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PubMed1995

Patient preferences for treatment of metastatic breast cancer: a study of women with early-stage breast cancer.

PURPOSE: The purpose of this study was to elicit preferences for the treatment of metastatic breast cancer in women with early-stage breast cancer who were given hypothetical treatment scenarios. We predicted that quality of life, demographic, and treatment variables would have an impact on patient preferences. PATIENTS AND METHODS: One hundred fifteen patients with stage 1-IIIA breast cancer were interviewed. All patients had either mastectomy or lumpectomy plus radiotherapy as primary treatment. Sixty-seven (58%) had prior adjuvant chemotherapy. Patients were given four clinical scenarios that described a woman with metastatic breast cancer who was stated to have a life expectancy of 18 months. Side effects of the treatment options were systematically varied from low (hormonal therapy) to life-threatening (high-dose experimental therapy) and were consistent with common clinical situations. Patients were asked to select which treatment, with its associated toxicity, they would accept and prefer for a 50% chance of specified increments in life expectancy, ie, 5 years, 18 months, 1 year, 6 months, 1 month, and 1 week. RESULTS: Quality of life at the time of interview, previous chemotherapy treatment, and degree of difficulty of previous treatments did not predict patient preferences. The greater the toxicity potential of the treatment, the less likely patients were to accept the treatment, although approximately 15% of patients would prefer high-risk treatment for as little as 1 month of added life expectancy. Between 34% and 82% of patients would prefer different therapies for a 6-month addition to life expectancy, whereas almost all patients would accept treatment for a 5-year increase in length of survival. Younger patients were more willing to assume the risks of treatment for a small increase in life expectancy. Of note, between 54% and 78% of patients would elect to start the different treatments even without symptoms related to metastatic disease. Moreover, 76% of patients would prefer standard treatment or an experimental agent to reduce symptoms or pain, even if such treatment did not prolong life. Additionally, only 10% of patients would allow randomization to a clinical trial comparing high-dose with standard chemotherapy. Participation in the study was not distressing to most patients. CONCLUSION: Patients showed clear preferences for specific treatments for metastatic disease when given hypothetical scenarios. There was a wide range of patient preferences for treatment based on risk-benefit assessment, but a substantial percentage of patients would accept the risk of major toxicity for minimal increase in overall survival.

Adult↗
PubMed2000

The ratio of older women to men: historical perspectives and cross-national comparisons.

In nearly all populations throughout the world there are substantially more older women than men. Although there are many biological explanations for why women have greater longevity than men, the higher proportion of women in the older population appears to be a phenomenon of the twentieth century. Using contemporary data on population size and life expectancy in a large number of countries and historical life table data from a diverse subset of countries, cross-national contrasts and historical trends in the female to male ratio are explored. In the 1990's, only 4 countries had fewer women than men in the age group 75 years and older. The number of women per 100 men aged 75+ in the remainder of the world's countries ranged from 100 to 355. In general, countries with a lower overall life expectancy had a lower number of women per 100 men aged 75+, while countries with higher overall life expectancy had a higher female to male ratio in this age group. A hundred years ago there were nearly equal numbers of women and men aged 75+ in many countries. In all countries studied, the female to male ratio increased as the century progressed. Historical life table data were used to calculate the probability of surviving through 5 stages of life: ages 0 to 5, 5 to 15, 15 to 40, 40 to 65, and 65 to 85. Although the probability of survival through all age intervals increased dramatically during the century, the current disparity in the size of the older populations of men and women can be explained primarily by the divergence in male and female probabilities of survival for the two older age intervals as the century progressed. Thus, with higher life expectancy, whether it be comparing countries or over time within a country, the proportion of the older population that is female is greater. Changes in survival probability in middle and late life, rather than childhood and young adulthood, have been responsible for the increased number of women compared to men in the older population.

Adolescent↗
PubMed2005

Future longevity-demographic concerns and consequences.

One of gerontology's most intense and ongoing debates centers around the future shape of the human survival curve. Is average life expectancy destined to peak between the ages of 85 and 90, as some would argue, or will new ways be found to sustain the dramatic increase in life expectancy that unfolded during the 20th century? This article considers issues inherent in projecting the number of tomorrow's older people, with a focus on the future course of mortality. Although overall mortality declined in most countries during the past century, the decline has been irregular and has reversed in some countries because of unforeseen epidemics, cause-specific changes, and sociopolitical upheavals. On the positive side, scientists have identified several promising findings; mortality trajectories at very old ages may decline, old-age mortality can be altered by social interventions, the number of centenarians is exploding, new chemical entities have a demonstrable effect on life expectancy, and there has been a linear increase in worldwide record-setting life expectancy during the past 160 years. New projections made by the United Nations peer, for the first time, 300 years into the future. These projections foresee a rise of about 25 years in life expectancy at birth in North America over the next 3 centuries, which some experts today believe to be quite conservative. It is important to recognize the inherent uncertainty in life expectancy projections and how assumptions of future mortality change must-from a policy perspective-be considered in conjunction with potential concomitant changes in fertility and migration.

Aged↗
PubMed1995

[Non-homogeneity of the average life span in Slovakia].

The life expectancy at birth of males in the Slovak Republic (SR) is one of the shortest in Europe. Exact explanation of this phenomenon is still unknown. The statistical significance of the relation between life expectancy and various factors (infant mortality rate, ethnical structure, educational level, religious belief, economic activity of inhabitants and environmental factors) was analysed by multifactorial methods in all 38 districts of Slovakia. A surprising paradox phenomenon was observed in the areas with the highest pollutant emissions, where the life expectancy was the longest. Infant mortality rate, ethnical structure and particularly the educational level of the districts were significantly correlated with life expectancy. The life expectancy was negatively influenced mostly by the proportion of elementary--educated males. We suppose the style of life presents the background of these relations, but there is a lack of statistically reliable data from the individual districts of SR for more profound analysis. It must be stressed that neither the statistically high significant correlation is evidence of the causal connection between observed parameters. (Tab. 1, Fig. 5, Ref. 16.)

Aged↗
PubMedDate not supplied

Validating literature-based models with direct clinical trial results: the cost-effectiveness of secondary prophylaxis for PCP in AIDS patients.

OBJECTIVE: To compare literature-based estimates of the cost-effectiveness ratios of strategies for secondary prophylaxis of Pneumocystis carinii pneumonia (PCP) in AIDS patients with estimates obtained using data from a recent comparative clinical trial. DESIGN: A decision-analytic Markov model with data on drug efficacy and toxicity from both the medical literature and a national randomized clinical trial. Drug costs were from average wholesale prices. Discounted life expectancy, total direct medical costs, and cost-effectiveness were projected in dollars per year of life saved (YLS). SETTING: Hypothetical for the literature-based model, then the clinical trial results from the multicenter AIDS Clinical Trials Group (ACTG Protocol 021). PATIENT POPULATION: Patients with AIDS and a prior episode of PCP. INTERVENTIONS: Strategies included no prophylaxis, TMP-SMX (160/800 mg) daily, or aerosolized pentamidine (300 mg) monthly. Patients experiencing major toxic reactions to either medication would cross over to the other agent. MAIN RESULTS: In the literature-based model no prophylaxis was associated with a projected life expectancy of 1.430 years, and total direct cost of $42,080. TMP-SMX increased life expectancy to 2.051 years and cost to $42,300; for aerosolized pentamidine life expectancy was 2.066 years and cost $43,960. TMP-SMX had an incremental cost-effectiveness ratio of $350 per YLS compared with no prophylaxis; the incremental ratio for aerosolized pentamidine was $2,950 per YLS when compared with no prophylaxis, but rose to $110,880 per YLS compared with TMP-SMX. When data from ACTG clinical trial 021 were utilized in the model, the incremental cost-effectiveness ratio for TMP-SMX compared with no prophylaxis was $720 per YLS; aerosolized pentamidine was not cost-effective, and was "dominated" by TMP-SMX because it was associated with higher costs and shorter life expectancy. CONCLUSIONS: Literature-based cost-effectiveness models are useful in developing health policy before clinical trials are completed. Clinical trial results, when available, can be used to validate and revise these models. For secondary PCP prophylaxis in AIDS patients, TMP-SMX is substantially more cost-effective than aerosolized pentamidine.

AIDS-Related Opportunistic Infections↗
PubMed2006

Early allogeneic stem cell transplantation for chronic myelogenous leukemia in the imatinib era: a preliminary assessment.

We have examined the role of early allogeneic hematopoietic stem cell transplantation in patients with chronic phase chronic myelogenous leukemia (CML) who enter a complete cytogenetic remission with imatinib mesylate. Three kinds of data were used to examine the effect of the outcome of current BCR-ABL inhibitor treatment compared to early allogeneic stem cell transplantation: (1) the life expectancy of the general population of the United States as a function of age, (2) the life expectancy of CML patients as a function of the age of patients treated with imatinib mesylate (imatinib) who achieve a complete cytogenetic remission, and (3) the life expectancy of patients with CML treated with matched-related or matched-unrelated stem cell transplantation as a function of age, derived from data provided by the Center for International Blood and Marrow Transplant Research (CIBMTR). We also considered separately the transplant results of the Fred Hutchinson Cancer Research Center (FHCRC), which are substantially better than the "average" outcome from the CIBMTR. We have calculated the projected life expectancy from the age at which patients with CML enter complete cytogenetic remission with imatinib and that of those who receive allogeneic stem cell transplantation. The outcome with imatinib therapy of newly diagnosed patients with CML has been documented for only 4 and 1/2 years, whereas transplant data were available for up to 25 years. Thus, in order to compare life expectancy and 10-year survival probability, it was necessary to extrapolate the imatinib data. A basis for extrapolation is offered and conservative estimates have been used for comparison. Our best estimate is that patients receiving imatinib who have a complete cytogenetic remission have a higher projected probability of 10-year survival than patients who are transplanted, based on results provided by the CIBMTR, and have about the same probability compared to the data from the Fred Hutchinson Cancer Center for patients in the 30- to 60-year-old range. The mathematical approach used here permits reexamining the analysis using future data on BCR-ABL inhibitor therapy or allogeneic stem cell transplantation therapy or both.

Adult↗
PubMed1984

The risk ratio is insufficient for clinical decisions. The case of prophylactic cholecystectomy.

The medical literature contains studies that recommend both for and against prophylactic cholecystectomy when cholelithiasis is present. To investigate whether differing analytic techniques contribute to these disparate recommendations, we analyzed the decision to "wait and see" or "operate now," using both risk ratio and life expectancy analysis on the same data base. With intermediate symptom incidence estimates the risk ratio strongly favored an "operate now" approach, because it lessened the risk of death from gallbladder disease by up to 19-fold. In the group most favored by immediate surgery, 25-year-old men, risking death with immediate surgery increased life expectancy by only one percent (168 days). The risk ratio increased to over 30 for this group with the low incidence estimates, but the difference in life expectancy decreased to 120 days. With the high incidence estimates, the risk ratio declined to 16.4 and the life expectancy difference increased to 186 days. These data demonstrate that (1) the risk ratio can imply a course of action that is different from that implied by life expectancy analysis, and (2) the maximum expected return on the risk of immediate death with elective surgery for silent gallstones is only a one percent increase in life expectancy. This analysis suggests that single measures of effect such as the risk ratio and life expectancy do not capture all the information necessary to make an informed decision.

Adult↗
PubMed2005

Mortality of white Americans, African Americans, and Canadians: the causes and consequences for health of welfare state institutions and policies.

The life expectancy of African Americans has been substantially lower than that of white Americans for as long as records are available. The life expectancy of all Americans has been lower than that of all Canadians since the beginning of the 20th century. Until the 1970s this disparity was the result of the low life expectancy of African Americans. Since then, the life expectancy of white Americans has not improved as much as that of all Canadians. This article discusses two issues: racial disparities in the United States, and the difference in life expectancy between all Canadians and white Americans. Each country's political culture and institutions have shaped these differences, especially national health insurance in Canada and its absence in the United States. The American welfare state has contributed to and explains these differences.

Black or African American↗
PubMed2003

Mammography screening in elderly women: efficacy and cost-effectiveness.

The definition of an upper age limit for breast cancer screening is a rather complex issue, influenced by several conditions. Randomised trials specifically designed to investigate this aspect are not available, but all process indicators (positive predictive value, length of sojourn time, sensitivity of the test) indicate that screening efficacy does not change with increasing age. On the other hand, competing causes of death could decrease screening efficacy beyond age 74. Screening benefits depend on life expectancy and people with <5-10 years life expectancy are unlikely to benefit from screening, so it is still worthwhile considering the variability of life expectancy at different ages. Furthermore, economical implications are evident. Public health recommendations need to weigh the benefit of screening elderly women against costs, negative side effects and potential harm due to overdiagnosis and overtreatment of screen-detected lesions expected to have no effect on mortality. In this scenario, the medical system has an ethical obligation to properly inform the population invited to screening. Over the age of 74 years, encouraging individualized decisions may be more appropriate and may indicate further screening for those subjects for whom the potential benefit outweighs the potential negative effects.

Adult↗
PubMed2000

The cost-effectiveness of different management strategies for type I diabetes: a Swiss perspective.

AIMS/HYPOTHESIS: A computer model was developed to determine the health outcomes and economic consequences of different combinations of diabetes interventions in newly diagnosed patients with Type I (insulin-dependent) diabetes in Switzerland. METHODS: We modelled seven complications of diabetes: hypoglycaemia, ketoacidosis, acute myocardial infarction, stroke, lower extremity amputation, nephropathy, and retinopathy. Transition probabilities and costs were taken from published literature. The Swiss health insurance payer perspective was taken. Various combinations of diabetes management strategies, including intensive or conventional insulin therapy and screening and treatment strategies for renal and eye disease were defined. Life expectancy, cumulative incidences of complications, and mean expected total lifetime costs per patient were calculated under six different management strategies. Incremental cost-effectiveness ratios were calculated in terms of costs per life-year gained compared with conventional insulin therapy alone. RESULTS: The addition of screening for microalbuminuria and retinopathy followed by appropriate treatment, if detected, were cost saving, with reduction in cumulative incidence of end stage renal disease and blindness respectively, and, in the case of microalbulminuria screening and treatment, an improvement in life expectancy. Intensive therapy improved life expectancy but increased total lifetime costs. CONCLUSION/INTERPRETATION: Optimal management of Type I diabetic patients, including secondary and tertiary prevention, leads to reduced complications and improved life expectancy, with the increased costs of prevention offset to varying degrees by cost savings due to complications avoided.

Albuminuria↗
PubMed1998

Use of Markov series and Monte Carlo simulation in predicting replacement valve performances.

BACKGROUND AND AIMS OF THE STUDY: Several different biological, bioprosthetic and mechanical devices are available for heart valve replacement. We present a quantitative methodology to estimate the (event-free) life-expectancy and lifetime risk of valve-related events for individual patients after implantation of any one of these valve types. METHODS: We modelled the age-dependent prognosis of a patient after aortic valve replacement with a discrete-time Markov model and Monte-Carlo simulation to estimate (event-free) life-expectancy and life-time risk of valve-related events, respectively. Quantitative estimates to parameterize these models used hypothetical devices and presumed data were based on a limited review of published literature. RESULTS: This decision-analytical approach allowed an estimation of the overall and event-free life-expectancy as well as the lifetime risk of valve-related events after implantation of different types of prosthetic heart valve in the aortic position. In the current, hypothetical model, one valve type excelled for all age groups in terms of life expectancy and life-time risk of valve-related events. The choice of the second-best alternative varied according to patient age and comorbidity. Sensitivity analyses showed results to be especially dependent on the durability of the replacement valve and surgical risk. CONCLUSIONS: This methodological approach is very flexible, and its quantitative results may guide decision making, if increasing quantitative information on heart valve prosthesis performance becomes available in future. Markov models and Monte Carlo simulation may be used to obtain a better understanding of the effect that different types of prosthetic heart valves have on patient prognosis, while quantitative results may help cardiologists and cardiac surgeons to choose a specific valve type for an individual patient.

Adult↗
PubMed1993

Mortality in a rural South African mission, 1837-1909: an historical cohort study using church records.

Three decadal birth cohorts (1837-1846), 1870-1879 and 1900-1909) each of approximately 500 individuals, were constructed retrospectively through the parish records of the Moravian Mission at Mamre in the Western Cape region of South Africa. Nominative data collection techniques were used to determine the infant mortality rates (IMR), quinquennial mortality rates (QMR) and life expectancies of the three cohorts. The quality of the data was investigated, specifically non-registration and attrition. Overall, male registration coverage was substantially better than that for females. Birth registration was best for the 1837-1846 cohort for males and females, with the 1900-1909 registration being next best. Infant death registration was most complete for males in these two cohorts, but was poor for females. Based on these data, the IMR for the cohorts born in 1837-1846, 1870-1879 and 1900-1909 (196, 182 and 128 per 1000 respectively for males and 160, 172 and 97 per 1000 respectively for females) appeared to be underestimates. There was some evidence of a downward trend for the IMR with time for males, but this was not statistically significant. For the three cohorts QMR did not differ statistically for males, but for females the third cohort was consistently lower than the other cohorts. The difference was small (well within the 95% confidence interval) but the third cohort ranked consistently below the other two. The life expectancies did not differ significantly between cohorts. The life expectancies at birth (range 34-40 years for males and 32-45 years for females) were probably overestimates due to biased IMR. The life expectancies at age 1 (range 41-44 for males and 37-49 for females) were considered to be more representative figures. Life expectancies at age 20 (37-45 years) were fairly stable over time except for females in the 1900-1909 cohort whose life expectancies were substantially higher than the figures for the earlier cohorts. All mortality indices investigated in this study consistently showed a lighter burden of mortality in historical Mamre compared to 'coloureds' in the Cape Colony at the turn of the century. This is probably the result of the better housing, environmental, social, economic and educational conditions on the missions relative to the rest of the Colony in the century after the emancipation of slaves.

Adult↗
PubMed2005

[Gender-specific health reporting in the Bodenseekreis: future theme of " health in boys and men"].

Population prognoses predict a far over-proportional increase in the number of male seniors, entailing substantial implications for the planning of health supply and care, as well as various possibilities to intervene preventively by specific risk avoidance or boosting health responsibility. In the future men's health and male-specific health reporting will become eminently important. A gender-specific life table analysis for the years 1998 - 2002 shows which causes of death are more responsible for loss of life expectancy of men compared to women in both the Bodenseekreis and Baden-Württemberg. Baden-Württemberg and the Bodenseekreis are regions with a well above-average life expectancy compared to other regions in Germany. The average life expectancy in Baden-Württemberg in the year 2000 amounted to 82 years (Bodenseekreis: 82.2) in women, and 76.4 years (Bodenseekreis: 77.3) in men. Among the main causes for the 5.6 year difference in life expectancy are cardiovascular diseases, cancer illnesses, traffic accidents and suicide. These groups of causes of death explain the major part of the difference in average life expectancy. An analysis of death risks specific to age and gender shows some promising approaches for health promotion and prevention based on identification of critical phases of life. In this case, special attention should be paid to infancy, as examinations made within the scope of enrolment at schools identify considerable differences in the prevalence of various disturbances. However, early adulthood and old age also prove to be important periods concerning men-specific interventions. The presented results show first possible starting points which, however, should above all make a contribution to the establishment of the topic of men's health as a focus on gender-specific health reporting, health promotion and prevention. The described target group for health promotion and prevention is, on the one hand, sufficiently large, on the other hand, sufficiently disadvantaged in terms of health to demand more attention in the future.

Adolescent↗
PubMed1998

Are we selecting the right patients for treatment of localized prostate cancer? Results of an actuarial analysis.

OBJECTIVES: To determine our accuracy in selecting patients with at least a 10-year life expectancy for aggressive treatment of localized prostate cancer. METHODS: The medical records of 261 consecutive patients who underwent radical retropubic prostatectomy were submitted to the actuarial division of American General Life and Accident Insurance Company (AGLA) for estimation of life expectancy, excluding the diagnosis of prostate cancer. Survival curves were generated from predicted individual survivals. In patients with less than a 10-year life expectancy, AGLA provided us with the basis for assigning suboptimal survival rates. RESULTS: The mean life expectancy for the group was 15.2 years. Two hundred ten men (80%) were projected to have a life expectancy of more than 10 years, including 27 of 55 (49%) and 4 of 8 (50%) men who were older than or equal to 70 and 75 years of age, respectively. Coronary artery disease and diabetes mellitus were the most common coexisting medical conditions that adversely affected risk as single disease entities. CONCLUSIONS: Although clinicians do not estimate life expectancy with the scientific exactitude of an actuary, the ability to assess the patient in person and assimilate pertinent medical information in a less rigid format yields similar results. Selection of men for definitive treatment of localized prostate cancer should be based on the inherent aggressiveness of the disease and the health of the individual and should not be limited by specific age cutoffs. Populations of men undergoing radical prostatectomy are younger and healthier than those in reported series of watchful waiting for prostate cancer.

Actuarial Analysis↗
PubMed2005

Misdirection on the road to Shangri-La.

Will life expectancy in the United States rise or fall in this century? The implications of either scenario are far reaching. We contend that the rise of childhood obesity in the United States in the past three decades has been so dramatic that it will soon lead to higher than expected death rates at middle ages and a possible decline in life expectancy by midcentury. The most detrimental health and longevity effects will not be seen for decades--a phenomenon that cannot be detected by current methods used to forecast life expectancy or estimate the number of deaths currently attributable to obesity. This scenario contrasts sharply with the views of mathematical demographers who generate forecasts by relying on the assumption that the U.S. pattern of longevity will follow that of other longer lived nations and on the extrapolation of historical trends in life expectancy into the future.

Adolescent↗
PubMed1994

Longitudinal analysis of amyotrophic lateral sclerosis mortality in Norway, 1966-1989: evidence for a susceptible subpopulation.

Mortality from amyotrophic lateral sclerosis (ALS) in Norway has increased substantially over the last two or three decades, as it has in other Western nations. The reasons for this general increase are not clear, but the rise has been attributed to increasing exposure to a broad range of environmental agents. Our previous research has indicated that another explanation for the substantial rise in ALS mortality is more likely to be valid. In particular, the mortality rate curve for ALS is consistent with deaths being confined to an inherently susceptible subpopulation. The size of susceptible subpopulations and mortality rates within them have been shown to be consistent in England and Wales, Japan and the United States. The same methods have been used to analyse Norwegian mortality data. The analysis demonstrates that the rise in ALS mortality is real and that the cause of the increase is almost entirely attributable to the increasing life expectancy of the Norwegian population. Increased life expectancy, a consequence of decreasing general mortality, allows ALS susceptible individuals to survive to the ages at which ALS is expressed. As in other national populations, it is expected that mortality from the disease will continue to increase with continuing increases in life expectancy.

Adolescent↗
PubMed2002

Initial evaluation of rectal bleeding in young persons: a cost-effectiveness analysis.

BACKGROUND: Evaluation of rectal bleeding in young patients is a frequent diagnostic challenge. OBJECTIVE: To determine the relative cost-effectiveness of alternative diagnostic strategies for young patients with rectal bleeding. DESIGN: Cost-effectiveness analysis using a Markov model. DATA SOURCES: Probability estimates were based on published medical literature. Cost estimates were based on Medicare reimbursement rates and published medical literature. TARGET POPULATION: Persons 25 to 45 years of age with otherwise asymptomatic rectal bleeding. TIME HORIZON: The patient's lifetime. PERSPECTIVE: Modified societal perspective. INTERVENTIONS: Diagnostic strategies included no evaluation, colonoscopy, flexible sigmoidoscopy, barium enema, anoscopy, or any feasible combination of these procedures. OUTCOME MEASURES: Life expectancy and costs. RESULTS OF BASE-CASE ANALYSIS: For 35-year-old patients, the no-evaluation strategy yielded the least life expectancy. The incremental cost-effectiveness of flexible sigmoidoscopy compared with no evaluation or with any strategy incorporating anoscopy (followed by further evaluation if no anal disease was found on anoscopy) was less than $5300 per year of life gained. A strategy of flexible sigmoidoscopy plus barium enema yielded the greatest life expectancy, with an incremental cost of $23 918 per additional life-year gained compared with flexible sigmoidoscopy alone. RESULTS OF SENSITIVITY ANALYSIS: As patient age at presentation of rectal bleeding increased, evaluation of the entire colon became more cost-effective. The incremental cost-effectiveness of flexible sigmoidoscopy plus barium enema compared with colonoscopy was sensitive to estimates of the sensitivity of the tests. In a probabilistic sensitivity analysis comparing flexible sigmoidoscopy with anoscopy followed by flexible sigmoidoscopy if needed, the middle 95th percentile of the distribution of the incremental cost-effectiveness ratios ranged from flexible sigmoidoscopy yielding an increased life expectancy at reduced cost to $52 158 per year of life gained (mean, $11 461 per year of life saved). CONCLUSIONS: Evaluation of the colon of persons 25 to 45 years of age with otherwise asymptomatic rectal bleeding increases the life expectancy at a cost comparable to that of colon cancer screening.

Adult↗
PubMed2000

[P53-status in primary ovarian carcinomas, ovarian metastases of neoplasms in other sites and benign ovarian tumors: predictive value in comparison to histopathological parameters].

OBJECTIVE: The purpose of this study was to determine whether the tumor suppressor gene p53 can be used as a prognosis factor to assess individual patient risk in primary ovarian carcinoma. MATERIALS AND METHODS: The concentration of the mutated, as well as the wild type p53 was examined in 98 cases of ovarian carcinoma. Among 98 ovarian tumors examined, 77 were primary carcinomas, 14 tumors were metastasis of foreign tumors, and 7 were benign ovarian tumors. The pan-53 ELISA from Fa. Dianova was used to test for the p53 protein. RESULTS: The p53 protein concentration exhibited a wide range in the different tissue samples. Benign tumors contained significantly lower p53 concentrations than malignant tumors. After the data was analyzed using Kaplan-Meier, a p53 concentration of 507.1 pg/ml was established as cut-off point for assessing cancer prognosis as good or poor. Patients exhibiting p53 concentrations over 507.1 pg/ml had a median life expectancy of 20 months, and patients exhibiting lower tumor concentrations of p53 had a life expectancy of over 70 months. A significant relationship between patient life expectancy could also be shown for tumor stage and type, whereas not for tumor grading. CONCLUSIONS: Based on the results of this study, the routine measurement of p53 may allow for a better prognostic assessment of life expectancy of patients with primary ovarian carcinoma.

Age Factors↗