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Study assesses normal tissue effects after axillary radiotherapy for early breast cancer 研究评估早期乳腺癌腋窝放疗后正常组织的影响

IF 232.4 1区医学 Q1 ONCOLOGY

CA: A Cancer Journal for Clinicians

Pub Date : 2025-11-07 DOI: 10.3322/caac.70039

Carrie Printz

In 2020, the multicenter, randomized, phase 3 FAST-Forward trial reported 5-year results showing that delivery of whole breast or chest wall adjuvant radiotherapy was a safe and effective alternative to the 3-week regimen. Current UK and European guidelines support 26 Gy in 5 daily fractions (Fr) as a standard of care for early breast cancer.In a FAST-Forward substudy published in Radiotherapy & Oncology (doi:10.1016/j.radonc.2025.110915), researchers sought to assess normal tissue effects on the axilla after the same 1- and 3-week radiotherapy dose schedules. Findings showed no patient-reported differences between the two protocols after 5 years and thus indicated that 26-Gy/5-Fr/1-week hypofractionation radiotherapy is safe for patients with breast cancer who need it.This substudy followed the same design as the randomized, noninferiority, nonblinded FAST-Forward trial. The ongoing trial compares two 5-Fr schedules of adjuvant radiotherapy to the whole breast or chest wall delivered in 1 week with the 15-Fr/3-week schedule. A total of 469 patients with invasive breast cancer from 50 UK centers were included in the substudy. Participants had surgery (either lumpectomy or mastectomy) and required axillary radiotherapy (any or all levels [1–4]). The analysis compared 40 Gy and 5 Fr (3 weeks, control) to 26 Gy and 5 Fr (1 week). The primary endpoint was 5-year patient-reported moderate or marked arm or hand swelling. The median age was 61 years.In the group, 54% and 39% of the patients had grade 2 and 3 tumors, respectively, and 56% of the patients had axillary dissection. Patients were randomized to either the 3-week control group (n = 182) or the 1-week treatment group (n = 183). A third arm (27 Gy and 5 Fr) that enrolled 104 patients was stopped early because increased toxicity was detected.Participants completed questionnaires at the baseline and 3, 6, 12, 24, and 60 months after randomization. These included the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life tool, a breast cancer module, a body image scale, and fatigue questionnaires. In addition, patients were asked protocol-specific questions about the adverse effects of radiotherapy and were clinically assessed.The primary endpoint was 5-year patient-reported moderate or marked arm or hand swelling reported via the EORTC Quality of Life questionnaire. Secondary endpoints included patient- and clinician-reported outcomes for late radiotherapy adverse effects. A composite endpoint consisted of the worst grade for problems and other adverse effects such as breast distortion, shrinkage, induration, and lymphedema.The 5-year questionnaires were returned by 307 patients, with 300 including data on the primary endpoint. Clinicians provided 5-year assessments for 376 patients. At 5 years, moderate or marked hand or arm swelling was reported by 11 of 107 patients (10%) in the 3-week radiotherapy group

2020年，多中心、随机、3期FAST-Forward试验报告了5年的结果，显示全乳或胸壁辅助放疗是三周方案的安全有效替代方案。目前英国和欧洲的指南支持将26 Gy / 5 daily fractions （Fr）作为早期乳腺癌的护理标准。发表在《放射治疗与肿瘤学》（doi:10.1016/j.radonc.2025.110915）上的一项FAST-Forward子研究中，研究人员试图评估在相同的1周和3周放疗剂量计划后对腋窝正常组织的影响。研究结果显示，5年后两种方案之间没有患者报告的差异，因此表明26 gy /5 fr /1周低分割放疗对需要放疗的乳腺癌患者是安全的。该亚研究遵循与随机、非劣效性、非盲法FAST-Forward试验相同的设计。正在进行的试验比较了两种5-Fr方案的全乳或胸壁辅助放疗方案和15-Fr/3周方案。来自英国50个中心的469名浸润性乳腺癌患者被纳入该亚研究。参与者接受了手术（乳房肿瘤切除术或乳房切除术），并需要腋窝放疗（任何或所有级别[1-4]）。分析比较了40 Gy和5 Fr（3周，对照组）和26 Gy和5 Fr（1周）。主要终点是5年患者报告的中度或明显的手臂或手肿胀。中位年龄为61岁。本组2级肿瘤占54%，3级肿瘤占39%，腋窝清扫占56%。患者被随机分为3周对照组（n = 182）和1周治疗组（n = 183）。第三组（27 Gy和5 Fr）纳入104例患者，由于检测到毒性增加而提前停止。参与者在基线和随机分组后3、6、12、24和60个月完成问卷调查。其中包括欧洲癌症研究和治疗组织（EORTC）的生活质量工具、乳腺癌模块、身体形象量表和疲劳问卷。此外，还向患者询问有关放疗不良反应的具体方案问题，并进行临床评估。主要终点是通过EORTC生活质量问卷报告的5年患者报告的中度或明显的手臂或手肿胀。次要终点包括患者和临床报告的晚期放疗不良反应的结果。复合终点包括最差等级的问题和其他不良反应，如乳房扭曲、收缩、硬化和淋巴水肿。307名患者返回了5年的调查问卷，其中300名患者包括主要终点的数据。临床医生对376名患者进行了5年评估。5年时，3周放疗组107例患者中有11例（10%）报告中度或明显的手或手臂肿胀，1周放疗组116例患者中有13例（11%）报告中度或明显的手或手臂肿胀。10例患者（每组5例）在5年时报告了明显的症状。其他正常组织的影响没有差异，治疗组之间在身体形象或身体、情绪或认知疲劳方面没有差异。两组的症状性肋骨骨折、心脏病和肺骨折发生率均极低。作者指出，结果与主要试验中报告的正常组织效应相似，因此并不令人惊讶。不过，他们补充说，这些发现令人放心。因为主要的FAST-Forward试验将在2025年晚些时候公布10年的疗效结果，研究人员建议在建议广泛的实践改变之前等待这些数据。在5月举行的2025年欧洲放射治疗与肿瘤学会年会上，该试验的口服结果显示，1周的术后放射治疗具有与传统3周治疗相当的安全性和有效性。如果已发表的研究结果证实复发率低，对于需要乳腺或胸壁和腋窝辅助放疗的患者，26 Gy / 5 Fr可能是一种选择。“这项子研究对我们过去50年来在辐射方面的研究来说是一个非常有趣的补充。“我们已经看到每个疗程的乳腺癌治疗次数从25到30次下降到15到20次，现在这是最新的数据，支持能够只做5次治疗，”马萨诸塞州塔夫茨医学卫生系统的放射肿瘤学家和癌症服务线医生主管Mark Bonnen医学博士说。“这对病人来说是件大事。”他指出，研究人员长期以来一直在研究每次治疗的剂量、总剂量和治疗间隔时间的综合效应。博南博士说：“这是数十年来通过多次临床试验的努力的结果，这些试验系统地设计了一些关于辐射如何影响患者的知识，使研究人员能够得出这些结果。” 他补充说，虽然之前的研究，包括FAST-Forward，发现5年的乳房放射治疗是安全有效的，但这个亚研究也检查了需要淋巴结放射治疗的患者。Bonnen博士指出：“对于那些很难反复治疗超过5次的患者，我使用5次治疗方案，但我还没有在任何淋巴结癌症患者身上使用这种方案。”“大多数美国医生都期待着FAST-Forward 10年的研究结果，这将有望表明，针对乳房和淋巴结的一周治疗方案是安全有效的。”在较短时间内给予大剂量辐射的担忧之一是，在接受下一次治疗之前，组织能否自我修复。然而，他说，许多临床医生认为，这项亚研究和其他研究的5年结果提供了关于1周治疗毒性的重要数据。此外，他指出，需要乳腺内淋巴结放射治疗的患者并未包括在本研究中。因此，尚不清楚他们是否适合进行为期一周的治疗。此外，本研究中只有1%的患者接受了重建手术。因此，一些外科医生和放射肿瘤学家可能不愿意为这些患者选择1周的治疗方案，Bonnen博士说。另一个需要考虑的问题是，越来越多的乳腺癌患者，如三阴性亚型患者，在放疗期间接受了全身治疗。他说，一些患者和临床医生可能会对同时使用免疫治疗药物和大剂量的每日放射治疗犹豫不决。Bonnen博士强调了在美国实施更少的放射治疗的另一个挑战，他指出，放射设施是根据他们提供的治疗次数付费的。他说，如果这个数字从目前推荐的15种治疗减少到大多数乳腺癌患者的5种治疗，一些机构可能会面临财务挑战。博南博士指出：“我们担心这些设施的长期生存能力，因此需要在政策方面给予一些考虑。”他补充说，考虑到这一点，去年国会提出了一项立法，要求对每个病人而不是每个放射治疗进行报销。“这将给医生自由，用他们认为最合适的治疗方案进行治疗，而不会产生经济影响。”如果我们要为所有病人保留地理上的访问权，这是非常重要的。

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Frailty in patients undergoing cancer treatment linked to significantly more adverse outcomes 在接受癌症治疗的患者中，虚弱与更多的不良后果相关

IF 232.4 1区医学 Q1 ONCOLOGY

CA: A Cancer Journal for Clinicians

Pub Date : 2025-11-07 DOI: 10.3322/caac.70038

Carrie Printz

Researchers have long known that frailty is associated with worse cancer outcomes. Half of older adults with cancer as well as some young patients with cancer have frailty, which is defined as a loss of biological reserves that makes people more vulnerable to physical stressors. Previous research has shown that frailty often is associated with increased risks of toxicity and death related to cancer treatment.

Clinicians need effective screening tools to determine which patients with cancer are at risk for frailty and poor outcomes. This information can help them to determine the best protocol for each patient.

Although several frailty screening tools exist, the Geriatric 8 (G8) geriatric screening tool is the only one that has been evaluated and undergone systematic reviews for its prognostic ability. The G8 assesses eight areas: age, food intake, mobility, weight loss, body mass index, number of prescription drug medications, neuropsychological condition, and self-reported health.

In a study published in the Journal of the National Cancer Institute (doi:10.1093/jnci/djaf017), researchers conducted a meta-analysis of 58 studies that synthesizes and summarizes current evidence on the association between frailty assessment tools and cancer treatment outcomes in adults with cancer.

“I think the findings synthesize a lot of what we already know,” says Mina Sedrak, MD, an associate professor and director of the Cancer and Aging Program at the David Geffen School of Medicine of the University of California, Los Angeles. “Ultimately, these tools are just as important as the biomarkers we use to test for tumor biology in determining treatment.”

Screening tools such as the G8 can identify some of the subtle changes that cannot be seen with eye tests to identify patients who require more in-depth frailty assessment, he adds.

Researchers searched five databases from inception to January 2023 to identify 58 prognostic-factor studies for this meta-analysis. These studies reported on the associations between validated pre-treatment frailty assessments and outcomes in adults with solid-organ cancers who were undergoing treatment. Outcomes included survival, toxicity, treatment tolerance, functional decline/quality of life, and hospitalization.

The research occurred for a range of tumor sites and mainly in older patients and in advanced and/or palliative disease settings. Nine frailty assessment tools were evaluated. The meta-analysis showed the prognostic value of two screening tools: the G8 and the Vulnerable Elders Survey 13 (VES-13). The latter helps to identify seniors who are at greater risk of functional decline or death during the next 2 years. Its score is based on age, self-reported health, and physical and functional ability limitations. Both tools are simple and quick to administer.

Pooled estimates show that frailty is associated with an increased risk of mortality (hazard ratio, 1.68; 95% co

研究人员早就知道，身体虚弱与更糟糕的癌症结果有关。一半的老年癌症患者和一些年轻癌症患者都很虚弱，这被定义为生物储备的丧失，使人们更容易受到身体压力的影响。先前的研究表明，虚弱往往与癌症治疗相关的毒性和死亡风险增加有关。临床医生需要有效的筛查工具来确定哪些癌症患者有身体虚弱和预后不良的风险。这些信息可以帮助他们确定每个病人的最佳治疗方案。尽管存在几种虚弱筛查工具，但老年病筛查工具是唯一一种对其预后能力进行了评估和系统评价的工具。八国集团评估了八个方面：年龄、食物摄入量、活动能力、体重减轻、体重指数、处方药数量、神经心理状况和自我报告的健康状况。在《美国国家癌症研究所杂志》（doi:10.1093/jnci/djaf017）上发表的一项研究中，研究人员对58项研究进行了荟萃分析，综合并总结了成人癌症患者虚弱评估工具与癌症治疗结果之间关系的现有证据。“我认为这些发现综合了我们已经知道的很多东西，”Mina Sedrak医学博士说，她是加州大学洛杉矶分校大卫·格芬医学院癌症和衰老项目的副教授和主任。“最终，这些工具与我们用来测试肿瘤生物学的生物标志物一样重要，可以确定治疗方法。”他补充说，诸如G8这样的筛查工具可以识别出一些眼部检查无法看到的细微变化，从而识别出需要更深入的衰弱评估的患者。研究人员检索了5个数据库，从建立到2023年1月，为这项荟萃分析确定了58项预后因素研究。这些研究报告了接受治疗的成人实体器官癌患者治疗前虚弱评估与预后之间的关联。结果包括生存、毒性、治疗耐受性、功能下降/生活质量和住院。该研究发生在一系列肿瘤部位，主要是老年患者和晚期和/或姑息性疾病患者。对9种脆弱性评价工具进行评价。荟萃分析显示两种筛查工具：G8和脆弱老年人调查13 （VES-13）的预后价值。后者有助于识别在未来两年内功能衰退或死亡风险更大的老年人。它的评分基于年龄、自我报告的健康状况以及身体和功能限制。这两种工具都简单且易于管理。汇总估计显示，虚弱与死亡风险增加（危险比1.68；95%可信区间[CI]， 1.41-2.00）、毒性（优势比[OR]， 1.83; 95% CI, 1.24-2.68）、治疗不耐受（OR, 1.68; 95% CI, 1.32-2.12）和住院（OR, 1.94; 95% CI, 1.32-2.83）相关。作者得出结论，G8和VES-13工具预测了接受癌症治疗的患者的一系列重要结果，并强调临床医生应该使用共同决策来教育患者了解其潜在的不良反应风险。Grant Williams医学博士是伯明翰阿拉巴马大学的老年病专家和医学肿瘤学家，他称赞这项研究将现有的文献结合在一起，表明虚弱的病人在接受癌症治疗之前需要特别注意。他引用了另一项研究，该研究进一步说明了不仅评估脆弱性，而且根据这些结果采取行动以改善癌症治疗效果的重要性：2021年发表在《柳叶刀》上的集群随机GAP70+研究（doi:10.1016/S0140-6736(21)01789-X）。在该研究中，研究结果表明，老年评估和管理可以减少患有晚期癌症和年龄相关疾病的老年患者的毒性作用。美国临床肿瘤学会（ASCO）于2018年发布了一份在癌症患者中实施老年评估和虚弱筛查的临床指南（doi:10.1200/JCO.2018.78.8687），并于2023年更新（doi:10.1200/JCO.23.00933）。2021年ASCO对1000多名肿瘤学家成员进行的一项调查发现，尽管大多数人都意识到老年评估的重要性，但69%的人表示他们依赖于主观的非正式评估，只有20%的人遵循了ASCO指南推荐的评估。障碍包括资源最少，培训有限，以及不确定如何使用这些工具。此外，威廉斯博士说，该领域面临的更大挑战之一是寻找比八国集团和ves13更全面的工具来全面评估脆弱性。“对于很多病人来说，你需要一个更详细的工具来了解导致他们虚弱的复杂原因，”他指出。 “是坠落吗？”是功能性障碍吗？营养不良?焦虑和抑郁？并发症?筛查工具并不足以捕获所有信息，但可以突出那些需要进一步评估的患者。”他补充说，如果临床医生更好地了解导致虚弱的具体情况，他们就可以寻求制定具体的干预措施。例如，如果一个病人被确定为营养不良，那么这个人可能需要去看营养学家以及职业和/或物理治疗师。Sedrak博士对此表示赞同，并指出：“虚弱意味着病人的油箱很低，所以当发动机受到压力时，即使它之前看起来很好，它也会分崩离析。”例如，80多岁的病人可能看起来和行为都很好，但癌症治疗等压力源会迅速显著降低他们的生理储备。Sedrak博士说，这就是为什么根据衰老的真正功能、生物和生理指标而不是仅仅根据实数年龄或东部肿瘤合作组织的表现状况来定制治疗是很重要的。他补充说，老年筛查评估是一种生物标志物，可以指导在剂量调整、治疗计划、特定类型的治疗和支持性护理方面的共同决策。在许多欧洲国家，老年癌症患者的老年评估是标准化护理的一部分。他指出，美国的情况并非如此。“另一个挑战是，当我们发现缺陷时，如何处理这些信息，”塞德拉克博士说。“我们必须利用我们的资源，而我们的资源并不多。老年病医生和初级保健医生严重短缺，而且他们工作过度。”威廉姆斯博士也承认这个问题。他建议，由于不同的诊所和地区拥有不同的资源，比如营养学家和治疗师，他们必须利用任何可用的资源来最好地帮助他们虚弱的病人。关于未来的研究方向，他说：“我认为有空间分离不同的干预措施，看看在改善结果方面是否有些比其他更重要。”Sedrak博士认为他的导师Arti Hurria医学博士是这一领域的先锋工作。Arti Hurria是一名老年病学专家、肿瘤学家，也是加州杜阿尔特希望之城癌症与老龄化中心的前主任。“她是先驱者，也是最早提出‘让我们使用老年筛查工具来改善老年癌症患者的护理’的人之一，”他说。“我们现在所做的一切都是她遗产的一部分，为这个不断增长的、脆弱的、高风险的人群提供更好的护理。”

{"title":"Frailty in patients undergoing cancer treatment linked to significantly more adverse outcomes","authors":"Carrie Printz","doi":"10.3322/caac.70038","DOIUrl":"https://doi.org/10.3322/caac.70038","url":null,"abstract":"Researchers have long known that frailty is associated with worse cancer outcomes. Half of older adults with cancer as well as some young patients with cancer have frailty, which is defined as a loss of biological reserves that makes people more vulnerable to physical stressors. Previous research has shown that frailty often is associated with increased risks of toxicity and death related to cancer treatment.Clinicians need effective screening tools to determine which patients with cancer are at risk for frailty and poor outcomes. This information can help them to determine the best protocol for each patient.Although several frailty screening tools exist, the Geriatric 8 (G8) geriatric screening tool is the only one that has been evaluated and undergone systematic reviews for its prognostic ability. The G8 assesses eight areas: age, food intake, mobility, weight loss, body mass index, number of prescription drug medications, neuropsychological condition, and self-reported health.In a study published in the Journal of the National Cancer Institute (doi:10.1093/jnci/djaf017), researchers conducted a meta-analysis of 58 studies that synthesizes and summarizes current evidence on the association between frailty assessment tools and cancer treatment outcomes in adults with cancer.“I think the findings synthesize a lot of what we already know,” says Mina Sedrak, MD, an associate professor and director of the Cancer and Aging Program at the David Geffen School of Medicine of the University of California, Los Angeles. “Ultimately, these tools are just as important as the biomarkers we use to test for tumor biology in determining treatment.”Screening tools such as the G8 can identify some of the subtle changes that cannot be seen with eye tests to identify patients who require more in-depth frailty assessment, he adds.Researchers searched five databases from inception to January 2023 to identify 58 prognostic-factor studies for this meta-analysis. These studies reported on the associations between validated pre-treatment frailty assessments and outcomes in adults with solid-organ cancers who were undergoing treatment. Outcomes included survival, toxicity, treatment tolerance, functional decline/quality of life, and hospitalization.The research occurred for a range of tumor sites and mainly in older patients and in advanced and/or palliative disease settings. Nine frailty assessment tools were evaluated. The meta-analysis showed the prognostic value of two screening tools: the G8 and the Vulnerable Elders Survey 13 (VES-13). The latter helps to identify seniors who are at greater risk of functional decline or death during the next 2 years. Its score is based on age, self-reported health, and physical and functional ability limitations. Both tools are simple and quick to administer.Pooled estimates show that frailty is associated with an increased risk of mortality (hazard ratio, 1.68; 95% co","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"75 6","pages":"463-465"},"PeriodicalIF":232.4,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145449849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

CA turns 75: Looking at the future but never forgetting the roots CA年满75岁：展望未来，但不忘根

IF 232.4 1区医学 Q1 ONCOLOGY

CA: A Cancer Journal for Clinicians

Pub Date : 2025-11-03 DOI: 10.3322/caac.70040

Don S. Dizon MD, Sumanta Kumar Pal MD, Banu E. Symington MD, MACP, Razelle Kurzrock MD, Arif H. Kamal MD, Christina M. Annunziata MD, PhD, Shanthi Sivendran MD, MSCR, MBA, Ahmedin Jemal DVM, MPH, William L. Dahut MD

CA: A Cancer Journal for Clinicians (CA) began in 1950 as CA: A Bulletin of Cancer Progress (Figure 1) and, in 2025, celebrates its 75th year in continuous publication. Today, it is the flagship journal of the American Cancer Society (ACS) and is associated with the highest impact factor of any medical or scientific journal, inside and outside of oncology—a testament to its value, not only to professionals in this space but to the wider public at large. The core reason for its domestic and global reach is cancer statistics, a continuous and evolving effort to describe the incidence and mortality of cancers and how changes in exposures, diagnosis, and treatment affect them. We would be remiss if not acknowledging the 14 years of significant contributions made to the intellectual rigor and refined analyses of these reports, assembled under the guidance of Dr Ahmedin Jemal, Senior Vice President of the Surveillance and Health Equity Science Department.Beyond cancer statistics, CA fulfills a major role: the dissemination of information about cancer across its continuum. It has provided our peers and the public contemporary and updated, expert, open-access reviews, at no cost, actively demonstrating a core value of the ACS on the widespread dissemination of cancer practice, research, and education. Reflecting the collaboration of the editorial team and authors, these reviews serve as a resource for everyone and do not require specialization in oncology to comprehend them.As CA celebrated its 60th year, the editorial team led by Dr Ted Gansler reflected on seminal publications during its first decade, from the Papanicolaou smear for the early detection of cervical cancer to prognostic disclosure in clinician–patient communication.1 It seems fitting then that, as members of the editorial board, we offer our own perspective as we highlight significant publications since that first decade. Finally, we collectively reflect on our mission as we move into the future.Colorectal cancer (CRC) is the fourth most common diagnosed cancer and the second leading cause of cancer death in the United States, effecting over 150,000 people and accounting for over 50,000 deaths.2 In 2017, Siegel et al. reported increased CRC incidence rates in both men and women younger than 55 years, whereas rates continued to decline in aged 55 years or older.3 Consequently, the proportion of CRC being diagnosed in people younger than 55 years rose from 11% of all cases in 1995 to 20% in 2019.2 The increase in young-onset CRC is a global phenomenon, with rates rising in parts of Europe, South America, Oceania, and Asia as well as in Canada.4, 5 Work is underway to understand the biologic and systemic factors that account for early onset CRC and ways to improve early detection and treatment.A testa

CA：临床医生癌症杂志（CA）始于1950年，当时名为CA：癌症进展公报（图1），并于2025年庆祝其连续出版75周年。今天，它是美国癌症协会（ACS）的旗舰杂志，在肿瘤学内外的任何医学或科学杂志中具有最高的影响因子——这证明了它的价值，不仅对这个领域的专业人士，而且对更广泛的公众。其国内和全球影响力的核心原因是癌症统计，这是一项持续不断的努力，旨在描述癌症的发病率和死亡率，以及暴露、诊断和治疗的变化如何影响它们。14年来，在监测和卫生公平科学司高级副总裁Ahmedin Jemal博士的指导下，对这些报告进行了严谨的知识分析和细致的分析，如果不承认这些报告所作出的重大贡献，那就是我们的失职。图1在图形查看器中打开CA的ppt封面：癌症进展公报第一卷，第1期，1950年11月。除了癌症统计之外，CA还发挥着重要作用：在整个连续体中传播有关癌症的信息。它为我们的同行和公众免费提供了现代的、最新的、专家的、开放获取的评论，积极地展示了ACS在广泛传播癌症实践、研究和教育方面的核心价值。这些综述反映了编辑团队和作者的合作，作为每个人的资源，不需要肿瘤学专业来理解它们。在CA庆祝其成立60周年之际，由Ted Gansler博士领导的编辑团队回顾了其第一个十年中具有开创性的出版物，从用于宫颈癌早期检测的Papanicolaou涂片到临床与患者沟通中的预后披露因此，作为编辑委员会的成员，我们在强调第一个十年以来的重要出版物时，提供我们自己的观点似乎是合适的。最后，当我们走向未来时，我们共同反思我们的使命。

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引用次数: 0

The contemporary management of prostate cancer. 当代前列腺癌的治疗。

IF 232.4 1区医学 Q1 ONCOLOGY

CA: A Cancer Journal for Clinicians

Pub Date : 2025-11-01 Epub Date: 2025-06-26 DOI: 10.3322/caac.70020

Deep Chakrabarti, Peter Albertsen, Aidan Adkins, Amar Kishan, Vedang Murthy, Chris Parker, Angela Pathmanathan, Alison Reid, Oliver Sartor, Nicholas Van As, Jochen Walz, Alison Tree

Prostate cancer is the most common cancer in two thirds of the world, with an expected doubling in both incidence and mortality in the next two decades. No strong environmental associations exist for the development of prostate cancer; therefore, lifestyle measures are unlikely to mitigate this increasing burden. The last three decades have seen rapid developments in the diagnostic and therapeutic landscape of prostate cancer, including multiparametric magnetic resonance imaging, positron emission tomography, robotic surgery, image-guided hypofractionated and stereotactic radiotherapy, novel anti-androgens and radioligand therapies. Prostate cancer is unique in that not everyone with a diagnosis needs treatment, and active surveillance is the preferred option for some. This review discusses the contemporary management of all stages of prostate cancer in the light of these modern developments, enabling holistic individualization of treatment, and describes the promise of future research to further improve outcomes.

前列腺癌是世界上三分之二地区最常见的癌症，预计未来二十年发病率和死亡率将翻一番。环境因素与前列腺癌的发展并没有很强的联系；因此，生活方式的措施不太可能减轻这种日益增加的负担。在过去的三十年里，前列腺癌的诊断和治疗领域发展迅速，包括多参数磁共振成像、正电子发射断层扫描、机器人手术、图像引导下的低分割和立体定向放疗、新型抗雄激素和放射配体治疗。前列腺癌的独特之处在于，并不是每个确诊的患者都需要治疗，主动监测是一些人的首选。这篇综述讨论了在这些现代发展的基础上对前列腺癌所有阶段的当代管理，使治疗的整体个性化成为可能，并描述了未来研究的前景，以进一步改善结果。

引用次数: 0

Learning from prostate cancer statistics 从前列腺癌统计数据中学习

IF 232.4 1区医学 Q1 ONCOLOGY

CA: A Cancer Journal for Clinicians

Pub Date : 2025-09-29 DOI: 10.3322/caac.70037

Ruth Etzioni PhD, Lukas Owens BA

The population represents the ultimate uncontrolled experiment, yet data on cancer statistics provide an opportunity to learn about real-world outcomes of cancer control activities and policies. In the case of prostate cancer, population data have been critically important in generating and confirming hypotheses about the impacts of screening and treatment advances on the population burden of the disease. Tracking prostate cancer statistics—incidence, mortality, and survival—and how they change over time is thus a prerequisite for understanding the success (or lack thereof) of efforts to control this most common cancer in American men. But population statistics are multifactorial; explaining them requires also considering their many potential drivers and the mechanisms by which disease control efforts play out in the population.Consider the example of prostate cancer incidence, prominently reported in this issue’s update on prostate cancer statistics.1 Prostate cancer incidence is influenced by prostate-specific antigen (PSA) screening rates in the population. Incidence increased dramatically during the early years of the PSA screening era, prompting concerns that screening was leading to overdiagnosis. Although overdiagnosis did indeed turn out to be a problematic outcome of screening, work by Feuer and Wun2 in the early 1990s assured that increases in disease incidence were to be expected when a new screening test was adopted at the population level. The mechanism—initial depletion of the prevalent pool of cases by the screening test—leads to a predicted peak in incidence followed by declines because of the absence in the prevalent pool of those previously detected cases. Feuer and Wun demonstrated that the height and duration of the peak would be driven by the lead time, which is the time by which screening advances disease diagnosis. The lead time is critical not only in the timing of incidence swings after the adoption of screening but also in the delay until any effects of screening on disease mortality are observed. And the average lead time associated with prostate cancer screening is not short—estimates based on the first decade of PSA screening place the mean lead time between 5 and 7 years.3The update of prostate cancer statistics in this issue of CA: A Cancer Journal for Clinicians highlights more recent incidence trends, specifically the persistence of recent increases overall and in advanced-stage disease. These trends have generated concern because they are what one would expect in a population abandoning screening. Indeed, studies tracking both incidence and screening patterns have been on the alert for such trends, particularly after the issuance of the D recommendation against routine prostate cancer screening for all ages by the US Preventive Services Task Force in 2012.4 Although some modest reductions in pro

人口代表了最终的不受控制的实验，但癌症统计数据提供了一个了解癌症控制活动和政策的现实结果的机会。就前列腺癌而言，人口数据在产生和确认关于筛查和治疗进展对该疾病人口负担影响的假设方面至关重要。跟踪前列腺癌的统计数据——发病率、死亡率和存活率——以及它们如何随时间变化，是了解成功（或失败）控制这种美国男性最常见癌症的先决条件。但人口统计是多因素的；解释它们还需要考虑它们的许多潜在驱动因素以及疾病控制工作在人群中发挥作用的机制。以前列腺癌发病率为例，在本期更新的前列腺癌统计数据中有显著的报道前列腺癌发病率受人群中前列腺特异性抗原（PSA）筛查率的影响。在PSA筛查时代的早期，发病率急剧上升，引发了人们对筛查导致过度诊断的担忧。虽然过度诊断确实被证明是筛查的一个有问题的结果，Feuer和Wun2在20世纪90年代初的工作确信，当在人群水平上采用新的筛查试验时，疾病发病率的增加是可以预期的。这种机制——筛查试验最初耗尽流行病例库——导致发病率达到预期峰值，随后下降，因为以前检测到的病例在流行库中缺失。Feuer和Wun证明，峰值的高度和持续时间将由提前期驱动，提前期是筛查提前疾病诊断的时间。提前期不仅对采用筛查后发病率波动的时机至关重要，而且对观察到筛查对疾病死亡率的任何影响之前的延迟也至关重要。前列腺癌筛查的平均提前期并不短根据PSA筛查的头十年估计平均提前期在5到7年之间。3本期《CA: A cancer Journal for clinical》中更新的前列腺癌统计数据强调了最近的发病率趋势，特别是近期总体和晚期疾病的持续增长。这些趋势引起了人们的关注，因为这是人们在放弃筛查的人群中所期望的。事实上，跟踪发病率和筛查模式的研究已经对这种趋势保持警惕，特别是在2012年美国预防服务工作组发布了反对所有年龄段常规前列腺癌筛查的D建议之后。2.4尽管在该建议之后发现前列腺癌筛查略有减少，但没有研究将这些模式与最近的发病率趋势联系起来。当然，这样做是非常具有挑战性的，但一个必要的条件是，发病率的模式符合在人口中进行筛查的机制效果和考虑到其他潜在影响因素的情况下所预期的结果。从机制的角度来看，减少筛查预计将导致筛查时代开始时观察到的模式的逆转，但逆转的时间和幅度将取决于减少的程度以及前置时间。一个预测大规模停止PSA筛查后发病率的机制模型表明，发病率最初会大幅下降，但随后很快开始上升预计晚期发病率不会下降，反而会增加。在2012年美国预防服务工作组提出建议后，发病率确实下降了，但这种下降只是加速了已经在进行的下降。此后，远期发病率呈上升趋势。因此，从机制的角度来看，最近的晚期和总体发病率趋势与PSA检测减少是一致的。然而，其他可能导致这些趋势的因素值得考虑，包括筛查方式和前列腺癌分期方法的变化所起的作用。自从在人群中采用PSA筛查以来，男性筛查和诊断的方式发生了许多变化。随着时间的推移，活检技术已经发生了显著的变化，这是导致筛查下发病率的一个关键因素。活检芯从4个或6个增加到10个或12个，随后努力减少临床无关紧要的癌症的诊断，主要是通过反射测试（例如使用磁共振成像）。在解释疾病发病率趋势时，这些变化在疾病诊断和检测到的癌症概况中的作用值得考虑。此外，使用更先进的成像技术和病理技术的改进可能会抢走病例的风头，并导致晚期诊断的明显增加。最近的分析研究了对观察到的发病率趋势的相互矛盾的解释。Owens等人7研究了前列腺癌初诊时年龄和PSA的最新趋势，并得出结论，这些数量的变化更符合检测延迟（例如，因为停止筛查），而不是诊断时的优势。Nyame等人8使用了一个机制模型来预测减少筛查使用率对晚期发病率的影响，并得出结论，这些数据与减少筛查的影响是一致的。这些研究为以下评估提供了额外的支持：前列腺癌发病率和晚期发病率的当前趋势可能是由人口筛查的减少引起的。这一解释前列腺癌发病率趋势的讨论显示了人口癌症统计的多因素性质。诊断技术和实践的变化将影响观察到的发病率和生存率趋势，但其中一些变化可能是人为的。了解筛查实践变化的机制含义对于正确解释前列腺癌趋势是必要的。筛查的增加通常会导致同期发病率上升，但随后下降。减少年轻人群的筛查将对老年人群的晚期发病率产生影响。采用新的疾病分期技术，如前列腺特异性膜抗原-正电子发射断层扫描/计算机断层扫描，将不可避免地改变疾病的发病率，甚至改变晚期疾病的定义认识到机械驱动因素是如何随着时间的推移产生疾病模式的，并扩大对解释的考虑，而不是简单的，近端因素，这将是必要的，以避免在从前列腺癌统计数据中学习时过度简化或跳到预先的结论。利益冲突声明除了提交的工作，Etzioni还拥有Seno Medical的股票。两位作者都报告了国家癌症研究所的资助/合同。

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引用次数: 0

A patient with newly diagnosed breast cancer found to have mosaic TP53 likely pathogenic variant 新诊断的乳腺癌患者发现嵌合TP53可能致病变异

IF 254.7 1区医学 Q1 ONCOLOGY

CA: A Cancer Journal for Clinicians

Pub Date : 2025-09-24 DOI: 10.3322/caac.70034

Hetal D. Mistry, MacKenzie R. Adams, Charu Taneja, Lauren J. Massingham, Elizabeth H. Dibble, Kara L. Leonard, Jesse Hart, Galina G. Lagos, Mary Anne Fenton

<h2> CASE OVERVIEW</h2>A 36-year-old, nulligravid woman with a history of controlled eosinophilic esophagitis, asthma, and dense fibrocystic breasts was referred to the Breast Health Center after abnormal screening mammography. She reported recent fatigue and intermittent diarrhea but had a negative colonoscopy and food allergy testing this year.Her family history was significant for a maternal grandmother with a question of uterine cancer, a maternal grandfather who died of renal cancer at age 62 years, a paternal grandmother who died of brain cancer at age 56 years, a paternal grandfather who died of brain cancer at age 80 years, and a history of premalignant changes in the esophagus in her father. She has never smoked tobacco and consumes zero to three drinks of alcohol weekly. She has been physically active in multiple sports, including biking and swimming, and played the cello.Mammography demonstrated extremely dense breast tissue with new calcifications in both breasts. Diagnostic mammography demonstrated indeterminate grouped calcifications spanning 19 mm in the right breast at 5 o'clock and 7 mm in the left breast 12 o'clock. She subsequently underwent stereotactic needle biopsies of both areas, which revealed right breast ductal carcinoma in situ (DCIS), nuclear grade 3, with 90% estrogen receptor (ER) expression; and left ductal carcinoma, nuclear grade 3, with 95% ER expression, 40% progesterone receptor (PR) expression, negative human epidermal growth factor receptor 2 (HER-2) status, and a Ki-67 index of 40%. Within the left breast biopsy there was an absence of myoepithelial cells, raising concern that the findings reflected an unusual type of invasive carcinoma. She then underwent bilateral breast magnetic resonance imaging (MRI), which revealed the known areas of DCIS in the bilateral breasts and also revealed a 1.0-cm mass inferior to the left breast DCIS at 12 o'clock that was considered suspicious. On subsequent ultrasound, it corresponded to an 8-mm mass in the left breast at 10 o'clock. A biopsy of the mass demonstrated a spindle cell tumor, favoring malignant phyllodes tumor with pleomorphic liposarcomatous differentiation that was negative for ER, PR, and HER2 (triple-negative), with a Ki-67 index of 30%.At her multidisciplinary consultation, she was referred for genetic evaluation having met National Comprehensive Cancer Network (NCCN) criteria based on her diagnosis of breast cancer when younger than 50 years.1 Given the concern for invasive left breast cancer and possible need for chemotherapy, she was also referred for fertility preservation.She completed a comprehensive 76-gene germline genetic test, which revealed tumor protein p53 (TP53) likely pathogenic variant (LPV; c.716A>G; p.N239S). Pathogenic variants (PVs) and LPVs are DNA sequence changes that are associated with increased risk of disease. There is well established evidence that PVs are di

病例概述：一名36岁无孕妇女，有嗜酸性粒细胞控制性食管炎、哮喘和致密纤维囊性乳房病史，经异常乳房x光检查后转介至乳腺健康中心。她最近报告了疲劳和间歇性腹泻，但今年结肠镜检查和食物过敏测试呈阴性。她的家族史对于有子宫癌问题的外祖母，62岁死于肾癌的外祖父，56岁死于脑癌的外祖母，80岁死于脑癌的外祖父，以及父亲有食道癌前病变的病史具有重要意义。她从不吸烟，每周喝0到3杯酒。她一直积极参加多种体育运动，包括骑自行车和游泳，并演奏大提琴。乳房x光检查显示双侧乳房组织异常致密并有新的钙化。诊断性乳房x光检查显示不确定的成组钙化，在右乳房5点钟位置有19mm宽的钙化，在左乳房12点钟位置有7mm宽的钙化。随后，她接受了两个区域的立体定向针活检，发现右乳导管原位癌（DCIS），核3级，雌激素受体（ER）表达90%；左导管癌，核3级，ER表达95%，孕激素受体（PR）表达40%，人表皮生长因子受体2 （HER-2）状态阴性，Ki-67指数40%。在左乳活检中，肌上皮细胞缺失，这引起了人们的关注，认为这是一种不寻常的浸润性癌。然后行双侧乳房磁共振成像（MRI），显示双侧乳房DCIS已知区域，并在左侧乳腺DCIS下方12点钟方向发现一个1.0 cm肿块，认为可疑。在随后的超声检查中，它对应于10点钟左乳房一个8毫米的肿块。肿块的活检显示为梭形细胞肿瘤，倾向于恶性叶状肿瘤，伴多形性脂肪肉瘤分化，ER、PR和HER2阴性（三阴性），Ki-67指数为30%。在她的多学科咨询中，她被转介进行基因评估，根据她在50岁以下诊断为乳腺癌，符合国家综合癌症网络（NCCN）的标准考虑到浸润性左乳腺癌和可能需要化疗，她也被转介为保留生育能力。她完成了全面的76个基因生殖系基因检测，发现肿瘤蛋白p53 （TP53）可能的致病变异（LPV; c.716A>；G; p.N239S）。致病性变异（pv）和lpv是与疾病风险增加相关的DNA序列变化。有充分的证据表明，pv是致病的，并且有强烈的怀疑，但没有明确的证据。两者都被认为是基因检测的阳性结果，表明诊断结果。当TP53 pv / lpv在一个全面的生殖系面板中被发现时，这引起了对Li-Fraumeni综合征（LFS）的关注。然而，描述TP53 PV/LPV的起源是必要的，因为TP53 PV/LPV的检测可以通过多种机制发生，包括克隆造血不确定电位（CHIP）、嵌合体或真正的种系发现。她选择继续进行双侧皮肤和乳头保留乳房切除术，左腋窝前哨淋巴结（SLN）活检（SLNB）和磁trace注射（Endomag； A Hologic公司）到右乳房治疗延迟性SLNB。皮瓣的神经化是通过从第四和第五肋间神经移植到乳头-乳晕复合体和放置乳头前组织扩张器进行的。术后恢复良好，最终病理显示右侧乳腺DCIS，左侧乳腺DCIS未残留，恶性叶状肿瘤切除至阴性边缘。左侧SLNB阴性，无需腋窝淋巴结清扫。

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引用次数: 0

Advances in pancreatic cancer early diagnosis, prevention, and treatment: The past, the present, and the future 胰腺癌早期诊断、预防和治疗的进展：过去、现在和未来

IF 254.7 1区医学 Q1 ONCOLOGY

CA: A Cancer Journal for Clinicians

Pub Date : 2025-09-19 DOI: 10.3322/caac.70035

Alessandro Mannucci, Ajay Goel

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with a dismal prognosis, largely because of late-stage diagnosis and therapeutic resistance. PDAC incidence has been rising, with modifiable and non-modifiable risk factors contributing to disease development. Chronic pancreatitis, diabetes mellitus, smoking, obesity, and familial predisposition have been implicated in PDAC pathogenesis. Early clinical manifestations are vague and insidious; therefore, PDAC is often diagnosed at an advanced stage, limiting curative treatment options. Efforts to improve early detection have focused on serum biomarkers (e.g., carbohydrate antigen 19-9), imaging modalities, and liquid biopsies. Endoscopic ultrasound and magnetic resonance imaging have demonstrated potential in identifying early-stage disease in certain high-risk populations. Surgical resection remains the only potentially curative option, but only 15%–20% of patients have resectable disease at diagnosis. Neoadjuvant chemotherapy has emerged as a promising strategy to improve resectability and survival outcomes. For patients with locally advanced or metastatic PDAC, combination chemotherapy regimens such as FOLFIRINOX (folinic acid, 5-fluorouracil, irinotecan, and oxaliplatin), NALIRIFOX (5-fluorouracil, oxaliplatin, liposomal irinotecan, and leucovorin), and combined gemcitabine/nanoparticle albumen-bound paclitaxel offer survival benefits, although toxicity remains a concern, especially for platinum-based therapies. Several breakthroughs in molecular profiling have led to the development of targeted therapies, including sotorasib and olaparib. Immunotherapy has shown limited success in PDAC due to its immunosuppressive tumor microenvironment. However, novel combination approaches are under investigation, including quadruplet therapy, immune checkpoint inhibitors with oncolytic viruses, stromal-targeting agents, and personalized neoantigen vaccines. Key priorities for future research include identifying reliable biomarkers for early detection, refining patient selection for targeted therapies, and developing innovative strategies to overcome treatment resistance.

胰腺导管腺癌（Pancreatic ductal adencarcinoma， PDAC）是一种预后不佳的侵袭性恶性肿瘤，主要是因为其诊断较晚且治疗有耐药性。PDAC发病率一直在上升，可改变和不可改变的风险因素有助于疾病的发展。慢性胰腺炎、糖尿病、吸烟、肥胖和家族易感性都与PDAC的发病机制有关。早期临床表现模糊、隐匿；因此，PDAC通常在晚期才被诊断出来，限制了治疗选择。改善早期检测的努力主要集中在血清生物标志物（如碳水化合物抗原19-9）、成像方式和液体活检上。内窥镜超声和磁共振成像已经证明了在某些高危人群中识别早期疾病的潜力。手术切除仍然是唯一可能治愈的选择，但只有15%-20%的患者在诊断时可切除。新辅助化疗已成为一种有希望改善可切除性和生存结果的策略。对于局部晚期或转移性PDAC患者，联合化疗方案如FOLFIRINOX（亚叶酸、5-氟尿嘧啶、伊立替康和奥沙利铂）、NALIRIFOX（5-氟尿嘧啶、奥沙利铂、伊立替康脂体和亚叶酸钙）和吉西他滨/纳米颗粒蛋白结合紫杉醇联合化疗方案提供了生存益处，尽管毒性仍然是一个问题，特别是铂基治疗。在分子分析方面的一些突破导致了靶向治疗的发展，包括sotorasib和olaparib。由于其免疫抑制肿瘤微环境，免疫治疗在PDAC中显示出有限的成功。然而，新的联合治疗方法正在研究中，包括四联体治疗、溶瘤病毒免疫检查点抑制剂、基质靶向药物和个体化新抗原疫苗。未来研究的重点包括确定早期检测的可靠生物标志物，改进靶向治疗的患者选择，以及开发克服治疗耐药性的创新策略。

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引用次数: 0

Reviewer acknowledgement 2025 审稿人致谢2025

IF 232.4 1区医学 Q1 ONCOLOGY

CA: A Cancer Journal for Clinicians

Pub Date : 2025-09-15 DOI: 10.3322/caac.70033

In order to maintain the high standards of CA’s content, the Editors of CA rely on the knowledge and dedication of many experts in deciding which topics to pursue, which manuscripts to publish, and what modifications to make to ensure medical and scientific accuracy and suitability for our readers. We thank our Associate Editors and our Editorial Advisory Board, who continue to provide these services for us time and time again.

We are also greatly indebted to the effort and expertise of the following individuals for reviewing manuscripts for the journal from July 1, 2024, to June 30, 2025. These individuals go beyond expectations by consistently and expeditiously delivering comprehensive, discerning reviews.

Lauren Antrim

Pedro Barata

Nabila Bennani

Ari Birnbaum

Sue Bornstein

Donald Cannon

Michael Carney

Elizabeth Cathcart-Rake

Annie Chan

Huizi Chen

Carissa Chu

Sean David

Ruth Etzioni

Robert Ferris

Courtney Finlayson

Bryan Fuchs

Elizabeth Garrett-Mayer

William Hall

Michael Halpern

Ole-Petter Hamnvik

David Hui

Linda Jacobs

Salvador Jaime-Casas

Rebecca Johnson

Corinne Joshu

David Keefe

WonSeog Kim

Elise Kohn

Lindsay M. Kuroki

Rita Kuwahara

Richard Lee

Shing Lee

Phebe Lemert

Stanley Liauw

Stephen Liu

Shail Maingi

Sendurai Mani

Jonathan Marron

Brittany C. McGill

Jacob Miller

Paul Montgomery

Susan O'Brien

Krishnan Patel

Rodolfo Alberto Rey

Tina Rizack

Nabil Saba

Stephanie Smith

Umang Swami

Wade Swenson

Russell Taichman

Yungan Tao

Molly Taylor

Ayalew Tefferi

Sarah Temkin

William Tew

Premal Thaker

Jonathan Thompson

Michael Thun

Katherine Tossas

Zaza Tsitsishvili

Adam Wahida

Thomas Zilli

Miguel Zugman

为了保持CA内容的高标准，CA的编辑依靠许多专家的知识和奉献精神来决定追求哪些主题，发表哪些手稿，以及进行哪些修改，以确保医学和科学的准确性和适合我们的读者。我们感谢我们的副编辑和我们的编辑顾问委员会，他们一次又一次地为我们提供这些服务。我们也非常感谢以下个人在2024年7月1日至2025年6月30日期间审稿的努力和专业知识。这些人通过持续、迅速地提供全面、有洞察力的评估，超越了人们的期望。劳伦·安特朗·佩德罗·巴拉塔娜比拉·本纳拉·阿里·伯恩鲍姆苏·伯恩斯坦唐纳德·加农迈克尔·卡尼伊丽莎白·卡特·拉克安妮·詹惠子·陈卡里萨·楚恩大卫·露丝·埃齐奥罗伯特·费里斯·考特尼·芬莱森布莱恩·福克斯伊丽莎白·加勒特·梅耶威廉·霍尔迈克尔·哈尔珀诺·皮特·汉尼克大卫·惠琳达·雅各布·萨尔瓦多·杰米·卡什丽贝卡·约翰逊科琳娜·乔舒迪·基夫·沃恩格·金莉斯·科恩林赛·m·黑利塔·库瓦哈拉理查德·李欣·李菲·莱默斯斯坦利·刘·斯蒂芬·刘hail MaingiSendurai ManiJonathanMarronBrittany C. McGillJacob MillerPaul montgomery苏珊O'BrienKrishnan PatelRodolfo Alberto ReyTina RizackNabil SabaStephanie smithummanswimiwade SwensonRussell TaichmanYungan TaoMolly TaylorAyalew TefferiSarah TemkinWilliam TewPremal ThakerJonathan ThompsonMichael ThunKatherine TossasZaza TsitsishviliAdam wahidas zillimuel Zugman

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引用次数: 0

Correction to “Cancer treatment and survivorship statistics, 2025” 对“2025年癌症治疗和生存统计”的更正。

IF 232.4 1区医学 Q1 ONCOLOGY

CA: A Cancer Journal for Clinicians

Pub Date : 2025-09-13 DOI: 10.3322/caac.70036

Wagle NS, Nogueira L, Devasia TP, et al. Cancer treatment and survivorship statistics, 2025. CA Cancer J Clin. 2025;75(4):308-340. doi:10.3322/caac.70011

In the “Cancers in children and adolescents” section, the first sentence currently reads: “As of January 1, 2025, it is estimated that 40,260 children (aged 14 years and older) and 44,290 adolescents (aged 15–19 years) are living in the United States with a previous cancer diagnosis.” The correct age category for children is “0–14 years” and should read: “As of January 1, 2025, it is estimated that 40,260 children (aged 0–14 years) and 44,290 adolescents (aged 15–19 years) are living in the United States with a previous cancer diagnosis.”

The authors apologize for this oversight.

Wagle NS, Nogueira L, Devasia TP，等。癌症治疗和生存统计，2025年。中华肿瘤学杂志，2015;31(4):391 - 391。doi: 10.3322 /民航总局。70011在“儿童和青少年的癌症”部分，第一句话目前是：“截至2025年1月1日，据估计，美国有40,260名儿童（14岁及以上）和44,290名青少年（15-19岁）患有先前的癌症诊断。”儿童的正确年龄类别是“0-14岁”，应该是：“截至2025年1月1日，估计有40,260名儿童（0-14岁）和44290名青少年（15-19岁）生活在美国，以前曾被诊断患有癌症。”作者为这个疏忽道歉。

引用次数: 0

Fertility counseling for reproductive-age women with cancer should address gestational carriers 对患有癌症的育龄妇女的生育咨询应针对妊娠携带者

IF 232.4 1区医学 Q1 ONCOLOGY

CA: A Cancer Journal for Clinicians

Pub Date : 2025-09-13 DOI: 10.3322/caac.70031

Carrie Printz

Major cancer organizations, including the American Society of Clinical Oncology and the National Comprehensive Cancer Network, recommend that all reproductive-age women with cancer should receive fertility counseling. Certain cancer treatments, particularly those for women with breast or gynecological cancers, can affect fertility and make it more difficult for women to conceive. Upon receiving fertility counseling before cancer treatment, some patients may decide to freeze their oocytes or embryos for future in vitro fertilization (IVF). Others may not seek family planning help until after receiving chemotherapy or pelvic radiation, which can damage their ability to have biological children.Women in both groups may turn to gestational carriers, also called surrogates, to carry a child for them through IVF. Gestational carriers may be the only option for patients whose uterus was removed or damaged during cancer treatment.In a study published in Cancer (doi:10.1002/cncr.35844), researchers sought to further characterize the role of gestational carriers among reproductive-age women diagnosed with cancer. The study assessed which patients used gestational carriers and how often, as well as their pregnancy outcomes.Researchers used data from eight statewide cancer registries linked with the Society for Assistive Reproductive Technology Clinic Outcomes Reporting System (SART CORS). Reporting IVF cycles is federally mandated, and SART CORS includes information from more than 90% of US clinics. Drawing on these data, investigators assessed a retrospective cohort of women with a cancer diagnosis who subsequently initiated IVF procedures from 2004 to 2018.The statewide cancer registries were in Arizona, California, Colorado, Massachusetts, Maryland, North Carolina, New York, and Virginia. Each state has a high number of IVF cycles performed annually and 1000 or more IVF-assisted births each year.Modified Poisson models were used to estimate prevalence rates and 95% confidence intervals (CI). Discrete Cox regression models were used to calculate the hazard ratio and CI. Multivariable models were adjusted for age, state, and calendar year.Of the 1095 women diagnosed with cancer who used IVF with cryopreserved embryos or oocytes, 19.1% worked with a gestational carrier. Women involved gestational carriers more often when they were initiating IVF for fertility preservation rather than after their cancer treatment. Those who had chemotherapy versus no chemotherapy also were more likely to use gestational carriers. In addition, the use of donor oocytes or embryos was more common in women who worked with a gestational carrier.In the sample, 156 women were diagnosed with gynecologic cancer, with 89 having possibly threatened fertility related to surgery or pelvic radiation. In this group, 14.6% (n = 13) initiated IVF before treatment, with 12 ultimately using a gestational carrier. In the group th

包括美国临床肿瘤学会和国家综合癌症网络在内的主要癌症组织建议，所有患有癌症的育龄妇女都应该接受生育咨询。某些癌症治疗，特别是针对患有乳腺癌或妇科癌症的女性的治疗，可能会影响生育能力，使女性更难怀孕。在接受癌症治疗前接受生育咨询后，一些患者可能会决定冷冻他们的卵母细胞或胚胎，以便将来进行体外受精（IVF）。其他人可能直到接受化疗或盆腔放疗后才寻求计划生育帮助，这可能会损害他们生育孩子的能力。这两类女性可能会求助于妊娠载体，也被称为代孕者，通过体外受精为她们生孩子。妊娠载体可能是在癌症治疗期间子宫切除或受损的患者的唯一选择。发表在《癌症》杂志上的一项研究（doi:10.1002/cncr）。35844)，研究人员试图进一步描述妊娠携带者在诊断为癌症的育龄妇女中的作用。该研究评估了哪些患者使用了妊娠载体，使用频率，以及她们的妊娠结局。研究人员使用了与辅助生殖技术临床结果报告系统（SART CORS）相关的八个州癌症登记处的数据。报告试管婴儿周期是联邦政府强制要求的，并且SART CORS包括来自90%以上的美国诊所的信息。根据这些数据，研究人员评估了一组回顾性的癌症诊断女性，这些女性随后在2004年至2018年期间开始了体外受精手术。全州范围内的癌症登记处位于亚利桑那州、加利福尼亚州、科罗拉多州、马萨诸塞州、马里兰州、北卡罗来纳州、纽约州和弗吉尼亚州。每个州每年都有大量的试管婴儿周期，每年有1000或更多的试管婴儿辅助分娩。修正泊松模型用于估计患病率和95%置信区间（CI）。采用离散Cox回归模型计算风险比和CI。多变量模型根据年龄、州和日历年进行调整。在1095名诊断患有癌症的女性中，有19.1%的人使用了冷冻胚胎或卵母细胞进行体外受精。与癌症治疗后相比，女性在开始体外受精以保持生育能力时更常涉及妊娠载体。接受化疗和未接受化疗的患者也更有可能使用妊娠载体。此外，在与妊娠载体一起工作的妇女中，使用供体卵母细胞或胚胎更为常见。在样本中，156名女性被诊断患有妇科癌症，89名女性可能因手术或盆腔放疗而威胁到生育能力。在该组中，14.6% （n = 13）在治疗前开始体外受精，其中12人最终使用妊娠载体。在妇科手术或放疗后开始体外受精的一组中，有31名妇女使用了妊娠载体。在完整的妇科癌症样本中，使用妊娠载体的女性在四次移植尝试中总体受孕率超过92%，其中50%在第一次移植尝试后怀孕，而未使用妊娠载体的女性分别为90.8%和47.4%。在患有乳腺癌的妇女中，有87.6%的人在妊娠载体的四个周期内怀孕，46.2%的人在第一次移植尝试后怀孕。在没有与妊娠载体一起工作的人群中，这一比例分别为91.6%和45.1%。作者指出，保存生育能力的成本很高——卵子或胚胎冷冻的成本估计为1万至1.5万美元，每个胚胎移植周期的成本为1万至1.5万美元。他们报告说，有五个州要求私人保险公司为正在接受可能影响其生育能力的癌症治疗的患者支付保留生育能力的费用，但大多数接受公共医疗补助的患者没有得到任何费用保险。与此同时，没有任何计划涵盖与使用妊娠载体相关的费用，各州关于使用妊娠载体的法律差异很大，有些州不允许对代孕者进行补偿或执行合同。研究人员说，研究结果表明，需要提供生育咨询，包括使用妊娠载体的成本和可用保护信息。“我祝贺作者，因为尽管这一领域很重要，但在这方面的研究很少，”比利时鲁汶大学妇科肿瘤学家fracimadric Amant医学博士说。“近20%的女性使用了妊娠载体，这一数字高于预期，也高于我们在咨询期间解释的数字。咨询机构需要考虑将妊娠携带作为一个现实的选择。”不过，他也指出了使用妊娠载体的挑战，从财务问题到伦理和宗教问题。 “预测患者使用冷冻保存的卵母细胞或胚胎的几率也是一个挑战，”Amant博士说。当病人后来不想要孩子、自然怀孕、选择收养或死于癌症时，冷冻保存是徒劳的。我们需要尽可能精确，更好地选择患者进行这些手术。”他引用了他和他的同事在2018年发表在《妇科和产科调查》（doi:10.1159/000478045）上的一项研究。该研究是最早报道保存生育能力的现实经验的研究之一，它发现，在69种冷冻保存的卵巢材料中，只有两种最终被使用。Lidia Schapira医学博士是加州斯坦福大学的肿瘤学教授和乳腺癌专家，她称赞作者提供了更多关于妊娠载体使用的细节。她说：“让我们注意到这一点很重要，因为不是每个人都能获得医疗服务。”“这需要付出巨大的代价。我很感激这些信息，我认为这有助于为那些考虑使用妊娠载体的患者提供咨询。”据夏皮拉博士说，尽管医学指南强调与被诊断患有癌症的妇女讨论保留生育能力的选择的重要性，但在癌症治疗后和患者整个生育年龄期间，对持续沟通和咨询的关注较少。她说：“我们需要进行更多的研究，这样我们才能更好地为我们的病人提供咨询，并确保他们在有兴趣寻求代孕时掌握必要的知识。”夏皮拉博士和她的癌症幸存者同事正在研究一种工具，帮助育龄妇女思考她们建立家庭的想法和希望。“我们需要找到一种方法，将代孕作为一种选择，而真正的问题是，谁应该在什么时候与患者进行这些对话？”作为一名乳腺癌专家，她指出，在生育选择方面的研究进展可能会使她的病人受益。例如，2023年发表在《新英格兰医学杂志》（doi:10.1056/NEJMoa2212856）上的POSITIVE试验发现，激素受体阳性的早期乳腺癌妇女可以暂停辅助激素治疗，尝试怀孕，而不会经历更大的乳腺癌复发短期风险。夏皮拉博士说：“对患者来说，做出这些生育决定通常是复杂、微妙和困难的，而他们的癌症团队可以开辟对话的空间。”“我们可能无法解决问题，但我们至少可以提供一个安全的空间，帮助她们表达自己的目标，并就怀孕可能如何影响她们的最终结果向她们提出建议。”

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