Cancer Medicine最新文献

Background

Although the overall colorectal cancer (CRC) incidence has been steadily declining in the United States, a dramatic increase in the number of CRC cases among individuals younger than 50 years of age (early-onset CRC) has been observed. CRC is the second and first leading cause of cancer death in the United States and among Hispanic men and women living in Puerto Rico (PRH), respectively. We report CRC incidence rates from 2000 to 2021 among PRH and compare them to data in the Surveillance, Epidemiology, and End Results Program (SEER).

Methods

Data on colorectal adenocarcinomas diagnosed between January 1, 2000, and December 31, 2021, were obtained from the Puerto Rico Central Cancer Registry and SEER17, including race and ethnicity. Age-standardized incidence rates were calculated using the direct method. The Joinpoint Regression Program calculated temporal trends on CRC incidence rates based on age-adjusted Average Annual Percent Change (AAPC) estimates.

Results

A total of 729,479 incident cases of CRC were analyzed. US Hispanics had the highest percentage of early-onset CRC (EOCRC) cases (17.0%) among the racial and ethnic groups studied. PRH had the highest age-standardized EOCRC incidence rate (12.18 per 100,000 persons) and the highest increase in EOCRC incidence temporal trends (AAPC = 2.68; 95% CI: 1.83 to 3.51).

Conclusions

A significantly higher increase in EOCRC incidence was observed among Hispanic populations. Future studies should disaggregate Hispanic subpopulations by considering the country of ancestral origin, which will help identify specific risk factors and exposures and aid in developing tailored prevention and risk stratification strategies to reduce EOCRC incidence.

Background

Establishing a population-based cancer registry is crucial for understanding cancer incidence, identifying risk factors, and developing effective cancer control programs. The Kabul Cancer Registry (KCR), Afghanistan's first population-based cancer registry, was established in 2018. The purpose of this study was to estimate the incidence of cancer in Kabul between 2018 and 2020.

Methods

The KCR, adhering to International Agency for Research on Cancer (IARC) standards, actively collected data on new cancer cases from health facilities in Kabul between 2018 and 2020. We used CanReg5 software to calculate age-standardized incidence rates (ASIRs) by cancer site in males and females, using the direct method with Segi's World Standard Population.

Results

The KCR recorded 4498 new cancer cases among Kabul residents, with a male-to-female ratio of 0.82:1. The overall ASIR was 44.3 per 100,000 person-years in males and 60.9 in females. The top five cancer sites in males were stomach (ASIR = 9.1), esophagus (ASIR = 5.5), colorectum (ASIR = 3.7), lymphoma (ASIR = 2.4), and liver (ASIR = 2.1). In females, the top five cancer sites were breast (ASIR = 14.9), esophagus (ASIR = 6.7), stomach (ASIR = 4.2), colorectum (ASIR = 3.8), and gallbladder (ASIR = 1.8). Childhood cancers (aged 0–14 years) represented 6.8% of all cancers, with leukemia accounting for 43.5% of the new cancer cases.

Conclusions

The high incidence of breast, stomach, and esophagus cancers highlights the need for policymakers and healthcare providers to develop cancer control programs focused on primary prevention, early detection, and quality diagnosis and treatment. Additionally, this study underscores the importance of cancer registries and emphasizes the need to strengthen the KCR to improve data quality.

Background

The increasing costs of cancer treatment impose a tremendous economic burden on patients and their families, adversely impacting their quality of life and patients' outcomes. Financial toxicity (FT), as a concept describing the economic burden on patients, is crucial to comprehend the extent and determinants within specific contexts.

Objective

To understand the current status of FT among Chinese pancreatic cancer (PC) patients, identify risk factors for FT, and summarize the characteristics of high-risk groups.

Methods

A cross-sectional study involving 296 PC patients was conducted to investigate their general information, financial toxicity, quality of life, positive and negative affects, and social support. Univariate and multiple linear regression analyses were used to examine the correlation between FT and other variables.

Results

The PC patient's FT score was 54.27 ± 14.50, with 25.7% being forced to change their work status due to the disease diagnosis and 29.4% exhibiting economically related treatment nonadherence behaviors. Factor analysis showed financial toxicity associated with fewer household savings, more total out-of-pocket (OOP) costs, treatment nonadherence, unemployment, diminished positive affect, and insufficient social support.

Conclusions

FT was highly prevalent among PC patients and associated with factors such as household savings and total OOP costs. There was a need to identify and manage patients exhibiting high-risk characteristics and to implement targeted interventions to mitigate their economic burden.

Objective

This study aimed to identify risk factors associated with the development of metastases in breast cancer patients, to investigate survival rates, and the relationship between local recurrences and distant metastases.

Methods

This retrospective case-cohort study included women with breast cancer who were treated at a certified Breast Unit between 2001 and 2015. Cases who developed distant metastases were compared to controls based on diagnosis year, stage, and age at diagnosis. Comprehensive information on patient characteristics, tumor biology, and treatment options was gathered.

Results

The study included 412 patients who developed distant metastases and 433 controls who remained metastasis-free over a median follow-up of 150 months (interquartile range 87–202). The 20-year overall survival was 99.23% for the control group and 23.62% for those with metastasis (p < 0.01). Significant risk factors for metastasis included lobular invasive carcinoma (odds ratio (OR) 2.26, p < 0.001), triple-negative subtype (OR 4.06, p = 0.002), high tumor grade (OR 2.62, p = 0.004), larger tumor size (OR 1.02, p < 0.001), lymph node involvement (p < 0.001), and loco-regional recurrence (OR 4.32, p < 0.001). Progesterone receptor (PR) expression was protective (OR 0.52, 95% confidence interval 0.34–0.81, p = 0.003). Machine learning models supported these findings, though their clinical significance was limited.

Conclusions

Lobular invasive carcinoma, specific tumor subtypes, high grade, large tumor size, lymph node involvement, and loco-regional recurrence are all significant risk factors for distant metastasis, whereas PR expression is protective. The potential of machine learning in predicting metastasis was explored, showing promise for future personalized risk assessment.

Background

Gastric cancer (GC) has a high prevalence in Asian countries, and there is an unmet need for non-invasive and efficient GC screening methods. This study evaluated the diagnostic efficacy of GASTROClear, a panel of blood serum miRNAs for the detection of GC, in a Japanese population.

Methods

We conducted a pilot cohort study, comprising 103 patients with GC and 122 healthy controls. Serum samples were prospectively collected from study participants at two Japanese hospitals using a predefined blood-processing protocol. The diagnostic performance of GASTROClear was analyzed using a receiver operating characteristic curve and cutoff. By applying a logistic regression algorithm, we evaluated the diagnostic efficacy of novel combinations of GC diagnostic biomarker panels, consisting of GASTROClear and alternative serum markers (anti-Helicobacter pylori [Hp] antibody and pepsinogen).

Results

Most patients had Stage I (58%) GC and were asymptomatic (59%). The area under the curve (AUC) value for the detection of GC using GASTROClear was 0.80, with 70.9% sensitivity and 75.2% specificity. GASTROClear performed equally well within the subgroups based on age, sex, symptoms, Hp status, and tumor characteristics. We improved the diagnostic performance of GASTROClear by combining it with an anti-Hp antibody and pepsinogen. This yielded an AUC value of 0.88, with the highest specificity (86.9%) at a fixed sensitivity (70.9%).

Conclusions

GASTROClear demonstrated competent diagnostic efficacy for GC in the detection of GC in our Japanese cohort, even in the early stages of cancer and asymptomatic cases. Its combination with existing serum markers may contribute to efficient risk stratification to detect GC.

Background

Tracheal adenoid cystic carcinoma (TACC) is a rare salivary gland malignant tumor. Previous studies mainly focused on surgery, radiation, and chemotherapy. The purpose of this study is to describe more clinical characteristics, treatments, and overall survival (OS) of TACC.

Methods

Retrospectively analyzed TACC patients from two medical institutions and the SEER database from January 2010 to December 2021. Survival curves were drawn using the Kaplan–Meier method, and the effects of prognosis were analyzed by multivariate COX regression and AFT. The endpoint of the study was overall survival (OS).

Results

One hundred fifty TACC patients were enrolled (DZM 11, EG 64, SEER 75), and the 5- and 10-year survival rate was 70.62% and 35.80%, with a median survival time of 98 months. Lymph node status (yes) is an independent risk factor for TACC (HR = 3.020, 95% CI = 1.419–6.426, p = 0.004), and surgery is an independent protective factor (HR = 0.293, 95% CI = 0.146–0.587, p = 0.001). The AFT yielded similar results. In subgroup analysis of 63 non-surgical patients, lymph node status (Yes) (HR = 3.511, 95% CI = 1.498–8.229, p = 0.004), and tumor longitudinal diameter range (TLDR) > 1 (HR = 2.975, 95% CI = 1.360–6.506, p = 0.006) are independent risk factors, while Targeted Therapy (HR = 0.248, 95% CI = 0.096–0.637, p = 0.004) is an independent protective factor.

Conclusion

Lymph node status and TLDR are prognostic factors of TACC. Surgery is associated with prolonged survival of TACC. Targeted therapy may be associated with improved survival among non-surgical TACC patients.

Trial Registration: ChiCTR2400083551

Background

Financial toxicity (FT) is a common and significant challenge for people with cancer, impacting immediate clinical outcomes such as treatment adherence, as well as long-term outcomes such as quality of life and mortality. Multiple studies have tested interventions to address FT and develop recommendations for their implementation.

Methods

In this scoping review, we analyzed thirty-six studies across 35,405 participants examining institution-based interventions for FT in both pediatric and adult patients and survivors of cancer in the U.S.

Results

Common interventions included: financial navigation (n = 15), direct financial/medical assistance (n = 8), financial counseling or coaching (n = 5), and cost conversations prompters or encounter decision aids for treatment and cost (n = 5). Outcome measures varied widely, including the COmprehensive Score for financial Toxicity (COST), the Medical Expenditure Panel Survey (MEPS), total out-of-pocket costs or savings, and mental/psychological quality-of-life measured by the Patient-Reported Outcomes Measurement Information System (PROMIS). Many interventions showed promising results on improving FT, including financial assistance (e.g., free medication, copay assistance), treatment and insurance decision aids, and financial counseling. These strategies improved FT-related metrics, including patient out-of-pocket costs, care-related financial burden, health insurance knowledge, quality of life, and even overall survival. There was no dominant intervention method, with both low- and high-resource options proving effective.

Discussion

Future research should seek to understand causal relationships between interventions and FT through robust study designs, such as randomized controlled trials with longitudinal follow-up, and evaluate interventions' implementation potential. There is also a need for standardized metrics for evaluating and reporting FT to better compare different interventions' success.

Background

This study examined whether sick leave due to severe stress (stress leave) and duration of leave are associated with future cancer risk.

Methods

We conducted a matched case–control study using complete-population data from Swedish national registers (2005 to 2018), including 516,678 primary cancer cases and 2,357,433 matched controls. Odds ratios (OR) were calculated by conditional logistic regression and adjusted for pre-specified confounders.

Results

Stress leave of any duration, reported to the Swedish Social Insurance Register, was associated with a slightly increased cancer risk, with the highest risk estimate for 1–30 versus 0 days (adjusted OR 1.05, 95% CI 1.02–1.09). In men, a clear exposure-response trend was present. We observed increased risks of prostate cancer (adjusted OR for > 90 days: 1.10, 95% CI 1.01–1.20) and cervical cancer (adjusted OR for > 90 days: 1.11, 95% CI 1.05–1.17, including cancer in situ). In etiology-based analyses, a positive association was found for smoking-related cancers, and the risk relationship for non-cervical HPV-related cancers was similar to that for cervical cancer. Risk estimates were above one for several types of stress in relation to overall cancer risk, including an exposure-response trend for acute stress reactions (p-trend 4.0 × 10⁻⁴) but a null association for post-traumatic stress disorder.

Conclusions

Stress leave was associated with a modestly higher risk of cancer overall and prostate and cervical cancers specifically. Regardless of whether the link is biological or reflective of lifestyle mediators or for cervical cancer, lower participation in screening, these findings suggest a potential relevance of severe stress for cancer prevention.

Background

Germline mutations in BRCA1/2 are known to cause hereditary tumors in the breast, ovary, and other organs. With the widespread adoption of comprehensive diagnostics, including comprehensive genomic profiling (CGP) tests for solid tumors, many patients with BRCA1/2 variants have been identified.

Methods

In this study, we extracted and analyzed cases of BRCA1/2 variants that were presumed to be germline, which were repeatedly detected using the CGP test for solid tumors in northeastern Japan. The frequencies of BRCA1/2 variants in regional areas were compared with those of healthy individuals or nationwide cancer cohorts to investigate regional distribution.

Results

Our findings revealed regional disparities in BRCA1/2 pathogenic germline variants, while variants of unknown significance (VUS) showed no such differences. The regional distribution of BRCA1 and BRCA2 variants showed distinct patterns: pathogenic variants of BRCA1 exhibited regional differences and were less prevalent compared to VUS, whereas BRCA2 variants, including both pathogenic variants and VUS, did not exhibit such clear regional localization. This discrepancy in regional distribution between BRCA1 and BRCA2 variants could be attributed to factors such as the diversity of the genome, gender differences, and cancer types.

Conclusions

These results highlight the importance of considering regional differences in comparative cohort studies, particularly in assessing the differential extension of mutations in pathogenic changes and VUS. Moreover, a presumption of pathogenicity variants would need to be discussed at the regional level.

Aim

With advances in systemic therapy, the number of patients with hepatocellular carcinoma (HCC) who can undergo hepatic resection has increased in recent years, but there are no reports evaluating the immune status in the peritumoral area.

Methods

We enrolled 14 patients who underwent hepatic resection after lenvatinib (LEN, n = 7) or atezolizumab plus bevacizumab (ATZ/BEV, n = 5) therapy. Tumor-infiltrating lymphocytes (TILs), including CD3+ and CD8+ TILs, in the peritumoral area were evaluated by hematoxylin and eosin staining and immunohistochemistry.

Results

The median TIL counts after LEN and ATZ/BEV therapy were 32 and 92 cells/0.237 mm², respectively (p = 0.0044). The median CD3+ TIL counts after LEN and ATZ/BEV therapy were 26 and 71 cells/0.237 mm², respectively (p = 0.0057). The median CD8+ TIL counts after LEN and ATZ/BEV therapy were 14 and 42 cells/0.237 mm², respectively (p = 0.0044).

Conclusion

TIL counts, including those of CD3+ and CD8+ TILs, in the peritumoral area were significantly higher after ATZ/BEV than after LEN therapy.