RESUMEN
BACKGROUND: It is important to regularly update survival estimates of patients with malignant mesothelioma as prognosis may vary according to epidemiologic factors and diagnostic and therapeutic management. METHODS: We assessed overall (baseline) survival as well as related prognostic variables in a large cohort of 1353 patients with a confirmed diagnosis of malignant mesothelioma between 2005 and 2008. RESULTS: About 50% of the patients were 70 years or older at diagnosis and the median latency time since start of asbestos exposure was 49 years. One year after diagnosis, 47% of the patients were alive, 20% after 2 years and 15% after 3 years. Prognostic variables independently associated with worse survival were: older age (HR=1.04 per year 95% CI (1.03-1.06)), sarcomatoid subtype (HR=2.45 95% CI (2.06-2.90)) and non-pleural localisation (HR=1.67 95% CI (1.26-2.22)). CONCLUSION: Survival of patients with malignant mesothelioma is still limited and depends highly on patient age, mesothelioma subtype and localisation. In addition, a substantial part of the patients had a long latency time between asbestos exposure and diagnosis.
Asunto(s)
Mesotelioma/diagnóstico , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Mesotelioma/mortalidad , Persona de Mediana Edad , Países Bajos/epidemiología , Neoplasias Pleurales/diagnóstico , Neoplasias Pleurales/mortalidad , Vigilancia de la Población , Pronóstico , Factores de Riesgo , Análisis de SupervivenciaRESUMEN
BACKGROUND: Numerous markers have been evaluated to facilitate the non-invasive diagnostic work-up of mesothelioma. The purpose of this study was to conduct a structured review of the diagnostic performance of non-invasive marker tests for the detection of mesothelioma in patients with suspected mesothelioma. METHODS: Studies on the diagnostic accuracy of serum and cytological markers published till 31 December 2009, available in either PUBMED or Embase, to detect or exclude the presence of mesothelioma were extracted. Study quality was assessed with use of the Quadas criteria. RESULTS: In total, 82 articles were included in this systemic review. Overall, quality of the incorporated studies to address our objective was poor. The most frequently studied immunohistochemical markers for cytological analysis were EMA, Ber-Ep4, CEA, and calretinin. The most frequently investigated serum marker was soluble mesothelin-related protein (SMRP). The markers CEA, Ber-EP4, and calretinin were most valuable in discriminating mesothelioma from other malignant diseases. Markers EMA and SMRP were most valuable in discriminating mesothelioma from non-malignant diseases. No marker performed well in discriminating between mesothelioma and all other diseases. CONCLUSION: Currently, there is only limited evidence to properly assess the value of non-invasive marker tests in the diagnosis of mesothelioma. Studies were of limited value to address our objective and results showed considerable unexplained study heterogeneity.
Asunto(s)
Biomarcadores de Tumor/análisis , Mesotelioma/diagnóstico , Neoplasias Pleurales/diagnóstico , Algoritmos , Biomarcadores de Tumor/sangre , Biomarcadores de Tumor/metabolismo , Humanos , Mesotelioma/sangre , Mesotelioma/metabolismo , Mesotelioma/patología , Derrame Pleural/diagnóstico , Derrame Pleural/patología , Neoplasias Pleurales/sangre , Neoplasias Pleurales/metabolismo , Neoplasias Pleurales/patología , Valor Predictivo de las Pruebas , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To simultaneously assess cardiovascular (CV) and gastrointestinal (GI) risk with traditional non-steroidal anti-inflammatory drugs (tNSAIDs) and cyclo-oxygenase 2 (COX-2) inhibitors. METHODS: Using the PHARMO Record Linkage System, including drug-dispensing and hospitalisation data of >2 million residents of The Netherlands, subjects with first hospitalisation for acute myocardial infarction (AMI), CV and GI events were identified. Use of COX-2 inhibitors and traditional non-selective NSAIDs was classified into remote, recent and current. Cases were matched to controls in a 1:4 ratio on age and event date. Multivariate analyses adjusted for gender, history of hospitalisations and medications. RESULTS: Compared to remote use, AMI risk was increased among current users of COX-2 inhibitors combined (adjusted odds ratio (OR) 1.73, 95% CI 1.37 to 2.19) and tNSAIDs combined (OR 1.41, 95% CI 1.23 to 1.61). AMI risk with celecoxib (OR 2.53, 95% CI 1.53 to 4.18), rofecoxib (OR 1.60, 95% CI 1.22 to 2.10), ibuprofen (OR 1.56, 95% CI 1.19 to 2.05) and diclofenac (OR 1.51, 95% CI 1.22 to 1.87) was significantly increased. CV risk with current use of individual COX-2 inhibitors and tNSAIDs was significantly increased (OR from 1.17 to 1.64), as was GI risk with current use of rofecoxib (OR 1.99, 95% CI 1.51 to 2.63), naproxen (OR 4.44, 95% CI 3.36 to 5.86), ibuprofen (OR 1.90, 95% CI 1.40 to 2.58), diclofenac (OR 4.77, 95% CI 3.94 to 5.76), other tNSAIDs (OR 2.59, 95% CI 2.08 to 3.21), but not celecoxib (OR 1.36, 95% CI 0.70 to 2.66). Compared to current use of celecoxib and AMI risk was significantly decreased with current use of naproxen (OR 0.48, 95% CI 0.26 to 0.87) only. GI risk was increased with current naproxen (OR 3.26, 95% CI 1.59 to 6.70) and diclofenac (OR 3.50, 95% CI 1.76 to 6.98). CONCLUSIONS: AMI and CV risk increased similarly with individual COX-2 inhibitors and tNSAIDs, whereas GI risk was found to be greater with naproxen and diclofenac. Residual confounding and "channelling" cannot be excluded.
Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Enfermedades Cardiovasculares/inducido químicamente , Enfermedades Gastrointestinales/inducido químicamente , Anciano , Anciano de 80 o más Años , Antiinflamatorios no Esteroideos/administración & dosificación , Enfermedades Cardiovasculares/epidemiología , Inhibidores de la Ciclooxigenasa 2/administración & dosificación , Inhibidores de la Ciclooxigenasa 2/efectos adversos , Esquema de Medicación , Métodos Epidemiológicos , Femenino , Enfermedades Gastrointestinales/epidemiología , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/inducido químicamente , Infarto del Miocardio/epidemiología , Países Bajos/epidemiologíaRESUMEN
A survey was performed to study the implementation of the results of a clinical trial on the effect of ventilation tubes on daily clinical practice. Two random samples of 75 Dutch otorhinolaryngologists each were drawn: one before the conduction of the trial and another after the results were disseminated. In both surveys participants were asked to give their personal estimate of the probability of complete recovery without treatment and after the insertion of ventilation tubes in an infant with bilateral otitis media with effusion. The trial showed no long lasting effects of ventilation tubes on hearing, language development and quality of life, yet, the overall expectation with respect to the effect of ventilation tubes remained high. The study suggests that the adoption of research results require more than simple dissemination of the results. (Inter)national debate is recommended to value the results of clinical trials for daily practice.