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P Lenner

Publications and source records attributed to P Lenner.

At least 55 records · Page 3Linked to original sources
PubMed1994

A population-based seroepidemiological study of cervical cancer.

The epidemiology of cervical cancer indicates the presence of a sexually transmitted risk factor, attributable at least in part to infection with human papillomavirus (HPV) type 16 or 18. We performed a seroepidemiological study of HPV and cervical cancer in the counties of Västerbotten and Norrbotten in Northern Sweden, a low-risk area for cervical cancer. Sera from 94 cases of incident cervical cancer were matched against 188 age- and sex-matched controls derived from a population-based blood bank. IgG and IgA antibodies were measured against a panel of 12 antigens derived from HPV types 6, 11, 16, or 18, as well as against Herpes simplex virus type 1 and 2, Chlamydia trachomatis, cytomegalovirus, Epstein-Barr virus, and bovine papillomavirus. Significantly increased relative risks (RRs) were found for IgG to HPV 16- or 18-derived antigens from the L1 (RR = 3.1), E2 (RRs = 2.8 and 9.2), and E7 (RRs = 3.8 and 2.7) open reading frames and for IgA to HPV 16-derived antigens from the E2 (RR = 3.3) and E6 (RR = 2.7) open reading frames. The highest RR (9.2, confidence intervals 4.4-19.4) was associated with IgG to an HPV 18 E2 antigen. Antibodies against cytomegalovirus, Herpes simplex virus type 2, Epstein-Barr virus, or bovine papillomavirus were, on their own, not significantly associated with cervical cancer, but seropositivity against multiple infections was associated with a successively increased relative risk. An increased risk was also found for IgG to Chlamydia trachomatis (RR = 1.7, confidence interval = 1.0-2.7). The results indicate that several HPV antibodies are strongly associated with cervical cancer, providing further seroepidemiological support for an etiological role of HPV in cervical cancer.

Adult↗
PubMed1994

Pap smear screening and changes in cervical cancer mortality in Sweden.

OBJECTIVES: Age-adjusted incidence of cervical carcinoma has fallen dramatically in Sweden in recent decades. This investigation is an attempt to evaluate the effectiveness of the gynecologic Pap smear screening program in terms of reduction of mortality from cervical cancer. METHODS: Cervical cancer mortality trends in relation to age, calendar period, county and degree of screening activities in the population were analyzed. Multiplicative Poisson regression models were utilized. The reduction of mortality was attributed to the activities of cervical screening. RESULTS: The analysis gave a calculated 53% reduction in cervical cancer mortality (95% confidence limits 23-72%), attributable to screening. CONCLUSIONS: The study supports the hypothesis that gynecological Pap smear screening has had an important impact on the reduction in cervical cancer mortality.

Adult↗
PubMed1994

Patient age as a prognostic factor in prostate cancer.

Whether patient age per se is a prognostic factor of significance in prostate cancer is controversial. To investigate this issue age-specific relative survival was analyzed, and the number of years lost due to this disease was calculated in a large and unselected cohort of 6,890 prostate cancer patients diagnosed between 1971 and 1987 in the northern region of Sweden. The tumor grade was derived from filed notification forms, which showed 26.4% well (grade 1), 40.0% moderately (grade 2) and 17.7% poorly (grade 3) differentiated tumors. There was an overrepresentation of grade 3 tumors among the youngest patients. The age-specific relative survival rate did not differ significantly among different age groups and slight differences almost vanished when adjusting for tumor grade. This finding does not support the view that tumors appearing in younger patients are more aggressive per se. However, loss of life expectancy differed significantly among all age classes and in all 3 grades. In patients with grade 1 tumors the years lost due to prostate cancer ranged from 11.0 to 1.2 in the youngest and oldest age strata, even though the relative survival was approximately 0.70 in all age classes. It was concluded that even if relative survival is constant with patient age, the absolute impact of prostate cancer at different ages varied substantially as indicated by loss of life expectancy. This finding might indicate that younger prostate cancer patients should be given more aggressive treatment than older patients.

Age Factors↗
PubMed1994

Treatment of early and intermediate stages of supradiaphragmatic Hodgkin's disease: the Swedish National Care Programme experience. Swedish Lymphoma Study Group.

PURPOSE: Since 1985 a Swedish National Care Programme has provided tailored principles for the staging, treatment and follow-up of patients with Hodgkin's disease (HD). This report presents treatment results for all patients below 60 years of age who were diagnosed with early and intermediate stages, between 1985 and 1989. PATIENTS AND TREATMENT: During that period, 210 patients with supradiaphragmatic HD in clinical (CS) and pathological (PS) stages IA+IIA, PS IB+IIB, and PS III1 A were diagnosed in five Health Care Regions in Sweden. In patients with CS IA, staging laparotomy was not recommended provided that the radiological assessment of the abdomen was adequate, whereas this procedure was recommended in stages CS IB, IIA and IIB in order to minimize treatment. In the absence of bulky mediastinal disease, patients with CS+PS IA and PS IIA were treated with mantle (occasionally mini-mantle) irradiation alone, while patients with bulky disease, as well as those with stages PS IB+IIB+III1 A, were treated with one cycle of MOPP/ABVD prior to mantle (PS III1 A sub-total nodal) irradiation. Full chemotherapy followed by radiotherapy to initial sites with bulky disease was recommended for patients with CS IIA who did not undergo laparotomy. RESULTS: After a median follow-up in excess of five years, treatment results are 'favourable' for all stages, provided the recommendations were followed. In patients with CS+PS IA treated according to the recommendations, recurrence rates were 14% (9/65) with all but one patient (64/65, 98%) remaining in continuous first or second remission. These figures were worse in patients treated inadequately (9/26 [35%] and 22/26 [85%], respectively). In PS IIA, adequately-treated patients had a recurrence rate of 13% (7/52) whereas 5/7 (71%) of those with bulky disease who received only mantle irradiation developed recurrences. Similar patterns also emerged in patients with CS IIA, PS IB+IIB and PS III1 A. CONCLUSIONS: The tailored principles, which usually entail less staging and/or treatment than is generally the case, produced favourable results when applied to an entirely unselected group of patients with early and intermediate stages of HD.

Adolescent↗
PubMed1994

Chronic lymphocytic leukemia: a retrospective study of 122 cases.

During the period 1978-1982 in the three northernmost countries of Sweden all 143 patients with a registered diagnosis of chronic lymphocytic leukemia (CLL) were retrospectively analyzed. After re-evaluation, 122 cases remained in the study. The mean age was 71 years and the male/female ratio was 2.2:1. Sixty-one patients were Binet stage A, 29 stage B and 32 stage C. The diagnosis CLL was made after routine check-up for other diseases in most of the patients and they had no symptoms from the CLL. The median survival was 51 months and there were no differences in crude survival according to stage or other prognostic factors such as hemoglobin, lymphocytes or thrombocytes in peripheral blood. Analysis of CLL as a cause of specific mortality showed the stage of CLL to have a slight prognostic significance. This could be due to the fact that many of the patients suffered from other serious diseases, allowing the detection of early stage or advanced CLL with no symptoms.

Adult↗
PubMed1994

Evaluation of the effect on breast cancer mortality of population based mammography screening programmes.

OBJECTIVE: To evaluate, by analysis of breast cancer mortality data from all the 26 Swedish counties for the years 1971 to 1990, whether the effect of the introduction of mammography screening in Sweden can be assessed by observation from existing mortality data. METHODS: A Poisson regression model was used to study whether a decrease in breast cancer mortality among women aged 50-74 years was associated with the extent of mammography screening in different counties and periods. RESULTS: In regions where mammography screening had been introduced, breast cancer mortality tended to be decreased, on average, compared with regions without screening. If a 10 year time lag between the start of screening and its full effect on mortality is assumed then the estimated reduction in breast cancer mortality associated with introduction of screening was 19% with a 95% confidence interval ranging from -3% to 37%. CONCLUSIONS: The results suggest that the effect of mammography screening may be studied using existing routine mortality data and appropriate statistical modelling. This way of assessing the outcome of the screening is valuable when continuously monitoring a screening programme that has become a public health routine.

Age Factors↗
PubMed1994

Prostate cancer in northern Sweden. Incidence, survival and mortality in relation to tumour grade.

In order to study changes in incidence, survival and mortality of prostate cancer in relation to morphological grade, we analysed all incident cases of prostate cancer in Northern Sweden during three 2-year periods (1974-1975, 1980-1981 and 1986-1987). The age-adjusted incidence increased by 35% from 1974-1975 to 1986-1987, but there was only a minor increase in the mortality rates. The increase in incidence was mainly due to well-differentiated (G1) and moderately differentiated (G2) tumours, whereas the incidence of poorly differentiated (G3) tumours remained stable. The 5-year relative survival rate increased significantly from 1974-1975 to 1986-1987. The relative survival rate for each tumour grade was, however, almost stable over the studied time period. After adjustment for tumour grade the differences in relative survival rate diminished. We believe that the most likely explanation for these changes in incidence, survival and mortality is enhanced detection of tumours with more favourable histology as a result of a more frequent use of the diagnostic tools available.

Aged↗
PubMed1993

Prognostic significance of serum lactic dehydrogenase levels and fraction of S-phase cells in non-Hodgkin lymphomas.

Sixty-four untreated patients with non-Hodgkin lymphomas (NHL) were analyzed with respect to fraction of S-phase cells in tumor material and serum lactic dehydrogenase (LD) levels. A significant correlation between the two variables was found in the low-grade (LGM) (r = 0.44, p < 0.01), but not in the high-grade (HGM) lymphomas. Shorter survival times were found for patients with tumors showing a high fraction of S-phase cells (> 4%) (p < 0.001) as well as for patients with elevated LD values (> or = 7.5 mukat/l) (p < 0.001). A multivariate analysis showed clinical stage (p < 0.001), S-phase fraction (p = 0.002) and age (p = 0.002) to be independent prognostic factors. For serum LD a borderline value (p = 0.05) was found, whereas morphology and B-symptoms were non-significant. LD level, but not fraction of S-phase cells, added prognostic information for LGM lymphomas (p < 0.001). For HGM lymphomas, the clinical stage was the strongest factor for prediction of prognosis. We conclude that the fraction of S-phase cells describes the biological behavior in a more reliable way than morphology (HGM vs LGM) and better identifies lymphomas with poor or good prognosis. The strong additional prognostic information obtained by serum LD within LGM lymphomas is assumed to be due to an association with the tumor burden.

Adult↗
PubMed1993

Non-Hodgkin's lymphoma in northern Sweden. A retrospective analysis of morphologic diagnosis and stage in a material from the Swedish Cancer Registry.

Morphologic diagnosis and clinical stage were studied in a retrospective material of non-Hodgkin's lymphomas comprising 352 patients diagnosed 1978 until 1982 and reported to a regional cancer registry. Classification was made according to the original Kiel classification. Patients who could be classified as belonging to low- (46%) or high-grade (47%) malignancy groups (n = 337) were further studied. The median age was high, 65 years, which probably reflects the low degree of selection in a regional register material compared to most hospital register-based materials. The proportion of stage I cases was rather high, in low-grade lymphomas 24%, and in high-grade 39%, which can be attributed to incomplete staging procedures in old patients. The aim of the study was to illustrate the distribution according to morphologic subclasses and clinical features in a material with a low degree of patient selection.

Adolescent↗
PubMed1993

Non-Hodgkin's lymphoma in northern Sweden. Prognostic factors and response to treatment.

A total of 352 cases of non-Hodgkin's lymphoma reported to the Cancer Registry of Northern Sweden during 1978-1982 were retrospectively analysed. After morphologic review, 327 cases classifiable as low (n = 162) or high-grade (n = 165) according to the Kiel classification remained for further study. The purpose of the study was to evaluate the interrelations between some variables and their bearing on prognosis in an almost unselected clinical material. Age, morphological grade of malignancy, clinical stage, systemic symptoms, bulk of disease and serum lactate dehydrogenase (LDH) level turned out to be associated with the clinical outcome in terms of response to treatment, disease-free survival and survival. In the heterogenous group of low-grade lymphoma, six pretreatment characteristics were negatively associated with survival in a univariate analysis, namely; stage II-IV, systemic symptoms, bone marrow infiltration, two or more extranodal sites, elevated LDH and age above 65 years. In high-grade lymphoma, stage II-IV, bone marrow infiltration and elevated LDH predicted a worse prognosis in a multivariate analysis. The impact of the number of these prognostic factors on survival in high-grade lymphoma was demonstrated.

Adolescent↗
PubMed1991

Trends in cancer incidence, survival and mortality in northern Sweden 1960-1986.

The impact of cancer on a population may be measured in several ways. Incidence, relative survival and mortality are frequently utilized for this purpose. Incidence and relative survival are, however, often influenced by changes in the diagnostics of incident cancer, particularly by an altered rate of detection of non-fatal cancer. Mortality, as traditionally studied, is often influenced by changes of death causes diagnostics or of coding routines. In an attempt to overcome some of these difficulties, the concept of excess mortality was suggested, which is independent of death cause diagnoses or coding routines, as well as of the rate of detection of non-fatal cancer. In order to elucidate time trends in the overall effects of cancer we analysed incidence, survival and mortality from all cancer in the northern region of Sweden 1960-1986. An increasing age-adjusted cancer incidence was paralleled by an improvement in relative survival, whereas age-adjusted cancer mortality was mainly unchanged, at least when studied as excess mortality. We interpreted these findings as due mainly to an increased detection of non-fatal cancer, and to an unchanged occurrence rate of fatal cancer.

Adolescent↗
PubMed1991

Hodgkin's disease in northern Sweden 1971-1981. I. A histopathological reevaluation of 223 cases.

A histopathological reexamination was made of diagnostic material in 223 patients with Hodgkin's disease (HD) collected between 1971 and 1981. The diagnosis of HD was considered to be incorrect in 90 cases (40%). Change of diagnosis to non-Hodgkin's lymphoma was made in 56 cases, of which 23 were high-grade and 26 were low-grade lymphomas (7 not determined), and to angioimmunoblastic lymphadenopathy in 10 cases. These discrepancies were considered to be due mainly to progress in the understanding and classification of malignant lymphomas, which stresses the importance of review of histologic material in retrospective studies on Hodgkin's disease.

Follow-Up Studies↗
PubMed1991

Hodgkin's disease in northern Sweden 1971-1981. II. A retrospective analysis of prognostic factors.

Factors relevant for prognosis were retrospectively studied in a series of 133 morphologically reviewed patients with Hodgkin's disease collected between 1971 and 1981. For the whole material complete remission rate was 74% and 5-year survival was 62%. These seemingly rather poor results could be explained by a high mean age (48 years) in this relatively unselected material, in combination with a very unfavourable outcome for the elderly patients. In a multivariate analysis of prognostic factors age of the patient turned out to be the only independent factor with a significant bearing on the prognosis.

Adolescent↗
PubMed1991

Hodgkin's disease in northern Sweden 1971-1981. III. The clinical and prognostic impact of age.

A retrospective material of 133 patients with Hodgkin's disease treated between 1971 and 1981 was analysed. In part II of this study it was shown that the prognosis was closely associated with age of the patient. In this part some clinical factors, including therapy, were compared between 66 patients less than 50 years of age and 67 patients 50 years or more. The groups differed mainly in the outcome of primary chemotherapy. Older patients with Hodgkin's disease were particularly vulnerable to chemotherapy, probably as an effect of the disease itself.

Adolescent↗
PubMed1991

Metastatic renal cell carcinoma treated with purified leukocyte interferon. Clinical response in relation to tumor DNA content.

Twenty-eight patients with renal cell carcinoma and evaluable metastases were treated with a purified leukocyte interferon 2-7 x 10(6) IU daily. DNA content was analyzed by flow cytometry. Nine patients had lung metastases only, 12 had dissemination to lungs and to other sites as well, and 7 had metastases in other sites only. Two patients had complete response and one had minor response of lung metastases. Another 3 patients had mixed responses: 2 of them complete disappearance and one minor response of lung metastases but concomitant progression of skeletal and abdominal metastases. The overall response rate restricted to lung metastases only was 21% (6 of 28 patients) including the 3 patients with mixed response. The 6 patients with any kind of response were found among 19 patients with aneuploid primary tumors while no response was noted in 8 patients with diploid tumors.

Adult↗