Archives

  • 2019-10
  • 2020-03
  • 2020-07
  • 2020-08
  • 2021-03
  • br The second group also included all analysed cancers for

    2021-03-10


    The second group also included all analysed cancers for young patients (Hodgkin lymphoma, testicular, and thyroid cancer) in addition to bladder, non-Hodgkin lymphoma (NHL), melanoma, breast, prostate, and corpus uteri (Supplementary material Figs. A and B). Patients’ LE when diagnosed at 45 years old ranked from approximately 38.8 (thyroid female) to 25.3 (NHL male) and patients’ LE after 15 years since diagnosis (attained age = 60 years) ranked from 25.6 (thyroid female) to 15.8 (thyroid male) (Supplementary material Tables 3 and 4).
    The YLL indicator at age 45 years was particularly high for lung cancer (24.5 in women and 29.6 in men), ovarian cancer (22.7), and stomach cancer (19.0 in women and 17.6 in men). The lowest YLL at age 45 years was estimated for the cancers defined in the second group such as thyroid cancer in women (1.7) and melanoma in men (5.9) (Tables 1 and 2). After 15 years since diagnosis, YLL for patients diagnosed with digestive cancers, qPCR and corpus uteri, prostate, and thyroid cancers became less than two years for all or almost all age classes at diagnosis (Supplementary material Tables 3 and 4). The YLL trend over time since diagnosis was ever decreasing with different speeds according to the lethality of the cancer type and the age at diagnosis.
    After some years since diagnosis, all LE curves tended to overlap each other and most converged to the population values. In the long term, the patients’ loss of LE with respect to the general population depended only on the attained age. At an attained age of 80 years, for example, LE of breast cancer patients varied very little (from 7.1 in women diagnosed at age 80 years to 8.7 in those diagnosed at age 45 years), both not very far from the LE of 10 estimated in cancer-free women of the same age (Fig. 1).
    Discussion
    The greatest difference in the patients’ LE with respect to the sex- and age-matched general population was observed immediately after cancer diagnosis for each age class and analysed cancer due to the rapidly lethal course of the most aggressive cases. This initial difference was the highest for the youngest patients and progressively decreased with age at diagnosis, as young patients−although they generally
    have better cancer prognosis than older patients−had much lower mortality risks for non-cancer related causes. With increasing time since qPCR diagnosis, two different scenarios emerged. For more lethal cancers, patients’ LE tended to increase during the first three to five years immediately after diagnosis. Indeed, the prognosis for survivors improved with each additional year survived, with the largest improvement in the first years after diagnosis. Patients’ LE with less aggressive cancers did not show the same behaviour, as was the case for melanoma, bladder cancer, and NHL in both sexes; and breast, corpus uteri, and thyroid for females and prostate, testis, and leukaemias for males.
    YLL over time since diagnosis can be also interpreted as a measure of how close from being cured long-term survivors can be considered. For example, a proposed YLL cut-off of less than two years [10] could be defined as a threshold for cure in male colon cancer patients at nine years after diagnosis, when it occurred at age 45 years and three years after diagnosis at age 72 years. The identification of persisting YLL after many years since diagnosis was also consistent with other research [10,15]. A small but persisting patient excess risk in the cured patients with respect to the general population caused by factors linked with the cancer but that were not the cancer itself was described in a previous study [15]. This loss of lifetime can be attributed to second cancers, mostly for breast and testicular cancer [16,17], side effects of treatments, or to common risk factors shared with other diseases (for example, smoking and diet); therefore, the condition of reaching the same mortality risk of the general population may be too stringent to define cure.
    The results presented herein can be compared with those obtained from the data from the US for the period 2010-2012 [10]. The general population’s LE was one to two years higher in Italy than in the US, and this was also reflected in the patients’ LE. Taking this into account, YLL was approximately one year lower in the US than in Italian women diagnosed with colon and breast cancers (the greater difference was detected for breast cancer diagnosed at age 55-59 years, 4.6 vs 7, and after 15 years since diagnosis, 1 vs 3), while YLL was one to two years higher for men diagnosed with colon cancer in the US. This could be explained by their lower long-term RS, for example, 10-year RSs in 60-64 and 55-59-year-old patients in Italy were respectively 68% and 72% (Supplementary material Table 2) and approximately 61% and 63% in the US [18]. Other studies have estimated LE only at diagnosis using a cohort approach. Andersson et al. [5] used a flexible parametric model to estimate LE in a cohort of Swedish patients diagnosed with four cancer types in 1961-1970. Hakama et al. [19] analysed Finnish breast cancer data from 1956 to 1970. In both papers, a lower LE was estimated at diagnosis compared to Italian data. These differences can be attributable to the cohort approach and to the consequential use of less recent data to estimate the survival experience of patients in the first period after diagnosis and also to differences in country-specific LE of the general population.