Paul W. Dickman

Background:The aim was to investigate time trends for incidence and long-term net survival in the morphologic subtypes and stages of cervical cancer in Sweden during the period 1960 to 2014.Methods:Women with invasive cervical cancer were identified through the Swedish Cancer Registry. Incidence and net survival were calculated according to morphology, age at diagnosis, and FIGO stage at diagnosis.Results:In total, 29,579 cases of invasive cervical cancer between 1960 and 2014 were included. The age-standardized incidence for squamous cell carcinoma (SCC) decreased until 2000; thereafter, the incidence rate stagnated, and a small increase was found in 2014. The incidence of adenocarcinoma continuously increased. The age-standardized 5-year net survival increased. However, decreasing net survival with increasing age was found. A higher stage at diagnosis showed a worse net survival. SCC and adenocarcinoma did not statistically differ as regards net survival in the last years of the study.Conclusions:Age-standardized 5-year net survival improved between 1960 and 2014. A positive trend for short- and long-term net survival was seen for women ages 18 to 64 years but long-term net survival for women ≥75 years decreased. In this study, age and FIGO stage at diagnosis were found to be important prognostic factors in determining net survival. The morphologies, SCC, and adenocarcinoma did not statistically differ as regards net survival in the last years of the study.Impact:This study demonstrates longitudinal data on cervical cancer in Sweden for over 50 years with sub analyses on morphology, age, and stage at diagnosis.

Age-standardized 5-year net survival according to morphology. A, age-standardized 5-year net survival for squamous cell carcinoma and adenocarcinoma with 95% confidence intervals. B, Difference in age-standardized 5-year net survival of adenocarcinoma and squamous cell carcinoma with 95% confidence intervals. No statistical difference in net survival was found between squamous cell carcinoma and adenocarcinoma 1990–2000 and after 2010.

Age-standardized incidence depending on morphology. Age-standardized incidence depending on the morphology squamous cell carcinoma and adenocarcinoma per 100,000 women years standardized to the world population.

Age-standardized 5-year net survival according to morphology per stage. Age-standardized 5-year net survival according to squamous cell carcinoma and adenocarcinoma, FIGO stages I–II and III–IV during the time 2005–2014 with 95% confidence intervals (top figure). Difference in age-standardized 5-year net survival of adenocarcinoma and squamous cell carcinoma, stages I–II and III–IV during the period 2005–2014 with 95% confidence intervals (bottom figure). No statistical difference in net survival was found between squamous cell carcinoma and adenocarcinoma in stages I–II after year 2012 and neither in stages III–IV after year 2011.

Age-specific net survival. Time trends for 1-, 5-, and 10-year net survival according to age groups and for squamous cell carcinoma and adenocarcinoma.

Table 1 from Time Trends for Incidence and Net Survival of Cervical Cancer in Sweden 1960–2014—A Nationwide Population-Based Study

Flow chart. ICD-7 171 tumor of cervix uteri. ICD-10 C53.0 malignant tumor of the endocervix, C53.1 malignant tumor of the exocervix, C53.9 unspecified localization of malignant tumor of cervix uteri. *Some cases fulfilled more than one exclusion criteria.

Background: Few population-based studies on nasopharyngeal carcinoma (NPC) prognosis exist. Such real-world data with complete follow-up are needed to enable accurate estimation of survival probabilities and monitor progress in early detection and treatment. Methods: In a population-based study of 2529 patients with incident NPC in southern China diagnosed in 2010–2013, we developed a passive-active-passive follow-up strategy involving data linkage and direct contact to track patients’ vital status, cause of death, and migration through December 31, 2018. We calculated 5-year survival probabilities by the Kaplan-Meier method, and estimated avoidable deaths comparing hypothetical scenarios and real-world observations. Results: Early-stage (I–II) patients accounted for 11·5%, and 21·1% were treated in medical-university-affiliated or province-level hospitals. With a mean follow-up time of 5·5 years after diagnosis (98.3% complete), 5-year overall and NPC-specific survival probabilities were 70·1% and 74·5%. The 5-year overall survival probabilities for stage I, II, III, IVa, IVb, and IVc were 91·3%, 87·8%, 79·8%, 63·9%, 57·7%, and 34·4%, respectively. Survival of non-metastatic (I-IVb) population-based patients diagnosed in 2010–2013 was comparable to that of a hospital-based southern Chinese NPC cohort diagnosed in 1997–2007. Based on observed data, if all patients were diagnosed at stages I–II, then total avoidable deaths within 5 years after diagnosis would be 156 per 1000 patients. Conclusions: Real-world population-based NPC survival lags behind that of large hospital-based cohorts, but earlier diagnosis has the potential to substantially reduce mortality from NPC. Our results highlight the importance of improving the accessibility of health resources and promoting early detection of NPC.

BACKGROUND: The effect of myocardial infarction (MI) on life expectancy is difficult to study because the prevalence of MI hinders direct comparison with the life expectancy of the general population. We sought to assess this in relation to age, sex, and left ventricular ejection fraction (LVEF) by comparing individuals with MI with matched comparators without previous MI. METHODS: We included patients with a first MI between 1991 and 2022 from the nationwide SWEDEHEART registry (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies), each matched with up to 5 comparators on age, sex, and region of residence. Flexible parametric survival models were used to estimate excess mortality and mean loss of life expectancy (LOLE) depending on index year, age, sex, and LVEF, and adjusted for differences in characteristics. RESULTS: A total of 335 748 cases were matched to 1 625 396 comparators. A higher LOLE was observed in younger individuals, women, and those with reduced LVEF (<50%). In 2022, the unadjusted and adjusted mean LOLE spanned from 11.1 and 9.5 years in 50-year-old women with reduced LVEF to 5 and 3.7 months in 80-year-old men with preserved LVEF. Between 1992 and 2022, the adjusted mean LOLE decreased by 36% to 55%: from 4.4 to 2.0 years and from 3.3 to 1.9 years in 50-year-old women and men, respectively, and from 1.7 to 1.0 years and from 1.4 to 0.9 years in 80-year-old women and men, respectively. CONCLUSIONS: LOLE is higher in younger individuals, women, and those with reduced LVEF, but is attenuated when adjusting for comorbidities and risk factors. Advances in MI treatment during the past 30 years have almost halved LOLE, with no clear sign of leveling off to a plateau.

Arvid Sjölander, Paul Dickman; Why test for proportional hazards – or any other model assumptions?, American Journal of Epidemiology, , kwae002, https://doi.org