Background Cancer is a major cause of morbidity and mortality among people with HIV (PWH). We assessed temporal trends in five-year mortality and compared recent cancer survival with standardized Italian general-population estimates. Methods We conducted a retrospective single-center cohort study including adult PWH diagnosed with malignancy at Luigi Sacco Hospital, Milan, between 2000 and 2020. Cancers were classified as AIDS-defining cancers (ADCs), virus-related non-AIDS-defining cancers (NADCs), and non-virus-related NADCs. Five-year all-cause and cancer-related mortality were compared between 2000–2007 and 2008–2020 using survival estimates and adjusted Cox models. For selected cancers diagnosed in 2008–2020, five-year net survival was estimated using the Ederer II method and descriptively compared with standardized Italian estimates. Results Overall, 476 malignancies were diagnosed, including 200 ADCs and 276 NADCs. Five-year all-cause mortality decreased from 39.3% to 15.7% for ADCs (adjusted hazard ratio [aHR] 0.39, 95% confidence interval [CI] 0.20–0.74; p = 0.004), from 56.4% to 31.1% for virus-related NADCs (aHR 0.34, 95% CI 0.16–0.71; p = 0.004), and from 58.8% to 44.3% for non-virus-related NADCs (aHR 0.55, 95% CI 0.32–0.94; p = 0.029). Five-year net survival in PWH was 30% for lung cancer, 60% for liver cancer, 83% for anal cancer, 71% for non-Hodgkin lymphoma, and 95% for Kaposi sarcoma. Corresponding standardized general-population estimates were 24%, 31%, 70%, 80%, and 84%, respectively. Conclusions Five-year mortality among PWH with cancer improved substantially over time, particularly for ADCs and virus-related NADCs. Net survival point estimates were numerically higher than standardized references for liver and anal cancer, broadly similar for lung cancer, and lower for non-Hodgkin lymphoma; the Kaposi sarcoma reference was historical (2005–2009). Persistently high mortality among PWH with non-virus-related cancers underscores the need to strengthen prevention, early diagnosis, and access to appropriate oncological care.
Background Gastric cancer remains one of the most lethal malignant tumors worldwide. Whether selenium status before diagnosis is associated with survival following gastric cancer diagnosis remains unclear. Methods Among 653 patients diagnosed with gastric cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, we examined associations of pre-diagnostic plasma selenium (Se), selenoprotein P (SELENOP) concentrations, and glutathione peroxidase 3 (GPX3) activity with gastric cancer-specific and overall mortality using multivariable Cox proportional hazards models. Results Blood samples were collected an average of 8.8 years before diagnosis. During follow-up, 483 patients died, including 359 from gastric cancer. The median observed time from diagnosis to death or censoring was 1.3 years. Multivariable-adjusted HRs (95% CIs) per one-SD increase in Se, SELENOP, and GPX3 were 0.95 (0.83–1.09), 0.94 (0.82–1.07), and 1.00 (0.88–1.14), respectively, for gastric cancer-specific mortality, and 0.97 (0.87–1.09), 0.94 (0.84–1.05), and 0.98 (0.87–1.09) for overall mortality. Conclusions Pre-diagnostic biomarkers of selenium status were not clearly associated with gastric cancer-specific or overall mortality in this cohort. Further studies in populations with different selenium exposure distributions are needed to assess the generalizability of these findings and to replicate exploratory subgroup results.
Objectives: Mesothelioma mortality continues to reflect asbestos exposure because of its long latency. While previous Spanish studies focused primarily on pleural disease, this study assessed mesothelioma mortality across the ICD-10 C45 category in Spain from 1999 to 2024. Materials and methods: A population-based time-trend study was conducted using mortality data (ICD-10 C45) from the Spanish National Statistics Institute. Age-standardised mortality rates (ASMRs) were calculated using the 2013 European Standard Population. Temporal trends and sex-specific parallelism were evaluated using Joinpoint regression. Results: Among 9733 recorded mesothelioma deaths (7311 men, 2422 women), ASMRs were consistently higher in men, although temporal trends were parallel by sex. Overall mortality increased until 2016 (annual percentage change [APC] 2.3%, 95% CI 1.5-3.0) and subsequently declined non-significantly, yielding an average annual percentage change (AAPC) of 1.0% (95% CI 0.2-1.7) for 1999-2024. Pleural mortality increased until 2011 before declining non-significantly, whereas recorded peritoneal mortality increased throughout the study period (AAPC 2.0%, 95% CI 0.7-3.2). Deaths coded as unspecified site (C45.9) showed the largest increase in ASMR (AAPC 2.1%, 95% CI 1.1-3.1) and accounted for 43.5% of male and 31.8% of female mesothelioma deaths in 2024. Conclusions: Absolute mesothelioma deaths increased in Spain while age-standardised rates attenuated after 2016. The continued increase in recorded peritoneal mortality and the substantial contribution of unspecified-site deaths indicate that surveillance should not rely solely on pleural mesothelioma, highlighting the need for comprehensive monitoring of the complete ICD-10 C45 category and improved anatomical classification.
Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide. However, comprehensive population-level data describing etiologic patterns, treatment exposure, healthcare utilisation, and survival remain limited in many countries. This study aimed to characterise the national burden, care patterns, and outcomes of HCC in Turkey. Methods: We performed a nationwide, real-world analysis of adult patients diagnosed with HCC between 2016 and 2024 using administrative health data. Cases were identified by an administrative case definition requiring at least three separate records of ICD-10 codes C22, C22.0, or C22.9; at least one C22.0 code was not required, so HCC could not be confirmed at the individual level. Baseline comorbidities were restricted to conditions recorded on or before the date of diagnosis. Demographic characteristics, underlying liver disease, etiologic factors, treatment exposure, and the level and type of diagnosing institution were assessed. Overall survival (OS) was estimated using the Kaplan-Meier method. To reduce immortal-time bias, treatment exposure was analysed in a three-month landmark cohort; because treatment dates were unavailable, this reduces but does not eliminate the bias. Multivariable Cox regression was performed within the same cohort. Results: A total of 13,674 patients (64.6% male; median age 64 years, IQR 55-73) were included, of whom 61.4% had died at the data cutoff; median follow-up was 53.0 months. The median OS was 13.2 months (95% CI 12.1-14.5), with 1-, 3-, and 5-year OS of 50.9%, 41.1%, and 36.9%; because patients dying before three qualifying records accumulated could not enter the cohort, these estimates apply to patients meeting the case-identification algorithm and are likely to overstate population survival. OS was markedly longer in women than in men (median 50.9 vs 8.2 months), and longer in patients without cirrhosis recorded at diagnosis than in those with cirrhosis (18.5 vs 9.0 months; both P < 0.001). Hepatitis B was the most frequently recorded specific etiology (29.4%); among mutually exclusive categories, NAFLD-associated HCC had the most favourable survival (5-year OS 61.0%) and alcohol-related HCC the least (median 8.8 months), while HBV-HDV co-infection was associated with longer survival than HBV mono-infection (58.2 vs 12.0 months; P < 0.001), a difference that persisted after adjustment for age, sex, and cirrhosis; no specific etiology could be assigned in 56.1% of patients. Sensitivity analyses restricting etiologic ascertainment to codes recorded within 3 months before to 3 months after diagnosis, or incorporating viral serology, attenuated the survival of the specific viral etiologies, indicating survival-dependent ascertainment. In a multivariable Cox model fitted in the three-month landmark cohort (n = 8958), older age, male sex, cirrhosis, and systemic therapy were associated with higher mortality (all P < 0.001), with time-varying associations for age, cirrhosis, and systemic therapy. The association of local therapy with mortality was not constant over follow-up (HR 0.78, 95% CI 0.72-0.85 during 0-24 months after the landmark and 1.22, 1.04-1.43 thereafter); the overall association was no longer evident after liver transplantation was excluded from the local-therapy category. Care was highly centralised within secondary and tertiary institutions. Conclusions: In this nationwide analysis, HCC in Turkey was characterised by limited OS and pronounced sex-based disparities, with survival differing by cirrhosis status and recorded etiology; etiologic ascertainment was itself survival-dependent, so these contrasts describe recorded categories. Hepatitis B was the most frequently recorded specific etiology, underscoring the continued importance of HBV prevention, screening, and surveillance, while HCV, HDV, alcohol-related and metabolic liver disease accounted for smaller recorded proportions; temporal trends in etiology were not analysed. Because tumour stage and liver function were unavailable, the treatment-survival associations are descriptive and subject to confounding by indication. Efforts focused on HBV control, earlier detection, risk-based surveillance of patients with cirrhosis, and improved referral pathways may improve population-level outcomes.
Background: Head and neck cancer (HNC) imposes a substantial burden in Aotearoa New Zealand (AoNZ), yet contemporary population-level data on incidence and early mortality across sociodemographic groups remain limited. Methods: This population-based retrospective cohort study used New Zealand Cancer Registry to identify all primary HNC diagnoses from 2009 to 2020 (n = 6980). The cases were classified according to ICD-10 subsites. Incidence rates (IRs), age-standardised IRs, and age-standardised rate ratios were estimated by age, sex, ethnicity, socioeconomic deprivation, and rurality. Regression models were used to estimate annual percentage change in IRs and to estimate adjusted risk ratios for two-year all-cause mortality. Results: In total 6980 people were diagnosed with HNC; an overall incidence rate of 13.5 per 100,000 person-years (PY). Oropharyngeal cancer (OPC), the most common subsite, increased from 3.4 per 100,000 PY in 2009-2011-4.9 per 100,000 PY in 2018-2020, whereas IRs for oral cavity cancer (OCC), the second most common, were more stable. HNC IRs were higher among males, older adults, Ma & strns;ori, Pacific Peoples and people living in the most socioeconomically deprived areas, with subsite-specific differences: Ma & strns;ori experienced higher OPC incidence rates, while Pacific Peoples experienced higher OCC IRs. Within two years of diagnosis, 25.2% of patients had died. Two-year all-cause mortality was 44.4% for hypopharyngeal cancer, 30.9% for OCC, and 22.7% for OPC. Among people diagnosed with HNC, after adjusting for available sociodemographic factors and treatment timing, two-year all-cause mortality was higher for Ma & strns;ori, Pacific Peoples, and those in the most deprived quintile. Rurality showed no consistent association with incidence or two-year mortality. Conclusions: These findings indicate an OPC-driven shift in HNC epidemiology in AoNZ and a persistent inequitable burden of both disease occurrence and early mortality, supporting stronger surveillance and equity-focused cancer-control responses.
