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Characteristics and survival of interval and sporadic colorectal cancer patients: a nationwide population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature112999
Source
Am J Gastroenterol. 2013 Aug;108(8):1332-40
Publication Type
Article
Date
Aug-2013
Author
Rune Erichsen
John A Baron
Elena M Stoffel
Søren Laurberg
Robert S Sandler
Henrik Toft Sørensen
Author Affiliation
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. re@dce.au.dk
Source
Am J Gastroenterol. 2013 Aug;108(8):1332-40
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Cohort Studies
Colonoscopy
Colorectal Neoplasms - diagnosis - mortality - pathology
Comorbidity
Denmark - epidemiology
Female
Humans
Logistic Models
Male
Middle Aged
Neoplasm Staging
Prevalence
Proportional Hazards Models
Registries
Risk factors
Sex Factors
Survival Rate
Abstract
Colorectal cancers (CRCs) diagnosed relatively soon after a colonoscopy are referred to as interval CRCs. It is not clear whether interval CRCs arise from prevalent lesions missed at colonoscopy or represent specific aggressive biology leading to poor survival.
Using Danish population-based medical registries (2000-2009), we investigated patients with "interval" CRC diagnosed within 1-5 years of a colonoscopy, and compared them with cases with colonoscopy =10 years before diagnosis and to "sporadic" CRCs with no colonoscopy before diagnosis. Multivariate logistic regression was used to explore the association between clinical, demographic, and comorbidity characteristics and interval CRC. We assessed survival using Kaplan-Meier methods and mortality rate ratios (MRRs) using Cox regression, adjusting for covariates including the Charlson Comorbidity Index (CCI 0, 1-2, 3+).
The comparison of the 982 interval CRCs to the 358 patients with CRC =10 years after colonoscopy revealed nearly similar characteristics and mortality. In the comparison with the 35,704 sporadic CRCs, interval cases were slightly older (74 vs. 71 years), more likely to be female (54 vs. 48%), have comorbidities (CCI3+: 28 vs. 15%), have proximal tumors (38 vs. 22%), and tumors with mucinous histology (9.1 vs. 7.0%), but stage was similar (metastatic 23 vs. 24%). In logistic regression analysis, female sex, localized stage at diagnosis, proximal tumor location, and high comorbidity burden were factors independently associated with interval CRC. The 1-year survival was 68% (95% confidence interval (CI): 65%, 71%) in interval and 71% (95% CI: 70%, 71%) in sporadic cases, with an adjusted MRR of 0.92 (95% CI 0.82, 1.0). After 5 years, survival was 41% (95% CI: 37%, 44%) in interval and 43% (95% CI: 42%, 43%) in sporadic cases, and the adjusted 2-5 year MRR was 1.0 (95% CI 0.88, 1.2).
Clinical characteristics and survival among interval CRCs did not suggest aggressive biology, but rather that the majority represented missed lesions.
Notes
Comment In: Am J Gastroenterol. 2013 Aug;108(8):1341-323912407
PubMed ID
23774154 View in PubMed
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Editorial: colonoscopy and colorectal cancer mortality: strong beliefs or strong facts?

https://arctichealth.org/en/permalink/ahliterature142362
Source
Am J Gastroenterol. 2010 Jul;105(7):1633-5
Publication Type
Article
Date
Jul-2010
Author
Robert S Sandler
Source
Am J Gastroenterol. 2010 Jul;105(7):1633-5
Date
Jul-2010
Language
English
Publication Type
Article
Keywords
Colonoscopy - statistics & numerical data
Colorectal Neoplasms - mortality
Humans
Mass Screening
Ontario - epidemiology
Risk factors
United States - epidemiology
Notes
Comment In: Am J Gastroenterol. 2011 Feb;106(2):37021301465
Comment On: Am J Gastroenterol. 2010 Jul;105(7):1627-3220197758
PubMed ID
20606662 View in PubMed
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Risk of cancer in patients with inflammatory bowel diseases: a nationwide population-based cohort study with 30 years of follow-up evaluation.

https://arctichealth.org/en/permalink/ahliterature114587
Source
Clin Gastroenterol Hepatol. 2014 Feb;12(2):265-73.e1
Publication Type
Article
Date
Feb-2014
Author
Michael D Kappelman
Dora K Farkas
Millie D Long
Rune Erichsen
Robert S Sandler
Henrik T Sørensen
John A Baron
Author Affiliation
Department of Pediatrics, Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: michael_kappelman@med.unc.edu.
Source
Clin Gastroenterol Hepatol. 2014 Feb;12(2):265-73.e1
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Cohort Studies
Colitis, Ulcerative - epidemiology
Colorectal Neoplasms - epidemiology
Crohn Disease - epidemiology
Denmark - epidemiology
Gastrointestinal Neoplasms - epidemiology
Hematologic Neoplasms - epidemiology
Humans
Inflammatory Bowel Diseases
Neoplasms - epidemiology
Registries
Abstract
Data regarding the risk of gastrointestinal and extraintestinal cancers in Crohn's disease (CD) and ulcerative colitis (UC) are needed to understand the clinical course of inflammatory bowel diseases (IBDs) and their treatments.
We performed a nationwide historical cohort study using Danish health care databases. We identified patients with a diagnosis of CD or UC, recorded from 1978 through 2010, and followed them up until the first occurrence of cancer, death, or emigration. We used standardized incidence ratios (SIRs) to compare cancer incidence in CD and UC patients with that expected in the general population.
Excluding cancers diagnosed within 1 year of IBD diagnosis, 772 cases of invasive cancer occurred among 13,756 patients with CD (SIR, 1.3; 95% confidence interval [CI], 1.2-1.4) and 2331 occurred among 35,152 patients with UC (SIR, 1.1; 95% CI, 1.0-1.1). CD was associated weakly with gastrointestinal cancers (SIR, 1.2; 95% CI, 1.0-1.4) and extraintestinal cancers (SIR, 1.3; 95% CI, 1.2-1.4), with the strongest associations for hematologic malignancies (SIR, 1.9; 95% CI, 1.5-2.3), smoking-related cancers (SIR, 1.5; 95% CI, 1.3-1.8), and melanoma (SIR, 1.4; 95% CI, 1.0-1.9). Associations between UC and gastrointestinal and extraintestinal cancers were weaker (SIR, 1.1; 95% CI, 1.0-1.2; and SIR, 1.1; 95% CI, 1.0-1.1, respectively). The relative risk of extraintestinal cancers among patients with IBD was relatively stable over time, although the risk of gastrointestinal cancers decreased.
Patients with IBD, particularly CD, are at increased risk for gastrointestinal and extraintestinal malignancies. The relative risk of gastrointestinal malignancy has decreased since 1978, without a concomitant increase in the risk of nongastrointestinal malignancy.
Notes
Comment In: Clin Gastroenterol Hepatol. 2014 Feb;12(2):274-624183955
PubMed ID
23602821 View in PubMed
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Risk of colorectal cancer in patients with acute myocardial infarction and stroke: a nationwide cohort study.

https://arctichealth.org/en/permalink/ahliterature107137
Source
Cancer Epidemiol Biomarkers Prev. 2013 Nov;22(11):1994-9
Publication Type
Article
Date
Nov-2013
Author
Rune Erichsen
Claus Sværke
Henrik T Sørensen
Robert S Sandler
John A Baron
Author Affiliation
Authors' Affiliations: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; and Department of Medicine, Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Source
Cancer Epidemiol Biomarkers Prev. 2013 Nov;22(11):1994-9
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Acute Disease
Aged
Cohort Studies
Colorectal Neoplasms - epidemiology
Denmark - epidemiology
Female
Humans
Male
Myocardial Infarction - epidemiology
Risk factors
Stroke - epidemiology
Abstract
An association between colorectal cancer and acute myocardial infarction (AMI) and stroke has been suggested, but evidence is conflicting.
We conducted a population-based cohort study (1978-2010) of the association between AMI/stroke and colorectal cancer by linking nationwide Danish registries. We calculated standardized incidence ratios (SIR) of colorectal cancer after AMI/stroke as the ratios of observed to expected incidence.
A total of 297,523 patients with AMI (median age, 69.4 years; 64% men) were followed for a median of 3.1 years (range, 0-33 years) and 4,387 developed colorectal cancer [SIR, 1.08; 95% confidence interval (CI), 1.05-1.11; P
PubMed ID
24049127 View in PubMed
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Thromboembolic risk among Danish children and adults with inflammatory bowel diseases: a population-based nationwide study.

https://arctichealth.org/en/permalink/ahliterature136841
Source
Gut. 2011 Jul;60(7):937-43
Publication Type
Article
Date
Jul-2011
Author
Michael D Kappelman
Erzsebet Horvath-Puho
Robert S Sandler
David T Rubin
Thomas A Ullman
Lars Pedersen
John A Baron
Henrik T Sørensen
Author Affiliation
Department of Pediatrics, Division of Paediatric Gastroenterology, University of North Carolina Chapel Hill, Chapel Hill, NC 27599, USA. michael_kappelman@med.unc.edu
Source
Gut. 2011 Jul;60(7):937-43
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Child
Child, Preschool
Colitis, Ulcerative - complications - epidemiology
Crohn Disease - complications - epidemiology
Denmark - epidemiology
Epidemiologic Methods
Female
Humans
Infant
Infant, Newborn
Inflammatory Bowel Diseases - complications - epidemiology
Male
Middle Aged
Pulmonary Embolism - epidemiology - etiology
Sex Distribution
Thromboembolism - epidemiology - etiology
Venous Thrombosis - epidemiology - etiology
Young Adult
Abstract
Recommendations for venous thromboembolism (VTE) prophylaxis in patients with inflammatory bowel disease (IBD) can be refined by incorporating patient-specific risk factors.
To determine the risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) in children and adults with Crohn's disease and ulcerative colitis and evaluate whether this risk varies by age and/or presence of other risk factors.
We performed a cohort study using Danish administrative data. Incidence rates of DVT and PE were calculated among patients with IBD and an age- and gender-matched comparison population and compared using Cox proportional hazards regression. We performed additional analyses stratifying by age, gender and disease type and restricting outcomes to unprovoked events (occurring without known malignancy, surgery, fracture/trauma or pregnancy). We next performed a nested case-control study to adjust for additional co-morbidities (congestive heart failure, diabetes, myocardial infarction and stroke) and the use of hormone replacement and antipsychotic medications.
The study included 49,799 patients with IBD (14,211 Crohn's disease, 35,229 ulcerative colitis) and 477,504 members of the general population. VTE risk was elevated in patients with IBD (HR=2.0 (95% CI 1.8 to 2.1) for total events, HR=1.6 (95% CI 1.5 to 1.8) for unprovoked events). Although the incidence of VTE increased with age, the RR was higher in younger patients. Among those = 20 years old, HRs were 6.0 (95% CI 2.5 to 14.7) for DVT and 6.4 (95% CI 2.0 to 20.3) for PE. After further adjusting for co-morbidity and medication use in the case-control analysis, ORs for all events remained in the 1.5-1.8 range.
Patients with IBD have twice the incidence of PE or DVT as does the general population. This risk persisted after taking into account other VTE risk factors. Relative risks were particularly high at young ages, though actual incidence increased with age. These findings can further inform risk-benefit analysis of VTE prophylaxis.
Notes
Comment In: Gastroenterology. 2012 Feb;142(2):404-522192428
PubMed ID
21339206 View in PubMed
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