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J Cuzick

Publications and source records attributed to J Cuzick.

At least 163 records · Page 9Linked to original sources
PubMed1987

Value of flow cytometric determination of ploidy as a guide to prognosis in operable rectal cancer: a multivariate analysis.

The DNA content of 203 cases of rectal cancer, with at least 15 years follow-up, was analysed by flow cytometry. One hundred and twenty-nine (64%) were DNA aneuploid and corrected survivals were significantly influenced by ploidy distribution (p less than 0.01). The DNA content and details of stage and grade were subjected to multivariate analysis using the Cox regression model. Ploidy was entered into models including Dukes' stage alone, tumour differentiation alone, Dukes' stage and differentiation in combination and a more comprehensive range of discrete stage- and grade-related parameters. All four models demonstrated its independent contribution to survival. However, its contribution was very small (5%, 18%, 5%, 4% respectively). These findings illustrate that results based on new technological developments should not be viewed in isolation, but their values must be assessed in combination with traditionally available data by means of multivariate analysis.

Adenocarcinoma↗
PubMed1987

A comparison of the incidence of the myelodysplastic syndrome and acute myeloid leukaemia following melphalan and cyclophosphamide treatment for myelomatosis. A report to the Medical Research Council's working party on leukaemia in adults.

Twelve of 648 patients in the Medical Research Council's first two trials in myelomatosis have developed myelodysplasia or acute leukaemia. This corresponds to a 5-year actuarial prevalence of 3% and an 8-year prevalence of 10%. Patients were randomised to treatment with either melphalan or cyclophosphamide and the relative capabilities of these two drugs to cause these conditions were examined as a function of duration of treatment. A significant relationship with length of melphalan treatment was found but no relationship was observed for cyclophosphamide treatment. The amount of melphalan treatment given in various intervals before diagnosis of myelodysplasia or leukaemia was studied and it was found that the amount of treatment in the most recent 3-year period was the most important determinant of risk (P = 0.0001). It is estimated that the risk of haemopoietic neoplasia after 10 years of follow-up is about 3% for each year of melphalan treatment and that much of this risk will occur within three years of the last treatment.

Aged↗
PubMed1987

Overview of randomized trials of postoperative adjuvant radiotherapy in breast cancer.

An overview of the mortality results of the mature trials in which radiotherapy was a randomized option after simple or radical mastectomy is presented. The principal aim of the overview was to study long-term survival, and recent trials, often including chemotherapy options, have not been included. A total of 7941 patients were entered into these trials and 4148 deaths occurred. No differences were found in survival in the first 10 years of follow-up, in trials employing either radical mastectomy or simple mastectomy. Follow-up information after 10 years came mostly from trials employing radical mastectomy with or without irradiation, and in these trials a significant excess of deaths was observed among patients given radiotherapy (P less than 0.001, all trials; P = 0.002, radical mastectomy trials only). Further data collection will be necessary to determine which causes of death are elevated.

Breast Neoplasms↗
PubMed1987

Overview of randomized trials comparing radical mastectomy without radiotherapy against simple mastectomy with radiotherapy in breast cancer.

An overview of mortality in the mature randomized trials comparing radical mastectomy without radiotherapy against simple mastectomy with radiotherapy has been conducted. These trials mark a transitional period between radical mastectomy and simple mastectomy as the generally preferred surgical treatment and as such are not strictly trials assessing the value of postoperative adjuvant radiotherapy. All known mature trials have been included and these four trials have entered a total of 3236 patients, in whom 1678 deaths have been recorded. Overall, no significant difference in survival was seen, but there was a nonsignificant trend for patients given radiotherapy to do worse after 15 years of follow-up.

Breast Neoplasms↗
PubMed1987

A trial of human alpha interferon as an adjuvant agent in breast cancer after loco-regional recurrence.

Thirty-two women who had developed loco-regional recurrence of breast carcinoma were entered into a controlled trial of adjuvant alpha-interferon. All patients had histological confirmation of recurrence, local treatment with radiotherapy and negative staging investigations. They were then randomized to either observation alone, or treatment with human alpha interferon 3 x 10(6) units subcutaneously daily for 1 year. There were no differences detected in the rate of local or distant relapse. With this lack of clinically significant efficacy and a high incidence of side effects, it is concluded that alpha interferon is of doubtful value in the adjuvant treatment of breast cancer.

Adjuvants, Immunologic↗
PubMed1986

Progressive potential of mild cervical atypia: prospective cytological, colposcopic, and virological study.

A prospective study of 100 women with cytological and colposcopic evidence of mild cervical atypia consistent with cervical intraepithelial neoplasia (CIN) grade I was started in October, 1983. 26% of early preinvasive cervical lesions progressed to histologically proven CIN III. Spontaneous regression of mild cervical atypia occurred in only 11 cases, and in 4 of these CIN recurred. The overall prevalence of human papillomavirus type 16 (HPV 16) in the study group, detected by filter DNA-DNA hybridisation of a cervical cytological specimen, was 39%. However, 22 of the 26 (85%) cases of progressive disease were positive for HPV 16. Detection of HPV 16 may be a non-invasive way of identifying women at high risk of rapid progression of mild cervical atypia to CIN III.

Adult↗
PubMed1986

The prevention of breast cancer.

The case for treating women at high risk of breast cancer with the anti-oestrogen tamoxifen is presented. This is a logical extension of a screening programme and is scientifically based on the effectiveness of tamoxifen in established disease, the relation between free oestradiol (and other hormone-related factors) to the risk of breast cancer, and the lack of side-effects from tamoxifen treatment. Choice of a high-risk group is critical; a specific trial protocol is outlined.

Adult↗
PubMed1986

The grading of rectal cancer: historical perspectives and a multivariate analysis of 447 cases.

The grade of a tumour is gauged on the subjective assessment of a number of histopathological parameters. The problems associated with this exercise were viewed from a historical perspective and survival analysis of 447 patients receiving surgery for rectal adenocarcinoma was undertaken. Only deaths from rectal adenocarcinoma were included as events in the survival analysis. Seven grade-related parameters were scored by one observer. A grading system was constructed using the Cox regression model. The variables in the best-fitting parsimonious model comprised lymphocytic infiltration, tubule configuration and pattern of growth. Scores were derived from the model and a four grade system was created in which the groups were of similar size. Good reproducibility of the selected histopathological parameters was demonstrated. Grade-related parameters were then allowed to compete with stage-related parameters in an overall model of pathological prognostic categories. The parameters selected in the best model were number of affected lymph nodes, the presence of lymphocytic infiltration and extent of spread through bowel wall. A set of five prognostic categories was developed from this model.

Adenocarcinoma↗
PubMed1985

The prognostic value of serum beta 2 microglobulin compared with other presentation features in myelomatosis.

The levels of serum beta 2 microglobulin, blood urea concentration, serum creatinine, haemoglobin and performance status have been measured in 476 patients in the Medical Research Council's 4th trial for myelomatosis. Levels of serum beta 2 microglobulin were also subsequently measured in 208 patients who achieved a stable "plateau" condition. Serum beta 2 microglobulin levels, uncorrected for serum creatinine, were found to be the single most powerful prognostic variable available at presentation. Multivariate analysis showed that only the addition of haemoglobin levels could improve upon this and the improvement, though statistically significant (P = 0.006), appeared to be of much less clinical value. The prognostic value of serum beta 2 microglobulin at plateau appeared to be equally large for a given difference in value, but the variability between patients was much less at that time. Serum beta 2 microglobulin would appear to be a key measurement for assessing the prognosis and response to treatment in patients with myelomatosis.

Creatinine↗
PubMed1985

A method for analysing case-control studies with ordinal exposure variables.

A method is proposed for analysing case-control studies with ordinal or continuous, but unruly, exposure levels. A test is proposed which is an appropriate linear combination of stratum-specific Wilcoxon tests. An estimator for the mean percentile shift between the case and control exposure levels is given. Methods for assessing heterogeneity of the mean percentile shift across strata are also discussed. The performance of the test as a function of the number of controls per case is studied for both local and distant alternatives. The asymptotic relative efficiency compared to the best parametric test with the same number of controls is evaluated and its performance is compared to tests based on a dichotomized exposure variable. Finally, the method is illustrated by two numerical examples.

Analysis of Variance↗
PubMed1984

Which patients are cured of breast cancer?

The clinical and pathological features of 51 patients who survived for more than 20 years after diagnosis of cancer of the breast were compared with those of 176 contemporaries who died within 20 years after diagnosis. Of those who survived, 18 (35%) had had pathologically affected axillary nodes compared with at least 86 (49%) of those who died. Also, 11 (21%) of the survivors had had small tumours compared with 10 (6%) of those who died. Pathological review of tumours in the survivors showed 40 (78%) to have been infiltrating ductal carcinomas, of which 13 (32%) were grade 3 lesions. These differences between the two groups were largely due to the prognostic value of these variables in the first five years after diagnosis. After a patient had survived five years the major prognostic variables were of little value in the prediction of which patients would be cured of breast cancer. Advanced age, which was of little prognostic value in the first five years after diagnosis, was of significant prognostic value in the longer term, partly due to the steep age gradient for mortality from other diseases. Nevertheless, seven of 19 deaths more than 20 years after first treatment were due to breast cancer. Late deaths from breast cancer may, however, have often been the result of metastases from second primaries rather than the late manifestation of micrometastases from the original primary carcinoma. Age, menstrual state, clinical stage, and axillary nodes being affected are thus of some prognostic value in cancer of the breast, but the present inadequacy of knowledge of the behaviour of the disease makes accurate prediction of which patients will be cured impossible.

Adult↗
PubMed1984

Palmar keratoses and cancers of the bladder and lung.

In a case control study of the prevalence of palmar keratoses in 69 bladder cancer patients, 66 lung cancer patients, and 218 hospital controls palmar keratoses were more common in the cases, especially among those with cancer of the bladder. Above the age of 50 years, 87% of bladder cancer patients and 71% of lung cancer patients but only 36% of the controls had one or more keratoses. The prevalence increased with age and keratoses were more common in males. No features could be found which distinguished the keratoses in cases from those in controls.

Adult↗
PubMed1984

Comparison of trends in the incidence of multiple myeloma in Malmö, Sweden, and other countries, 1950-1979.

Dramatic increases in mortality from multiple myeloma have been reported in the United States and the United Kingdom over the past three decades. To assess what fraction of this increase, if any, might be attributable to a change in the incidence of this disease, we examined the incidence of multiple myeloma during 1950 to 1979 in Malmö, Sweden, a city chosen because of its medical community's longstanding interest in this disease. The average annual incidence rates per 100,000 population were 4.9 for males and 3.7 for females (adjusted to the European age-standardized population). These rates are among the highest in the world. Unlike secular trends for myeloma in the United States and the United Kingdom, where large increases in mortality rates have been reported, the rates in Malmö have increased only slightly, and the increase was restricted to males, suggesting the possibility of environmental causes. We suggest that the rates in Malmö may represent the asymptote of myeloma's incidence that will be approached in other white populations as case ascertainment among them becomes complete.

Adult↗
PubMed1984

Bilateral primary breast cancer: a prospective study of disease incidence.

A prospective study was carried out, between January 1980 and March 1982, of all women who presented to the Breast Cancer Unit, Guy's Hospital, with a second primary breast cancer. The percentage of new simultaneous tumours detected clinically or by mammography was approximately 3 per cent. Routine mammographic screening of the contralateral breasts of patients with unilateral disease increased the rate of detection, fivefold, of simultaneous bilateral cancers. The incidence of nonsimultaneous bilateral disease was 7.6 second cancers per thousand patients at risk per year. The annual rate of occurrence of second primary cancers was a constant event and showed no trend either to increase or to decrease with follow-up. However, the risk of a nonsimultaneous second cancer was strongly correlated with age at first primary. Women who developed their first breast cancers under the age of 40 years had three times the risk of developing a second breast cancer compared with those who developed their first cancer after the age of 40. The risk of a second nonsimultaneous primary was 5.9 times that of the risk of occurrence of cancer in the first breast in the general female population.

Adult↗
PubMed1984

A review of semi-parametric models for life histories.

The development of various generalizations of Cox's proportional hazards regression model to the study of more complicated life histories is reviewed. Cox's paper provided a framework for the regression modelling of single failure (deaths) in terms of a proportional hazards assumption and subsequent work has extended this approach to the cases of multiple (non-catastrophic) failures, multi-state life histories, non-independent failure times (family studies and matched pairs), and more complicated censoring mechanisms.

Animals↗