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Publications (7 of 7) Show all publications
Nyström, K. & Olsson, L. (2024). A systematic review of population-based studies on metachronous metastases of colorectal cancer. World Journal of Surgery, 48(6), 1521-1533
Open this publication in new window or tab >>A systematic review of population-based studies on metachronous metastases of colorectal cancer
2024 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 48, no 6, p. 1521-1533Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: The occurrence of metachronous metastases (MM) of colorectal (CRC), colon (CC), and rectal (RC) cancer of population-based studies has not been compiled in a systematic review previously.

METHODS: MEDLINE, Embase, and Cochrane Library were searched for primary studies of any design from inception until January 2021 and updated in August 2023 (CRD42021261648). The PRISMA guidelines were adopted, and the Newcastle-Ottawa Quality Assessment Scale used for risk of bias assessment. Outcomes on overall and organ-specific MM were extracted. A narrative analysis followed.

RESULTS: Out of 2143 unique hits, 162 publications were read in full-text and 37 population-based cohort studies published in 1981-2022 were included. Ten studies adopted time-dependent analyses; eight were registry-based and seven had a low risk of bias. Three studies reported 5-year recurrence rate of MM overall of stages I-III; for CRC, it was 20.5%, for CC, it was 18% and 25.6%, and for RC, it was 23%. Four studies reported 5-year recurrence rate of organ-specific MM of stages I-III-for CRC, it was 2.2% and 5.5% for peritoneal metastases and 5.8% for lung metastases and for CC 4.5% for peritoneal metastases. Twenty-seven studies reported proportions of patients diagnosed with MM, but data on the length of follow-up was incomplete and varied widely. Proportions of patients with CRC stages I-III that developed MM overall was 14.4%-26.1% in 10 studies. In relation to the enrollment period, a downward trend may be discernible.

CONCLUSION: Studies adopting a more appropriate analysis were highly heterogeneous, whereas uncertain data of partly inadequate studies may indicate that MM are overall declining.

Place, publisher, year, edition, pages
Springer, 2024
Keywords
Colorectal neoplasms, population‐based study, recurrence, systematic review
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-113680 (URN)10.1002/wjs.12204 (DOI)001222813100001 ()38747538 (PubMedID)2-s2.0-85193412366 (Scopus ID)
Funder
Region Örebro County
Available from: 2024-05-21 Created: 2024-05-21 Last updated: 2024-07-23Bibliographically approved
Olsson, L. & Sjöberg, D. (2023). Accuracy of a faecal immunochemical test in patients under colonoscopy surveillance of colorectal adenoma and cancer. Upsala Journal of Medical Sciences, 128(1)
Open this publication in new window or tab >>Accuracy of a faecal immunochemical test in patients under colonoscopy surveillance of colorectal adenoma and cancer
2023 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 128, no 1Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Surveillance of colorectal neoplasia place great strain on colonoscopy resources, and faecal immunochemical tests (FIT) are under-investigated for this purpose. The aim of this study was to report the outcome of FIT among patients scheduled for post-polypectomy and post-resection colorectal cancer (CRC) surveillance.

METHODS: Patients scheduled for colonoscopy surveillance at five endoscopy units in mid-Sweden in 2016-2020 were eligible. They provided a faecal sample from 2 separate days, which were analysed by iFOBT QuikRead go® (Aidian Oy). Both the colonoscopies, and the FIT analyses were conducted by staff blinded to the other.

RESULTS: Out of 216 included patients, 157 (73%) underwent both a complete colonoscopy and had at least one FIT analysed prior to the examination. The indication for surveillance was previous adenoma in 69 (44%) and post-resection CRC in 88 (56%) patients. Two (1%) in the CRC surveillance group were diagnosed with a metachronous CRC, whereas 49 (56%) patients in the CRC surveillance, and 17 (25%) in the adenoma group had no pathology identified at colonscopy (P < 0.001). The proportion of patients diagnosed with adenomas requiring surveillance according to European Society of Gastrointestinal Society (ESGE) guidelines 2020 was 6 (7%) in the post-CRC resection versus 7 (10%) in the adenoma surveillance group (P = 0.4). Based on one FIT and at cut-off 10 µg Hb/g, sensitivity for CRC was 100%, specificity 83% (95% confidence interval [CI]: 77-89), Positive Predictive Value (PPV) 7% (-2 to 16) and Negative Predictive Value (NPV) 100%. All patients with an adenoma requiring surveillance had a FIT below this cut-off. Adding a second FIT decreased the specificity.

CONCLUSION: Larger studies to evaluate the accuracy and consequences of using FIT for surveillance of colorectal neoplasia are needed. FIT may be more interesting for post-resection CRC surveillance than follow-up of adenoma.

Place, publisher, year, edition, pages
Upsala Medical Society, 2023
Keywords
Colorectal cancer, adenoma, colonoscopy, faecal immunochemical test, surveillance
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-107480 (URN)10.48101/ujms.v128.8869 (DOI)001029067400001 ()37441110 (PubMedID)2-s2.0-85164847384 (Scopus ID)
Funder
Afa Sjukförsäkringsaktiebolag
Available from: 2023-08-09 Created: 2023-08-09 Last updated: 2024-03-05Bibliographically approved
Snellman, A., Carlberg, S. & Olsson, L. (2023). Conflict of interest and risk of bias in systematic reviews on methylphenidate for attention-deficit hyperactivity disorder: a cross-sectional study. Systematic Reviews, 12(1), Article ID 175.
Open this publication in new window or tab >>Conflict of interest and risk of bias in systematic reviews on methylphenidate for attention-deficit hyperactivity disorder: a cross-sectional study
2023 (English)In: Systematic Reviews, E-ISSN 2046-4053, Vol. 12, no 1, article id 175Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Systematic reviews (SRs) are pivotal to evidence-based medicine, yet there is limited research on conflicts of interest in SRs. Our aim was to investigate financial conflicts of interest and risk of bias (RoB) in SRs of a well-defined clinical topic.

METHODS: A librarian searched Medline, Cochrane Library, Embase, and PsycINFO for SRs investigating the effect of methylphenidate on ADHD in December 2020. The selection process adhered to the PRISMA guidelines. Two blinded reviewers independently searched open websites, including other publications, for information on financial conflicts of interest of all authors of the included SRs. A time limit of 3 years before or after the index SR was adopted. Declarations on conflict of interest were extracted from the included SRs for comparison. ROBIS was used for RoB assessment.

RESULTS: Out of 44 SRs included, 15 (34%) declared conflict of interest, 27 (61%) did not, and a declaration of conflict of interest was missing for 2 (5%). On open websites, conflict of interest was found for at least one author of 23 (52%) SRs: disclosed in 15 (34%) and not disclosed in 8 (18%) SRs. Seven (16%) SRs had low, 36 (82%) had high, and 1 (2%) had unclear RoB. Among SRs with financial conflict of interest found in open sources, 6/22 (27%) had low RoB compared to 1/21 (5%) if no such conflict of interest was identified. Among SRs with financial conflict of interest identified, 1/6 (17%) at low RoB did not disclose their conflict of interest, whereas the corresponding proportion among SRs at high RoB was 7/16 (44%). Eight (18%) SRs presented conflict of interest disclosed in the included primary studies. Four of them (50%) had low RoB, compared to 3/36 (8%) for SRs not reporting on this aspect.

CONCLUSION: Financial conflict of interest was underreported in 18% of the SRs using our reference standard, and overall it was present for every second SR. This group embraced both SRs at low RoB disclosing conflict of interest and SRs at high RoB not disclosing their conflict of interest. Further studies to explore this heterogeneity are warranted.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Conflict of interest, Disclosure, Risk of bias, Systematic review
National Category
Information Studies Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-108578 (URN)10.1186/s13643-023-02342-x (DOI)001072385400001 ()37752560 (PubMedID)2-s2.0-85172152639 (Scopus ID)
Available from: 2023-09-27 Created: 2023-09-27 Last updated: 2023-10-17Bibliographically approved
Czajkowski, M. & Olsson, L. (2023). Intressekonflikter påverkar den medicinska forskningen i alla led: [Conflicts of interest are ever present in medical research]. Läkartidningen, 120(20/21), Article ID 23013.
Open this publication in new window or tab >>Intressekonflikter påverkar den medicinska forskningen i alla led: [Conflicts of interest are ever present in medical research]
2023 (English)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 120, no 20/21, article id 23013Article in journal (Refereed) Published
Abstract [sv]

Evidensbaserad vård förutsätter opartiska underlag.

Intressekonflikter är ständigt närvarande i medicinsk forskning, och mycket har gjorts för att de ska redovisas på ett transparent sätt.

Enbart transparens löser dock inte problemet.

Studier tyder på att finansiella intressekonflikter i kliniska prövningar påverkar både forskningsfråga, metod, resultat och tolkning.

Icke-finansiella intressekonflikter kan också finnas, men är mindre studerade.

Det behövs mer forskning om intressekonflikter, deras konsekvenser och hur de ska hanteras.

Abstract [en]

Considerable efforts have been undertaken to optimize the disclosures of authors but transparency alone will not solve the problem. Financial conflicts of interest in clinical trials are known to affect the research question, study design, and results as well as the conclusions. Non-financial conflicts of interest are less well studied. As a non-negligible proportion of studies are associated with conflicts of interest, more research in this field is warranted, in particular on the management and consequences of such conflicts.

Place, publisher, year, edition, pages
Läkartidningen Förlag AB, 2023
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-105969 (URN)37191392 (PubMedID)
Available from: 2023-05-17 Created: 2023-05-17 Last updated: 2024-04-25Bibliographically approved
Lööv, A., Högberg, C., Lilja, M., Theodorsson, E., Hellström, P., Metsini, A. & Olsson, L. (2022). Diagnostic accuracy for colorectal cancer of a quantitative faecal immunochemical test in symptomatic primary care patients: a study protocol. Diagnostic and prognostic research, 6(1), Article ID 16.
Open this publication in new window or tab >>Diagnostic accuracy for colorectal cancer of a quantitative faecal immunochemical test in symptomatic primary care patients: a study protocol
Show others...
2022 (English)In: Diagnostic and prognostic research, ISSN 2397-7523, Vol. 6, no 1, article id 16Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There is increasing evidence supporting the use of faecal immunochemical tests (FIT) in patients reporting symptoms associated with colorectal cancer (CRC), but most studies until now have focused on selected subjects already referred for investigation. We therefore set out to determine the accuracy and predictive values of FIT in a primary care population.

METHOD: A prospective, multicentre, single-gated comparative diagnostic study on quantitative FIT in patients aged 40 years and above presenting in primary care with symptoms associated with CRC will be conducted. Patients representing the whole spectrum of severity of such symptoms met with in primary care will be eligible and identified by GPs. Participants will answer a short form on symptoms during the last month. They will provide two faecal samples from two separate days. Analyses will be performed within 5 days (QuikRead go®, Aidian Oy). The analytical working range is 10-200 μg Hb/g faeces. Reference test will be linked to the Swedish Colorectal Cancer Registry up to 2 years after inclusion. Accuracy, area under ROC curves, and predictive values will be calculated for one FIT compared to the highest value of two FIT and at cutoff < 10, 10-14.9, 15-19.9 and ≥ 20 μg Hb/g faeces. Subgroup analyses will be conducted for patients with anaemia and those reporting rectal bleeding. A model-based cost-effectiveness analysis based on the clinical accuracy study will be performed. Based on previous literature, we hypothesized that the sensitivity of the highest value of two FIT at cutoff 10 μg Hb/g faeces will be 95% (95% CI + / - 15%). The prevalence of CRC in the study population was estimated to be 2%, and the rate of non-responders to be 1/6. In all, 3000 patients will be invited at 30 primary care centres.

DISCUSSION: This study will generate important clinical real-life structured data on accuracy and predictive values of FIT in the most critical population for work-up of CRC, i.e. patients presenting with at times ambiguous symptoms in primary care. It will help establish the role of FIT in this large group.

TRIAL REGISTRATION: NCT05156307 . Registered on 14 December 2021-retrospectively registered.

Place, publisher, year, edition, pages
BioMed Central, 2022
Keywords
Colorectal cancer, Diagnostic accuracy study, Primary care, Quantitative faecal immunochemical test, Sensitivity
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-100720 (URN)10.1186/s41512-022-00129-7 (DOI)001210931700001 ()35978403 (PubMedID)
Available from: 2022-08-19 Created: 2022-08-19 Last updated: 2025-01-20Bibliographically approved
Li, M., Cao, Y. & Olsson, L. (2021). A population-based study on time trends of hemoglobin in primary care comparing prediagnostic colorectal cancer patients vs age- and sex-matched controls. Scandinavian Journal of Gastroenterology, 56(3), 266-273
Open this publication in new window or tab >>A population-based study on time trends of hemoglobin in primary care comparing prediagnostic colorectal cancer patients vs age- and sex-matched controls
2021 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 56, no 3, p. 266-273Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Some 40% of colorectal cancer (CRC) patients present with anemia. Temporal trends of gradually decreasing Hb are suggested as a supplementary diagnostic tool for CRC. We set out to explore this concept in a strictly defined population.

METHODS: A laboratory database identified patients ≥40 years that had ≥1 Hb test reported from primary care, Örebro county in 2000-17. Linkage to the Swedish Colorectal Cancer Registry identified patients diagnosed with CRC. Other primary care patients served as controls (1:10), matched by age and sex. Prediagnostic Hb in cases and controls were compared and temporal trajectories of Hb modelled using a nonlinear three-parameter logistic function.

RESULTS: primary care was surprisingly low, and was ≥50% annually only in octogenarians.

CONCLUSION: The findings indicate a potential for Hb trends to inform the diagnostic process of CRC but whether it will translate into any clinical advantage is yet uncertain.

Place, publisher, year, edition, pages
Taylor & Francis, 2021
Keywords
Hemoglobin, colorectal neoplasms, early detection of cancer, primary healthcare
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-89462 (URN)10.1080/00365521.2021.1879245 (DOI)000616214000001 ()33555210 (PubMedID)2-s2.0-85100802761 (Scopus ID)
Note

Funding Agency:

Nyckelfonden, Örebro, Sweden

Available from: 2021-02-09 Created: 2021-02-09 Last updated: 2024-03-05Bibliographically approved
Breimer, L. H., Nousios, P., Olsson, L. & Brunnström, H. (2020). Immune checkpoint inhibitors of the PD-1/PD-L1-axis in non-small cell lung cancer: promise, controversies and ambiguities in the novel treatment paradigm. Scandinavian Journal of Clinical and Laboratory Investigation, 80(5), 360-369
Open this publication in new window or tab >>Immune checkpoint inhibitors of the PD-1/PD-L1-axis in non-small cell lung cancer: promise, controversies and ambiguities in the novel treatment paradigm
2020 (English)In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 80, no 5, p. 360-369Article, review/survey (Refereed) Published
Abstract [en]

Immune checkpoint inhibitors (ICIs) have received much attention not least for melanoma since the award of the Nobel prize in 2018. Here, we review the current state of knowledge about the use of these monoclonal antibodies (mAbs) in non-small cell lung cancer (NSCLC). These drugs have generally been conditionally approved on limited early data and there are few long-term follow-up data from randomized clinical trials. The effect observed for NSCLC thus far is, on average, moderately better than that obtained with chemotherapy. Severe side-effects are more common than might have been expected. The drugs themselves are expensive and are associated with time-consuming histopathologic testing even though the predictive value of these tests can be discussed. In addition, monitoring for side-effects involves increased workload and budgetary expense for clinical chemistry laboratories. Here, we review and summarize the current knowledge, controversies and ambiguities of ICIs for the treatment of NSCLC.

Place, publisher, year, edition, pages
Taylor & Francis, 2020
Keywords
Non-small-cell lung carcinoma, PD-1/PD-L1, biomarkers, immune checkpoint inhibition, pharmaceutical economics
National Category
Pharmacology and Toxicology
Identifiers
urn:nbn:se:oru:diva-81041 (URN)10.1080/00365513.2020.1742369 (DOI)000523024400001 ()32238062 (PubMedID)2-s2.0-85082809536 (Scopus ID)
Available from: 2020-04-06 Created: 2020-04-06 Last updated: 2024-03-05Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-8708-7502

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