In a meta-analysis of the available literature on time to AC, longer time to AC was associated with worse survival among patients with resected colorectal cancer.

The Ontario Cancer Registry (OCR) and the Surveillance, Epidemiology and End Results (SEER) databases were used to describe temporal trends in the incidence and survival of squamous cancers of the upper aerodigestive tract (UADT) in Ontario and the US between 1984 and 2001. Between the 1984-86 and 1999-01 periods, the age-adjusted incidence rate of all first primary cancers of the UADT decreased from 11.6 (11.2-12.0) to 8.8 (8.5-9.1) in Ontario and 13.0 (12.7-13.3) to 10.2 (10.0-10.4) in the US. Significant decreases in incidence were observed in many UADT sites but there was no significant change in the incidence of cancer of the oropharynx in either the US or Canada. Over the same period, the 5-year relative survival for all UADT cancers increased from 49.2% (47.2-51.2%) to 57.1%(55.0-59.1%) in Ontario and from 48.1% (46.9-49.3%) to 52.4% (51.2-53.6%) in the US. This significant improvement in the outcome of UADT cancer was largely due to a dramatic increase in the 5-year relative survival for cancers of the oropharynx from 31.1% (27.1-35.1%) to 53.6% (49.3-57.9%) in Ontario and from 35.3% (32.9-37.8%) to 51.0% (48.7-53.3%) in the US. Smaller increases in survival were observed in cancers of the oral cavity, nasopharynx, and hypopharynx, but there was no evidence of any increase in survival for cancer of the larynx. These results are consistent with the hypothesis that there has been a major change in the etiology of cancer of the oropharynx in Canada and the US and a concomitant change in its response to therapy. ' UICCKey words: head and neck cancer; cancer of the oropharynx; incidence; etiology; relative survival Cancer of the UADT remains a significant problem in North America. 1 Until recently, the use of tobacco and alcohol were considered to be the principal causes of UADT cancers in the developed countries. 2 The decline in smoking rates in recent decades has been associated with a reduction in the overall incidence of cancer of the UADT in the US. However, the incidence of cancer of the oropharynx has not decreased in parallel with that of other UADT cancers. 3,4 This has led to the hypothesis that a real decrease in the incidence of smoking-related cancers of the oropharynx may have been obscured by a simultaneous increase in the incidence of a new variant of the disease caused by human papilloma virus (HPV). [3][4][5][6][7][8][9] In a previous population-based study of UADT cancer over the period from 1982from to 1994 showed that the incidence of UADT cancers in Ontario, Canada was remarkably similar to that in the US. Smoking rates have been decreasing in Canada 11 as they have in the US, 3 but it is not yet known whether this has resulted in a decrease in the incidence of UADT cancer in Canada. The first objective of this study was to compare trends in the incidence of UADT cancers in Ontario and the US to determine: (a) whether the overall incidence of UADT cancer in Ontario has decreased as it has in the US; and (b) whether the temporal trend in the incidence of oropharyngeal cancer in Ontar...

The composition of the gastrointestinal microbiome is increasingly recognized as a crucial contributor to immune and metabolic homeostasis-deficiencies in which are characteristic of cystic fibrosis (CF) patients. The murine model (CFTR (-/-) , CF), has, in previous studies, demonstrated characteristic CF gastrointestinal (GI) manifestations including slowed transit and significant upregulation of genes associated with inflammation. To determine if characteristics of the microbiome are associated with these phenotypes we used a phylogenetic microarray to compare small intestine bacterial communities of wild type and congenic CF mice. Loss of functional CFTR is associated with significant decreases in GI bacterial community richness, evenness and diversity and reduced relative abundance of putative protective species such as Acinetobacter lwoffii and a multitude of Lactobacilliales members. CF mice exhibited significant enrichment of Mycobacteria species and Bacteroides fragilis, previously associated with GI infection and immunomodulation. Antibiotic administration to WT and CF animals resulted in convergence of their microbiome composition and significant increases in community diversity in CF mice. These communities were characterized by enrichment of members of the Lactobacillaceae and Bifidobacteriaceae and reduced abundance of Enterobacteriaceae and Clostridiaceae. These data suggest that Enterobacteria and Clostridia species, long associated with small intestinal overgrowth and inflammatory bowel disease, may suppress both ileal bacterial diversity and the particular species which maintain motility and immune homeostasis in this niche. Thus, these data provide the first indications that GI bacterial colonization is strongly impacted by the loss of functional CFTR and opens up avenues for alternative therapeutic approaches to improve CF disease management.

The relationship between survival and time to the start of adjuvant chemotherapy (AC) among breast cancer patients is unclear. In order to illustrate the effect of delaying the initiation of AC on survival we have undertaken a systematic review and meta-analysis. We identified 12 available studies in the meta-analysis including 15 independent analytical groups. This meta-analysis showed that a 4-week delay before AC was associated with a significantly worse overall survival (OS)(HR=1.13; 95% confidence interval [CI], 1.08-1.19) and disease free survival (DFS)(HR=1.14; 95%CI, 1.05-1.24). Two studies categorized patients into hormone receptor-positive, ERBB2-positive, and triple-negative breast cancer (TNBC) patients according to the clinicopathological features of breast cancer. The HRs for OS between waiting time (WT) ≤30 days and 31-60 days in the subgroups were extracted and analyzed. The analysis demonstrated that a WT of 31-60 days was related to worse OS among patients with TNBC (HR, 1.26; 95% CI, 1.08-1.48), but had no significant effect on OS among those with hormone receptor-positive (HR, 1.02; 95% CI, 0.89-1.15) or ERBB2-postive (HR, 0.95; 95%CI, 0.79-1.14) tumors. In this meta-analysis of the eligible literatures reviewing the time to AC, a longer waiting time to adjuvant chemotherapy may lead to worse survival in breast cancer patients, especially in TNBC patients. www.impactjournals.com/oncotarget/

BACKGROUND Practice guidelines recommend neoadjuvant chemotherapy (NACT) for bladder cancer. However, the evidence in support of adjuvant chemotherapy (ACT) is less robust. Here we describe whether the evidence of efficacy for NACT/ACT was sufficient to change clinical practice and whether the efficacy demonstrated in clinical trials was translated into effectiveness in the general population. METHODS Electronic records of treatment were linked to the population‐based Ontario Cancer Registry to identify all patients with bladder cancer treated with cystectomy in Ontario 1994‐2008. Utilization of NACT/ACT was compared across 1994‐1998, 1999‐2003, and 2004‐2008. Logistic regression was used to analyze factors associated with NACT/ACT. Cox model and propensity score analyses were used to explore the association between ACT and survival. RESULTS Two thousand forty‐four patients underwent cystectomy for muscle‐invasive bladder cancer (MIBC). Use of NACT remained stable (mean, 4%), whereas utilization of ACT increased over time (16%, 18%, 22%; P = .001). Advanced stage (T3/T4; OR, 1.83; 95% CI, 1.38‐2.46) and node‐positive disease (OR, 8.10; 95% CI, 6.20‐10.7) were associated with greater utilization of ACT. Five‐year overall survival (OS) and cancer‐specific survival (CSS) for all patients was 29% (95% CI, 28%‐31%) and 33% (95% CI, 31%‐35%), respectively. Utilization of ACT was associated with improved OS (HR, 0.71; 95% CI, 0.62‐0.81) and CSS (HR, 0.73; 95% CI, 0.64‐0.84). Results were consistent in propensity score analyses. CONCLUSIONS NACT remains substantially underutilized in routine clinical practice. Our results suggest that perioperative chemotherapy is associated with a substantial survival benefit in the general population. Patients who are planning to undergo cystectomy for bladder cancer should be reviewed by a multidisciplinary team. Cancer 2014;120:1630–1638. © 2013 American Cancer Society.

The adoption of C-CRT was associated with a significant improvement in overall survival of cervical cancer at the population level. The magnitude of the benefit of C-CRT in the general population was consistent with the results of the relevant clinical trials.

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