Feng Su, Xu Huang, Jun Yin, Hang Tang, Lijie Tan, Yaxing Shen
Background
In esophageal cancer, the ypN0 status after induction therapy could be categorized into two primary groups: “natural N0” (cN0/ypN0) and “down-staged N0” (cN+/ypN0). The assessment of cN status is typically based on clinical imagination or pathological regression. However, there is no standardized method for evaluating cN/ypN status. This study aims to investigate the prognosis of patients with cN+/ypN0 using both assessment methods through a cohort study and meta-analysis.
Methods
A prospectively maintained database encompassing esophageal cancer patients undergoing induction therapy followed by radical esophagectomy was comprehensively reviewed. The prognostic significance of cN+/ypN0 across two evaluation methods was quantified. Additionally, a meta-analysis using data from previous studies was conducted.
Results
578 patients were identified from the cohort analysis, with 342 classified as ypN0 and 236 as ypN+. When evaluated with clinical imagination, patients with cN+/ypN0 had survival outcomes comparable to those with natural N0 but significantly better than those with ypN+ (p < 0.001). Using pathological nodal regression, cN+/ypN0 patients showed superior overall survival compared to ypN+ patients (p = 0.0043), although their disease-free survival was notably inferior to that of natural N0 patients (p = 0.0088). A meta-analysis of 20 previous studies confirmed the prognostic value of cN+/ypN0 status in both clinical imagination and pathological regression.
Conclusions
For esophageal cancer patients receiving neoadjuvant, cN+/ypN0 status, assessed through both clinical imagination and pathological regression, serves as a significant prognostic factor. It holds precedence over ypN+ yet falls short of the natural N0. The pre-treatment categorizations warrant recognition as a novel and pertinent staging metric.
{"title":"Nodal Downstaging of Esophageal Cancer After Neoadjuvant Therapy: A Cohort Study and Meta-Analysis","authors":"Feng Su, Xu Huang, Jun Yin, Hang Tang, Lijie Tan, Yaxing Shen","doi":"10.1002/cam4.70664","DOIUrl":"https://doi.org/10.1002/cam4.70664","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In esophageal cancer, the ypN0 status after induction therapy could be categorized into two primary groups: “natural N0” (cN0/ypN0) and “down-staged N0” (cN+/ypN0). The assessment of cN status is typically based on clinical imagination or pathological regression. However, there is no standardized method for evaluating cN/ypN status. This study aims to investigate the prognosis of patients with cN+/ypN0 using both assessment methods through a cohort study and meta-analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospectively maintained database encompassing esophageal cancer patients undergoing induction therapy followed by radical esophagectomy was comprehensively reviewed. The prognostic significance of cN+/ypN0 across two evaluation methods was quantified. Additionally, a meta-analysis using data from previous studies was conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>578 patients were identified from the cohort analysis, with 342 classified as ypN0 and 236 as ypN+. When evaluated with clinical imagination, patients with cN+/ypN0 had survival outcomes comparable to those with natural N0 but significantly better than those with ypN+ (<i>p</i> < 0.001). Using pathological nodal regression, cN+/ypN0 patients showed superior overall survival compared to ypN+ patients (<i>p</i> = 0.0043), although their disease-free survival was notably inferior to that of natural N0 patients (<i>p</i> = 0.0088). A meta-analysis of 20 previous studies confirmed the prognostic value of cN+/ypN0 status in both clinical imagination and pathological regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>For esophageal cancer patients receiving neoadjuvant, cN+/ypN0 status, assessed through both clinical imagination and pathological regression, serves as a significant prognostic factor. It holds precedence over ypN+ yet falls short of the natural N0. The pre-treatment categorizations warrant recognition as a novel and pertinent staging metric.</p>\u0000 </section>\u0000 </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 3","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70664","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362458","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}
RETRACTION: J. Tian, X. Cao, Z. Jiang, J. Wang, W. Fan, S. Zhang, S. Zhao, and J. Sun, “LncRNA CCAT2 Promotes the Proliferation and Metastasis of Colorectal Cancer Through Activation of the ERK and Wnt Signaling Pathways by Regulating GNB2 Expression,” Cancer Medicine 13, no. 17 (2024): e70169, https://doi.org/10.1002/cam4.70169.
The above article, published online on 03 September 2024, in Wiley Online Library (http://onlinelibrary.wiley.com/), has been retracted by agreement between the authors; the journal Editor-in-Chief, Stephen Tait; and John Wiley & Sons Ltd. The authors reported to the journal that a third party had detected multiple overlapping panels within and between Figures 2 and 7 in this article. The authors further stated that, upon reviewing the published article, they discovered multiple issues related to image overlap and redundancy. All parties agree that the overlapping and duplicated images constitute a major error in the article and it must be retracted.
{"title":"RETRACTION: LncRNA CCAT2 Promotes the Proliferation and Metastasis of Colorectal Cancer Through Activation of the ERK and Wnt Signaling Pathways by Regulating GNB2 Expression","authors":"","doi":"10.1002/cam4.70616","DOIUrl":"https://doi.org/10.1002/cam4.70616","url":null,"abstract":"<p><b>RETRACTION:</b> J. Tian, X. Cao, Z. Jiang, J. Wang, W. Fan, S. Zhang, S. Zhao, and J. Sun, “LncRNA CCAT2 Promotes the Proliferation and Metastasis of Colorectal Cancer Through Activation of the ERK and Wnt Signaling Pathways by Regulating GNB2 Expression,” <i>Cancer Medicine</i> 13, no. 17 (2024): e70169, https://doi.org/10.1002/cam4.70169.</p><p>The above article, published online on 03 September 2024, in Wiley Online Library (http://onlinelibrary.wiley.com/), has been retracted by agreement between the authors; the journal Editor-in-Chief, Stephen Tait; and John Wiley & Sons Ltd. The authors reported to the journal that a third party had detected multiple overlapping panels within and between Figures 2 and 7 in this article. The authors further stated that, upon reviewing the published article, they discovered multiple issues related to image overlap and redundancy. All parties agree that the overlapping and duplicated images constitute a major error in the article and it must be retracted.</p>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 3","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70616","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362742","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}
Wude Yewondwosen Awlachew, Abel Tenaw Tasamma, Firehiwot Abebe Mengistie, Zekarias Tadele Alemineh, Samuel Tesfaye Tefera
Background
Chronic myeloid leukemia (CML) is a hematologic malignancy characterized by the translocation t(9;22)(q34;q11.2), which results in a constitutively active tyrosine kinase. The introduction of tyrosine kinase inhibitors (TKIs) has significantly altered the disease course for patients with BCR-ABL1+ CML globally.
Objective
This study aimed to evaluate the treatment outcomes of CML patients in Ethiopia.
Methodology
This was a single-center, cross-sectional study conducted on 330 patients diagnosed with CML, who were on TKI therapy and receiving follow-up at Tikur Anbessa Specialized Hospital (TASH). Data were collected from electronic medical records using a structured data abstraction tool. Chi-square statistics and binary logistic regression were employed to examine the associations between categorical variables, with statistical significance set at a p value < 0.05. A 95% confidence interval was used.
Results
The median age of patients was 37.0 years (interquartile range [IQR]: 29.0–49.3), and 185 (56.1%) of the patients were male. At diagnosis, 92.1% were in the chronic phase of CML, while 9 (2.7%) were in blast crisis. The complete hematologic response (CHR) rate at 3 months was 90.9% (291/320), while the CHR rate beyond 3 months was 90.2% (258/286). Multivariable logistic regression analysis showed that the likelihood of not achieving a complete/partial hematologic response was higher among those diagnosed in the advanced phase of CML (AOR: 6.114, 95% CI: 2.210, 16.910) and among patients requiring a treatment change (AOR: 5.765, 95% CI: 2.460, 13.512).
Conclusion
The median age of CML patients in our study was notably young. The 3-month and overall hematologic responses were excellent. The initial phase of CML at diagnosis and treatment switch was associated with the 3-month CHR, while only treatment switch was associated with the overall CHR.
{"title":"Assessment of Treatment Outcome in Chronic Myelogenous Leukemia Patients on Tyrosine Kinase Inhibitors: Insight From a Resource Limited Setting","authors":"Wude Yewondwosen Awlachew, Abel Tenaw Tasamma, Firehiwot Abebe Mengistie, Zekarias Tadele Alemineh, Samuel Tesfaye Tefera","doi":"10.1002/cam4.70635","DOIUrl":"https://doi.org/10.1002/cam4.70635","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic myeloid leukemia (CML) is a hematologic malignancy characterized by the translocation t(9;22)(q34;q11.2), which results in a constitutively active tyrosine kinase. The introduction of tyrosine kinase inhibitors (TKIs) has significantly altered the disease course for patients with BCR-ABL1+ CML globally.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to evaluate the treatment outcomes of CML patients in Ethiopia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>This was a single-center, cross-sectional study conducted on 330 patients diagnosed with CML, who were on TKI therapy and receiving follow-up at Tikur Anbessa Specialized Hospital (TASH). Data were collected from electronic medical records using a structured data abstraction tool. Chi-square statistics and binary logistic regression were employed to examine the associations between categorical variables, with statistical significance set at a <i>p</i> value < 0.05. A 95% confidence interval was used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median age of patients was 37.0 years (interquartile range [IQR]: 29.0–49.3), and 185 (56.1%) of the patients were male. At diagnosis, 92.1% were in the chronic phase of CML, while 9 (2.7%) were in blast crisis. The complete hematologic response (CHR) rate at 3 months was 90.9% (291/320), while the CHR rate beyond 3 months was 90.2% (258/286). Multivariable logistic regression analysis showed that the likelihood of not achieving a complete/partial hematologic response was higher among those diagnosed in the advanced phase of CML (AOR: 6.114, 95% CI: 2.210, 16.910) and among patients requiring a treatment change (AOR: 5.765, 95% CI: 2.460, 13.512).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The median age of CML patients in our study was notably young. The 3-month and overall hematologic responses were excellent. The initial phase of CML at diagnosis and treatment switch was associated with the 3-month CHR, while only treatment switch was associated with the overall CHR.</p>\u0000 </section>\u0000 </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 3","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70635","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362447","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}
Current evidence on relationships between serum lipid biomarkers and the risk of gastrointestinal cancers remains controversial, with no consensus reached.
Methods
We conducted a prospective cohort study within the Kailuan Cohort wherein 88,225 individuals with baseline information on triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) was followed from 2006 to 2021 for the incidence of esophageal cancer (EC), gastric cancer (GC), and colorectal cancer (CRC). Cox proportional hazards models and restricted cubic spline (RCS) analysis were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).
Results
Increased EC risk was associated with high HDL-C levels (HRQ4vs.Q1 = 2.50, 95% CI: 1.57–3.98), while a U-shaped relationship between HDL-C and EC risk was revealed in the RCS analysis (poverall ≤ 0.0001, pnonlinear = 0.02). No robust association was identified between lipid biomarkers and GC risk. In multivariable analysis, increased CRC risk was positively associated with high TC levels (HRQ4vs.Q1 = 1.42, 95% CI: 1.11–1.83, ptrend = 0.03), dose–responsely negatively associated with LDL-C levels over quartiles (HRQ2vs.Q1 = 0.83, 95% CI: 0.66–1.02; HRQ3vs.Q1 = 0.86, 95% CI: 0.69–1.07; HRQ4vs.Q1 = 0.68, 95% CI: 0.53–0.86, ptrend = 0.02), and showed a diminished negative association with HDL-C levels over quartiles (HRQ2vs.Q1 = 0.75, 95% CI: 0.60–0.94; HRQ3vs.Q1 = 0.76, 95% CI: 0.61–0.95; HRQ4vs.Q1 = 0.91, 95% CI 0.74–1.13, ptrend = 0.02). The subsequent RCS analysis revealed a linear negative relationship of LDL-C (poverall = 0.004, pnonlinear = 0.67) and a U-shaped relationship of HDL-C (poverall = 0.05, pnonlinear = 0.02) with CRC risk. Competitive risk analysis and sensitivity analysis confirmed the stability of our results.
Conclusion
We observed a U-shaped relationship regarding HDL-C levels with EC and CRC risk, and a linear inverse relationship between LDL-C levels and CRC risk. Relevant serum lipid levels should be properly managed in high-risk individuals of certain gastrointestinal cancers.
{"title":"Serum Lipid Biomarkers and the Risk of Gastrointestinal Cancers in a Chinese Population: The Kailuan Prospective Study","authors":"Ying Xiao, Xin Du, Tianjie Wang, Dong Liu, Hongzhao You, Hao Wang, Hanyang Liang, Zhengqing Ba, Yilu Liu, Yu Ren, Jinghan Zeng, Weixian Yang, Shouling Wu, Jiansong Yuan","doi":"10.1002/cam4.70654","DOIUrl":"https://doi.org/10.1002/cam4.70654","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Current evidence on relationships between serum lipid biomarkers and the risk of gastrointestinal cancers remains controversial, with no consensus reached.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a prospective cohort study within the Kailuan Cohort wherein 88,225 individuals with baseline information on triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) was followed from 2006 to 2021 for the incidence of esophageal cancer (EC), gastric cancer (GC), and colorectal cancer (CRC). Cox proportional hazards models and restricted cubic spline (RCS) analysis were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Increased EC risk was associated with high HDL-C levels (HR<sub>Q4vs.Q1</sub> = 2.50, 95% CI: 1.57–3.98), while a U-shaped relationship between HDL-C and EC risk was revealed in the RCS analysis (<i>p</i><sub>overall</sub> ≤ 0.0001, <i>p</i><sub>nonlinear</sub> = 0.02). No robust association was identified between lipid biomarkers and GC risk. In multivariable analysis, increased CRC risk was positively associated with high TC levels (HR<sub>Q4vs.Q1</sub> = 1.42, 95% CI: 1.11–1.83, <i>p</i><sub>trend</sub> = 0.03), dose–responsely negatively associated with LDL-C levels over quartiles (HR<sub>Q2vs.Q1</sub> = 0.83, 95% CI: 0.66–1.02; HR<sub>Q3vs.Q1</sub> = 0.86, 95% CI: 0.69–1.07; HR<sub>Q4vs.Q1</sub> = 0.68, 95% CI: 0.53–0.86, <i>p</i><sub>trend</sub> = 0.02), and showed a diminished negative association with HDL-C levels over quartiles (HR<sub>Q2vs.Q1</sub> = 0.75, 95% CI: 0.60–0.94; HR<sub>Q3vs.Q1</sub> = 0.76, 95% CI: 0.61–0.95; HR<sub>Q4vs.Q1</sub> = 0.91, 95% CI 0.74–1.13, <i>p</i><sub>trend</sub> = 0.02). The subsequent RCS analysis revealed a linear negative relationship of LDL-C (<i>p</i><sub>overall</sub> = 0.004, <i>p</i><sub>nonlinear</sub> = 0.67) and a U-shaped relationship of HDL-C (<i>p</i><sub>overall</sub> = 0.05, <i>p</i><sub>nonlinear</sub> = 0.02) with CRC risk. Competitive risk analysis and sensitivity analysis confirmed the stability of our results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We observed a U-shaped relationship regarding HDL-C levels with EC and CRC risk, and a linear inverse relationship between LDL-C levels and CRC risk. Relevant serum lipid levels should be properly managed in high-risk individuals of certain gastrointestinal cancers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 3","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70654","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143248761","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}
After the Fukushima Daiichi Nuclear Power Plant accident in 2011, the Fukushima Health Management Survey (FHMS) was implemented in Fukushima Prefecture to promote long-term health care. The FHMS included thyroid ultrasound examination (TUE) for individuals aged ≤ 18 years, including fetuses at the time of the accident. However, the FHMS may not have captured all cases of thyroid cancer because it only followed up with examinees. To address this gap, we aimed to merge individual-level information from the FHMS with national and local cancer registries (CRs) to determine the limitations of the FHMS and CRs in capturing thyroid cancer cases.
Methods
The FHMS-eligible residents' information was supplemented by merging and cross-validating the FHMS and CR data using the Fukushima Prefectural Cancer Registry (FPCR), 2008–2015, and the National Cancer Registry (NCR), 2016–2018. For analysis, registered cases were classified into three groups: registered in both the CR and FHMS, or only in the CRs, or only in the FHMS. The characteristics of each case were evaluated in each database.
Results
In the FHMS, 212 thyroid cancer cases were identified through 2018, with another 42 cases identified in the CRs. Of the 176 thyroid cancer cases registered until 2015, 28 (15.9%) were identified in the FHMS only and 13 (7.4%) in the FPCR only. Of the 78 additional cases identified since 2016, 29 (37.2%) were identified in the NCR only and 6 (7.7%) in the FHMS only. This indicates that the NCR captured the cases more efficiently than the FPCR.
Conclusion
Merging data from the FHMS and CRs at the individual level is necessary to capture thyroid cancer cases more accurately after the 2011 nuclear accident.
{"title":"Merging of the Fukushima Health Management Survey With the National and Local Cancer Registry to Refine the Detection of Thyroid Cancer Cases After the 2011 Fukushima Daiichi Nuclear Power Plant Accident","authors":"Reiko Kimura-Tsuchiya, Masanori Nagao, Shigehira Saji, Fumikazu Hayashi, Tetsuya Ohira, Hiroki Shimura, Fumihiko Furuya, Satoru Suzuki, Satoshi Suzuki, Tetsuo Ishikawa, Susumu Yokoya, Hitoshi Ohto, Seiji Yasumura","doi":"10.1002/cam4.70610","DOIUrl":"https://doi.org/10.1002/cam4.70610","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>After the Fukushima Daiichi Nuclear Power Plant accident in 2011, the Fukushima Health Management Survey (FHMS) was implemented in Fukushima Prefecture to promote long-term health care. The FHMS included thyroid ultrasound examination (TUE) for individuals aged ≤ 18 years, including fetuses at the time of the accident. However, the FHMS may not have captured all cases of thyroid cancer because it only followed up with examinees. To address this gap, we aimed to merge individual-level information from the FHMS with national and local cancer registries (CRs) to determine the limitations of the FHMS and CRs in capturing thyroid cancer cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The FHMS-eligible residents' information was supplemented by merging and cross-validating the FHMS and CR data using the Fukushima Prefectural Cancer Registry (FPCR), 2008–2015, and the National Cancer Registry (NCR), 2016–2018. For analysis, registered cases were classified into three groups: registered in both the CR and FHMS, or only in the CRs, or only in the FHMS. The characteristics of each case were evaluated in each database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the FHMS, 212 thyroid cancer cases were identified through 2018, with another 42 cases identified in the CRs. Of the 176 thyroid cancer cases registered until 2015, 28 (15.9%) were identified in the FHMS only and 13 (7.4%) in the FPCR only. Of the 78 additional cases identified since 2016, 29 (37.2%) were identified in the NCR only and 6 (7.7%) in the FHMS only. This indicates that the NCR captured the cases more efficiently than the FPCR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Merging data from the FHMS and CRs at the individual level is necessary to capture thyroid cancer cases more accurately after the 2011 nuclear accident.</p>\u0000 </section>\u0000 </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 3","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70610","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143248598","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}
Tareq Salous, Ryan Ashkar, Sandra K. Althouse, Clint Cary, Timothy Masterson, Nasser H. Hanna, Jennifer King, Lawrence H. Einhorn, Nabil Adra
Background
Brain metastasis (BM) is an independent adverse prognostic factor in metastatic germ cell tumors (mGCT). We aimed to establish an effective and practical BM prediction model.
Patients and Methods
Between January 1990 and September 2017, 2291 patients with mGCT who were treated at Indiana University were identified. Patients were divided into two categories: BM present (N = 154) and BM absent (N = 2137). Kaplan–Meier methods were used to analyze progression free survival (PFS) and overall survival (OS). Logistic regression was used to determine a predictive model for whether BM was present. The data was separated into training and validation datasets with equal numbers of events in each.
Results
The 2-year PFS and OS for patients with versus without BM: 17% versus 65% (p < 0.001) and 62% versus 91% (p < 0.001) respectively. Among the 154 patients with BM, 64 (42%) had radiation only (whole-brain radiotherapy or gamma knife), 22 (14%) had BM-surgery only, 14 (9%) had both radiation and BM-surgery. 54 patients (35%) did not receive local therapy for BM. Stepwise selection was used to determine the best model with p < 0.15 as the entry and staying criteria. The model with the largest ROC AUC was used moving forward. The model was tested in the validation dataset. A model was generated including age at diagnosis ≥ 40, choriocarcinoma predominant histology, pre-chemotherapy hCG≥ 5000, presence of pulmonary metastases size < 3, or ≥ 3 cm, and presence of bone metastasis. Patients with score of 0, 1, 2, 3, 4, 5, 6, 7, 8 points had a 0.6%, 1.4%, 3.5%, 8.2%, 18.3%, 36%, 58%, 78%, 90% probability of having BM, respectively.
Conclusions
The prediction model developed in this study demonstrated discrimination capability of predicting BM occurrence in mGCT and can be used to identify high-risk patients.
{"title":"Prediction Model for Brain Metastasis in Patients With Metastatic Germ-Cell Tumors","authors":"Tareq Salous, Ryan Ashkar, Sandra K. Althouse, Clint Cary, Timothy Masterson, Nasser H. Hanna, Jennifer King, Lawrence H. Einhorn, Nabil Adra","doi":"10.1002/cam4.70649","DOIUrl":"https://doi.org/10.1002/cam4.70649","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Brain metastasis (BM) is an independent adverse prognostic factor in metastatic germ cell tumors (mGCT). We aimed to establish an effective and practical BM prediction model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>Between January 1990 and September 2017, 2291 patients with mGCT who were treated at Indiana University were identified. Patients were divided into two categories: BM present (<i>N</i> = 154) and BM absent (<i>N</i> = 2137). Kaplan–Meier methods were used to analyze progression free survival (PFS) and overall survival (OS). Logistic regression was used to determine a predictive model for whether BM was present. The data was separated into training and validation datasets with equal numbers of events in each.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 2-year PFS and OS for patients with versus without BM: 17% versus 65% (<i>p</i> < 0.001) and 62% versus 91% (<i>p</i> < 0.001) respectively. Among the 154 patients with BM, 64 (42%) had radiation only (whole-brain radiotherapy or gamma knife), 22 (14%) had BM-surgery only, 14 (9%) had both radiation and BM-surgery. 54 patients (35%) did not receive local therapy for BM. Stepwise selection was used to determine the best model with <i>p</i> < 0.15 as the entry and staying criteria. The model with the largest ROC AUC was used moving forward. The model was tested in the validation dataset. A model was generated including age at diagnosis ≥ 40, choriocarcinoma predominant histology, pre-chemotherapy hCG≥ 5000, presence of pulmonary metastases size < 3, or ≥ 3 cm, and presence of bone metastasis. Patients with score of 0, 1, 2, 3, 4, 5, 6, 7, 8 points had a 0.6%, 1.4%, 3.5%, 8.2%, 18.3%, 36%, 58%, 78%, 90% probability of having BM, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The prediction model developed in this study demonstrated discrimination capability of predicting BM occurrence in mGCT and can be used to identify high-risk patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 3","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70649","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143248891","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}
Yi Li, Xin Wang, Yuanlin Li, Wanhu Li, Defeng Liu, Longxiang Guo, Xiuli Liu, Zhichao Li, Ao Liu, Minghuan Li
Background
This study aimed to explore the prognostic value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) metabolic parameters of immune organs and hematological immune-related markers for patients with locally advanced cervical cancer (LACC) undergoing concurrent chemoradiotherapy (CCRT), and to establish prognostic nomograms based on these potential biomarkers.
Methods
A total of 180 patients with LACC undergoing CCRT were retrospectively reviewed and randomly divided into training and validation groups at a 7:3 ratio. Cox regression analysis was performed to identify independent prognostic factors for progression-free survival (PFS) and overall survival (OS) from hematological immune-related markers and 18F-FDG PET/CT metabolic parameters of the primary tumor, spleen, and bone marrow (BM). Nomograms were developed and evaluated using receiver operating characteristic curves, concordance index (C-index), calibration curves, and decision curve analysis (DCA). Spearman correlation analysis was used to assess the relationships among metabolic parameters.
Results
Multivariable analysis identified International Federation of Gynecology and Obstetrics (FIGO) stage, neutrophil-to-lymphocyte ratio (NLR), and spleen maximum standardized uptake value (SUVspleen) as independent prognostic factors for PFS. For OS, the independent prognostic factors were FIGO stage, NLR, metabolic tumor volume, and SUVspleen. The nomograms demonstrated better prognostic performance for PFS (area under curve [AUC]: 0.875 and 0.862; C-index: 0.809 and 0.775) and OS (AUC: 0.858 and 0.814; C-index: 0.828 and 0.792) in the training and validation groups. Calibration curves and DCA indicated that the nomograms have good predictive accuracy and clinical utility. Spearman correlation analysis revealed significant positive correlations among total lesion glycolysis, SUVspleen, SUVBM, and platelet-to-lymphocyte ratio.
Conclusion
The nomograms based on metabolic parameters of immune organs and hematological immune-related markers demonstrated high predictive value for patients with LACC undergoing CCRT. The observed correlations between the metabolic parameters of the primary tumor and immune organs suggest a widespread disturbance of systemic immunity caused by the tumor.
{"title":"The Combined Prognostic Value of 18F-FDG PET/CT Metabolic Parameters of Immune Organs and Hematological Immune-Related Markers in Patients With Locally Advanced Cervical Cancer","authors":"Yi Li, Xin Wang, Yuanlin Li, Wanhu Li, Defeng Liu, Longxiang Guo, Xiuli Liu, Zhichao Li, Ao Liu, Minghuan Li","doi":"10.1002/cam4.70650","DOIUrl":"https://doi.org/10.1002/cam4.70650","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aimed to explore the prognostic value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (<sup>18</sup>F-FDG PET/CT) metabolic parameters of immune organs and hematological immune-related markers for patients with locally advanced cervical cancer (LACC) undergoing concurrent chemoradiotherapy (CCRT), and to establish prognostic nomograms based on these potential biomarkers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 180 patients with LACC undergoing CCRT were retrospectively reviewed and randomly divided into training and validation groups at a 7:3 ratio. Cox regression analysis was performed to identify independent prognostic factors for progression-free survival (PFS) and overall survival (OS) from hematological immune-related markers and <sup>18</sup>F-FDG PET/CT metabolic parameters of the primary tumor, spleen, and bone marrow (BM). Nomograms were developed and evaluated using receiver operating characteristic curves, concordance index (C-index), calibration curves, and decision curve analysis (DCA). Spearman correlation analysis was used to assess the relationships among metabolic parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Multivariable analysis identified International Federation of Gynecology and Obstetrics (FIGO) stage, neutrophil-to-lymphocyte ratio (NLR), and spleen maximum standardized uptake value (SUV<sub>spleen</sub>) as independent prognostic factors for PFS. For OS, the independent prognostic factors were FIGO stage, NLR, metabolic tumor volume, and SUV<sub>spleen</sub>. The nomograms demonstrated better prognostic performance for PFS (area under curve [AUC]: 0.875 and 0.862; C-index: 0.809 and 0.775) and OS (AUC: 0.858 and 0.814; C-index: 0.828 and 0.792) in the training and validation groups. Calibration curves and DCA indicated that the nomograms have good predictive accuracy and clinical utility. Spearman correlation analysis revealed significant positive correlations among total lesion glycolysis, SUV<sub>spleen</sub>, SUV<sub>BM</sub>, and platelet-to-lymphocyte ratio.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The nomograms based on metabolic parameters of immune organs and hematological immune-related markers demonstrated high predictive value for patients with LACC undergoing CCRT. The observed correlations between the metabolic parameters of the primary tumor and immune organs suggest a widespread disturbance of systemic immunity caused by the tumor.</p>\u0000 </section>\u0000 </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 3","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70650","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143248760","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}
For delivering high radiation doses to pancreatic tumors, organ motion management is indispensable; however, studies on this are limited. We aimed to evaluate the efficacy and safety of dynamic tumor tracking (DTT) moderately hypofractionated intensity-modulated radiotherapy (IMRT) in patients with locally advanced pancreatic cancer (LAPC).
Methods
Patients with histological confirmation for LAPC were included. A linac system, which was mounted with a gimbal function, was used for DTT-IMRT. The prescribed dose was 48 Gy in 15 fractions. The primary endpoint was the 1-year rate of freedom from locoregional progression (FFLP).
Results
DTT-IMRT was successfully administered in 25 patients enrolled from four institutions. The median range of respiratory motion during DTT-IMRT was 9.8 mm (range: 3.5–27.3 mm), and the median tracking accuracy was 2.6 mm (range: 0.7–5.2 mm). With a median follow-up period of 13.9 months, the 1-year FFLP rate was 75.3% (lower limit of one-sided 80% confidence interval [CI]: 60.2%), which satisfied the predetermined primary endpoint. One-year locoregional progression-free survival, progression-free survival, and overall survival were 56.0% (95% CI: 34.8%–72.7%), 44.0% (95% CI: 24.5%–61.9%), and 60.0% (95% CI: 38.4%–76.1%), respectively. Regarding nonhematologic toxicities, grade 3 acute gastrointestinal (GI) toxicity was observed in two patients (8%), and two patients (8%) each experienced grade 3 late GI and non-GI toxicities. No grade 4 or 5 nonhematologic toxicities were observed.
Conclusions
DTT moderately hypofractionated IMRT shows preferable locoregional control without significant toxicity in patients with LAPC.
{"title":"Multi-Institutional Phase II Study on the Efficacy and Safety of Dynamic Tumor-Tracking, Moderately Hypofractionated Intensity-Modulated Radiotherapy in Patients With Locally Advanced Pancreatic Cancer","authors":"Michio Yoshimura, Masahiro Hiraoka, Masaki Kokubo, Takashi Sakamoto, Katsuyuki Karasawa, Yukinori Matsuo, Mitsuhiro Nakamura, Nobutaka Mukumoto, Satoshi Morita, Takashi Mizowaki","doi":"10.1002/cam4.70648","DOIUrl":"10.1002/cam4.70648","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>For delivering high radiation doses to pancreatic tumors, organ motion management is indispensable; however, studies on this are limited. We aimed to evaluate the efficacy and safety of dynamic tumor tracking (DTT) moderately hypofractionated intensity-modulated radiotherapy (IMRT) in patients with locally advanced pancreatic cancer (LAPC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with histological confirmation for LAPC were included. A linac system, which was mounted with a gimbal function, was used for DTT-IMRT. The prescribed dose was 48 Gy in 15 fractions. The primary endpoint was the 1-year rate of freedom from locoregional progression (FFLP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>DTT-IMRT was successfully administered in 25 patients enrolled from four institutions. The median range of respiratory motion during DTT-IMRT was 9.8 mm (range: 3.5–27.3 mm), and the median tracking accuracy was 2.6 mm (range: 0.7–5.2 mm). With a median follow-up period of 13.9 months, the 1-year FFLP rate was 75.3% (lower limit of one-sided 80% confidence interval [CI]: 60.2%), which satisfied the predetermined primary endpoint. One-year locoregional progression-free survival, progression-free survival, and overall survival were 56.0% (95% CI: 34.8%–72.7%), 44.0% (95% CI: 24.5%–61.9%), and 60.0% (95% CI: 38.4%–76.1%), respectively. Regarding nonhematologic toxicities, grade 3 acute gastrointestinal (GI) toxicity was observed in two patients (8%), and two patients (8%) each experienced grade 3 late GI and non-GI toxicities. No grade 4 or 5 nonhematologic toxicities were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>DTT moderately hypofractionated IMRT shows preferable locoregional control without significant toxicity in patients with LAPC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>UMIN000017521</p>\u0000 </section>\u0000 </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 3","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70648","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143187815","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}
Currently, the most effective oral targeted therapies for NSCLC in clinical practice are EGFR-TKIs. However, acquired drug resistance often leads to tumor progression and recurrence. EGFR overexpression and activation of its downstream pathways are primary contributors to both mutations in tumor cells and their development of drug resistance. Silibinin has been identified as a promising agent that can suppress EGFR signaling through multiple mechanisms. However, its poor water solubility and difficulty penetrating cell membranes result in rapid metabolism in vivo, and significantly affect its concentration in the blood.
Methods
We conducted a comprehensive search of the English PubMed database using various combinations of keywords, including “silibinin,” “epidermal growth factor receptor,” “phosphorylation,” “chemotherapy,” “nano,” and “non-small cell lung cancer.” The results were then filtered for their relevance and impact on current treatment paradigms.
Results
This review presents a comprehensive exploration of the mechanisms underlying the EGFR autophosphorylation pathways that contribute to acquire drug resistance in. Additionally, this study delves into the potential of silibinin as a novel therapeutic agent for NSCLC, evaluating its advantages and limitations on the basis of existing research. The majority of the available data suggest that combining silibinin with first-generation TKIs would yield promising outcomes because of additive or synergistic effects, suggesting that optimizing the time and dosage of each of these treatments is crucial for achieving the best results.
Conclusion
The existing evidence is inadequate to endorse the clinical application of nano silibinin for NSCLC treatment. Developing multifunctional nanomedicines that incorporate silibinin, EGFR-TKIs, and other bioactive compounds is a recommended future strategy for NSCLC treatment.
{"title":"The Effects of Silibinin Combined With EGFR-TKIs in the Treatment of NSCLC","authors":"Xiaocen Wang","doi":"10.1002/cam4.70643","DOIUrl":"10.1002/cam4.70643","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Currently, the most effective oral targeted therapies for NSCLC in clinical practice are EGFR-TKIs. However, acquired drug resistance often leads to tumor progression and recurrence. EGFR overexpression and activation of its downstream pathways are primary contributors to both mutations in tumor cells and their development of drug resistance. Silibinin has been identified as a promising agent that can suppress EGFR signaling through multiple mechanisms. However, its poor water solubility and difficulty penetrating cell membranes result in rapid metabolism in vivo, and significantly affect its concentration in the blood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a comprehensive search of the English PubMed database using various combinations of keywords, including “silibinin,” “epidermal growth factor receptor,” “phosphorylation,” “chemotherapy,” “nano,” and “non-small cell lung cancer.” The results were then filtered for their relevance and impact on current treatment paradigms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This review presents a comprehensive exploration of the mechanisms underlying the EGFR autophosphorylation pathways that contribute to acquire drug resistance in. Additionally, this study delves into the potential of silibinin as a novel therapeutic agent for NSCLC, evaluating its advantages and limitations on the basis of existing research. The majority of the available data suggest that combining silibinin with first-generation TKIs would yield promising outcomes because of additive or synergistic effects, suggesting that optimizing the time and dosage of each of these treatments is crucial for achieving the best results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The existing evidence is inadequate to endorse the clinical application of nano silibinin for NSCLC treatment. Developing multifunctional nanomedicines that incorporate silibinin, EGFR-TKIs, and other bioactive compounds is a recommended future strategy for NSCLC treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 3","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70643","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143187830","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}
Carolyn Harris, Marilyn J. Hammer, Yvette P. Conley, Steven M. Paul, Bruce A. Cooper, Joosun Shin, Kate Oppegaard, Lisa Morse, Jon D. Levine, Christine Miaskowski
Background
Detailed information on patient characteristics and symptom burden associated with multimorbidity in oncology patients is extremely limited. Purposes were to determine the prevalence of low (≤ 2) and high (≥ 3) multimorbidity in a sample of oncology outpatients (n = 1343) undergoing chemotherapy and evaluate for differences between the two multimorbidity groups in demographic and clinical characteristics; the occurrence, severity, and distress of 38 symptoms; and the stability and consistency of symptom clusters.
Methods
Using the Self-Administered Comorbidity Questionnaire, patients were classified into low and high multimorbidity groups. Memorial Symptom Assessment Scale was used to assess the occurrence, severity, and distress of 38 symptoms prior to the patients' second or third cycle of chemotherapy. For each multimorbidity group, symptom clusters based on occurrence rates were identified using exploratory factor analysis.
Results
Compared to the low group (61.4%), patients in the high group (38.6%) were older, had fewer years of education, were less likely to be married or partnered, less likely to be employed, and had a lower annual income. In addition, they had a higher body mass index, poorer functional status, were a longer time since their cancer diagnosis, and were more likely to have received previous cancer treatments and have metastatic disease. Patients in the low and high groups reported 12.7 (±6.7) and 15.9 (±7.5) concurrent symptoms, respectively. Eight and seven symptom clusters were identified for the low and high groups, respectively. Psychological, gastrointestinal, weight gain, hormonal, and respiratory clusters were stable across multimorbidity groups. Weight gain and respiratory clusters were consistent. Three unstable clusters were identified in the low group and two in the high group.
Conclusions
Findings suggest that higher multimorbidity is associated with various social determinants of health and a higher symptom burden. Differences between multimorbidity groups may be related to aging, treatments, and/or comorbid conditions.
{"title":"Impact of Multimorbidity on Symptom Burden and Symptom Clusters in Patients Receiving Chemotherapy","authors":"Carolyn Harris, Marilyn J. Hammer, Yvette P. Conley, Steven M. Paul, Bruce A. Cooper, Joosun Shin, Kate Oppegaard, Lisa Morse, Jon D. Levine, Christine Miaskowski","doi":"10.1002/cam4.70418","DOIUrl":"https://doi.org/10.1002/cam4.70418","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Detailed information on patient characteristics and symptom burden associated with multimorbidity in oncology patients is extremely limited. Purposes were to determine the prevalence of low (≤ 2) and high (≥ 3) multimorbidity in a sample of oncology outpatients (<i>n</i> = 1343) undergoing chemotherapy and evaluate for differences between the two multimorbidity groups in demographic and clinical characteristics; the occurrence, severity, and distress of 38 symptoms; and the stability and consistency of symptom clusters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the Self-Administered Comorbidity Questionnaire, patients were classified into low and high multimorbidity groups. Memorial Symptom Assessment Scale was used to assess the occurrence, severity, and distress of 38 symptoms prior to the patients' second or third cycle of chemotherapy. For each multimorbidity group, symptom clusters based on occurrence rates were identified using exploratory factor analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to the low group (61.4%), patients in the high group (38.6%) were older, had fewer years of education, were less likely to be married or partnered, less likely to be employed, and had a lower annual income. In addition, they had a higher body mass index, poorer functional status, were a longer time since their cancer diagnosis, and were more likely to have received previous cancer treatments and have metastatic disease. Patients in the low and high groups reported 12.7 (±6.7) and 15.9 (±7.5) concurrent symptoms, respectively. Eight and seven symptom clusters were identified for the low and high groups, respectively. Psychological, gastrointestinal, weight gain, hormonal, and respiratory clusters were stable across multimorbidity groups. Weight gain and respiratory clusters were consistent. Three unstable clusters were identified in the low group and two in the high group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Findings suggest that higher multimorbidity is associated with various social determinants of health and a higher symptom burden. Differences between multimorbidity groups may be related to aging, treatments, and/or comorbid conditions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 3","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70418","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143248430","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}
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