Cancer Medicine最新文献_第10页

TMEM106A as a Macrophage-Associated Biomarker of Prognosis in IDH-Wildtype Glioma: Integrative Multi-Omics and Spatial Analyses TMEM106A作为idh野生型胶质瘤巨噬细胞相关的预后生物标志物：综合多组学和空间分析

IF 3.1 2区医学 Q2 ONCOLOGY

Cancer Medicine

Pub Date : 2025-12-07 DOI: 10.1002/cam4.71454

Wen-Shin Song, Pei-Chi Chang, Dueng-Yuan Hueng, Yao-Feng Li

Introduction

Gliomas remain aggressive despite current therapies, highlighting the urgent need for new biomarkers and targets. Transmembrane protein 106A (TMEM106A), implicated as a tumor suppressor in various cancers, has an unclear role in gliomas. We hypothesized that TMEM106A expression associates with tumor aggressiveness and may serve as a prognostic, microenvironmental biomarker.

Methods

We integrated TCGA and CGGA bulk RNA-seq, single-cell (GSE131928, GSE89567), spatial (Ivy Atlas, Visium), and immunohistochemistry (n = 79) to evaluate TMEM106A. Differential expression used limma. Survival used Kaplan–Meier and multivariable Cox models. Immune contexture used a 12-cell-state deconvolution and CIBERSORT. GSEA assessed hallmark pathways. Drug sensitivity was inferred using pRRophetic. Immunotherapy modeling combined TCGA expression with TCIA immunophenoscore and PD-L1.

Results

(1) TMEM106A mRNA is significantly upregulated in high-grade gliomas compared to lower-grade gliomas and normal brain. (2) In IDH-wildtype tumors, differential analyses highlight roles of TMEM106A and TMEM106C; high expression links to poorer prognosis. (3) TMEM106A is an independent prognostic factor associated with aggressive behavior, especially in IDH-wildtype astrocytomas. (4) Upregulation is confirmed by immunohistochemistry. (5) High TMEM106A associates with pro-inflammatory signatures and higher inferred fractions of myeloid cells and granulocytes. (6) Single-cell RNA-seq shows enrichment in myeloid lineages, and (7) CIBERSORT shows modest positive correlations with polarized macrophage signatures. (8) Spatial transcriptomics shows higher TMEM106A in myeloid-rich regions, consistent with a microenvironmental readout. (9) In IDH-wildtype tumors, pRRophetic predicts lower IC50 for multiple targeted agents in TMEM106A-high tumors. (10) TMEM106A-high IDH-wildtype tumors show higher IPS only when PD-1 is “on,” suggesting a context-dependent, inflamed-but-suppressed state.

Conclusion

TMEM106A independently predicts survival and correlates with myeloid-enriched transcriptional states in gliomas. Given its high expression in myeloid lineages in single-cell data, bulk upregulation is potentially driven by myeloid infiltration rather than tumor-cell intrinsic mechanisms. All findings are correlative; prospective studies are needed before any clinical use is considered.

尽管目前的治疗方法，胶质瘤仍然具有侵袭性，强调迫切需要新的生物标志物和靶点。跨膜蛋白106A （TMEM106A）在多种癌症中作为肿瘤抑制因子，在胶质瘤中的作用尚不清楚。我们假设TMEM106A表达与肿瘤侵袭性相关，并可能作为预后的微环境生物标志物。方法：采用TCGA和CGGA bulk RNA-seq、单细胞（GSE131928、GSE89567）、空间（Ivy Atlas、Visium）和免疫组织化学（n = 79）对TMEM106A进行评价。微分表达式使用了limma。生存率采用Kaplan-Meier和多变量Cox模型。免疫环境使用12细胞状态反卷积和CIBERSORT。GSEA评估了标志通路。使用prophytic推断药物敏感性。免疫治疗模型结合TCGA表达、TCIA免疫表型评分和PD-L1。结果：(1)与低级别脑胶质瘤和正常脑相比，TMEM106A mRNA在高级别脑胶质瘤中显著上调。(2)在idh野生型肿瘤中，差异分析突出了TMEM106A和TMEM106C的作用；高表达与预后较差有关。(3) TMEM106A是与侵袭行为相关的独立预后因素，尤其是在idh野生型星形细胞瘤中。(4)免疫组化证实上调。(5)高TMEM106A与促炎特征和更高的髓细胞和粒细胞推测分数相关。(6)单细胞RNA-seq显示髓系谱系富集，(7)CIBERSORT显示与极化巨噬细胞特征适度正相关。(8)空间转录组学显示，在骨髓丰富的区域TMEM106A较高，与微环境读数一致。(9)在idh野生型肿瘤中，prorophetic预测多种靶向药物在tmem106a高水平肿瘤中的IC50较低。（10） tmem106a高idh野生型肿瘤只有在PD-1“开启”时才表现出更高的IPS，这表明这是一种依赖于环境、炎症但抑制的状态。结论：TMEM106A独立预测胶质瘤的生存，并与髓细胞富集的转录状态相关。鉴于其在单细胞髓系中的高表达，大量上调可能是由髓系浸润而不是肿瘤细胞内在机制驱动的。所有发现都是相关的；在考虑任何临床应用之前，需要进行前瞻性研究。

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引用次数: 0

The Burden of Pancreatic Cancer in Five East Asian Countries From 1990 to 2021 and Its Prediction up to 2036: A Systemic Analysis of the Global Burden of Diseases Study 2021 1990年至2021年东亚五国胰腺癌负担及其预测：2021年全球疾病负担研究的系统分析

IF 3.1 2区医学 Q2 ONCOLOGY

Cancer Medicine

Pub Date : 2025-12-07 DOI: 10.1002/cam4.70656

Tianhao Guo, Wenjian Zhu, Yifan Hui, Yuhan Wang, Tingting Zhou, Weixing Shen, Liu Li, Yu Yang, Haibo Cheng

Background

Pancreatic cancer (PC) presents a significant challenge for prevention and treatment, posing a serious threat to the health and lives of patients. The five East Asian countries (China, Japan, North Korea, South Korea, and Mongolia) represent one of the most significant regions globally in terms of PC burden.

Methods

We retrieved data from the Global Burden of Disease (GBD) Study 2021 regarding the prevalence, incidence, mortality, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs) associated with PC in these five East Asian countries from 1990 to 2021. We employed joinpoint, age-period-cohort (APC), and decomposition analysis methods to assess the epidemiological characteristics of PC. To project the future burden of PC through 2036, we applied two prediction models: Autoregressive Integrated Moving Average (ARIMA) and Bayesian age-period-cohort (BAPC) models.

Results

China recorded the highest incidence, prevalence, mortality, YLLs, YLDs, and DALYs among the five East Asian countries in both 1990 and 2021. Japan exhibited the highest age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), age-standardized prevalence rate (ASPR), and age-standardized YLDs rate in both 1990 and 2021. Mongolia experienced significant increases in the number and rates of incidence, prevalence, death, YLLs, YLDs, and DALYs from 1990 to 2021. The age group with the highest prevalence, incidence, mortality, YLDs, YLLs, and DALYs rates across the five East Asian countries was consistently those aged 70 and older. The incidence rate across the five countries is influenced by aging populations, surpassing global averages. Projections for 2030 and 2036 suggest that Japan will have the highest ASPR (13.23 in 2030 and 13.85 in 2036), ASIR (12.14 in 2030 and 12.53 in 2036), and ASMR (10.97 in 2030 and 11.39 in 2036) among the countries.

Conclusion

The disease burden of PC in the five East Asian countries has steadily increased over the past three decades, particularly among older adults due to population aging.

背景：胰腺癌（Pancreatic cancer， PC）对患者的健康和生命构成严重威胁，是预防和治疗的重大挑战。五个东亚国家（中国、日本、朝鲜、韩国和蒙古）是全球PC负担最严重的地区之一。方法：我们从全球疾病负担（GBD）研究2021中检索数据，包括1990年至2021年这五个东亚国家与PC相关的患病率、发病率、死亡率、残疾生活年数（YLDs）、生命损失年数（YLLs）和残疾调整生命年（DALYs）。我们采用结合点、年龄-时期-队列（APC）和分解分析方法来评估PC的流行病学特征。为了预测到2036年的未来PC负担，我们应用了两种预测模型：自回归综合移动平均（ARIMA）和贝叶斯年龄-时期-队列（BAPC）模型。结果：1990年和2021年，中国的发病率、患病率、死亡率、年活龄、年活龄和残疾活龄在东亚五国中均为最高。1990年和2021年，日本的年龄标准化发病率（ASIR）、年龄标准化死亡率（ASMR）、年龄标准化患病率（ASPR）和年龄标准化YLDs率均最高。从1990年到2021年，蒙古的发病率、流行率、死亡率、生命周期、生命周期和生命周期均显著增加。在东亚五个国家中，患病率、发病率、死亡率、生命周期、生命周期和伤残调整生命年比率最高的年龄组始终是70岁及以上的年龄组。这五个国家的发病率受到人口老龄化的影响，超过了全球平均水平。对2030年和2036年的预测表明，日本将拥有最高的ASPR（2030年为13.23,2036年为13.85）、ASIR（2030年为12.14,2036年为12.53）和ASMR（2030年为10.97,2036年为11.39）。结论：东亚五国的PC疾病负担在过去三十年中稳步增加，特别是在老年人中，由于人口老龄化。

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引用次数: 0

Pretreatment Amide Proton Transfer-Weighted Imaging Histogram Analysis Combined With ER-Negative and HER2-Positive Expression Predicts Pathologic Complete Response After Neoadjuvant Chemotherapy in Breast Cancer 预处理酰胺质子转移加权成像直方图分析联合er阴性和her2阳性表达预测乳腺癌新辅助化疗后病理完全缓解。

IF 3.1 2区医学 Q2 ONCOLOGY

Cancer Medicine

Pub Date : 2025-12-07 DOI: 10.1002/cam4.71420

Mingzhe Xu, Dongqiu Shan, Xuejun Chen, Renzhi Zhang, Chunmiao Xu, Jing Li, Zhiwei Shen, Yue Wu, Jinrong Qu

Purpose

To evaluate the predictive value of pre-treatment histogram analysis using APTWI, diffusion-weighted imaging (DWI), and early contrast-enhanced silhouette imaging in determining pathological complete response (pCR) post-NAC in breast cancer, and to investigate whether combining immunohistochemical indicators enhances predictive accuracy.

Materials and Methods

A retrospective continuous collection of 108 females with breast cancer who underwent NAC and pre-treatment APTWI, DWI, and dynamic contrast-enhanced imaging at our hospital. Clinical, MRI imaging, and pathological characteristics were analyzed for patients. NAC response was divided into pCR and non-pCR. Tumor segmentation and histogram feature extraction were performed on APT, ADC, and early contrast-enhanced silhouette images, and combined them with clinical features to construct an NAC efficacy prediction model. Diagnostic performance was assessed using receiver operating characteristic curves, with DeLong's test employed to compare areas under the curve (AUC).

Results

In pCR group, mean, root-mean-square deviation, and 5th, 10th, 15th, 25th, 50th, 75th, 85th percentile of MTRasym, along with 1st percentiles of ADC were significantly higher in the pCR group than in the non-pCR group (p < 0.05). Conversely, the interquartile range of MTRasym and 10th percentiles of ADC were significantly lower in the pCR group (p < 0.05). ER-negative, HER2-positive expression, and 5th percentile MTRasym value were identified as independent predictors of pCR post-NAC (odds ratios, 0.16, 7.25, and 1.35, respectively). The combined diagnostic model demonstrated an AUC of 0.844, significantly outperforming individual parameters (p < 0.05).

Conclusion

Pre-treatment histogram analysis of MTRasym values derived from APTWI provides significant predictive value for pCR post-NAC in breast cancer. The combined diagnostic model incorporating APTWI with ER and HER2 expression status further enhances diagnostic performance.

目的：评价应用APTWI、弥散加权成像（diffusion weighted imaging， DWI）和早期增强剪影成像进行治疗前直方图分析对乳腺癌nac后病理完全反应（pathological complete response, pCR）的预测价值，并探讨联合免疫组化指标是否能提高预测准确性。材料与方法：回顾性连续收集我院行NAC及治疗前APTWI、DWI、动态增强成像的女性乳腺癌患者108例。分析患者的临床、MRI及病理特征。NAC反应分为pCR反应和非pCR反应。对APT、ADC和早期增强剪影图像进行肿瘤分割和直方图特征提取，并结合临床特征构建NAC疗效预测模型。采用受试者工作特征曲线评估诊断性能，采用DeLong试验比较曲线下面积（AUC）。结果：pCR组MTRasym的均值、均方根偏差、5、10、15、25、50、75、85百分位数以及ADC的1百分位数均显著高于非pCR组(p)。结论：APTWI提取的MTRasym值的治疗前直方图分析对乳腺癌pCR后nac有显著的预测价值。将APTWI与ER和HER2表达状态结合的联合诊断模型进一步提高了诊断效能。

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引用次数: 0

Dualistic Roles of High Mobility Group Box 1 in Cancer and Inflammation 高迁移率组1在癌症和炎症中的双重作用。

IF 3.1 2区医学 Q2 ONCOLOGY

Cancer Medicine

Pub Date : 2025-12-07 DOI: 10.1002/cam4.71455

Wen Zeng, Xu Zhang, Yulu Jiang, Yuxiang Luo, Zuao Wang, Xiaohong Du, Leifeng Chen

<div> <section> <h3> Background</h3> <p>The High Mobility Group Box 1 (HMGB1) protein, a member of the HMG family, plays a crucial role in both cancer progression and inflammatory responses. HMGB1 can act as a damage-associated molecular pattern (DAMP) to activate immune responses and modulate inflammation. Its dualistic roles in promoting and inhibiting tumor growth, as well as its involvement in DNA repair and drug resistance, make it a key target for understanding and treating cancer and inflammatory diseases.</p> </section> <section> <h3> Objective</h3> <p>This review aims to explore the dualistic roles of HMGB1 in cancer and inflammation, focusing on its pro-inflammatory and anti-inflammatory functions in the tumor microenvironment, its impact on DNA damage repair and tumor drug resistance, and its potential as a therapeutic target for cancer and inflammatory diseases.</p> </section> <section> <h3> Methods</h3> <p>We conducted a comprehensive review of the literature on HMGB1, analyzing its structural features, biological functions, and mechanisms of action in various pathological contexts. We also examined the impact of HMGB1 on tumor progression, immune responses, and metabolic reprogramming in cancer cells, as well as its role in inflammatory signaling pathways.</p> </section> <section> <h3> Results</h3> <p>HMGB1 exhibits both oncogenic and tumor-suppressive effects in cancer. It promotes tumor growth, metastasis, and immune evasion through mechanisms such as shaping the tumor microenvironment, driving metabolic reprogramming, and inducing drug resistance. Conversely, HMGB1 can enhance anti-tumor immunity by activating dendritic cells and T cells. In inflammation, HMGB1 acts as a DAMP, activating immune responses via receptors like RAGE and TLR4. Its redox state and subcellular localization determine its proinflammatory or anti-inflammatory functions. Targeting HMGB1 has shown promise in preclinical and clinical studies, with potential applications in anti-cancer and anti-inflammatory therapies.</p> </section> <section> <h3> Conclusion</h3> <p>The dualistic roles of HMGB1 in cancer and inflammation highlight its complexity and potential as a therapeutic target. Future research should focus on elucidating the context-specific mechanisms of HMGB1, developing precision-targeted therapies to modulate its multifunctional activities, and translating these findings into clinical practice to improve patient outcomes.</p> </section>

背景：高迁移率组框1 （HMGB1）蛋白是HMG家族的成员，在癌症进展和炎症反应中起着至关重要的作用。HMGB1可以作为一种损伤相关分子模式（DAMP）激活免疫反应并调节炎症。它在促进和抑制肿瘤生长方面的双重作用，以及参与DNA修复和耐药性，使其成为了解和治疗癌症和炎症性疾病的关键靶点。目的：本文旨在探讨HMGB1在肿瘤和炎症中的双重作用，重点探讨其在肿瘤微环境中的促炎和抗炎功能，对DNA损伤修复和肿瘤耐药的影响，以及其作为癌症和炎症疾病治疗靶点的潜力。方法：我们对有关HMGB1的文献进行了全面的综述，分析其结构特征、生物学功能以及在各种病理情况下的作用机制。我们还研究了HMGB1对肿瘤进展、免疫反应和癌细胞代谢重编程的影响，以及它在炎症信号通路中的作用。结果：HMGB1在肿瘤中具有致癌和抑瘤双重作用。它通过塑造肿瘤微环境、驱动代谢重编程和诱导耐药等机制促进肿瘤生长、转移和免疫逃避。相反，HMGB1可以通过激活树突状细胞和T细胞增强抗肿瘤免疫。在炎症中，HMGB1作为一种DAMP，通过RAGE和TLR4等受体激活免疫反应。其氧化还原状态和亚细胞定位决定了其促炎或抗炎功能。靶向HMGB1在临床前和临床研究中显示出良好的前景，在抗癌和抗炎治疗中具有潜在的应用前景。结论：HMGB1在肿瘤和炎症中的双重作用突出了其复杂性和作为治疗靶点的潜力。未来的研究应侧重于阐明HMGB1的环境特异性机制，开发精确靶向治疗来调节其多功能活动，并将这些发现转化为临床实践以改善患者预后。

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引用次数: 0

Overexpressed CD24 and CD47 Indicate a Worse Prognosis in Cervical Cancer CD24和CD47过表达提示宫颈癌预后较差

IF 3.1 2区医学 Q2 ONCOLOGY

Cancer Medicine

Pub Date : 2025-12-07 DOI: 10.1002/cam4.71443

Min Yu, Mengdong Ni, Fei Xu, Chi Fang, Jiajia Li, Xiaohua Wu, Guihao Ke

Background

Two antiphagocytic (“don't eat me”) signals that allow tumor immune evasion have been discovered, including CD24 and CD47. This study explored the association between CD24/CD47 expression and macrophage infiltration and clinical outcomes in cervical cancer.

Methods

RNA expression and survival data of the Cancer Genome Atlas (TCGA) cohort were extracted from OncoLnc. The macrophage infiltration level was calculated using xCell, TIMER, and ImmuCellAI. The expression of CD24 and CD47 was detected by immunohistochemistry in tissue microarrays composed of 130 clinical cervical cancer specimens from Fudan University Shanghai Cancer Center (FUSCC). Patients' medical records were also retrospectively assessed to correlate demographic and survival data.

Results

Expression levels of both CD24 and CD47 in the cancer population were higher than those in the normal population. Patients with high CD24 expression had poorer survival than those with low CD24 expression in the TCGA and FUSCC cervical cancer cohorts. Although CD47 alone was not statistically significant in predicting outcomes, patients with high CD47 and low CD11c expression, a specific marker of M1-polarized macrophages, exhibited worse survival in the TCGA cohort.

Conclusions

Our study implies that high CD24 expression is an important predictor of a worse prognosis, and CD24 blockade might have therapeutic potential for the treatment of cervical cancer. High expression levels of CD47 and low M1-polarized macrophage infiltration predict a worse prognosis.

背景：已经发现了两种允许肿瘤免疫逃避的抗吞噬（“不要吃我”）信号，包括CD24和CD47。本研究探讨CD24/CD47表达、巨噬细胞浸润与宫颈癌临床结局的关系。方法：提取肿瘤基因组图谱（TCGA）队列的RNA表达和生存数据。使用xCell、TIMER和ImmuCellAI计算巨噬细胞浸润水平。应用免疫组织化学方法检测了130例复旦大学上海肿瘤中心宫颈癌临床标本组织微阵列中CD24和CD47的表达。患者的医疗记录也被回顾性评估，以关联人口统计学和生存数据。结果：肿瘤人群中CD24和CD47的表达水平均高于正常人群。在TCGA和FUSCC宫颈癌队列中，CD24高表达患者的生存率低于CD24低表达患者。虽然CD47在预测预后方面没有统计学意义，但在TCGA队列中，高CD47和低CD11c（一种m1极化巨噬细胞的特异性标志物）表达的患者表现出更差的生存率。结论：本研究提示CD24高表达是宫颈癌预后不良的重要预测因子，CD24阻断可能具有治疗宫颈癌的潜力。CD47高表达和低m1极化巨噬细胞浸润预示着较差的预后。

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引用次数: 0

Predicting Benefit of Neoadjuvant Chemotherapy and Elective Nodal Irradiation in Pancreatic Adenocarcinoma: A Supervised Machine Learning Approach 预测胰腺癌新辅助化疗和选择性淋巴结放疗的获益：一种监督机器学习方法。

IF 3.1 2区医学 Q2 ONCOLOGY

Cancer Medicine

Pub Date : 2025-12-05 DOI: 10.1002/cam4.71447

Garrett K. Harada, Jino Park, Nicholas Peterson, Akul Munjal, David Imagawa, Zeljka Jutric, Farshid Dayyani, Jennifer Valerin, David S. Hong, Steven N. Seyedin

Background

The relative benefit of neoadjuvant therapies remains controversial for patients with (borderline) resectable pancreatic ductal adenocarcinoma (PDAC). The purpose of this study was to create a model to predict response to multiagent neoadjuvant chemotherapy (NAC) followed by radiotherapy with elective nodal irradiation (ENI).

Methods

Using the National Cancer Database (NCDB), we identified patients with cT1-4N0M0 PDAC diagnosed between 2006 and 2020 treated with multiagent NAC, radiation with ENI, followed by curative resection with nodal dissection. A LASSO logistic regression model was used to predict ypN0 status, with generation of a nomogram and assessment of outcomes in training and testing cohorts. Secondary endpoints of negative-margin resection and overall survival were also examined. Out-of-sample predictions were then made on a separate ENI-naïve cohort, with similar assessments of selected outcomes. The threshold for statistical significance was set to p < 0.05.

Results

A total of 1053 patients were identified with a median age of 64.0 years (IQR = 57–70 years). The final model included pancreatic body tumor location, clinical T stage, time from diagnosis to radiation therapy and surgery, ENI dose, and duration of NAC, among others. Patients predicted for treatment response were more likely to be ypN0 (71.5% vs. 29.7%, p < 0.001), had more R0 resections (87.3% vs. 62.6%, p < 0.001), and improved OS after accounting for competing risks of perioperative death (SHR = 0.64, 95% CI = 0.46–0.89, p = 0.008). A similar significant trend was noted in the ENI-naïve cohort (N = 1258). Model AUC was 0.718 and 0.725 in training and testing cohorts, respectively.

Conclusions

Using a machine learning approach, we define a nomogram capable of predicting treatment response to multiagent NAC followed by radiotherapy with or without ENI. Patients selected by this model had higher rates of ypN0, higher R0 resection rates, and improved OS.

背景：对于（交界性）可切除胰腺导管腺癌（PDAC）患者，新辅助治疗的相对益处仍然存在争议。本研究的目的是建立一个模型来预测多药新辅助化疗（NAC）后选择性淋巴结放射治疗（ENI）的反应。方法：使用国家癌症数据库（NCDB），我们确定了2006年至2020年间诊断为cT1-4N0M0 PDAC的患者，他们接受了多药NAC、ENI放射治疗，然后进行了根治性切除和淋巴结清扫。使用LASSO逻辑回归模型预测ypN0状态，生成nomogram并评估训练和测试队列的结果。阴性切缘切除的次要终点和总生存期也进行了检查。然后在一个单独的ENI-naïve队列中进行样本外预测，对选定的结果进行类似的评估。结果：共发现1053例患者，中位年龄64.0岁（IQR = 57 ~ 70岁）。最终模型包括胰腺体肿瘤位置、临床T分期、从诊断到放疗和手术时间、ENI剂量、NAC持续时间等。预测治疗反应的患者更有可能是ypN0（71.5%对29.7%,p）。结论：使用机器学习方法，我们定义了一个能够预测多药NAC治疗反应的nomogram (nomogram)，随后是有或没有ENI的放疗。该模型选择的患者具有更高的ypN0率、更高的R0切除率和更高的OS。

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引用次数: 0

Factors Influencing Time to Treatment Initiation for Breast Cancer in Ethiopia 影响埃塞俄比亚乳腺癌开始治疗时间的因素。

IF 3.1 2区医学 Q2 ONCOLOGY

Cancer Medicine

Pub Date : 2025-12-04 DOI: 10.1002/cam4.71439

Anteneh Ayelign Kibret, Jason Jiang, Edom Seife Woldetsadik, Miliyard Demeke Tafese, Biniyam Tefera Deressa, Chaojie Liu

Background

Breast cancer remains a major public health concern in Ethiopia, with timely access to care critical for improving outcomes. This study examined factors associated with delays in the breast cancer care pathway.

Methods

This cross-sectional study collected data from 458 women with histologically confirmed breast cancer between July and September 2024 at three tertiary hospitals. Data were collected through structured interviews and clinical records. Five time intervals from symptom detection to treatment initiation were analyzed using the Model of Pathways to Treatment. Factors were categorized using Andersen's Behavioral Model, and Accelerated Failure Time (AFT) models were used to estimate time ratios (TRs) with 95% confidence intervals (CIs).

Results

Rural residence (TR = 1.84; 95% CI: 1.20–2.80) and painless breast mass (TR = 1.94; 95% CI: 1.26–3.00) were linked to longer delays from symptom recognition to first healthcare contact. Low breast cancer literacy and consulting traditional healers before diagnosis were consistently associated with prolonged delays. Consulting ≥ 3 providers extended both intervals, from first healthcare contact to diagnosis (TR = 3.13; 95% CI: 1.96–4.98) and symptom detection to diagnosis (TR = 1.63; 95% CI: 1.02–2.62). Delays were also associated with first providers failing to suspect or refer for cancer. Longer diagnosis-to-treatment intervals were observed among unmarried women, low-income groups, and those using traditional healing post-diagnosis. Older women (≥ 60 years) experienced shorter delays in initiating treatment (TR = 0.62; 95% CI: 0.41–0.93).

Conclusion

Delays in breast cancer care in Ethiopia are driven by individual, sociocultural, and systemic barriers. Multilevel interventions are needed to promote early detection and timely treatment.

背景：在埃塞俄比亚，乳腺癌仍然是一个主要的公共卫生问题，及时获得护理对改善结果至关重要。本研究探讨了与乳腺癌治疗途径延迟相关的因素。方法：本横断面研究收集了三家三级医院2024年7月至9月组织学证实的458名乳腺癌妇女的数据。通过结构化访谈和临床记录收集数据。用治疗途径模型分析了从症状发现到治疗开始的五个时间间隔。使用Andersen行为模型对因素进行分类，并使用加速失效时间（AFT）模型以95%置信区间（ci）估计时间比率（TRs）。结果：农村居住（TR = 1.84; 95% CI: 1.20-2.80）和无痛性乳房肿块（TR = 1.94; 95% CI: 1.26-3.00）与从症状识别到首次医疗联系的较长延迟有关。低乳腺癌知识水平和在诊断前咨询传统治疗师一直与长期延误有关。咨询≥3个提供者延长了从首次医疗接触到诊断（TR = 3.13; 95% CI: 1.96-4.98）和症状检测到诊断（TR = 1.63; 95% CI: 1.02-2.62）这两个间隔。延迟也与第一提供者未能怀疑或推荐癌症有关。在未婚女性、低收入群体和诊断后使用传统治疗的人群中，观察到较长的诊断到治疗间隔。老年妇女（≥60岁）延迟开始治疗的时间较短（TR = 0.62; 95% CI: 0.41-0.93）。结论：埃塞俄比亚的乳腺癌护理延迟是由个人、社会文化和系统障碍驱动的。需要采取多层次干预措施，以促进早期发现和及时治疗。

{"title":"Factors Influencing Time to Treatment Initiation for Breast Cancer in Ethiopia","authors":"Anteneh Ayelign Kibret, Jason Jiang, Edom Seife Woldetsadik, Miliyard Demeke Tafese, Biniyam Tefera Deressa, Chaojie Liu","doi":"10.1002/cam4.71439","DOIUrl":"10.1002/cam4.71439","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Breast cancer remains a major public health concern in Ethiopia, with timely access to care critical for improving outcomes. This study examined factors associated with delays in the breast cancer care pathway.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study collected data from 458 women with histologically confirmed breast cancer between July and September 2024 at three tertiary hospitals. Data were collected through structured interviews and clinical records. Five time intervals from symptom detection to treatment initiation were analyzed using the Model of Pathways to Treatment. Factors were categorized using Andersen's Behavioral Model, and Accelerated Failure Time (AFT) models were used to estimate time ratios (TRs) with 95% confidence intervals (CIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Rural residence (TR = 1.84; 95% CI: 1.20–2.80) and painless breast mass (TR = 1.94; 95% CI: 1.26–3.00) were linked to longer delays from symptom recognition to first healthcare contact. Low breast cancer literacy and consulting traditional healers before diagnosis were consistently associated with prolonged delays. Consulting ≥ 3 providers extended both intervals, from first healthcare contact to diagnosis (TR = 3.13; 95% CI: 1.96–4.98) and symptom detection to diagnosis (TR = 1.63; 95% CI: 1.02–2.62). Delays were also associated with first providers failing to suspect or refer for cancer. Longer diagnosis-to-treatment intervals were observed among unmarried women, low-income groups, and those using traditional healing post-diagnosis. Older women (≥ 60 years) experienced shorter delays in initiating treatment (TR = 0.62; 95% CI: 0.41–0.93).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Delays in breast cancer care in Ethiopia are driven by individual, sociocultural, and systemic barriers. Multilevel interventions are needed to promote early detection and timely treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 23","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.71439","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145675891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

Housing Insecurity and Threats of Utility Shut-Offs Among Cancer Survivors in the United States, BRFSS 2022–2023 美国癌症幸存者的住房不安全感和公用事业关闭的威胁，BRFSS 2022-2023。

IF 3.1 2区医学 Q2 ONCOLOGY

Cancer Medicine

Pub Date : 2025-12-04 DOI: 10.1002/cam4.71436

Tina Duong Nguyen, Jan M. Eberth, Elochukwu Ezenwankwo, Gabriel L. Schwartz

Background

The financial burden of cancer treatment can increase the risk of housing insecurity for patients undergoing treatment and survivors.

Objective

To evaluate the burden of housing and utility insecurity among cancer survivors compared to individuals without a cancer history, examine outcome differences by housing tenure (renters vs. homeowners) and treatment status (active vs. posttreatment), and identify predictors of housing insecurity.

Methods

We analyzed data from 14 states that completed the Social Determinants and Cancer Survivorship modules of the 2022 and 2023 Behavioral Risk Factor Surveillance System (BRFSS), yielding 5499 respondents with a previous cancer diagnosis (excluding skin cancers) and 61,883 respondents without a cancer diagnosis. We estimated prevalences and fit logistic regressions.

Key Results

Cancer history was associated with greater odds of housing (AOR 1.43, 95% CI: 1.18–1.74) and utility (AOR 1.36, 95% CI: 1.09–1.69) insecurity, but this varied by treatment timing and housing tenure. Patients currently undergoing treatment were more likely to report housing and utility insecurity (AOR 1.96, 95% CI: 1.28–3.01 and AOR 1.67, 95% CI: 1.06–2.61, respectively) than individuals without a history of cancer. Such insecurity was elevated even after treatment for renters, but not for homeowners. In absolute terms, 34.7% of renters with a cancer history reported housing insecurity, compared to 7.1% of their homeowner counterparts.

Conclusions

Cancer diagnosis and treatment can contribute to housing and utility insecurity during and after treatment. Addressing this through targeted interventions within both healthcare systems and social policy may mitigate hardship and improve well-being.

背景：癌症治疗的经济负担会增加接受治疗的患者和幸存者住房不安全的风险。目的：与没有癌症病史的个体相比，评估癌症幸存者的住房和公用事业不安全负担，检查住房使用权（租房者与自有房屋者）和治疗状态（积极治疗与治疗后）的结果差异，并确定住房不安全的预测因素。方法：我们分析了来自14个州的数据，这些数据完成了2022年和2023年行为风险因素监测系统（BRFSS）的社会决定因素和癌症存活模块，产生了5499名以前患有癌症诊断（不包括皮肤癌）的受访者和61883名没有癌症诊断的受访者。我们估计患病率并拟合逻辑回归。主要结果：癌症病史与住房（AOR 1.43, 95% CI: 1.18-1.74）和效用（AOR 1.36, 95% CI: 1.09-1.69）不安全感的几率较大相关，但这因治疗时间和住房期限而异。目前正在接受治疗的患者比没有癌症病史的患者更有可能报告住房和公用事业不安全（AOR分别为1.96,95% CI: 1.28-3.01和1.67,95% CI: 1.06-2.61）。即使对租房者进行治疗后，这种不安全感也会增加，但对房主却没有。从绝对值来看，34.7%的有癌症病史的租房者报告住房不安全，而房主的这一比例为7.1%。结论：癌症的诊断和治疗可能导致治疗期间和治疗后的住房和公用事业不安全。通过在医疗保健系统和社会政策中采取有针对性的干预措施来解决这一问题，可能会减轻困难并改善福祉。

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引用次数: 0

Real-World Outcomes of Adjuvant Therapy in Stage III Melanoma and the Impact of Somatic Mutations III期黑色素瘤辅助治疗的实际结果和体细胞突变的影响。

IF 3.1 2区医学 Q2 ONCOLOGY

Cancer Medicine

Pub Date : 2025-12-04 DOI: 10.1002/cam4.71410

Derek Effiom, Tyler Aprati, Anastasios Karneris, Aleigha Lawless, Tatyana Sharova, Rebecca Johnson, Alexander Menzies, Georgina Long, Benjamin Park, Seungyeon Jung, Douglas Johnson, David Liu, Xue Bai, Keith Flaherty, Ryan Sullivan, Genevieve M. Boland, Sonia Cohen

Purpose

A significant proportion of patients with locoregional (stage III) cutaneous melanoma recur despite adjuvant systemic therapy. Staging criteria and surgical nodal management have changed since the trials were completed. Data assessing the effect of systemic therapy compared to surveillance are limited, and factors associated with recurrence are unclear. We assessed the efficacy of adjuvant systemic therapy in real-world patients and assessed whether baseline genomic characteristics could prognosticate or predict benefit from therapy.

Methods

We collected demographic, histopathologic, clinical, and genomic data for patients diagnosed with stage III cutaneous melanoma. Outcomes of interest were recurrence-free survival (RFS) and distant-metastasis-free survival (DMFS). Survival analysis was performed using the Kaplan–Meier method with log-rank analysis. Univariate and multivariate analyses were performed using a Cox regression analysis.

Results

Two hundred and fifteen patients were included, of which 65 and 76 were treated with BRAF/MEK inhibitors (BRAFi/MEKi) and anti-PD1 adjuvant systemic therapy respectively. Seventy four underwent active surveillance. Both adjuvant therapies reduced the hazard of recurrence when compared to patients undergoing active surveillance: anti-PD1 HR: 0.32 (p < 0.01) and BRAFi/MEKi HR: 0.39 (p = 0.03). Anti-PD1-treated patients with a BRAF V600 mutation had a shorter RFS than patients with BRAF WT melanoma (p < 0.01); this was validated in external data where the presence of a BRAF V600 mutation was associated with an increased hazard recurrence (HR: 2.1, p = 0.025).

Conclusion

Adjuvant systemic therapy improved RFS in our cohort. We found that BRAF V600 mutation was associated with a worse RFS for adjuvant anti-PD1 monotherapy. The effect of BRAF mutation on the response to anti-PD1 therefore may be considered when choosing between adjuvant anti-PD1 and BRAFi/MEKi for patients with BRAF V600 mutant melanoma.

目的：很大一部分局部（III期）皮肤黑色素瘤患者尽管接受了辅助全身治疗，但仍会复发。自试验完成以来，分期标准和手术淋巴结处理发生了变化。与监测相比，评估全身治疗效果的数据有限，与复发相关的因素也不清楚。我们评估了在现实世界患者中辅助全身治疗的疗效，并评估了基线基因组特征是否可以预测或预测治疗的益处。方法：我们收集了诊断为III期皮肤黑色素瘤患者的人口学、组织病理学、临床和基因组数据。研究的结果是无复发生存期（RFS）和无远处转移生存期（DMFS）。生存分析采用Kaplan-Meier法和log-rank分析法。采用Cox回归分析进行单因素和多因素分析。结果：纳入215例患者，其中65例和76例患者分别接受BRAF/MEK抑制剂（BRAFi/MEKi）和抗pd1辅助全身治疗。74人接受了主动监视。与接受主动监测的患者相比，两种辅助治疗都降低了复发的风险：抗pd1 HR: 0.32 (p)。结论：辅助全身治疗改善了我们队列中的RFS。我们发现BRAF V600突变与辅助抗pd1单药治疗的较差RFS相关。因此，在BRAF V600突变型黑色素瘤患者选择辅助抗pd1和BRAFi/MEKi时，可以考虑BRAF突变对抗pd1反应的影响。

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引用次数: 0

Association Between Discharge Medications and Oncologic Post-Embolization-Syndrome-Related Outcomes 出院药物与栓塞后肿瘤综合征相关结局的关系

IF 3.1 2区医学 Q2 ONCOLOGY

Cancer Medicine

Pub Date : 2025-12-03 DOI: 10.1002/cam4.71418

Hanzhou Li, John Moon, Nathan Sim, Michal Horný, Nicholas Lima, Menelaos Konstantinidis, Deepak Iyer, Sonia Benenati, Judy Gichoya, Janice Newsome, Zachary Bercu

Background

Post-embolization syndrome after transarterial chemoembolization (TACE) and Yttrium-90 radioembolization (TARE) causes significant morbidity. Understanding whether discharge prescriptions influence short-term outcomes may guide standardized pain-management strategies.

Methods

A retrospective cohort study of 3191 patients (3988 procedures) with hepatocellular carcinoma from the Merative MarketScan Databases (2009–2022) was performed. The composite outcome was 7-day drug escalation or hospital readmission. Bivariate logistic regression identified candidate variables (p < 0.10); multivariable logistic regression with patient-clustered robust standard errors estimated adjusted odds ratios (aORs), adjusting for age, sex, and Charlson Comorbidity Index (CCI).

Results

Compared to patients discharged without opioids post-chemoembolization, those prescribed opioids at discharge had 83% lower odds of experiencing drug escalation or readmission (odds ratio [aOR] = 0.17, p < 0.001), and those undergoing radioembolization had 59% lower odds (aOR = 0.41, p < 0.001). Being prescribed antiemetics or steroids was also associated with lower odds of escalation/readmission events, with percentages varying by procedure type.

Conclusions

Prescribing opioids, along with antiemetics and steroids, at discharge may reduce the likelihood of post-procedural events, such as drug escalation and readmission, in patients undergoing trans-arterial chemoembolization and radioembolization for hepatocellular carcinoma. These findings highlight the importance of a comprehensive pain management strategy in interventional oncology and warrant consideration in clinical practice guidelines.

背景：经动脉化疗栓塞（TACE）和钇-90放射栓塞（TARE）后的栓塞后综合征发病率很高。了解出院处方是否会影响短期结果，可以指导标准化的疼痛管理策略。方法：对来自Merative MarketScan数据库（2009-2022）的3191例（3988例手术）肝细胞癌患者进行回顾性队列研究。综合结局为7天药物升级或再入院。结果：与化疗栓塞后未使用阿片类药物出院的患者相比，出院时使用阿片类药物的患者发生药物升级或再入院的几率降低了83%（优势比[aOR] = 0.17, p）。出院时开具阿片类药物、止吐药和类固醇可降低肝细胞癌经动脉化疗栓塞和放射栓塞患者手术后事件的可能性，如药物升级和再入院。这些发现强调了在介入肿瘤学中全面的疼痛管理策略的重要性，值得在临床实践指南中加以考虑。

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引用次数: 0