European Journal of Cancer Prevention最新文献

Background: This research aimed to quantify the incidence and risk factors for all-cause early mortality (defined as death within 3 months of diagnosis) versus cancer-specific early mortality in patients with nasopharyngeal squamous cell carcinoma (NPSCC).

Methods: Data on NPSCC patients diagnosed between 2004 and 2014 were retrieved from the Surveillance, Epidemiology, and End Results database. Early mortality was defined as survival less than or equal to 3 months. Logistic regression was employed to identify determinants associated with both overall and cancer-specific early mortality.

Results: Among 1891 eligible patients, 176 (9.3%) died within 3 months of diagnosis, including 156 (8.2%) whose deaths were cancer-related. Univariate analysis revealed that older age, single/divorced/widowed status, poorly differentiated histology, advanced T category, advanced N category, and distant metastasis were significantly linked to both overall and cancer-specific early mortality. After multivariable adjustment, older age, unmarried status, lower histologic grade, high T stage, and metastatic disease remained independent predictors of overall and cancer-specific early mortality. The advanced nodal stage was additionally associated with cancer-specific early mortality (all P < 0.05).

Conclusion: Elderly patients, aggressive tumor biology (poor differentiation, advanced T/N stage, distant metastasis), and unmarried status independently predict early mortality in NPSCC.

Germline BRCA1 and BRCA2 pathogenic and likely pathogenic variants (PVs) significantly increase the risk of breast cancer and ovarian cancer, forming the basis for hereditary breast and ovarian cancer syndrome. Current guidelines recommend risk-reducing salpingo-oophorectomy (RRSO) for women with PVs. This study aimed to evaluate the rate of uptake of RRSO among women with breast cancer who carry germline BRCA PVs. This retrospective study collected data from women with breast cancer who were identified to have germline BRCA PVs between 2020 and 2024 at Siriraj Hospital, Bangkok, Thailand. Baseline characteristics, including age, BMI, underlying diseases, menopausal status, recurrent or metastatic breast cancer, BRCA1 and BRCA2 PVs were recorded. The uptake rate and associated factors of RRSO among these women were analyzed. In addition, the time to surgery and pathological outcomes were evaluated in the RRSO group. One hundred and thirty-eight women were included in the final analysis. Among them, 81 (58.7%) underwent RRSO. Ovarian cancer was detected in six (7.4%) women who underwent RRSO. Factors associated with undergoing RRSO including age greater than or equal to 45 years and the absence of distant metastasis. The median interval between genetic testing and RRSO was 8 months. In the surveillance group, the median follow-up time was 39 months, and no cases of cancer were detected. The RRSO uptake rate among breast cancer patients with germline BRCA PVs was 58.7%. Efforts to improve this rate should focus on understanding reasons for refusal and offering alternative prevention strategies.

Background: Epidemiological evidence on dietary fat intake and advanced prostate cancer (PCa) risk is limited and inconclusive; moreover, no prospective study has been conducted to investigate the association between fat quality and quantity and advanced and lethal PCa risk.

Methods: This prospective cohort included 49 424 men from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. The fat quality index (FQI) and low-fat diet score (LFDs) were used to evaluate the quality and quantity separately, where higher scores indicated greater adherence. Cox proportional hazards regression was used to evaluate the risk of PCa incidence and mortality. Subgroup analyses were conducted to identify potential confounders. Sensitivity analyses were performed to assess the robustness of the results.

Results: During follow-up, a total of 857 incident cases of advanced PCa, including 425 lethal PCa were documented. Individuals in the highest compared with the lowest quartiles of FQI had a lower advanced PCa [hazard ratioQ4 versus Q1 : 0.72, 95% confidence interval (CI): 0.58-0.88, P for trend = 0.002] and lethal PCa (hazard ratioQ4 versus Q1 : 0.65, 95% CI: 0.48-0.87, P for trend = 0.005). This inverse association between FQI and advanced PCa risk was not observed for nonlethal PCa. Subgroup analyses indicated this inverse association of FQI with advanced PCa was only observed in participants with higher LFDs. No significant associations were found between LFDs and the risk of advanced and lethal PCa.

Conclusion: Our findings suggest focusing on higher quality, rather than restricting the quantity of fat intake, may be an effective approach to reduce the risk of advanced PCa in the US population, particularly for lethal PCa.

With 2,4-dichlorophenoxyacetic acid (2,4-D) being a widely used herbicide, understanding its potential health implications is crucial. This study investigates the association between 2,4-D exposure and all-cause and cancer mortality. A total of 9168 participants were enrolled from National Health and Nutrition Examination Survey. The levels of 2,4-D were measured with liquid chromatography/mass spectrometry. Cox proportional hazards regression analysis was conducted to explore associations with all-cause and cancer mortality. The average level of 2,4-D was 0.81 μg/l. After a median of 7.1-year follow-up, 903 all-cause and 203 cancer death occurred. Participants with higher 2,4-D levels were older, predominantly male, and exhibited a higher percentage of smokers with reduced estimated glomerular filtration rate levels. Comparing with the lowest quartile, the third quartile of 2,4-D was independently associated with decreased all-cause mortality [hazard ratio 0.79, 95% confidence interval (CI): 0.66-0.96; P = 0.015]. For cancer mortality, the highest quartile of 2,4-D was linked to increased risks (hazard ratio 2.18, 95% CI: 1.50-3.17; P < 0.001). The 2,4-D exposure was negatively associated with all-cause mortality. However, higher 2,4-D levels were consistently associated with elevated cancer mortality. These findings underscore the complex relationship between 2,4-D exposure and health outcomes, emphasizing the need for further research and consideration of multiple factors influencing mortality risks.

Colorectal cancer (CRC) is the third leading cause of cancer-related deaths worldwide, with smoking being a significant risk factor. Understanding the temporal and spatial patterns of the CRC burden attributable to smoking is crucial for global public health strategies. Data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 were used to calculate the number of deaths, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR) per 100 000 population, and age-standardized disability-adjusted life year rate (ASDR). The average annual percentage change (AAPC) was calculated from 1990 to 2021 to analyze disease burden trends. Frontier analysis was conducted to assess efficiency, and predictions were made for the next decade. In 2021, the global death toll and DALYs attributable to smoking were 47 613 and 1 235 667, respectively. From 1990 to 2021, the absolute number of deaths and DALYs increased, while ASMR (AAPC: -1.20) and ASDR (AAPC: -1.22) showed a significant decline. The disease burden was notably higher in males than females. Analysis by the Social Development Index revealed that more developed regions had a higher burden than less developed areas. China ranked first in the number of deaths and DALYs, while Greenland had the highest ASMR and ASDR. From 1990 to 2021, the age-standardized burden of CRC attributable to smoking decreased globally. However, the absolute burden remains a significant public health challenge, requiring sustained and targeted interventions.

This study aimed to evaluate the ability of the preoperative Hemoglobin, Albumin, Lymphocyte count, and Platelet (HALP) score to predict lymph node metastasis (LNM) in patients with rectal cancer (RC) and improve prediction accuracy by incorporating clinical parameters. Data from 263 patients with RC were analyzed. The receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value (OCV) for the HALP score in predicting LNM. Based on this cutoff value, patients were divided into two groups. A baseline analysis was conducted to identify independent factors linked to LNM. A support vector machine (SVM) prediction model was developed, and its performance was evaluated using ROC, calibration curves, decision curve analysis, and Kolmogorov-Smirnov curve. The OCV for HALP score was 45.979. Patients were then classified into a low HALP group ( n  = 182) and a high HALP group ( n  = 81). The analysis found 21 clinical factors significantly associated with LNM. Among them, the key risk factors included high inflammatory status, poor nutritional condition, and a low HALP score. The SVM model incorporated these factors and showed robust predictive performance, with area under the curve values of 0.897, 0.813, and 0.750 for the training, validation, and testing datasets, respectively. The HALP score was significantly associated with LNM in RC patients. A machine learning model integrating the HALP score and inflammatory markers may be an effective tool for predicting LNM in RC.

Deuterium is a natural heavy isotope of hydrogen, containing a neutron and a proton. This gives it distinct biophysical and biochemical properties, compared with hydrogen. Deuterium alters enzymatic activity in significant ways. Human metabolic processes minimize the amount of deuterium in mitochondrial water, because it causes a dysfunction in mitochondrial ATPase pumps, leading to excessive reactive oxygen species (ROS) and loss of ATP production. Mitochondrial dysfunction is a characteristic feature of cancer and many other diseases. Lactate plays an important role in cancer progression, and a central role holds also for vacuolar ATPases (V-ATPases). In the presence of excess deuterium, cancer cells show a remarkably altered metabolic policy, enabling invasion and proliferation. Cancer cells protect their mitochondria from excessive ROS by minimizing the use of ATPase to synthesize ATP. Instead, they rely on glycolysis to supply ATP and support the massive synthesis of lactate, which is excreted into the microenvironment. They also use V-ATPases in an unusual way at the plasma membrane to pump deuterium-depleted protons out of the cell, enriching cytoplasmic deuterium. These complex processes suggest that cancer cells are able to sense deuterium levels in the medium and commit apoptosis when deuterium levels are low or proliferate when they are high. Tumorigenesis involves a metabolic switch that supports increased cellular deuterium levels, decreasing the deuterium burden overall in the organism. Strong clinical evidence supports deuterium-depleted water (DDW) as an anticancer treatment. More investigations on cancer autophagic behavior are needed to guide DDW clinical use.

The growing number of cancer survivors has led to an increase in the frequency of multiple primary cancers. This study aimed to describe the temporal trends in the incidence rates and standardized incidence ratios (SIRs) of second primary cancers (SPCs) among patients diagnosed with a first primary cancer (FPC) in 2000-03, 2004-07 and 2008-11 in Northern Portugal. Population-based samples of patients diagnosed with an FPC (excluding skin non-melanoma) in 3 periods of 4 years, between 1 January 2000 and 31 December 2011, and registered in the Portuguese North Region Cancer Registry were followed for the diagnosis of an SPC or death until 31 December 2013. Incidence rates and SIRs were estimated for each period by sex, and considering the time between FPC and SPC diagnosis (synchronous and metachronous). During follow-up, 10 119 (7.4%) SPCs were identified among patients diagnosed with an FPC in 2000-11 ( n  = 136 382). The incidence rate of SPCs was over 10-fold higher in the first few months, remaining stable over the follow-up. Higher rates were observed in 2004-07 and 2008-11. Overall, a greater proportion of SPCs was diagnosed among males than females. The proportion of SPCs diagnosed increased with age. Increases in SIRs of SPCs were observed from 2000-03 to 2008-11, ranging from 1.16 to 1.77 and from 1.54 to 2.33, among males and females, respectively. This was particularly evident for FPCs and SPCs of the lip, oral cavity, pharynx, oesophagus and larynx among males, and colon and rectum, lung, ovary and cervix among females. Survivors of cancer in Northern Portugal had higher incidence rates of cancer than the general population, which have increased over time. Our findings highlight the need for enhanced surveillance and tailored strategies for survivors of cancer, emphasizing the challenges of their heightened cancer risk, patient expectations, and associated economic burden.

Objectives: The prognostic significance of microsatellite instability (MSI) and HER2 status in advanced gastric cancer (AGC) treated with neoadjuvant or conversion chemotherapy (NAC) remains unclear. This study aimed to evaluate their impact on pathological response and survival outcomes in AGC patients undergoing NAC followed by surgery.

Methods: This single-center, retrospective observational study included 121 patients with gastric adenocarcinoma at clinical stage >cT2N0, defined as tumor invasion beyond the muscularis propria, nodal involvement, or both. Eligible patients received at least two cycles of NAC and underwent surgical resection. Adults without other malignancies and with biopsy samples available for molecular analysis were included. Data were obtained from a prospectively maintained surgical database. Imaging studies were reviewed by expert radiologists, and molecular analyses were performed in the pathology department.

Results: Among the 121 patients, MSI was identified in 6.6% and HER2 positivity in 9.9%. All MSI tumors were HER2 negative ( P  < 0.001). HER2 positivity was more frequent in intestinal-type tumors ( P  = 0.034) and was associated with better pathological response ( P  = 0.048). The 5-year overall survival (OS) rate was 44.7%, with a median OS of 42.6 months. Multivariate Cox regression identified tumor location in the upper third, residual tumor, nodal stage, Lauren diffuse-mixed histotype, and negative HER2 status as independent prognostic factors ( P  < 0.05). MSI status was not significantly associated with OS ( P  = 0.786), although a trend toward improved survival was observed in MSI-H patients.

Conclusions: HER2 overexpression correlated with better pathological response and independently predicted improved OS. MSI and HER2 status may serve as biomarkers to guide preoperative treatment strategies in AGC.

It is often reported that participation in the German colorectal cancer (CRC) screening program is low. However, it must be considered that fecal occult blood testing (FOBT) and colonoscopy are offered in parallel and both are also used for diagnostic purposes. We aimed to quantify and characterize the uptake of these colorectal examinations in Germany. Using the claims database German Pharmacoepidemiological Research Database (~20% of the German population), we included persons aged 50 in 2011 in cohort 1 (cohort 2: age 55) and assessed whether they utilized FOBT or colonoscopy for screening or diagnostic purposes until age 59 (cohort 2: age 64). We have stratified the analyses, i.e. by gender and educational level. Among 185 949 50-year olds, 80% of women and 63% of men had ≥1 colorectal examination (i.e. FOBT or colonoscopy) until age 59; 25% of women and 31% of men had ≥1 colonoscopy (among those, 76 and 62% had a screening colonoscopy). In women with lower vs higher education, 79 vs 82% had any colorectal examination; in men, these proportions were 60 vs 67%. Among 156 258 55-year olds, 78% of women and 69% of men had ≥1 colorectal examination until age 64. Our study demonstrates a high utilization of colorectal examinations in Germany. It also illustrates the value of health claims data to monitor CRC screening in Germany due to their longitudinal character and because they include information on screening, on examinations done for diagnostic reasons as well as information suitable to characterize users and nonusers.