Alfred I Neugut

New York Presbyterian Hospital, New York, New York, United States

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Publications (591)3970.01 Total impact

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    ABSTRACT: The role of gene-specific methylation in white blood cells (WBC) as a marker of breast cancer risk is currently unclear. We determined whether promoter hypermethylation in blood DNA of candidate tumor suppressor genes frequently methylated in breast tumors can be used as a surrogate biomarker for breast cancer risk. Promoter methylation of BRCA1, CDH1 and RARβ was analyzed in WBC DNA from a population-based sample of 1,021 breast cancer patients and 1,036 controls by the MethyLight assay. Gene-specific promoter methylation in the DNA of 569 tumor tissue samples was also analyzed to determine the correlation of methylation levels with blood from the same individual. Hypermethylation of BRCA1 (OR: 1.31; 95% CI: 0.98-1.75) in WBC was associated with an increased risk of breast cancer when positive methylation was defined as ≥0.1% methylated. There was lack of concordance between tumor tissue and paired WBC DNA methylation. These results provide limited support that hypermethylation of BRCA1 in WBC DNA may be useful for determination of breast cancer risk. Additional studies with larger numbers of genes are needed to fully understand the relationship between WBC methylation and breast cancer risk.
    Full-text · Article · Aug 2015 · Journal of Cancer
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    ABSTRACT: Organochlorine insecticides have been studied extensively in relation to breast cancer incidence and results from two meta-analyses have been null for late-life residues, possibly due to measurement error. Whether these compounds influence survival remains to be fully explored. We examined associations between organochlorine insecticides (p,p'-DDT, its primary metabolite, p,p'-DDE, and chlordane) assessed shortly after diagnosis and survival among women with breast cancer. A population-based sample of women diagnosed with a first primary invasive or in situ breast cancer in 1996-1997 and with available organochlorine blood measures (n=633) were followed for vital status through 2011. After follow-up of 5 and 15 years, we identified 55 and 189 deaths, of which 36 and 74, respectively, were breast cancer-related. Using Cox regression models, we estimated the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for lipid-adjusted organochlorine concentrations with all-cause and breast cancer-specific mortality. At 5 years after diagnosis, the highest tertile of DDT concentration was associated with all-cause (HR=2.19; 95%CI: 1.02, 4.67) and breast cancer-specific (HR=2.72; 95%CI: 1.04, 7.13) mortality. At 15 years, middle tertile concentrations of DDT (HR=1.42; CI 0.99, 2.06) and chlordane (HR=1.42; 95%CI: 0.94, 2.12) were modestly associated with all-cause and breast cancer-specific mortality. Third tertile DDE concentrations were inversely associated with 15-year all-cause mortality (HR=0.66; 95%CI: 0.44, 0.99). This is the first population-based study in the United States to show that DDT may adversely impact survival following breast cancer diagnosis. Further studies are warranted given the high breast cancer burden and the ubiquity of these chemicals. This article is protected by copyright. All rights reserved. © 2015 UICC.
    No preview · Article · Aug 2015 · International Journal of Cancer
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    ABSTRACT: Limited resection has been increasingly used in older patients with stage IA lung cancer. However, the equivalency of limited resection versus lobectomy according to histology is unknown. We identified patients older than 65 years with stage IA invasive adenocarcinoma or squamous cell carcinoma ≤ 2 cm who were treated with limited resection (wedge or segmentectomy) or lobectomy in the Surveillance, Epidemiology, and End Results-Medicare database. We estimated propensity scores that predicted the use of limited resection and compared survival of patients treated with limited resection versus lobectomy. Treatments were considered equivalent if the upper 95th percentile of the hazard ratio (HR) for limited resection was ≤ 1.25. Overall, 27% of 2,008 patients with adenocarcinoma and 32% of 1,139 patients with squamous cell carcinoma underwent limited resection. Survival analyses, adjusted for propensity score by using inverse probability weighting, showed that limited resection was not equivalent to lobectomy in patients with adenocarcinoma (HR, 1.21; upper 95% CI,1.34) or squamous cell carcinoma (HR, 1.21; upper 95% CI, 1.39). Although patients with adenocarcinomas treated with segmentectomy had equivalent survival rates to those treated with lobectomy (HR, 0.97; upper 95% CI, 1.07), outcomes of those treated with wedge resection (HR, 1.29; upper 95% CI, 1.42) did not. Among patients with squamous cell carcinoma, neither wedge resection (HR, 1.34; upper 95% CI, 1.53) nor segmentectomy (HR, 1.19; upper 95% CI, 1.36) were equivalent to lobectomy. We found generally that limited resection is not equivalent to lobectomy in older patients with invasive non-small-cell lung cancer ≤ 2 cm in size, although segmentectomy may be equivalent in patients with adenocarcinoma. © 2015 by American Society of Clinical Oncology.
    No preview · Article · Aug 2015 · Journal of Clinical Oncology
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    ABSTRACT: Although many patients with end-stage cancer are offered chemotherapy to improve quality of life (QOL), the association between chemotherapy and QOL amid progressive metastatic disease has not been well-studied. American Society for Clinical Oncology guidelines recommend palliative chemotherapy only for solid tumor patients with good performance status. To evaluate the association between chemotherapy use and QOL near death (QOD) as a function of patients' performance status. A multi-institutional, longitudinal cohort study of patients with end-stage cancer recruited between September 2002 and February 2008. Chemotherapy use (n = 158 [50.6%]) and Eastern Cooperative Oncology Group (ECOG) performance status were assessed at baseline (median = 3.8 months before death) and patients with progressive metastatic cancer (N = 312) following at least 1 chemotherapy regimen were followed prospectively until death at 6 outpatient oncology clinics in the United States. Patient QOD was determined using validated caregiver ratings of patients' physical and mental distress in their final week. Chemotherapy use was not associated with patient survival controlling for clinical setting and patients' performance status. Among patients with good (ECOG score = 1) baseline performance status, chemotherapy use compared with nonuse was associated with worse QOD (odds ratio [OR], 0.35; 95% CI, 0.17-0.75; P = .01). Baseline chemotherapy use was not associated with QOD among patients with moderate (ECOG score = 2) baseline performance status (OR, 1.06; 95% CI, 0.51-2.21; P = .87) or poor (ECOG score = 3) baseline performance status (OR, 1.34; 95% CI, 0.46-3.89; P = .59). Although palliative chemotherapy is used to improve QOL for patients with end-stage cancer, its use did not improve QOD for patients with moderate or poor performance status and worsened QOD for patients with good performance status. The QOD in patients with end-stage cancer is not improved, and can be harmed, by chemotherapy use near death, even in patients with good performance status.
    Full-text · Article · Jul 2015
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    ABSTRACT: While the last three decades have seen numerous advances in the treatment of cervical cancer, it remains unclear if population level survival has improved. We examined relative survival, the ratio of survival in cervical cancer patients to matched controls over time. Patients with cervical cancer diagnosed from 1983-2009 and recorded in the Surveillance, Epidemiology, and End Results database were examined. Survival models were adjusted for age, race, stage, year of diagnosis, and time since diagnosis. Changes in stage-specific relative survival for patients with cervical cancer compared to the general population matched by age, race, and calendar year were examined over time. A total of 46,932 patients were identified. . For women with stage I tumors, the excess hazard ratio for women diagnosed in 2009 was 0.91 (95% CI, 0.86-0.95) compared to 2000, 0.81 (95% CI, 0.73-0.91) compared to 1990, and 0.75 (95% CI, 0.64-0.88) in comparison to 1983. For patients with stage III tumors, the excess hazard ratio's for patients diagnosed in 2009 (relative to those diagnosed in 2000, 1990, and 1983) were 0.83 (95% CI, 0.80-0.87), 0.68 (95% CI, 0.62-0.75), and 0.59 (95% CI, 0.52-0.68). Similar trends in improved survival over time were noted for women with stage II tumors. There were no statistically significant improvements in relative survival over time for women with stage IV tumors. Relative survival has improved over time for women with stage I-III cervical cancer, but has changed little for those with metastatic disease. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Jul 2015 · American journal of obstetrics and gynecology
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    ABSTRACT: Baseline, persistent, incident, and remittent dipstick proteinuria have never been tested as predictors of mortality in an undeveloped country. The goal of this study was to determine which of these four types of proteinuria (if any) predict mortality. Baseline data was collected from 2000-2002 in Bangladesh from 11,121 adults. Vital status was ascertained over 11-12 years. Cox models were used to evaluate proteinuria in relation to all-cause and cardiovascular disease (CVD) mortality. CVD mortality was evaluated only in those with baseline proteinuria. Persistent, remittent, and incident proteinuria were determined at the 2-year exam. Baseline proteinuria of 1+ or greater was significantly associated with all-cause (hazard ratio (HR) 2.87; 95% C.I., 1.71 - 4.80) and CVD mortality (HR: 3.55; 95% C.I., 1.81-6.95) compared to no proteinuria, adjusted for age, gender, arsenic well water concentration, education, hypertension, BMI, smoking, and diabetes mellitus. Persistent 1+ proteinuria had a stronger risk of death, 3.49 (1.64 - 7.41)-fold greater, than no proteinuria. Incident 1+ proteinuria had a 1.87 (0.92 - 3.78)-fold greater mortality over 9-10 years. Remittent proteinuria revealed no increased mortality. Baseline, persistent, and incident dipstick proteinuria were predictors of all-cause mortality with persistent proteinuria having the greatest risk. In developing countries, those with 1+ dipstick proteinuria, particularly if persistent, should be targeted for definitive diagnosis and treatment. The two most common causes of proteinuria to search for are diabetes mellitus and hypertension. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · Jul 2015 · Preventive Medicine
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    ABSTRACT: Procedural volume is associated with outcomes for many surgical interventions. Little is known about the association between volume and outcomes of radiation. We examined the association between treatment center and hospital volume and outcomes for women with locally advanced cervical cancer treated with radiation. Women with stage IIB-IVA cervical cancer treated with primary radiation from 1998-2011 and recorded in the National Cancer Database were examined. Hospital volume was estimated as the mean annualized volume, while center-specific effects on care were examined using a hospital-specific random effect. Multivariable regression models adjusted for metrics of treatment quality were used to estimate survival. 20,766 patients treated at 1115 hospitals were identified. The median follow-up was 24.2months while 5-year survival was 36.5% (95% CI, 35.6-37.4%). Higher hospital volume was associated with receipt of brachytherapy (P<0.05), but had no effect on use of chemotherapy. In a multivariable model accounting for clinical and demographic factors as well as quality of care, hospital volume was not associated with survival (P=0.25). The specific hospital in which patients received care was the strongest predictor of survival (P<0.0001) followed by stage, year of diagnosis and treatment quality (P<0.0001 for all). The hospital-specific effect on mortality expressed as a hazard ratio, ranged from 0.66-1.53 across hospitals. For locally advanced cervical cancer, hospital volume has a minimal impact on outcome; however, the specific center in which care is delivered is strongly associated with survival. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · Jul 2015 · Gynecologic Oncology
  • Alfred I. Neugut · Edward P. Gelmann

    No preview · Article · Jun 2015 · European Urology
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    ABSTRACT: Using a nationwide database, 4,874 patients with hypercalcemia of malignancy were identified. The in-hospital mortality rate was 6.8%. Overall, 1,971 (40.4%) patients received pamidronate and 1,399 (28.7%) received zoledronic acid during hospitalization. Calcitonin was utilized in 1,337 (27.4%) patients while glucocorticoids were administered to 1,311 (26.9%). Use of contraindicated medications was noted in 136 (2.8%) patients who received thiazide diuretics and 12 (0.2%) who received lithium. Tumor site, presence of bone metastases, and severity of illness were predictors of treatment. There was no association between treatment with bisphosphonates, calcitonin, or glucocorticoids and morbidity or mortality.
    Full-text · Article · Jun 2015 · Cancer Investigation
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    ABSTRACT: Patients with solid tumors are at greatest risk for dying from their cancers in the five years following diagnosis. For most malignancies, deaths from other chronic diseases begin to exceed those from cancer at some point. As little is known about the causes of death among long-term survivors of ovarian cancer, we examined causes of death by years from diagnosis. The Surveillance, Epidemiology, and End Results (SEER) database was used to identify women diagnosed with ovarian cancer between 1988 and 2012. We compared causes of death by stage, age, and interval time after diagnosis. A total of 67,385 women were identified. For stage I neoplasms, 13.6% (CI, 13.0-14.2%) died from ovarian cancer, 4.2% (CI, 3.8-4.5%) from cardiovascular disease, 3.6% (CI, 3.3-3.9%) from other causes and 2.6% (CI, 2.4-2.9%) from other tumors; ovarian cancer was the leading cause of death until 7years after diagnosis after which time deaths are more frequently due to other causes. For those with stage III-IV tumors, 67.8% (CI, 67.3-68.2%) died from ovarian cancer, 2.8% (CI, 2.6-2.9%) from other causes, 2.3% (CI, 2.2-2.4%) from cardiovascular disease and 1.9% (CI, 1.7-2.0%) from other cancers; ovarian cancer was the most frequent cause of death in years 1-15 after which time deaths were more commonly due to other causes. The probability of dying from ovarian cancer decreases with time. Ovarian cancer remains the most common cause of death for 15years after diagnosis in women with stage III-IV tumors. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · Jun 2015 · Gynecologic Oncology
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    ABSTRACT: Although axillary lymph node evaluation is standard of care in the surgical management of invasive breast cancer, a benefit has not been demonstrated in ductal carcinoma in situ (DCIS). Despite uncertainty regarding the efficacy, axillary evaluation is often performed in women with DCIS. To determine the incidence of axillary evaluation in women with DCIS and identify clinical, hospital, and surgeon-related factors associated with axillary evaluation. Cross-sectional analysis conducted from January 2006 through December 2012 of medical records contained in the Perspective database for women with DCIS who underwent breast-conserving surgery (BCS) or mastectomy. A total of 35 591 women aged 18 to 90 years were included in the analysis. Receipt or nonreceipt of surgical axillary evaluation, categorized as sentinel lymph node biopsy (SLNB), axillary lymph node dissection (ALND), or none. Analyses were stratified by surgery type, and multivariable regression analysis was used to identify factors associated with axillary evaluation. Of women identified with DCIS, 26 580 (74.7%) underwent BCS while 9011 (25.3%) underwent mastectomy; 17.7% undergoing BCS and 63.0% undergoing mastectomy had an axillary evaluation. Rates of axillary evaluation increased over time with mastectomy (2006, 56.6%; 2012, 67.4%) and were relatively stable with BCS (2006, 18.5%; 2012, 16.2%). Rates of ALND decreased in women undergoing mastectomy (2006, 20.0%; 2012, 10.7%) and BCS (2006, 1.2%; 2012, 0.3%), with increasing use of SLNB. In a multivariable analysis, hospital factors including nonteaching hospital (risk ratio [RR], 1.17; 95% CI, 1.05-1.30) and urban location (RR, 1.15; 95% CI, 1.03-1.29) influenced axillary evaluation with mastectomy. Surgeon volume was the most significant predictor of axillary evaluation among women undergoing BCS (mid vs low volume: RR, 0.87; 95% CI, 0.70-0.94; high vs low volume: RR, 0.54; 95% CI, 0.44-0.65). Despite guidelines recommending against axillary lymph node evaluation in women with DCIS undergoing BCS and uncertainty regarding its use with mastectomy, SLNB or ALND is performed frequently. Given the additional morbidity and cost of these procedures, alternative surgical approaches or prospective evaluation of the clinical benefit of axillary evaluation in women with DCIS is needed.
    No preview · Article · Jun 2015
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    ABSTRACT: Breast cancer, the leading cancer diagnosis among American women, is positively associated with postmenopausal obesity and little or no recreational physical activity (RPA). However, the underlying mechanisms of these associations remain unresolved. Aberrant changes in DNA methylation may represent an early event in carcinogenesis, but few studies have investigated associations between obesity/RPA and gene methylation, particularly in postmenopausal breast tumors where these lifestyle factors are most relevant. We used case-case unconditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CI) for the associations between body mass index (BMI=weight [kg]/height [m(2)]) in the year prior to diagnosis, or RPA (average hours/week), and methylation status (methylated vs. unmethylated) of 13 breast cancer-related genes in 532 postmenopausal breast tumor samples from the Long Island Breast Cancer Study Project. We also explored whether the association between BMI/RPA and estrogen/progesterone-receptor status (ER+PR+ vs. all others) was differential with respect to gene methylation status. Methylation-specific PCR and the MethyLight assay were used to assess gene methylation. BMI 25-29.9kg/m(2), and perhaps BMI≥30kg/m(2), was associated with methylated HIN1 in breast tumor tissue. Cases with BMI≥30kg/m(2) were more likely to have ER+PR+ breast tumors in the presence of unmethylated ESR1 (OR=2.63, 95% CI 1.32-5.25) and women with high RPA were more likely to have ER+PR+ breast tumors with methylated GSTP1 (OR=2.33, 95% CI 0.79-6.84). While biologically plausible, our findings that BMI is associated with methylated HIN1 and BMI/RPA are associated with ER+PR+ breast tumors in the presence of unmethylated ESR1 and methylated GSTP1, respectively, warrant further investigation. Future studies would benefit from enrolling greater numbers of postmenopausal women and examining a larger panel of breast cancer-related genes.
    Full-text · Article · May 2015
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    ABSTRACT: Data from single institution studies suggest that perioperative complication rates following stereotactic needle brain biopsies range from 6-12%, with permanent morbidity and mortality ranging from 3.1-6.4% and 0-1.7%, respectively. However, no population-level data are available. We conducted a population-based analysis to study complications following needle brain biopsy. We analyzed patients recorded in the Nationwide Inpatient Sample who underwent stereotactic needle brain biopsy for neoplastic lesions between 2006 and 2012. A multivariate logistic model was used to identify factors associated with complications. We identified 7514 patients who underwent biopsy for various intracranial pathologies, including primary malignant neoplasm (52.3%), unspecified neoplasm (17.9%), metastasis (9.7%), meningioma (1.5%), radiation necrosis (0.8%), lymphoma (0.5%), and pineal region neoplasm (0.3%). Intracranial hemorrhage was the most frequent complication (5.8%). Other complications, including operative infection (0.1%) and wound breakdown (0.2%), were rare. Multivariate logistic regression analysis revealed that hemorrhage is associated with older age (ref <40yrs; 40-59yrs OR=2.26, 95% CI 1.51-3.38; ≥60yrs OR=1.90, 95% CI 1.22-2.97), hydrocephalus (OR=3.02, 95% CI 2.20-4.14) and cerebral edema (OR=2.16, 95% CI 1.72-2.72). Hemorrhage is less likely when biopsying a primary malignant neoplasm (OR=0.73, 95% CI 0.59-0.90). Overall inpatient mortality following biopsy was 2.8%. Patients with intracranial hemorrhage were significantly more likely than patients without hemorrhage to expire in the hospital (12.8% vs. 2.2%, P<0.001) or be discharged to a rehabilitation/nursing facility (45.2% vs. 23.1%, P<0.001). Intracranial hemorrhage is the most frequent complication associated with needle brain biopsy and is associated with inpatient mortality and hospital disposition. Other complications are rare. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · May 2015 · World Neurosurgery
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    ABSTRACT: Little is known about how modifiable lifestyle factors interact with the epigenome to influence disease. Body mass index (BMI, weight kg/height m2) and physical activity are associated with postmenopausal breast cancer, but the mechanisms are not well-understood. We hypothesized that BMI or physical activity may modify the association between markers of global DNA methylation and postmenopausal breast cancer risk. Resources from a population-based case-control study (~1300 postmenopausal women) were used to construct logistic regression models. We explored whether the association between breast cancer and global methylation, assessed using the luminometric methylation assay (LUMA) and long interspersed elements-1 (LINE-1) methylation in white blood cell DNA, was modified by BMI or recreational physical activity (RPA). The LUMA-breast cancer association was modified by BMI (multiplicative p=0.03) and RPA (p=0.004). Non-obese women in the highest quartile of LUMA experienced a greater than two-fold increased risk of postmenopausal breast cancer (BMI<25kg/m2: OR=2.16; 95% CI=1.35, 3.57 and BMI 25-29.9kg/m2: OR=2.96; 95% CI=1.69, 5.19) compared to women in the lowest LUMA quartile. Similar increases in the LUMA-breast cancer association were observed among women who were physically active (moderate RPA: OR=2.62; 95% CI=1.44, 4.75 and high RPA: OR=2.62; 95% CI=1.53, 4.49). Estimates among obese and inactive women were less pronounced and imprecise. Although we observed statistical interactions (p<0.05) between BMI and RPA with LINE-1, we were unable to discern any clear associations with breast cancer. The association between LUMA and postmenopausal breast cancer risk may be modified by postmenopausal body size and physical activity.
    Full-text · Article · May 2015 · Journal of Cancer
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    ABSTRACT: Cytoreduction for ovarian cancer is associated with substantial morbidity. We examined the outcome of patients undergoing surgery for ovarian cancer to determine if there are sub-groups of patients who may benefit from alternative treatments. The National Surgical Quality Improvement Program database was used to identify women who underwent surgery for ovarian cancer from 2005-2012. Multivariable logistic regression models were used to examine the effect of age, race, functional status, ASA class, preoperative albumin and performance of extended cytoreductive procedures on morbidity, mortality and resource utilization. A total of 2870 women were identified. The perioperative complication rate increased from 9.5% in women <50 years, to 13.4% in those age 60-69 years, and 14.6% in women ≥70 years (P<0.0001). Similarly, complications rose from 7.3% in those who did not require any extended procedures to 12.9% after 1 procedure, 28.4% for those who had 2, and 30.0% in women who underwent ≥3 extended procedures (P<0.0001). In a series of multivariable models, the number of extended cytoreductive procedures performed and preoperative albumin were the factors most consistently associated with morbidity. Using a series of model fit statistics, compared to chance alone, the ability to predict any complication increased by 27.4% when procedure score was analyzed, 22.0% with preoperative albumin, 11% with age, and 4% with functional status. While preoperative clinical and demographic factors may help predict the risk of adverse outcomes for women undergoing surgery for ovarian cancer, performance of extended cytoreductive procedures is the strongest risk factor for complications. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · May 2015 · Gynecologic Oncology
  • Grace Clarke Hillyer · Alfred I. Neugut
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    ABSTRACT: Although colonoscopy is predominant among the selection of colorectal cancer screening tests, stool testing (particularly fecal immunochemical testing) has also carved out an important niche for itself. Its simplicity and low cost make it ideal for mass population screening both in the United States and abroad, and it is an alternative choice for those reluctant to undergo endoscopy.
    No preview · Article · May 2015 · Cancer

  • No preview · Article · May 2015 · Cancer Research
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    ABSTRACT: To examine relative survival (a metric that incorporates changes in survival within a population) in women with ovarian cancer from 1975 to 2011. Women diagnosed with ovarian cancer from 1975 to 2011 and recorded in the National Cancer Institute's Surveillance, Epidemiology, and End Results database were examined. Relative survival, estimated as the ratio of the observed survival of cancer patients (all-cause mortality) to the expected survival of a comparable group from the general population, was matched to the patients with the main factors that are considered to affect patient survival such as age, calendar time, and race. Hazard ratios were adjusted for age, race, year of diagnosis, time since diagnosis, and the interaction of age and years since diagnosis (except for stage II). A total of 49,932 women were identified. For stage I ovarian cancer, the adjusted excess hazard ratio for death in 2006 was 0.51 (95% confidence interval [CI] 0.41-0.63) compared with those diagnosed in 1975. The reduction in excess mortality remained significant when compared with 1980 and 1985. For women with stage III-IV tumors, the excess hazard of mortality was lower in 2006 compared with all other years of study ranging from 0.49 (95% CI 0.44-0.55) compared with 1975 to 0.93 (95% CI 0.87-0.99) relative to 2000. For women aged 50-59 years, 10-year relative survival was 0.85 (99% CI 0.61-0.95) for stage I disease and 0.18 (99% CI 0.10-0.27) for stage III-IV tumors. For women aged 60-69 years, the corresponding 10-year relative survival estimates were 0.89 (99% CI 0.58-0.98) and 0.15 (99% CI 0.09-0.21). Relative survival has improved for all stages of ovarian cancer from 1975 to 2011. II.
    No preview · Article · May 2015 · Obstetrics and Gynecology

  • No preview · Article · May 2015 · Gastrointestinal Endoscopy

  • No preview · Article · May 2015 · Cancer Research

Publication Stats

18k Citations
3,970.01 Total Impact Points


  • 1994-2016
    • New York Presbyterian Hospital
      • • Department of Obstetrics and Gynecology
      • • Department of Pain Medicine
      New York, New York, United States
  • 1988-2016
    • Columbia University
      • • Department of Epidemiology
      • • College of Physicians and Surgeons
      • • Mailman School of Public Health
      • • Department of Medicine
      New York, New York, United States
  • 2010-2015
    • Weill Cornell Medical College
      • • Department of Urology
      • • Division of Radiation Oncology
      New York, New York, United States
  • 1978-2015
    • CUNY Graduate Center
      New York, New York, United States
  • 2014
    • Kaiser Permanente
      Oakland, California, United States
  • 2013
    • University of Rochester
      Rochester, New York, United States
  • 2006
      Bakersfield, California, United States
  • 2003
    • Stony Brook University
      • Department of Medicine
      스토니브룩, New York, United States
  • 2002
    • Queen Elizabeth Dental Services Inc.
      Montréal, Quebec, Canada
    • New York Medical College
      • Department of Medicine
      New York, New York, United States
  • 2001
    • Yeshiva University
      New York, New York, United States
  • 2000
    • Ashford University
      New York, New York, United States
  • 1996
    • Harvard University
      Cambridge, Massachusetts, United States
    • Dana-Farber Cancer Institute
      Boston, Massachusetts, United States
  • 1995-1996
    • Mid-Columbia Medical Center
      DLS, Oregon, United States
    • Icahn School of Medicine at Mount Sinai
      Manhattan, New York, United States
  • 1993
    • New York State
      New York City, New York, United States
  • 1988-1993
    • Rambam Medical Center
      • Department of Oncology
      H̱efa, Haifa District, Israel
  • 1992
    • Gracie Square Hospital, New York, NY
      New York City, New York, United States