CA: A Cancer Journal for Clinicians最新文献

A 73-year-old, para five, postmenopausal woman with a history of type 2 diabetes mellitus, hypertension, hyperlipidemia, sarcoidosis, and osteoarthritis presented to the Emergency Department with shortness of breath, abdominal distention, and early satiety for 1 month. She had a remote history of an abdominal hysterectomy for uterine fibroids. Chest x-ray and subsequent computed tomography (CT) of the chest revealed a moderate, right-sided pleural effusion with compressive atelectasis. A CT of the abdomen and pelvis revealed a large, complex, cystic, and solid left adnexal mass measuring 8 × 13 cm with a smaller mass in the right lower pelvis measuring 4.3 cm. Omental thickening and ascites also were noted. The patient was admitted to the hospital and underwent an ultrasound-guided thoracentesis. One liter of fluid was drained and sent for cytology, which returned positive for malignancy. Her cancer antigen 125 level was elevated at 424 U/ml. The patient was discharged home with a plan for outpatient gynecologic oncology follow-up given the concern for ovarian cancer.

The patient was seen in consultation and an extensive history was taken. She denied a family history of cancer. Management options were discussed, including either primary cytoreductive surgery followed by chemotherapy or neoadjuvant chemotherapy with possible interval cytoreduction. Given the extent of her disease on imaging and her presentation, with symptomatic pleural effusions limiting her mobility and functional status, it was recommended she undergo neoadjuvant chemotherapy. While awaiting chemotherapy, the patient was readmitted to an outside hospital with recurrent shortness of breath caused by the re-accumulation of pleural fluid. She underwent repeat thoracentesis, and a PleurX catheter (Becton, Dickinson and Company) was placed. An omental biopsy was also performed and revealed metastatic adenocarcinoma of Mullerian origin.

The patient subsequently completed four cycles of neoadjuvant chemotherapy with paclitaxel, carboplatin, and bevacizumab, with normalization of her cancer antigen 125 level to 18 U/ml after three cycles. She developed worsening peripheral neuropathy grade 2 between cycles three and four despite the use of B6, glutamine, and alpha lipoic acid. Preoperative CT demonstrated an interval decrease in size of her bilateral adnexal masses and resolution of her omental caking, ascites, and pleural effusion. Her PleurX catheter was removed before surgery. At the time of exploratory laparotomy, she had a palpably thickened omentum and normal adnexa. She underwent bilateral salpingo-oophorectomy, infracolic omentectomy, biopsies, and external iliac lymph node sampling, with no gross residual cancer palpated or visualized at the end of the case (R0 resection). Pathology revealed microscopic, high-grade, serous epithelial ovarian adenocarcinoma involving the ovaries and omentum.

The patient's postoperative course was complicated by readmission

American Indian and Alaska Native (AIAN) individuals are diverse culturally and geographically but share a high prevalence of chronic illness, largely because of obstacles to high-quality health care. The authors comprehensively examined cancer incidence and mortality among non-Hispanic AIAN individuals, compared with non-Hispanic White individuals for context, using population-based data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries. Overall cancer rates among AIAN individuals were 2% higher than among White individuals for incidence (2014 through 2018, confined to Purchased/Referred Care Delivery Area counties to reduce racial misclassification) but 18% higher for mortality (2015 through 2019). However, disparities varied widely by cancer type and geographic region. For example, breast and prostate cancer mortality rates are 8% and 31% higher, respectively, in AIAN individuals than in White individuals despite lower incidence and the availability of early detection tests for these cancers. The burden among AIAN individuals is highest for infection-related cancers (liver, stomach, and cervix), for kidney cancer, and for colorectal cancer among indigenous Alaskans (91.3 vs. 35.5 cases per 100,000 for White Alaskans), who have the highest rates in the world. Steep increases for early onset colorectal cancer, from 18.8 cases per 100,000 Native Alaskans aged 20–49 years during 1998 through 2002 to 34.8 cases per 100,000 during 2014 through 2018, exacerbated this disparity. Death rates for infection-related cancers (liver, stomach, and cervix), as well as kidney cancer, were approximately two-fold higher among AIAN individuals compared with White individuals. These findings highlight the need for more effective strategies to reduce the prevalence of chronic oncogenic infections and improve access to high-quality cancer screening and treatment for AIAN individuals. Mitigating the disparate burden will require expanded financial support of tribal health care as well as increased collaboration and engagement with this marginalized population.

In response to the increase in colon cancer rates in younger individuals in 2018, the ACS—with other organizations following suit—recommended lowering the age for starting colorectal cancer screening of average-risk individuals to 45 years. Researchers from the Stanford University School of Medicine in California believe that enough time has now passed to begin assessing the impact of this change. Specifically, they wanted to examine any changes in the proportion of younger people screened in Stanford endoscopy clinics and whether the inclusion of the younger subjects would dilute the ADR. The study appears in Clinical Gastroenterology and Hepatology (doi:10.1016/j.cgh.2022.04.037.)

The researchers used data from Stanford’s Colonoscopy Quality Assurance Program, which collects information from four of the university’s Northern California endoscopy clinics. The researchers compared subjects who underwent screening colonoscopy during two periods. Period 1 covers October 2017 through December 2018 and represents the time before the 2018 ACS guideline. Period 2 covers January 2019 through August 2021, after dissemination of the new guideline. Subjects from each time period were divided into several groups: patients between the ages of 45 and 49 years and those 50 years old or older (in five-year age groups) at their initial colonoscopies as well as patients in the same age groups who were undergoing rescreening colonoscopy.

For each group and by time period, the researchers compared detection rates for adenomas, advanced adenomas, sessile serrated lesions (SSLs), and advanced SSLs; the mean number of adenomas per colonoscopy; and the mean number of lesions per colonoscopy.

Dr Ladabaum, who is the lead author of the study, and his colleagues compared detection rates from Period 2 to Period 1 for patients aged 45–50 years to explore whether patients at low risk for colorectal neoplasia might be self-selecting for screening in Period 2. “When the ACS guidelines were first published, concerns were raised that the 45- to 49-yearolds who would present for screening might be health-conscious persons with the best access to medical services, and that these persons might in fact be a low-risk group.”

The researchers also compared Period 2 detection rates among the younger patients with those of the older groups (those who underwent initial screening or rescreening) for whom colorectal cancer screening is encouraged under new and previous guidelines.

From records of 29,166 unique colonoscopies, the study selected patients who had undergone colonoscopy with documentation of the extent of examination to the cecum and a Boston Bowel Preparation Score of at least 2 in each segment (indicating bowel preparation that was adequate for visualizing the bowel lining). The final study data set included 7990 patients who had undergone colonoscopies from October 2017 through August 2021; 4266 were first-time colonoscopies, and 3724 w

Although it is widely accepted that obesity is a cancer risk factor, there has been little research showing that losing weight and maintaining that loss reduce the risk of developing and possibly dying of certain cancers. A new study by Cleveland Clinic Health System (CCHS) researchers, published in the Journal of the American Medical Association (doi:10.1001/jama.2022.9009), does just that by focusing on patients who underwent bariatric surgery.

Although the biological mechanisms are still incompletely understood, it is believed by many that obesity can affect cancer development and growth by causing increased inflammation, by altering microbiota, by causing insulin resistance, and by increasing the levels of circulating insulin-like growth factor, estrogens, and adipokines.

Lead study author Ali Aminian, MD, professor of surgery at the Lerner College of Medicine and director of Cleveland Clinic’s Bariatric & Metabolic Institute, says that the researchers focused on bariatric surgery because it is an effective and long-lasting way for patients with obesity to lose weight.

The primary composite end point of this retrospective, observational, matched cohort study was the time to first incidence of one of 13 obesity-associated cancers: esophageal adenocarcinoma; renal cell carcinoma; postmenopausal breast cancer; cancer of the gastric cardia, colon, rectum, liver, gallbladder, pancreas, ovary, corpus uteri, or thyroid; and multiple myeloma. The secondary end point was cancer-related mortality.

The SPLENDID study included 5053 adult patients with obesity who underwent either Roux-en-Y gastric bypass or sleeve gastrectomy at Cleveland Clinic hospitals between 2004 and 2017. Each surgical patient was matched with five patients who did not undergo bariatric surgery. These 25,265 nonsurgical control patients were selected via a logistic regression model based on 10 potential self-reported potential confounders, including the following: race (Black, White, or other), body mass index (35–39.9, 40–44.9, 45–49.9, 50–54.9, 55–59.9, or 60–80 kg/m²), smoking history (never, former, or current), presence of type 2 diabetes, Elixhauser Comorbidity Index, Charlson Comorbidity Index, and state of residence (classified as Florida or as Ohio [because many patients were treated at CCHS facilities in those states] or as other US states combined). The median age of the patients was 46 years. Most were female (77%), and 73% were White. The median follow-up interval was 5.8 years for the bariatric surgery group and 6.1 years for patients in the nonsurgical control group.

The CCHS researchers found rather dramatic results: The bariatric surgery patients had a 32% lower incidence of obesity-associated cancer and a 48% lower risk of death from cancer than the patients in the nonsurgical control group.

At the 10-year mark, the bariatric surgery group lost 19.2% more body weight than the control group did; this corresponde

The most common cancer caused by human papillomavirus (HPV) infection in the United States is oropharyngeal cancer (OPC), and its incidence has been rising since the turn of the century. Because of substantial long-term morbidities with chemoradiation and the favorable prognosis of HPV-positive OPC, identifying the optimal deintensification strategy for this group has been a keystone of academic head-and-neck surgery, radiation oncology, and medical oncology for over the past decade. However, the first generation of randomized chemotherapy deintensification trials failed to change the standard of care, triggering concern over the feasibility of de-escalation. National database studies estimate that up to one third of patients receive nonstandard de-escalated treatments, which have subspecialty-specific nuances. A synthesis of the multidisciplinary deintensification data and current treatment standards is important for the oncology community to reinforce best practices and ensure optimal patient outcomes. In this review, the authors present a summary and comparison of prospective HPV-positive OPC de-escalation trials. Chemotherapy attenuation compromises outcomes without reducing toxicity. Limited data comparing transoral robotic surgery (TORS) with radiation raise concern over toxicity and outcomes with TORS. There are promising data to support de-escalating adjuvant therapy after TORS, but consensus on treatment indications is needed. Encouraging radiation deintensification strategies have been reported (upfront dose reduction and induction chemotherapy-based patient selection), but level I evidence is years away. Ultimately, stage and HPV status may be insufficient to guide de-escalation. The future of deintensification may lie in incorporating intratreatment response assessments to harness the powers of personalized medicine and integrate real-time surveillance.

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver tumor and remains a fatal malignancy in the majority of patients. Approximately 20%–30% of patients are eligible for resection, which is considered the only potentially curative treatment; and, after resection, a median survival of 53 months has been reported when sequenced with adjuvant capecitabine. For the 70%–80% of patients who present with locally unresectable or distant metastatic disease, systemic therapy may delay progression, but survival remains limited to approximately 1 year. For the past decade, doublet chemotherapy with gemcitabine and cisplatin has been considered the most effective first-line regimen, but results from the recent use of triplet regimens and even immunotherapy may shift the paradigm. More effective treatment strategies, including those that combine systemic therapy with locoregional therapies like radioembolization or hepatic artery infusion, have also been developed. Molecular therapies, including those that target fibroblast growth factor receptor and isocitrate dehydrogenase, have recently received US Food and Drug Administration approval for a defined role as second-line treatment for up to 40% of patients harboring these actionable genomic alterations, and whether they should be considered in the first-line setting is under investigation. Furthermore, as the oncology field seeks to expand indications for immunotherapy, recent data demonstrated that combining durvalumab with standard cytotoxic therapy improved survival in patients with ICC. This review focuses on the current and future strategies for ICC treatment, including a summary of the primary literature for each treatment modality and an algorithm that can be used to drive a personalized and multidisciplinary approach for patients with this challenging malignancy.

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, 2021, to June 30, 2022. These individuals go beyond expectations by consistently and expeditiously delivering comprehensive, discerning reviews.

Eric Aboagye

Cecelia Bellcross

Patricia Brock

Gregory Calip

Yin Cao

Fumiko Chino

Yun Shin Chun

David Cohn

A. Dimitrios Colevas

Laurie Connors

John Cramer

K. Michael Cummings

James Cusack

Maggie Diller

Thomas Dilling

Didem Egemen

Joanne Elena

William Faquin

Kevin Fisher

Scott Floyd

Alison Freifeld

Hans Gerdes

Surbhi Grover

B. Ashleigh Guadagnolo

Arjun Gupta

Bishal Gyawali

Jill Hamilton-Reeves

Eugene Harper

Joseph Herman

J. Kevin Hicks

I-Chan Huang

Farhad Islami

Sophia Kamran

John Kang

Eva Kantelhardt

Nancy Kemeny

Anne Kirchhoff

Wayne Koch

Jill Kolesar

Scott Kopetz

Robert Krouse

Angela Lamarca

Laura Lambert

Jonathan Leeman

Joseph Lipscomb

Michelle Ludwig

Yehoda Martei

Cathy Meade

Winta Mehtsun

Jane Meisel

Jeffrey Meyer

Navya Nair

Elyse Park

Stephen Pastores

Jai Patel

Chyrstal Paulos

Meera Ragavan

Rifaquat Rahman

Joshua Reuss

Peggy Reynolds

Eric Roeland

Ari J. Rosenberg

Ali Shazib

Siddharth Sheth

David Shibata

Kevin Stein

Howard Strickler

Samuel Takvorian

Lauren Teras

Mary Beth Terry

Debu Tripathy

Andrew Vickers

Beth Virnig

Elizabeth Ward

J. Lee Westmaas

Stephanie Wheeler

Mary White

Andrew Wiemer

Risa Wong

Rongxiao Zhang

This article is the American Cancer Society’s update on female breast cancer statistics in the United States, including population-based data on incidence, mortality, survival, and mammography screening. Breast cancer incidence rates have risen in most of the past four decades; during the most recent data years (2010–2019), the rate increased by 0.5% annually, largely driven by localized-stage and hormone receptor-positive disease. In contrast, breast cancer mortality rates have declined steadily since their peak in 1989, albeit at a slower pace in recent years (1.3% annually from 2011 to 2020) than in the previous decade (1.9% annually from 2002 to 2011). In total, the death rate dropped by 43% during 1989–2020, translating to 460,000 fewer breast cancer deaths during that time. The death rate declined similarly for women of all racial/ethnic groups except American Indians/Alaska Natives, among whom the rates were stable. However, despite a lower incidence rate in Black versus White women (127.8 vs. 133.7 per 100,000), the racial disparity in breast cancer mortality remained unwavering, with the death rate 40% higher in Black women overall (27.6 vs. 19.7 deaths per 100,000 in 2016–2020) and two-fold higher among adult women younger than 50 years (12.1 vs. 6.5 deaths per 100,000). Black women have the lowest 5-year relative survival of any racial/ethnic group for every molecular subtype and stage of disease (except stage I), with the largest Black–White gaps in absolute terms for hormone receptor-positive/human epidermal growth factor receptor 2-negative disease (88% vs. 96%), hormone receptor-negative/human epidermal growth factor receptor 2-positive disease (78% vs. 86%), and stage III disease (64% vs. 77%). Progress against breast cancer mortality could be accelerated by mitigating racial disparities through increased access to high-quality screening and treatment via nationwide Medicaid expansion and partnerships between community stakeholders, advocacy organizations, and health systems.

Over the past several years, multifaceted advances in the management of cancer have led to a significant improvement in survival rates. Throughout patients’ oncological journeys, they will likely receive one or more implantable devices for the administration of fluids and medications as well as management of various comorbidities and complications related to cancer therapy. Infections associated with these devices are frequent and complex, often necessitating device removal, increasing health care costs, negatively affecting quality of life, and complicating oncological care, usually leading to delays in further life-saving cancer therapy. Herein, the authors comprehensively review multiple evidence-based recommendations along with best practices, expert opinions, and novel approaches for the prevention of diverse device-related infections. The authors present many general principles for the prevention of these infections followed by specific device-related recommendations in a systematic manner. The continuous involvement and meaningful cooperation between regulatory entities, industry, specialty medical societies, hospitals, and infection control-targeted interventions, along with primary care and consulting health care providers, are all vital for the sustained reduction in the incidence of these preventable infections.

This erratum corrects the following:

Elad S, Yarom N, Zadik Y, Kuten-Shorrer M, Sonis ST. The broadening scope of oral mucositis and oral ulcerative mucosal toxicities of anticancer therapies. CA Cancer J Clin. 2022;72(1):57–77. doi:10.3322/caac.21704

In the aforementioned article, an error appears in the Head and Neck Radiation Therapy section. The text should read as follows:

“From 59.4% to 100% of patients with H&N cancer who were treated with RT or chemoradiotherapy (CRT) have OM, with SOM affecting approximately 65% of patients.^9,10 The incidence is influenced by tumor site, radiation field, radiation technique, and the use of concomitant chemotherapy. A meta-analysis of 12 prospective trials including 1373 H&N cancer patients reported the incidence of SOM in 2 cisplatin-based CRT protocols. In this meta-analysis, the incidence of SOM was 40% for the high-dose cisplatin protocol (once every 3-4 weeks, 2 cycles) and 75% for the low-dose cisplatin protocol (once a week, 4-7 cycles) (P = .0202).¹¹” It is noteworthy that there was a significant survival benefit (P = .0185) for the high-dose schedule.

The authors apologize for the error.