European Journal of Cancer最新文献

Risk of pancreatic cancer after eradication treatment of Helicobacter pylori 根除幽门螺杆菌治疗后胰腺癌的风险

IF 7.1 1区医学 Q1 ONCOLOGY

European Journal of Cancer

Pub Date : 2025-12-18 DOI: 10.1016/j.ejca.2025.116192

Anna-Klara Wiklund , Giola Santoni , Cecilia Radkiewicz , Shaohua Xie , Helgi Birgisson , Eivind Ness-Jensen , My von Euler-Chelpin , Joonas H. Kauppila , Jesper Lagergren

Objectives

Helicobacter pylori infection seems to increase the risk of developing pancreatic cancer, but it is unknown whether eradication treatment of this bacterium changes this risk. We hypothesized that the increased risk of pancreatic cancer among individuals infected with Helicobacter pylori decreases over time after eradication treatment.

Methods

This multinational and population-based cohort study, using prospectively collected nationwide register data from 1995 to 2019, included all adults who received eradication treatment for Helicobacter pylori in Denmark, Finland, Iceland, Norway, or Sweden. Standardized incidence ratios (SIR) with 95 % confidence intervals (95 %CI) were calculated by dividing the incidence rates of pancreatic cancer in the eradication treatment cohort by that of the entire populations of the corresponding age, sex, calendar year, and country. The main outcome was changes in SIR over time after eradication treatment.

Results

During up to 24 years of follow-up of 661,827 participants and 5494,255 person-years in the eradication treatment cohort, 2331 participants developed pancreatic cancer. The risk of pancreatic cancer was increased during the first 1–5 years after eradication treatment (SIR 1.14, 95 % CI 1.07–1.21), after which it decreased and became similar to the level of the background population 6–10 years (SIR 0.99, 95 % CI 0.92–1.07) and 11–24 years (SIR 1.00, 95 % CI 0.92–1.08) after eradication treatment.

Conclusion

The elevated risk of developing pancreatic cancer among individuals with Helicobacter pylori infection seems to decrease after eradication treatment, reaching the risk estimates of the background population.

目的幽门螺杆菌感染似乎会增加患胰腺癌的风险，但目前尚不清楚根除这种细菌的治疗是否会改变这种风险。我们假设，幽门螺杆菌感染者胰腺癌风险的增加在根除治疗后随着时间的推移而降低。方法：这项以人群为基础的跨国队列研究，使用1995年至2019年期间前瞻性收集的全国登记数据，包括丹麦、芬兰、冰岛、挪威或瑞典接受幽门螺杆菌根除治疗的所有成年人。通过将根除治疗队列中胰腺癌的发病率除以相应年龄、性别、日历年和国家的整个人群的发病率，计算出具有95 %置信区间（95 %CI）的标准化发病率（SIR）。主要结果是根除治疗后SIR随时间的变化。结果在长达24年的随访中，661,827名参与者和根除治疗队列的5494,255人年，2331名参与者发展为胰腺癌。胰腺癌的风险在根除治疗后的前1-5年增加（SIR 1.14, 95 % CI 1.07-1.21），之后降低并与根除治疗后6-10年（SIR 0.99, 95 % CI 0.92-1.07）和11-24年（SIR 1.00, 95 % CI 0.92-1.08）的背景人群水平相似。结论幽门螺杆菌感染个体在根除治疗后发生胰腺癌的风险降低，达到背景人群的风险估计。

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引用次数: 0

Response to letter Re: “Patient-related prognostic factors in older adults with head and neck cancer: The EGeSOR clinical trial”. 对Re：“老年头颈癌患者相关预后因素：EGeSOR临床试验”的回应。

IF 7.1 1区医学 Q1 ONCOLOGY

European Journal of Cancer

Pub Date : 2025-12-13 DOI: 10.1016/j.ejca.2025.116170

Charlotte Lafont, Elena Paillaud, Lydia Brugel, Florence Canouï-Poitrine

引用次数: 0

Cardiotoxic effects of BRAF/MEK inhibition: An observational study BRAF/MEK抑制的心脏毒性作用：一项观察性研究

IF 7.1 1区医学 Q1 ONCOLOGY

European Journal of Cancer

Pub Date : 2025-12-12 DOI: 10.1016/j.ejca.2025.116182

Jannek Brauer , Daniel Scheidet , Sebastian Romann , Christina Zehender , Jessica Hassel , Norbert Frey , Lorenz H. Lehmann

Background

BRAF/MEK inhibitors are a cornerstone of the therapy of BRAF-mutant cancers. Despite frequent use, the incidence of cardiovascular side effects is still unclear. Data on cancer therapy-related cardiac dysfunction (CTRCD), particularly using contemporary biomarker-inclusive definitions, remain limited.

Objectives

To assess the incidence and risk factors of CTRCD in patients receiving BRAF/MEK inhibitors, using the International Cardio-Oncology Society (ICOS) definitions, which include cardiac imaging and biomarker assessments.

Methods

A total of 75 patients treated with BRAF/MEK inhibitors underwent prospective cardiotoxicity monitoring with two follow-up visits at 90 days (IQR 36–137 days) and 199 days (IQR 115–266 days). Standardized evaluations included echocardiography with global longitudinal strain (GLS), high-sensitivity cardiac troponin T (hs-cTnT), and NT-proBNP measurements at baseline and follow-up visits. CTRCD was classified according to ICOS criteria. Baseline risk was stratified by European Society of Cardiology (ESC) risk categories.

Results

CTRCD occurred in 33 of 75 patients (44 %), with 17 % classified as mild, 23 % moderate, and 4 % severe. Baseline age, sex, BMI, and most cardiovascular risk factors were not significantly associated with CTRCD. Coronary artery disease was the only baseline variable associated with increased CTRCD (OR 11.0, p = 0.029; univariate analysis), whereas elevated hs-cTnT, NT-proBNP, or reduced LVEF at baseline were not predictive. Absolute CTRCD numbers were highest in the high ESC-defined cardiovascular risk category group, while incidence peaked in the low-risk group. Other cardiac complications occurred in 41 patients (55 %).

Conclusions

CTRCD is frequent among patients treated with BRAF/MEK inhibitors. Traditional cardiovascular risk factors were not predictive, although coronary artery disease emerged as a strong risk marker. These findings highlight the need for dynamic surveillance strategies.

braf /MEK抑制剂是braf突变型癌症治疗的基础。尽管频繁使用，心血管副作用的发生率仍不清楚。关于癌症治疗相关心功能障碍（CTRCD）的数据，特别是使用当代生物标志物包容性定义的数据仍然有限。目的利用国际心脏肿瘤学会（ICOS）的定义，包括心脏成像和生物标志物评估，评估接受BRAF/MEK抑制剂的患者CTRCD的发生率和危险因素。方法对75例接受BRAF/MEK抑制剂治疗的患者进行前瞻性心脏毒性监测，并在90天（IQR 36-137天）和199天（IQR 115-266天）进行两次随访。标准化评估包括超声心动图总体纵向应变（GLS），高灵敏度心肌肌钙蛋白T (hs-cTnT)，以及基线和随访时的NT-proBNP测量。根据ICOS标准对CTRCD进行分类。基线风险按欧洲心脏病学会（ESC）风险分类分层。结果75例患者中有33例（44. %）发生sctrcd，其中轻度17 %，中度23 %，重度4 %。基线年龄、性别、BMI和大多数心血管危险因素与CTRCD无显著相关性。冠状动脉疾病是唯一与CTRCD升高相关的基线变量（OR 11.0, p = 0.029；单变量分析），而基线时hs-cTnT、NT-proBNP升高或LVEF降低没有预测作用。绝对CTRCD数在esc定义的心血管高危组最高，而发生率在低危组最高。其他心脏并发症41例（55% %）。结论sctrcd在BRAF/MEK抑制剂治疗的患者中较为常见。传统的心血管危险因素不能预测，尽管冠状动脉疾病成为一个强有力的危险标志。这些发现突出了动态监测战略的必要性。

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引用次数: 0

Review and comment on the retrospective analyses of the effect of immunotherapy-infusion time of day on outcome in patients with advanced non-small cell lung cancer 回顾和评论免疫治疗输注时间对晚期非小细胞肺癌患者预后影响的回顾性分析。

IF 7.1 1区医学 Q1 ONCOLOGY

European Journal of Cancer

Pub Date : 2025-12-11 DOI: 10.1016/j.ejca.2025.116171

Van Tai Nguyen , Rufina Binoy, Foteini Kalofonou, Michael Davidson, Mary O’Brien

引用次数: 0

Enhancing clinicians’ trust in large language models via transparent source attribution: A randomized controlled evaluation in uro-oncology 通过透明来源归因增强临床医生对大型语言模型的信任：一项泌尿肿瘤学随机对照评估。

IF 7.1 1区医学 Q1 ONCOLOGY

European Journal of Cancer

Pub Date : 2025-12-11 DOI: 10.1016/j.ejca.2025.116168

Nicolas Carl , Martin Joachim Hetz , Christoph Wies , Sarah Haggenmüller , Jana Theres Winterstein , Maurin Helen Mangold , Lasse Maywald , Thomas Stefan Worst , Niklas Westhoff , Maurice Stephan Michel , Frederik Wessels , Titus Josef Brinker

Introduction

Large language models (LLMs) are utilized to answer queries in urology and oncology, yet the performance is limited due to outdated data and missing source transparency, which undermines clinical reliability and therefore adoption.

Material and methods

We developed UroBot, a urology-specific chatbot integrating retrieval-augmented generation (RAG) to provide in-line references and source text previews for each response. In a randomized controlled reader study, UroBot and ChatGPT were compared across ten uro-oncological case rounds. Thirty urologists assessed recommendation correctness, source verifiability and trust with preference ratings collected after each round.

Results

UroBot performed significantly better than ChatGPT in recommendation correctness (73 % vs. 50 %; p < 0.001), source attribution (74 % vs. 30 %; p < 0.001) and verifiability of sources (84 % vs. 35 %; p < 0.001). Furthermore, clinicians consistently preferred UroBot for accuracy, source verifiability and trust. Qualitative analysis showed that ChatGPT often produced vague or incorrect citations, with 28 % being non-existent or outdated and 83 % lacking specific sections, whereas UroBot achieved complete alignment on guideline sub-section and page level. These gains in citation precision were mirrored by higher clinician ratings for verifiability and trust. Limitations include the small sample size of ten cases due to feasibility, which may not cover the full uro-oncological spectrum.

Conclusion

Our findings show that combining LLMs with RAG with in-line references and source text previews markedly enhances perceived source attribution and verifiability compared to state-of-the-art conventional LLMs. Importantly, this approach is readily transferable across medical subspecialties, enabling reliable and up-to-date clinical decision support.

简介：大型语言模型（llm）用于回答泌尿外科和肿瘤学的查询，但由于过时的数据和缺乏来源透明度，性能受到限制，这破坏了临床可靠性，因此被采用。材料和方法：我们开发了UroBot，一个泌尿科专用的聊天机器人，集成了检索增强生成（RAG），为每个回复提供内联参考和源文本预览。在一项随机对照阅读器研究中，UroBot和ChatGPT在10个泌尿肿瘤病例轮次中进行了比较。30名泌尿科医生评估推荐的正确性、来源的可验证性和信任度，并在每一轮后收集偏好评分。结果：UroBot在推荐正确性方面的表现明显优于ChatGPT（73% % vs. 50% %;p ）结论：我们的研究结果表明，与最先进的传统llm相比，将llm与带有内联参考文献和源文本预览的RAG相结合，显著提高了感知源归因和可验证性。重要的是，这种方法很容易在医学亚专科之间转移，从而实现可靠和最新的临床决策支持。

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引用次数: 0

Corrigendum to “International expert consensus on the clinical integration of circulating tumor cells in solid tumors” [Eur. J. Cancer 231 (2025) 116050] “循环肿瘤细胞在实体瘤中的临床整合的国际专家共识”的勘误表[欧洲]。癌症[j] . 231 (2025) 116050]

IF 7.1 1区医学 Q1 ONCOLOGY

European Journal of Cancer

Pub Date : 2025-12-10 DOI: 10.1016/j.ejca.2025.116167

Eleonora Nicolò , Carolina Reduzzi , Jean-Yves Pierga , Paola Gazzaniga , Nikolas H. Stoecklein , Valeria Denninghoff , Dominic G. Rothwell , Johann S. De Bono , Dario Marchetti , Evi Lianidou , Sabine Riethdorf , Daniele Generali , Paul Hofman , Lorenzo Gerratana , Peter Kuhn , Jean Paul Thiery , Michail Ignatiadis , Francois-Clement Bidard , Anthony Lucci , Sabine Kasimir-Bauer , Massimo Cristofanilli

引用次数: 0

Long-term outcomes of preoperative nivolumab with or without relatlimab in patients with resectable non-small-cell lung cancer (NEOpredict-Lung) 可切除的非小细胞肺癌患者术前nivolumab联合或不联合relalmab的长期预后（nepredict - lung）

IF 7.1 1区医学 Q1 ONCOLOGY

European Journal of Cancer

Pub Date : 2025-12-05 DOI: 10.1016/j.ejca.2025.116165

Kristof Cuppens , Marcel Wiesweg , Paul Baas , Brigitte Maes , Bert Du Pont , Till Ploenes , Dirk Theegarten , Michel Vanbockrijck , Clemens Aigner , Koen Hartemink , Fabian Doerr , Servet Bölükbas , Karin Pat , Martin Schuler

Background

Preoperative immunotherapy targeting PD-1/-L1 with chemotherapy induces histopathological responses and improves survival in patients with resectable non-small cell lung cancer (NSCLC). NEOpredict-Lung (NCT04205552) established the feasibility of dual blockade of PD-1 and LAG-3 immune checkpoints prior to curatively intended resection. Here we report extended follow-up, postoperative treatments and patterns of response and recurrence.

Patients and methods

Patients with resectable NSCLC (stages IB-IIIA) were randomized to receive two doses nivolumab (240 mg, arm A) with or without relatlimab (80 mg, arm B) every 2 weeks. Overall and disease-free survival (OS, DFS) rates, response and recurrence patterns and subsequent therapies were evaluated.

Results

60 patients were enrolled from March 2020 to July 2022. The present analysis was conducted per December 2024 with a median follow-up of 37.4 months. 45 patients were alive without disease recurrence,15 patients recurred (4 locoregional and 11 metastatic), and 7 patients died. The 3-year OS and DFS rates were 88.4 % and 73.3 % in arm A and 88.9 % and 60.3 % in arm B. Patients achieving major pathological response (≤10 % viable tumor cells in resected NSCLC) trended towards better DFS (HR 0.35; 95 % CI, 0.1–1.19). Downstaging was confirmed in 53.3 % of patients in arm A and in 66.7 % of patients in arm B. Nodal downstaging occurred in 28.6 % of patients with nodal disease in arm A and in 66.7 % of patients in arm B.

Conclusions

Short course preoperative nivolumab with or without relatlimab showed encouraging efficacy and survival outcomes, which compare favorably with chemo-immunotherapy-based perioperative treatment regimens.

背景：术前针对PD-1/-L1的免疫治疗联合化疗可诱导可切除的非小细胞肺癌（NSCLC）患者的组织病理反应并提高生存率。nepredict - lung （NCT04205552）确定了在治疗预期切除前双重阻断PD-1和LAG-3免疫检查点的可行性。在这里，我们报告延长随访，术后治疗和模式的反应和复发。患者和方法可切除的NSCLC （IB-IIIA期）患者每2周随机接受两种剂量的nivolumab（240 mg， A组）联合或不联合relatlimab（80 mg， B组）。评估总生存率和无病生存率（OS， DFS）、反应和复发模式以及随后的治疗。结果从2020年3月至2022年7月入组60例患者。本分析于2024年12月进行，中位随访时间为37.4个月。45例患者存活，无疾病复发，15例复发（4例局部，11例转移），7例死亡。A组的3年OS和DFS率分别为88.4 %和73.3 %，b组的3年OS和DFS率分别为88.9 %和60.3 %。达到主要病理反应（切除的NSCLC中活肿瘤细胞≤10 %）的患者趋向于更好的DFS （HR 0.35; 95 % CI, 0.1-1.19）。A组53.3 %的患者和b组66.7 %的患者证实了分期降低，A组28.6 %的淋巴结疾病患者和b组66.7 %的患者证实了分期降低。结论短期术前尼武单抗联合或不联合相对单抗显示出令人鼓舞的疗效和生存结果，与基于化学免疫治疗的围手术期治疗方案相比优势明显。

{"title":"Long-term outcomes of preoperative nivolumab with or without relatlimab in patients with resectable non-small-cell lung cancer (NEOpredict-Lung)","authors":"Kristof Cuppens , Marcel Wiesweg , Paul Baas , Brigitte Maes , Bert Du Pont , Till Ploenes , Dirk Theegarten , Michel Vanbockrijck , Clemens Aigner , Koen Hartemink , Fabian Doerr , Servet Bölükbas , Karin Pat , Martin Schuler","doi":"10.1016/j.ejca.2025.116165","DOIUrl":"10.1016/j.ejca.2025.116165","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative immunotherapy targeting PD-1/-L1 with chemotherapy induces histopathological responses and improves survival in patients with resectable non-small cell lung cancer (NSCLC). NEOpredict-Lung (NCT04205552) established the feasibility of dual blockade of PD-1 and LAG-3 immune checkpoints prior to curatively intended resection. Here we report extended follow-up, postoperative treatments and patterns of response and recurrence.</div></div><div><h3>Patients and methods</h3><div>Patients with resectable NSCLC (stages IB-IIIA) were randomized to receive two doses nivolumab (240 mg, arm A) with or without relatlimab (80 mg, arm B) every 2 weeks. Overall and disease-free survival (OS, DFS) rates, response and recurrence patterns and subsequent therapies were evaluated.</div></div><div><h3>Results</h3><div>60 patients were enrolled from March 2020 to July 2022. The present analysis was conducted per December 2024 with a median follow-up of 37.4 months. 45 patients were alive without disease recurrence,15 patients recurred (4 locoregional and 11 metastatic), and 7 patients died. The 3-year OS and DFS rates were 88.4 % and 73.3 % in arm A and 88.9 % and 60.3 % in arm B. Patients achieving major pathological response (≤10 % viable tumor cells in resected NSCLC) trended towards better DFS (HR 0.35; 95 % CI, 0.1–1.19). Downstaging was confirmed in 53.3 % of patients in arm A and in 66.7 % of patients in arm B. Nodal downstaging occurred in 28.6 % of patients with nodal disease in arm A and in 66.7 % of patients in arm B.</div></div><div><h3>Conclusions</h3><div>Short course preoperative nivolumab with or without relatlimab showed encouraging efficacy and survival outcomes, which compare favorably with chemo-immunotherapy-based perioperative treatment regimens.</div></div>","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"233 ","pages":"Article 116165"},"PeriodicalIF":7.1,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145735786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Surgical stage in the era of molecular profiling of endometrial cancer 子宫内膜癌分子图谱时代的手术分期

IF 7.1 1区医学 Q1 ONCOLOGY

European Journal of Cancer

Pub Date : 2025-12-05 DOI: 10.1016/j.ejca.2025.116164

J.C. Kasius , W. Kildal , S.W. Vrede , H.A. Askautrud , M. Pradhan , A.M. van Altena , K.-A.R. Tobin , K. Knoll , C. Reijnen , S. Reimann , G. Dackus , L. Vlatkovic , J. Huvila , M. Steinlechner , V. Tubita , A. Gil-Moreno , M.P.L.M. Snijders , M.C. Vos , T.S. Hveem , J. Asberger , A. Kleppe

Introduction

Molecular classification has reshaped risk stratification in endometrial cancer (EC), yet the relevance of tumor spread within molecular subgroups has not been reported so far.

Material and methods

This multicenter retrospective study included 2056 EC patients treated between 1994 and 2018 across 11 European centers. All histopathological subtypes and FIGO stages were included. Tumors were classified into four molecular subgroups: POLE-mutated (POLEmut), mismatch repair deficient (MMRd), no specific molecular profile (NSMP), and TP53/p53 abnormal (p53abn). Clinical and pathological data were extracted from existing cohort databases.

Results

Patients were diagnosed with FIGO stage I (69 %), II (9 %), III (16 %), and IV (6 %), and classified into: POLEmut (8 %), MMRd (28 %), NSMP (44 %), and p53abn (21 %). The overall 5-year cancer-specific death (CSD) and recurrence rates were 16.5 % (95 % CI, 14.9 %-18.2 %) and 23.8 % (95 % CI, 22.0 %-25.7 %), respectively. In multivariable analysis cancer-specific survival (CSS) was independently associated with molecular subtype, FIGO stage, age, histopathological type, grade, lymphovascular space invasion, adjuvant therapy, residual tumor, and lymphadenectomy. FIGO stage was significantly associated with CSD also in within each molecular subgroup (p < 0.001). Patients with tumors confined to the uterus had the most favourable prognosis. Lymph node metastases significantly decreased CSS in POLEmut, MMRd, and p53abn groups. Within FIGO stage IV, molecular subtype was not significantly related to outcome.

Discussion

Surgical stage remains a strong prognostic factor across molecular subtypes and should be considered alongside molecular classification when tailoring adjuvant treatment in EC.

分子分类重塑了子宫内膜癌（EC）的风险分层，但到目前为止，分子亚群内肿瘤扩散的相关性尚未报道。材料和方法本多中心回顾性研究纳入了1994年至2018年间在11个欧洲中心接受治疗的2056例EC患者。包括所有组织病理亚型和FIGO分期。肿瘤分为4个分子亚组：极点突变（POLEmut）、错配修复缺陷（MMRd）、无特异性分子谱（NSMP）和TP53/p53异常（p53abn）。从现有队列数据库中提取临床和病理数据。结果FIGO分期为ⅰ期（69 %）、ⅱ期（9 %）、ⅲ期（16 %）、ⅳ期（6 %），分为POLEmut期（8 %）、MMRd期（28 %）、NSMP期（44 %）、p53abn期（21 %）。总体5年癌症特异性死亡率（CSD）和复发率分别为16.5% %（95 % CI, 14.9 %-18.2 %）和23.8 %（95 % CI, 22.0% %-25.7 %）。在多变量分析中，癌症特异性生存（CSS）与分子亚型、FIGO分期、年龄、组织病理类型、分级、淋巴血管间隙侵犯、辅助治疗、残留肿瘤和淋巴结切除术独立相关。FIGO分期与CSD也在各分子亚组中显著相关（p <； 0.001）。肿瘤局限于子宫的患者预后最好。淋巴结转移显著降低POLEmut、MMRd和p53abn组的CSS。在FIGO IV期，分子亚型与预后无显著相关。手术分期在分子亚型中仍然是一个重要的预后因素，在制定EC的辅助治疗时应与分子分类一起考虑。

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引用次数: 0

Current and emerging opportunities for deintensification of systemic therapies in melanoma: A scoping review 黑素瘤系统性去强化治疗的当前和新机会：范围综述

IF 7.1 1区医学 Q1 ONCOLOGY

European Journal of Cancer

Pub Date : 2025-12-05 DOI: 10.1016/j.ejca.2025.116132

Jennifer A. Soon , Fanny Franchini , Peter Gourlay , Maarten J. IJzerman , Grant A. McArthur

Purpose

There is growing interest in optimising melanoma management to reduce over-treatment and improve patient safety and quality-of-life, yet clinical guidance on deintensification is minimal. This scoping review characterises the role of systemic therapies and biomarkers in current and emerging melanoma deintensification strategies. Study types, funding sources, and use of patient-reported outcomes (PRO) were also summarised.

Methods

MEDLINE, EMBASE and PubMed searches identified studies on deintensification in adult patients with cutaneous melanoma (January 2013 to June 2023). Additional texts were sourced via Google Scholar and backward citation searches. Three extraction tools were tailored to accommodate the breadth of articles included: A) deintensification approaches including biomarkers in late-phase development; B) non-systematic reviews; and C) early-phase biomarkers. Screening and data extraction were performed by two reviewers using Covidence. Data were analysed using descriptive statistics with results reported as per PRISMA-ScR guidelines.

Results

Of 3721 articles screened, 301 articles were included: 31 non-systematic reviews, 198 early-phase biomarker studies, and 72 studies on deintensification approaches. Five key approaches emerged: shortened duration of therapy, dose attenuation, biomarker-informed, neoadjuvant and/or response-adapted, and miscellaneous. Most data were retrospective; only five randomised controlled trials were included in Category A (two were trial protocols). Early-phase biomarker studies comprised 66 % (n = 198/301) of articles – few progressed to trials of clinical validation/utility. PRO were reported in 11 % (n = 5/45) of Category A studies.

Conclusions

Shortened duration of anti-PD-1 therapy and neoadjuvant approaches hold substantial promise in deintensification. Future trials should prioritise consistent incorporation of PRO and focus on determining clinical utility of biomarkers.

为了减少过度治疗，提高患者安全和生活质量，人们对优化黑色素瘤管理越来越感兴趣，但关于去强化的临床指导很少。本文综述了系统性治疗和生物标志物在当前和新出现的黑色素瘤去强化策略中的作用。还总结了研究类型、资金来源和患者报告结果（PRO）的使用情况。方法：medline、EMBASE和PubMed检索了2013年1月至2023年6月成人皮肤黑色素瘤患者去强化的研究。其他文本通过b谷歌Scholar和反向引文搜索获得。三种提取工具被定制以适应所包括文章的广度：A)去强化方法，包括后期开发的生物标志物；B)非系统评价；C)早期生物标志物。筛选和数据提取由两名审稿人使用covid - ence进行。使用描述性统计分析数据，并根据PRISMA-ScR指南报告结果。结果在筛选的3721篇文章中，纳入了301篇：31篇非系统综述，198篇早期生物标志物研究，72篇去强化方法研究。出现了五种关键方法：缩短治疗时间，剂量衰减，生物标志物信息，新辅助和/或反应适应，以及其他方法。大多数数据是回顾性的；只有5个随机对照试验被纳入A类（其中2个为试验方案）。早期阶段的生物标志物研究包括66 % （n = 198/301）的文章-很少进展到临床验证/实用性试验。11 % （n = 5/45）的A类研究报告了PRO。结论缩短抗pd -1治疗时间和新辅助方法在去强化方面具有很大的前景。未来的试验应优先考虑PRO的一致性合并，并专注于确定生物标志物的临床效用。

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引用次数: 0

Recent treatment and survival trends in older versus younger women with HR-positive HER2-negative metastatic breast cancer in the real-life multicenter French ESME cohort 在现实生活中的多中心法国ESME队列中，老年女性与年轻女性hr阳性her2阴性转移性乳腺癌的近期治疗和生存趋势

IF 7.1 1区医学 Q1 ONCOLOGY

European Journal of Cancer

Pub Date : 2025-12-05 DOI: 10.1016/j.ejca.2025.116166

Fanny Bouteiller , Sophie Gourgou , Michaël Bringuier , Angéline Galvin , Audrey Mailliez , Nicolas Bertrand , Mony Hung , Jean-Sébastien Frenel , Vincent Massard , Thomas Bachelot , Carole Pflumio , Anthony Gonçalves , Christelle Levy , Lise Bosquet , William Jacot , Suzette Delaloge , Thomas Grinda , Carine Bellera

Aim

To describe first-line treatments, overall (OS) and real-world progression-free (rwPFS) survival in women with hormone receptor-positive, HER2-negative (HR+/HER2-) metastatic breast cancer (mBC) following introduction of CDK4/6 inhibitors (CDK4/6i), according to age (<70; 70 +) and diagnostic period (before/after CDK4/6i).

Methods

We extracted data from the ESME database (NCT03275311) which includes consecutive patients starting first-line mBC in one of the 18 French Comprehensive cancer centres.

Results

We identified 17,830 eligible women (median age: 62 years). Women aged ≥ 70 years were less likely to present with aggressive disease characteristics. Use of endocrine therapy combined with CDK4/6i increased substantially over time in both age groups, from 0.9 % to 48.9 % in 70 + women, and from 0.8 % to 50.1 % in women < 70 (p < 0.001 for both). In contrast, first-line chemotherapy (alone or in combination) declined from 52.7 % to 30.0 % (p < 0.001), with consistently lower use among women 70 + compared to those < 70: 32.2 % vs. 61.1 % prior to 2016, and 16.4 % vs. 36.5 % after 2017 (p < 0.001 for both). Among 70 + women, OS improved over time (34.0–37.3 months, p = 0.03) but remained shorter than in younger women. rwPFS improved in both age groups: from 12.6 to 14.8 months in 70 + women, and from 12.3 to 14.4 months in women < 70 (p < 0.001 for both).

Conclusion

ET+CDK4/6i use rose up to ∼50 % after 2017, reaching ∼70 % in recent years among women with good PS, but remained ∼50 % in older patients with poor PS. Broader adoption is needed, with less chemotherapy use. Survival outcomes have improved but, causality cannot be confirmed due to the observational design.

目的：根据年龄描述激素受体阳性，HER2阴性（HR+/HER2-）转移性乳腺癌（mBC）患者在引入CDK4/6抑制剂（CDK4/6i）后的一线治疗，总体（OS）和真实无进展（rwPFS）生存率。方法：我们从ESME数据库（NCT03275311）中提取数据，其中包括在18个法国综合癌症中心之一开始一线mBC的连续患者。结果：我们确定了17830名符合条件的女性（中位年龄：62岁）。年龄≥ 70岁的女性出现侵袭性疾病特征的可能性较小。使用内分泌疗法结合CDK4/6i大幅增加随着时间在两个年龄组,从70年的0.9 % 48.9 % + 女性,从女性0.8 % 50.1 %结论:ET + CDK4/6i使用起来∼50 % 2017年之后,达到∼70 %近年来女性有很好的PS,但仍∼50 %与可怜的PS。老年患者需要更广泛的采用,减少化疗使用。生存结果有所改善，但由于观察性设计，不能确认因果关系。

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引用次数: 0