Real-life use of diagnostic biopsies before treatment of kidney cancer: results from a Norwegian population-based study

<p><b>Objective:</b> Interest in renal mass biopsies (RMBs) has increased in recent years. However, most publications are low-volume and/or single-center studies, so their generalizability is questionable. The aim of this study was to describe population-based, real-life use of diagnostic RMBs for localized and advanced kidney cancer (KC).</p> <p><b>Materials and methods:</b> All KC patients diagnosed during 2008–2013 extracted from the database at the Cancer Registry of Norway were included. Relationships with outcome were analyzed using multivariate logistic regression and competing risks analyses.</p> <p><b>Results:</b> Of patients treated radically for localized KC, a pretreatment RMB was used in 8.4%. For similar patients treated by observation only, the rate increased from 29.3% to 60.7% during the study period. Tumor size ≤4 cm, another malignancy, multiple tumors, old age (≥ 80 years) and second study half were independent RMB predictors. Competing risks analysis showed that among radically treated patients with localized KC, those who had undergone an RMB had a higher risk of dying of other diseases. In patients with advanced KC, biopsy was used in 54.5%, and is increasing. Study limitations include a lack of data on benign tumors, comorbidity and performance status.</p> <p><b>Conclusions:</b> For localized KC, the use of RMBs in Norway is in line with current guidelines. Because real-world data on RMB use are scarce, this study is useful for benchmarking in future studies. Furthermore, the study shows that fewer patients with advanced KC are treated without histopathological verification, and biopsies seem to have an increasing role in tailoring treatment.</p

Factors influencing access to palliative radiotherapy: a Norwegian population-based study

<p><b>Background:</b> Palliative radiotherapy (PRT) comprises half of all radiotherapy use and is an effective and important treatment modality for improving quality of life in incurable cancer patients. We have described the use of PRT in Norway and aimed to identify and quantify the impact of factors associated with PRT utilization.</p> <p><b>Material and methods:</b> Population-based data from the Cancer Registry of Norway identified 25,281 patients who died of cancer, 1 July 2009–31 December 2011. Additionally, individual-level data on socioeconomic status and community-level data on travel distance were collected. The proportion of patients who received PRT in the last two years of life (PRT_2Y) was calculated, and multivariable logistic regression was used to determine factors that influenced the PRT_2Y. Analyses of geographic variation in PRT use were also performed for the time period 2012–2016.</p> <p><b>Results:</b> PRT_2Y for all cancer sites combined was 29.6% with wide geographic variations (standardized inter-county range; 21.8–36.6%). Female gender, increasing age at death, certain cancer sites, short survival time, and previous receipt of curative radiotherapy were associated with decreased odds of receiving PRT. Patients with low education, those living in certain counties, or with travel distances 100–499 km, were also less likely to receive PRT. Patients with low household income (adjusted odds ratio (OR) = 0.63; 95% confidence interval (CI) = 0.56–0.72) and those diagnosed in hospitals without radiotherapy facility (OR = 0.70; 95% CI = 0.64–0.77) had especially low likelihood of receiving PRT. Significant inter-county variation in use of PRT remained during the time period 2012–2016.</p> <p><b>Conclusions:</b> Despite a publicly funded, universal healthcare system with equity as a stated health policy aim, utilization of PRT in Norway is significantly associated with factors such as household income and availability of radiotherapy facility at the diagnosing hospital. Even after adjustments for relevant factors, unexplained geographic variations in PRT utilization exist.</p

Overweight, obesity and height as risk factors for meningioma, glioma, pituitary adenoma and nerve sheath tumor: a large population-based prospective cohort study

<p><b>Background:</b> In 2016, the International Agency for Research on Cancer (IARC) has announced that avoiding body fatness (i.e. overweight and obesity) contributes to prevent meningioma occurrence, but considered the available evidence for glioma inadequate. The association of body fatness with other CNS tumor subgroups is largely unknown.</p> <p><b>Objectives:</b> To assess whether body fatness or body height are associated with risk for meningioma, glioma, pituitary adenoma (PA) or nerve sheath tumor (NST) in a large population-based Norwegian cohort.</p> <p><b>Methods:</b> In this prospective cohort study of 1.8 million Norwegian residents, weight and height were measured at baseline and incident intracranial tumors were subsequently identified by linkage to the Cancer Registry of Norway. Cox regression analyses were performed to estimate risk for each tumor subgroup in relation to anthropometric measures, stratified by sex and in different age groups.</p> <p><b>Results:</b> During 54 million person-years of follow-up 3335 meningiomas, 4382 gliomas, 1071 PAs and 759 NSTs were diagnosed. Obesity (BMI ≥30 kg/m²) was not associated with risk for meningioma or glioma, but was significantly associated with risk for PA (HR 1.43; 95% CI 1.09–1.88) compared with the reference group (BMI 20–24.9 kg/m²). For intracranial NSTs, obesity was associated with reduced tumor risk (HR 0.68; 95% CI 0.46–0.99). Body height was associated with increased risk for all four tumor subgroups.</p> <p><b>Conclusions:</b> This study does not confirm overweight or obesity as risk factors for meningioma. Additionally, overweight and obesity can be quite confidently excluded as risk factors for glioma. However, this study indicates that body fatness increases the risk for PA, while it reduces the risk for NST.</p