Mathematical models integrating an ultrasound-based technology improve the diagnosis of ovarian cancer

In the European countries, age standardized incidence rates (European standard) for ovarian cancer vary between 7.2 and 19.3/100,000 while mortality rates are ranging between 2.8 and 12.2/100,000.1 In Belgium, ovarian cancer is not as frequent as breast cancer since breast cancer presents with very high incidence rates (similar for other European countries). However, age standardized breast cancer mortality rates in 2008 were less than one fourth of the age standardized incidence rates whereas for ovarian cancer, mortality rates were two thirds of the incidence rates (see figure 1). And, unlike for breast cancer, mortality rates for ovarian cancer were not decreasing over the past years.2 Indeed, ovarian cancer is one of the leading causes of death from gynaecological malignancies.3 This is explained by the fact that in general, ovarian cancer is detected at too advanced stages. Early diagnosis of ovarian cancer is thus the key for improving outcomes for the disease. Medical imaging techniques have revolutionised medicine during the last decades. Ultrasound (US) in particular gives access to vital data in a non-invasive way and is effective for imaging soft tissues of the body. Compared to other medical imaging modalities, US has the following positive attributes: • US is a real-time, easy operation medical imaging technique • US has a non-invasive and radiation free nature • US is relatively low-priced, Hence US has become widely used as a diagnostic technique in general clinical practice. In gynaecology, US is one of the most important and primary diagnostic tools. Its use continues to increase and it is now an essential part of the diagnostic procedure in examining the female pelvis. Indeed, the use of US morphology to characterize adnexal masses and thus diagnose ovarian cancer is well established.4 As a part of patient management, gynaecologists use US morphology to differentiate between malignant and non-malignant ovarian masses that come to their attention. In addition, a large number of indexes and mathematical prediction models that assess the likelihood of malignancy for an ovarian mass have been developed and they all incorporate US. A novel computer-aided technology, HistoScanningTM, makes use of US data for characterising ovarian tissue suspicious of being malignant. In part I of this research work, we investigated whether ovarian HistoScanning could improve the performance of existing prediction models for the differential diagnosis of ovarian masses and we also explored what place could be granted to this new technology in clinical practise. Part I is organised as follows: Chapter 1 concerns the epidemiology of ovarian cancer and discusses the importance of differential diagnosis of ovarian masses. Detailed aims are described in chapter 2. Chapter 3 introduces the general methods used for this work. In chapter 4, two publications that present the results of this work are presented. Finally, a discussion, regarding the results presented in part I, concludes this work in chapter 5.(MED 3) -- UCL, 201

Beta-blocker use and mortality following ovarian cancer diagnosis: a population-based study.

BACKGROUND: Preclinical studies suggest that β-blockers could exhibit anticancer properties in ovarian cancer. Similar effects have also been reported in observational studies, but their results remain inconsistent and could be impaired by methodological limitations. This study aimed to investigate whether β-blocker use is associated with improved survival in ovarian cancer patients at the Belgian population level. METHODS: We conducted a population-based study by linking data of the Belgian Cancer Registry with medical claims data of the health insurance companies for patients diagnosed with ovarian cancer between 2004 and 2014. Information on ovarian-cancer-specific deaths was retrieved from mortality records collected by regional governments. Use of β-blockers was modelled as a time-varying covariate in Cox regression models to calculate adjusted hazards ratios (HRs) and 95% confidence intervals (95%CIs) for the association between postdiagnostic β-blocker exposure and overall or cancer-specific survival (OS and CSS, respectively). Adjustments were made for age at diagnosis, year of diagnosis, comorbidities, cancer stage, and cancer treatments. RESULTS: In our population of 6197 patients, 2373 patients (38%) had at least one prescription of β-blockers in the 5 years following diagnosis. Postdiagnostic exposure to β-blockers was associated with a significant decrease in OS (adjusted HR, 1.21, 95%CI 1.12;1.30, p < 0.001) and CSS (adjusted HR, 1.17, 95%CI 1.07;1.29, p < 0.001). Moreover, this association remained similar in dose-response analyses, in subgroup analyses (including by β-blocker selectivity types), and in sensitivity analyses. CONCLUSION: In this large nationwide cohort of ovarian cancer patients, β-blocker users had reduced survival

Statin use after diagnosis is associated with an increased survival in esophageal cancer patients: a Belgian population-based study

PURPOSE: Preclinical studies have shown that statins reduce proliferation in esophageal cancer. Three recent observational studies have shown encouraging results but suffered from limitations. This work aimed to assess at the Belgian population level whether statin usage was associated with a decreased mortality in esophageal cancer patients. METHODS: We conducted an observational, population-based study by linking data of the Belgian Cancer Registry (BCR) with medical claims data coming from health insurance companies and mortality records collected by regional governments for patients diagnosed with esophageal cancer between 2004 and 2014. Using time-dependent Cox regression models, hazard ratios (HRs) and 95% confidence intervals (CI) for overall and cancer-specific mortality were calculated. RESULTS: Of 6,238 patients with stage I-III esophageal cancer, post-diagnostic use of statins was found in 1,628 (26%) patients. Statins use after diagnosis was associated with a reduction in overall mortality (adjusted HR = 0.84, 95% CI [0.77; 0.92]) and cancer-specific mortality (adjusted HR = 0.87, 95% CI [0.78; 0.97]). Similar association were also seen for pre-diagnostic statin use in overall (adjusted HR = 0.83, 95% CI [0.76-0.91]) and cancer-specific analysis (adjusted HR = 0.86, 95% CI [0.77-0.96]). CONCLUSIONS: In this large cohort of Belgian patients with esophageal cancer, statins use after diagnosis was associated with a decreased mortality

Impact of metformin on gastric adenocarcinoma survival: A Belgian population based study

Background: Preclinical studies have shown anticancer activities of metformin in gastric cancer and a recent epidemiological study showed a decrease in recurrence and mortality of gastric cancer in metformin users. This study aimed to assess the impact of metformin on gastric cancer survival in diabetic patients at a Belgian population level. Methods: We conducted an observational, population-based study by linking data of the Belgian Cancer Registry with medical claims data coming from the health insurance companies for patients diagnosed with stage I to III gastric adenocarcinoma between 2006 and 2012. Information on gastric cancer-specific deaths was retrieved from mortality records collected by regional governments. Time-dependent Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CI) for overall survival (OS) and cancer-specific mortality (CSS). Results: In our population of 371 patients, a reduction in all-cause mortality was observed in metformin users (adjusted HR=0.73, 95% CI: [0.52; 1.01], p=0.06) but not for cancer specific mortality (adjusted HR=0.86, 95% CI: [0.56; 1.33], p=0.50). Pre-diagnosis exposure to metformin was associated with a significant improvement in OS (adjusted HR=0.75, 95% CI: [0.57; 0.98], p=0.04) that was not significant for CSS (adjusted HR=0.89, 95% CI: [0.62; 1.28], p=0.52). Moreover, no dose-response relationship between metformin use and either all-cause or cancer-specific mortality was observed. Conclusion: In the first population based study of metformin use in gastric cancer adenocarcinoma patients with previous diabetes, our findings suggest that metformin use might improve overall mortality. However, no such association was found for cancer-specific survival. Additional studies in other populations are required

Differential diagnosis of adnexal masses: sequential use of the risk of malignancy index and HistoScanning, a novel computer-aided diagnostic tool.

Our data suggest that HistoScanning may have the potential to improve the diagnostic accuracy of RMI, which could result in better triage for women with adnexal masses. Further prospective validation is warranted

Mathematical models to discriminate between benign and malignant adnexal masses : potential diagnostic improvement using ovarian HistoScanning.

Accurate preoperative clinical assessment of adnexal masses can optimize outcomes by ensuring appropriate and timely surgery. This article addresses whether a new technology, ovarian HistoScanning, has an additional diagnostic value in mathematical models developed for the differential diagnosis of adnexal masses

Statin use is associated with improved survival in ovarian cancer: A retrospective population-based study

<div><p>Background</p><p>Preclinical in vitro and in vivo studies suggest that statins could exhibit anticancer properties in ovarian cancer. Similar effects have also been reported in observational studies but their results remain inconsistent and could be impaired by methodological limitations. This study aimed to investigate whether statin use is associated with improved survival in ovarian cancer patients at the Belgian population-level.</p><p>Methods</p><p>All patients with invasive epithelial ovarian cancer diagnosed between 2004 and 2012 were identified from the Belgian Cancer Registry. Vital statuses were obtained from the Crossroads Bank for Social Security and ovarian cancer-specific deaths were identified from death certificates provided by regional administrations. Information on cancer treatments and statin use were retrieved from health insurance databases. Statin use was modelled as a time-varying covariate in Cox regression models to calculate adjusted hazards ratios (HR) and 95% confidence intervals (95%CI) for the association between postdiagnostic exposure to statins and overall- or ovarian cancer-specific mortality within three years after diagnosis. Adjustments were made for age at diagnosis, year of diagnosis, comorbidities, cancer stage, and cancer treatments.</p><p>Results</p><p>A total of 5,416 patients with epithelial ovarian cancer met the inclusion criteria. Of these 1,255 (23%) had at least one statin prescription within three years after diagnosis. Postdiagnostic use of statins was associated with a reduced risk of overall mortality (adjusted HR = 0.81, 95%CI:0.72–0.90, p<0.001). In analyses by statin type, this association was only significant for simvastatin (adjusted HR = 0.86, 95%CI:0.74–0.99, p = 0.05) or rosuvastatin (adjusted HR = 0.71, 95%CI:0.55–0.92, p = 0.01). In subgroup analyses by statin prediagnostic use, the protective association for postdiagnostic statin use was only observed in patients who were also using statins before diagnosis (adjusted HR = 0.73, 95%CI:0.64–0.83, p<0.001). Similar results were observed for ovarian cancer-specific mortality.</p><p>Conclusion</p><p>In this large nation-wide cohort of ovarian cancer patients postdiagnostic use of statins was associated with improved survival.</p></div

Association between statin use after diagnosis and overall mortality in patients with ovarian cancer.^*

<p>Association between statin use after diagnosis and overall mortality in patients with ovarian cancer.^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0189233#t002fn001" target="_blank">*</a>}</p