotherapy, and a larger proportion of men with stage T2-T4 underwent radical cystectomy (38% men vs 33% women, p<0.0001). The cancer-specific survival at 5 years was 77% for men and 72% for women (p<0.001), and the relative survival at 5 years was 72% for men and 69% for women (p<0.001). Conclusions: In this population-based cohort comprising virtually all patients diagnosed with UBC in Sweden between 1997 and 2011, female gender was associated with inferior cancer-specific and relative survival. Although women had a higher rate of aggressive tumours, a smaller proportion of women than men received optimal treatment.

  • 197.
    Thorstenson, Andreas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi. Karolinska Institute, Stockholm, Sweden; University of Oxford, Oxford, UK.
    Harmenberg, Ulrika
    Karolinska University Hospital, Solna, Stockholm, Sweden.
    Lindblad, Per
    Örebro University, Örebro, Sweden.
    Holmström, Benny
    Akademiska University Hospital, Uppsala, Sweden.
    Lundstam, Sven
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Cancer Characteristics and Current Treatments of Patients with Renal Cell Carcinoma in Sweden2015Ingår i: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, artikel-id 456040Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Methodology. Since the start in 2005 virtually all patients with newly diagnosed renal cell carcinoma (RCC) in Sweden are reported to the National Swedish Kidney Cancer Register (NSKCR). The register contains information on histopathology, nuclear grade, clinical stage, preoperative work-up, treatment, recurrence, and survival.

    Results. A total of 8556 patients with newly diagnosed RCC were registered in the NSKCR from 2005 to 2013 resulting in a coverage of 99% as compared to the Swedish Cancer Registry. The mean tumor size at detection decreased from 70 mm in 2005 to 64 mm in 2010. The proportion of patients who were incidentally detected increased. The proportion of patients with tumor stage T1a who underwent partial nephrectomy increased from 22% in 2005 to 56% in 2012. Similarly, the proportion of laparoscopically performed radical nephrectomies increased from 6% in 2005 to 17% in 2010. During the five years of follow-up 20% of the patients had a recurrence. Conclusion. Over the last decade there has been a trend of earlier detection and less advanced tumors at detection in patients with RCC. An increasing proportion of the patients undergo laparoscopic and nephron-sparing procedures.

  • 198.
    Thorstenson, Andreas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi. Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden; Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
    Harmenberg, Ulrika
    Lindblad, Per
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Lundstam, Sven
    Impact of quality indicators on adherence to National and European guidelines for renal cell carcinoma2016Ingår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 50, nr 1, s. 2-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The aim of this population-based study was to evaluate the impact of quality indicators on the adherence to guidelines for renal cell carcinoma (RCC). Material and methods: Since 2005, virtually all patients with newly diagnosed RCC in Sweden have been registered in the National Swedish Kidney Cancer Register (NSKCR). The register contains information on histopathology, nuclear grade, clinical stage, preoperative work-up, treatment, recurrence and survival. In addition, a number of quality indicators have been measured in the register aiming to increase the quality of care. The quality indicators are: the coverage of the register, histology reports, preoperative chest computed tomography (CT), partial nephrectomy, laparoscopic surgery, centralization to high-volume hospitals and waiting times. Results: A total of 8556 patients with diagnosed RCC were registered from 2005 to 2013 (99% coverage). In 2013, 99% of the histopathology reports were standardized. The number of patients with preoperatively chest CT increased from 59% in 2005 to 89% in 2013. The proportion of patients with RCC T1aN0M0 who underwent partial nephrectomy increased from 22% in 2005 to 56% in 2013. Similarly, laparoscopic radical nephrectomies increased from 6% in 2005 to 24% in 2013. The median tumour size at detection decreased from 60 mm in 2005 to 55 mm in 2013. The proportion of patients who were incidentally detected increased from 43% in 2005 to 55% in 2013. Conclusions: The data show an improved adherence to the guidelines for RCC as measured by quality indicators and a steady process of earlier detection of patients with RCC.

  • 199. Thulin, Helena
    et al.
    Kreicbergs, Ulrika
    Onelöv, Erik
    Ahlstrand, Christer
    Carringer, Malcolm
    Holmäng, Sten
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Malmström, Per-Uno
    Robinsson, David
    Wijkström, Hans
    Wiklund, N Peter
    Steineck, Gunnar
    Henningsohn, Lars
    Defecation disturbances after cystectomy for urinary bladder cancer2011Ingår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 108, nr 2, s. 196-203Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    What’s known on the subject? and What does the study add?Functional gastrointestinal symptoms and problems are common after radical cystectomy with urinary diversion. This study adds new important epidemiological data on this group of symptoms.

    OBJECTIVE: To describe and compare long-term defecation disturbances in patients who had undergone a cystectomy due to urinary bladder cancer with non-continent urostomies, continent reservoirs and orthotopic neobladder urinary diversions.

    PATIENTS AND METHODS: During their follow-up we attempted to contact all men and women aged 30–80 years who had undergone cystectomy and urinary diversion at seven Swedish hospitals. During a qualitative phase we identified defecation disturbances as a distressful symptom and included this item in a study-specific questionnaire together with free-hand comments. The patients completed the questionnaire at home. Outcome variables were dichotomized and the results are presented as relative risks with 95% confidence interval.

    RESULTS: The questionnaire was returned from 452 (92%) of 491 identified patients. Up to 30% reported problems with the physiological emptying process of stool (bowel movement, sensory rectal function, awareness of need for defecation, motoric rectal and anal function, straining ability). A sense of decreased straining capacity was reported by 20% of the men and women with non-continent urostomy and 14% and 8% of those with continent reservoirs and orthotopic neobladders, respectively.

    CONCLUSIONS: Of the cystectomized individuals 30% reported problems with the physiological emptying process of stool (bowel movement, sensory rectal function, awareness of need for defecation, motoric rectal and anal function, straining ability). Those wanting to improve the situation for bladder cancer survivors may consider communicating before surgery the possibility of stool-emptying problems, and asking about them after surgery.

  • 200. Thulin, Helena
    et al.
    Steineck, Gunnar
    Kreicbergs, Ulrika
    Onelöv, Erik
    Ahlstrand, Christer
    Carringer, Malcolm
    Holmäng, Sten
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Malmström, Per-Uno
    Robinsson, David
    Wijkström, Hans
    Wiklund, N Peter
    Henningsohn, Lars
    Hygiene and urinary tract infections after cystectomy in 452 Swedish survivors of bladder cancer.2009Ingår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410XArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES To determine whether or not an improved hygiene can lessen the incidence of symptomatic urinary tract infections (UTIs) in patients treated by cystectomy for urinary bladder cancer. PATIENTS AND METHODS We attempted to contact during their follow-up all men and women aged 30-80 years who had undergone cystectomy and urinary diversion at seven Swedish hospitals. During a qualitative phase we identified hygienic measures and included them in a study-specific questionnaire. The patients completed the questionnaire at home. Outcome variables were dichotomized and the results presented as relative risks (RR) with 95% confidence interval. RESULTS We received the questionnaire from 452 (92%) of 491 identified patients. The proportion of patients who had a symptomatic UTI in the previous year was 22% for orthotopic neobladder and cutaneous continent reservoir, and 23% for non-continent urostomy diversion. The RR for a UTI was 1.1 (0.5-2.5) for 'never washing hands' before handling with catheters or ostomy material. Patients with diabetes mellitus had a RR of 2.1 (1.4-3.2) for having a symptomatic UTI. CONCLUSIONS We could not confirm lack of hygiene measures as a cause of UTI for men and women who had a cystectomy with urinary diversion. Patients with diabetes mellitus have a greater risk of contracting a UTI.

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