Gesundheitsbezogene Lebensqualität bei Krebspatienten mit malignem Melanom und Mammakarzinom im Vergleich

Hintergrund: Zur Lebensqualität (LQ) nach Abschluss der Behandlung von Tumoren mit sehr guter Prognose liegen im Rahmen der Routineversorgung kaum Daten vor. Diese Arbeit stellt die Lebensqualität von Brustkrebspatientinnen und Patienten mit malignem Melanom im krankheitsfreien Intervall zwei Jahre nach Erstbehandlung dar. Methodik: Unter Nutzung der Strukturen des bevölkerungsbezogenen klinischen Tumorregisters München wurden die Patienten schriftlich mittels bekannten Lebensqualitätsmessinstrumenten (EORTC-QLQ C30 und BR23) befragt. Ergebnisse: Bei einer Responserate von über 70% konnten 1304 Brustkrebspatientinnen und 664 Melanompatienten ausgewertet werden. Melanompatienten hatten der Normalbevölkerung vergleichbare LQ-Werte. Signifikante Geschlechtsunterschiede fanden sich bei der emotionalen Funktion. Brustkrebspatientinnen hatten in allen Dimensionen signifikant schlechtere LQ-Werte als Melanompatientinnen. Bei beiden Tumorentitäten hatten Begleiterkrankungen und das Alter signifikanten Einfluss auf die LQ. Bei Brustkrebspatientinnen beeinflussten Brust- und Armbeschwerden, aber auch die Bewertung der Kommunikation im Rahmen der Behandlung die LQ. Schlussfolgerungen: Die bei gleich guter Prognose signifikant schlechteren LQ-Werte der Brustkrebspatientinnen dürften im Wesentlichen auf ausgeprägtere Behandlungsresiduen und nicht immer gelungene Kommunikation im Rahmen der Behandlung und Nachsorge zurückzuführen sein. Eine Rolle mag die mediale Präsenz der Brustkrebserkrankung spielen, die Patientinnen mit eine Informationsflut überfordert. Diesem Punkt sollte im Umgang mit Brustkrebspatientinnen besondere Aufmerksamkeit gewidmet werde

Changes in prognostic and therapeutic parameters in prostate cancer from an epidemiological view over 20 years

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; The study objective was to examine changes in prognosis and treatment of prostate cancer patients over 20 years and to evaluate their impact on survival. &lt;b&gt;&lt;i&gt;Patients and Methods:&lt;/i&gt;&lt;/b&gt; 38,861 prostate cancer patients diagnosed between 1990 and 2010 and living in the catchment area of the Munich Cancer Registry were analysed. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Pre-therapeutic prostate-specific antigen (PSA) testing increased substantially in the early 1990s. A shift from capsule-exceeding tumours to capsule-limited tumours also took place especially in the 1990s. The proportion of radical prostatectomy increased continuously over the last 20 years from 20% to almost 50% whereas hormone therapy decreased from 55% to 18%. Radiation therapy and transurethral resection of the prostate increased slightly from about 5% to 10%. The 5- and 10-year relative survival rates increased from 92% to 97% and from 86% to 92%, respectively. &lt;b&gt;&lt;i&gt;Conclusions:&lt;/i&gt;&lt;/b&gt; 2 reasons may account for the rise in survival rates over 20 years: First, the establishment of widely used PSA testing resulted in a shift towards more favourable T categories due to the detection of many additional small tumours as well as the noticeable change in initial treatment strategy towards more radical prostatectomies. The second factor that likely increased survival was improvements in the therapies themselves.</jats:p

Colonoscopy and polypectomy: beside age, size of polyps main factor for long-term risk of colorectal cancer in a screening population

PURPOSE Despite national and international guideline recommendations, few studies have been conducted to estimate the impact of colonoscopy screening on long-term colorectal cancer incidence. Aim of this study was to determine the long-term impact of a full colonoscopy with polypectomy on colorectal cancer incidence in a large screening population. METHODS In this prospective observational cohort study, a total of 10,947 colonoscopy screening participants from within the scope of the Munich Cancer Registry were consecutively recruited from participating gastroenterology practices and their subsequent colorectal cancer incidence assessed. Predictive factors associated with colorectal cancer were also evaluated in univariate and multivariate analyses. RESULTS After a median follow-up of 14.24~years (95% CI 14.21-14.25), 93 colorectal cancer cases were observed. This is equivalent to a truncated age-standardized rate of 69.0 (95{\%} CI 43.3-94.7) for male and 43.4 (95{\%} CI 29.4-57.5) for female participants ($\geq$ 50~years at colonoscopy). The ratio of this observed to the expected rate from cancer registry data showed a 67{\%} decrease in colorectal cancer incidence in the male and 65{\%} in the female participants (p {\textless} 0.0001). In multivariate analysis of screening patients, age at screening (p {\textless} 0.0001) was the main predictive factor for colorectal cancer. In the subgroup with positive polyp findings, age (p {\textless} 0.0001) and the polyp size (p = 0.0002) were associated with colorectal cancer. CONCLUSION These results underline the significance of a full colonoscopy screening combined with polypectomy in reducing the total disease burden of colorectal cancer

Age independent survival benefit for patients with hepatocellular carcinoma (HCC) without metastases at diagnosis: a population-based study

OBJECTIVE Hepatocellular carcinoma (HCC) is a major cause of death worldwide and its incidence is expected to increase globally. Aim of this study was to assess whether the implementation of screening policies and the improvement of treatment options translated into a real-world survival benefit in HCC patients. DESIGN 4078 patients diagnosed with HCC between 1998 and 2016 from the Munich Cancer Registry were analysed. Tumour characteristics and outcome were analysed by time period and according to age and presence of metastases at diagnosis. Overall survival (OS) was analysed using Kaplan-Meier method and relative survival (RS) was computed for cancer-specific survival. Cox proportional hazard models were conducted to control for prognostic variables. RESULTS While incidence of HCC remained substantially stable, tumours were diagnosed at increasingly earlier stages, although the median age at diagnosis increased. The 3 years RS in HCC improved from 19.8% in 1998-2002, 22.4% in 2003-2007, 30.6% in 2008-2012 up to 31.0% in 2013-2016. Median OS increased from 6 months in 1998-2002 to 12 months in 2008-2016. However, analysis according to the metastatic status showed that survival improved only in patients without metastases at diagnosis whereas the prognosis of patients with metastatic disease remained unchanged. CONCLUSION These real-world data show that, in contrast to the current assumptions, the incidence of HCC did not increase in a representative German region. Earlier diagnosis, likely related to the implementation of screening programmes, translated into an increasing employment of effective therapeutic options and a clear survival benefit in patients without metastases at diagnosis, irrespective of age