Fan Shu, Zhuo Liu, Peichen Duan, Yichang Hao, Xin Ma, Hongxian Zhang, Guoliang Wang, Xiaojun Tian, Lei Liu, Shudong Zhang
Objectives
To compare the perioperative and postoperative outcomes of transperitoneal and retroperitoneal robotic partial nephrectomy (RPN) and develop a prediction model for reference to select the approach.
Materials and Methods
We retrospectively reviewed our single-institutional RPN database. The patients were divided into training and validation sets. In training set, transperitoneal and retroperitoneal cases were matched using propensity score matching to balance confounding factors. The intraoperative and postoperative outcomes of both approaches were compared. A prediction model was constructed to predict the probability of the retroperitoneal approach. The model was then externally validated using the data from the validation set.
Results
A total of 318 patients were included in the training set, and after propensity score matching, 200 cases were left. Additionally, 92 patients were included in the validation set. The estimated blood loss (p = 0.021) and the hemoglobin change (p = 0.016) were greater in the transperitoneal group. There was no significant difference in operative time (p = 0.539), warm ischemia time (p = 0.678), hospitalization time (p = 0.673), extubation time (p = 0.621), creatinine change (p = 0.623), negative margin (p = 1), local recurrence (p = 1), postoperative complication (p = 0.229), long-term creatinine (p = 0.158), and overall survival (p = 0.671) between the two groups. Tumor diameter, anteroposterior location, longitudinal location, and accessory renal artery were employed as variables to construct the prediction model, resulting in area under the curve values of 0.84 and 0.77, respectively, during internal and external validation.
Conclusions
Retroperitoneal and transperitoneal approaches of RPN showed no difference in perioperative outcomes except estimated blood loss and hemoglobin change. The retroperitoneal approach is recommended for smaller tumors located in the upper pole or posterior and the presence of an accessory renal artery. Our model is available to predict the probability of the retroperitoneal approach.
{"title":"A Predictive Model for Surgical Approach Selection in Robotic Partial Nephrectomy and Its Perioperative Outcomes Based on Single-Center Retrospective Data","authors":"Fan Shu, Zhuo Liu, Peichen Duan, Yichang Hao, Xin Ma, Hongxian Zhang, Guoliang Wang, Xiaojun Tian, Lei Liu, Shudong Zhang","doi":"10.1002/cam4.70625","DOIUrl":"https://doi.org/10.1002/cam4.70625","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To compare the perioperative and postoperative outcomes of transperitoneal and retroperitoneal robotic partial nephrectomy (RPN) and develop a prediction model for reference to select the approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed our single-institutional RPN database. The patients were divided into training and validation sets. In training set, transperitoneal and retroperitoneal cases were matched using propensity score matching to balance confounding factors. The intraoperative and postoperative outcomes of both approaches were compared. A prediction model was constructed to predict the probability of the retroperitoneal approach. The model was then externally validated using the data from the validation set.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 318 patients were included in the training set, and after propensity score matching, 200 cases were left. Additionally, 92 patients were included in the validation set. The estimated blood loss (<i>p</i> = 0.021) and the hemoglobin change (<i>p</i> = 0.016) were greater in the transperitoneal group. There was no significant difference in operative time (<i>p</i> = 0.539), warm ischemia time (<i>p</i> = 0.678), hospitalization time (<i>p</i> = 0.673), extubation time (<i>p</i> = 0.621), creatinine change (<i>p</i> = 0.623), negative margin (<i>p</i> = 1), local recurrence (<i>p</i> = 1), postoperative complication (<i>p</i> = 0.229), long-term creatinine (<i>p</i> = 0.158), and overall survival (<i>p</i> = 0.671) between the two groups. Tumor diameter, anteroposterior location, longitudinal location, and accessory renal artery were employed as variables to construct the prediction model, resulting in area under the curve values of 0.84 and 0.77, respectively, during internal and external validation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Retroperitoneal and transperitoneal approaches of RPN showed no difference in perioperative outcomes except estimated blood loss and hemoglobin change. The retroperitoneal approach is recommended for smaller tumors located in the upper pole or posterior and the presence of an accessory renal artery. Our model is available to predict the probability of the retroperitoneal approach.</p>\u0000 </section>\u0000 </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 3","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70625","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380842","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}
Takaaki Hasegawa, Masanori Mori, Takashi Yamaguchi, Kengo Imai, Yoshinobu Matsuda, Isseki Maeda, Yutaka Hatano, Naosuke Yokomichi, Jun Hamano, Tatsuya Morita, East Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process (EASED) investigators
Introduction
Systemic opioids are recommended as a pharmacological treatment for dyspnea, and antipsychotics are widely used for delirium. Because little is known about optimal palliative pharmacological strategies for dyspnea in patients with delirium, this study explored the symptom course in such cases, including the use of opioids and antipsychotics.
Methods
This was a secondary analysis of a multicenter prospective and observational study. We consecutively enrolled adult patients with advanced cancer at palliative care units in Japan. The eligibility criteria for their participation were a dyspnea Integrated Palliative care Outcome Scale (IPOS) score ≥ 2 and the presence of delirium. We investigated pharmacological strategies, IPOS for dyspnea, and delirium symptoms using item 9 of the Memorial Delirium Assessment Scale.
Results
Of the 1896 patients, 141 were found eligible and were analyzed. Eighty-two (58%) patients had agitated delirium, and the median survival period was 4 days. Regarding pharmacological strategy, 31 (22%) received opioid initiation or dose escalation, whereas 92 (65%) used regular antipsychotics. Although mean dyspnea IPOS scores significantly decreased from Day 1 to Day 2 (0.44, 95% CI: 0.24–0.64), the proportion of responders (IPOS score ≤ 1) was 21% (30/141). In the agitated delirium group, the proportion of remaining agitation symptoms at Day 2 was 74% (61/82).
Conclusions
The combined distressing symptoms of dyspnea and delirium during the last days of life are likely to be refractory suffering, which shows a poor response to pharmacological interventions, including opioids and antipsychotics.
{"title":"Pharmacological Strategies for Providing Patients With Delirium Relief From Terminal Dyspnea: A Secondary Data Analysis","authors":"Takaaki Hasegawa, Masanori Mori, Takashi Yamaguchi, Kengo Imai, Yoshinobu Matsuda, Isseki Maeda, Yutaka Hatano, Naosuke Yokomichi, Jun Hamano, Tatsuya Morita, East Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process (EASED) investigators","doi":"10.1002/cam4.70677","DOIUrl":"https://doi.org/10.1002/cam4.70677","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Systemic opioids are recommended as a pharmacological treatment for dyspnea, and antipsychotics are widely used for delirium. Because little is known about optimal palliative pharmacological strategies for dyspnea in patients with delirium, this study explored the symptom course in such cases, including the use of opioids and antipsychotics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a secondary analysis of a multicenter prospective and observational study. We consecutively enrolled adult patients with advanced cancer at palliative care units in Japan. The eligibility criteria for their participation were a dyspnea Integrated Palliative care Outcome Scale (IPOS) score ≥ 2 and the presence of delirium. We investigated pharmacological strategies, IPOS for dyspnea, and delirium symptoms using item 9 of the Memorial Delirium Assessment Scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 1896 patients, 141 were found eligible and were analyzed. Eighty-two (58%) patients had agitated delirium, and the median survival period was 4 days. Regarding pharmacological strategy, 31 (22%) received opioid initiation or dose escalation, whereas 92 (65%) used regular antipsychotics. Although mean dyspnea IPOS scores significantly decreased from Day 1 to Day 2 (0.44, 95% CI: 0.24–0.64), the proportion of responders (IPOS score ≤ 1) was 21% (30/141). In the agitated delirium group, the proportion of remaining agitation symptoms at Day 2 was 74% (61/82).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The combined distressing symptoms of dyspnea and delirium during the last days of life are likely to be refractory suffering, which shows a poor response to pharmacological interventions, including opioids and antipsychotics.</p>\u0000 </section>\u0000 </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 3","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70677","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380759","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}
Andres F. Espinoza, Ekene Onwuka, David A. Siegel, Shifan Dai, Sanjeev A. Vasudevan, Michael E. Scheurer, Philip J. Lupo
Background
Wilms tumor (WT) is the most common pediatric malignancy of the kidney. Past studies describing WT incidence and survival used surveillance data with < 30% of the US population. We evaluated differences in WT incidence and survival comparing demographic groups and tumor characteristics.
Methods
We analyzed new cases of WT among patients aged < 20 years at diagnosis by using incidence data from US Cancer Statistics (USCS) for 2003–2020 and 5-year relative survival (RS) data from the National Program of Cancer Registries (NPCR) for 2001–2019. To assess incidence trends, average annual percent change (AAPC) was calculated by using joinpoint regression. Relative survival (RS) and all-cause survival were calculated overall and by demographic and clinical variables.
Results
During 2003–2020, 8218 cases of WT were reported in USCS, which represented an age-adjusted incidence rate of 5.7 cases per million. Rates were the highest among females (6.3), children aged 0–4 years (17.2), and non-Hispanic Black patients (7.1). Overall, trends remained stable (AAPC = −0.4, 95% CI: −1.4 to 0.4). Among 7567 cases of WT in NPCR, 5-year RS was 92.6%. Patients with the lowest survival include the following: those aged 10–19 years (hazard ratio [HR] = 1.65, 95% CI: 1.02–2.65); non-Hispanic Black patients (HR = 1.39, 95% CI: 1.11–1.76); those with regional stage (HR = 1.93, 95% CI: 1.47–2.54) or distant stage (HR = 5.12, 95% CI: 3.99–6.57); and patients from nonmetropolitan counties (HR = 1.46, 95% CI: 1.09–1.96). Individuals diagnosed during 2011–2019 (HR = 0.64, 95% CI: 0.53–0.77) had higher survival than those diagnosed during 2001–2010.
Conclusions
The highest WT incidence rates were patients who were female, 0–4 years, and non-Hispanic Black. Survival improved during the study period; survival differed by race, ethnicity, metropolitan status, and age. Further studies to delineate the causes of these disparities may improve outcomes.
{"title":"Incidence and Survival of Children and Adolescents With Wilms Tumor, United States, 2001–2020","authors":"Andres F. Espinoza, Ekene Onwuka, David A. Siegel, Shifan Dai, Sanjeev A. Vasudevan, Michael E. Scheurer, Philip J. Lupo","doi":"10.1002/cam4.70598","DOIUrl":"https://doi.org/10.1002/cam4.70598","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Wilms tumor (WT) is the most common pediatric malignancy of the kidney. Past studies describing WT incidence and survival used surveillance data with < 30% of the US population. We evaluated differences in WT incidence and survival comparing demographic groups and tumor characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed new cases of WT among patients aged < 20 years at diagnosis by using incidence data from US Cancer Statistics (USCS) for 2003–2020 and 5-year relative survival (RS) data from the National Program of Cancer Registries (NPCR) for 2001–2019. To assess incidence trends, average annual percent change (AAPC) was calculated by using joinpoint regression. Relative survival (RS) and all-cause survival were calculated overall and by demographic and clinical variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During 2003–2020, 8218 cases of WT were reported in USCS, which represented an age-adjusted incidence rate of 5.7 cases per million. Rates were the highest among females (6.3), children aged 0–4 years (17.2), and non-Hispanic Black patients (7.1). Overall, trends remained stable (AAPC = −0.4, 95% CI: −1.4 to 0.4). Among 7567 cases of WT in NPCR, 5-year RS was 92.6%. Patients with the lowest survival include the following: those aged 10–19 years (hazard ratio [HR] = 1.65, 95% CI: 1.02–2.65); non-Hispanic Black patients (HR = 1.39, 95% CI: 1.11–1.76); those with regional stage (HR = 1.93, 95% CI: 1.47–2.54) or distant stage (HR = 5.12, 95% CI: 3.99–6.57); and patients from nonmetropolitan counties (HR = 1.46, 95% CI: 1.09–1.96). Individuals diagnosed during 2011–2019 (HR = 0.64, 95% CI: 0.53–0.77) had higher survival than those diagnosed during 2001–2010.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The highest WT incidence rates were patients who were female, 0–4 years, and non-Hispanic Black. Survival improved during the study period; survival differed by race, ethnicity, metropolitan status, and age. Further studies to delineate the causes of these disparities may improve outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 3","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70598","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380430","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}
Susannah K. Ayre, Katelyn E. Collins, Xanthia E. Bourdaniotis, Grace L. Rose, Gosia Boardman, Constantina Depaune, Belinda C. Goodwin, Elizabeth A. Johnston
Aims
As more people live with and beyond a cancer diagnosis, the role of informal caregivers becomes increasingly vital. Despite emotional, physical, and financial challenges, the impact of caregiving on health behaviors, including diet, has been largely overlooked. This systematic review synthesized quantitative evidence on dietary quality and intake among cancer caregivers.
Methods
Five databases (CINAHL, Embase, PubMed, PsycINFO, Web of Science) were searched in February 2024 using keywords including cancer, caregiver, and diet. Articles published since 2013 that quantitatively assessed the dietary quality or intake of cancer caregivers were eligible. Articles were independently screened in Rayaan by two authors, with discrepancies resolved by a third author. Data on study design, aims, methods, sample characteristics, and results were extracted and summarized using descriptive analyses. One author performed data extraction, with a second author reviewing results for accuracy.
Results
Of 12,584 records identified, 22 met eligibility criteria. Most studies were conducted in the United States (68%), were cross-sectional (77%), and included caregivers who were partners (68%) of people with cancer. Four (18%) studies reported on energy or nutrient intakes, 13 (59%) reported on food or food group intakes, and 10 (45%) reported on diet quality or dietary patterns. Results varied widely due to differences in assessment methods used. Dietary changes due to caregiving were described in 8 (36%) studies, mostly using retrospective self-reported data. Negative, positive, and no dietary changes were reported in 7 (32%), 5 (23%), and 4 (18%) studies, respectively. Two (9%) studies did not specify the direction of change. Eight (36%) studies assessed adherence to dietary recommendations, with mixed results.
Conclusions
Evidence of the dietary quality and intake of cancer caregivers is inconclusive. Larger, longitudinal studies using validated measures, repeated observations, and comparison to dietary guidelines are needed to better understand the impacts of caregiving on diet.
{"title":"Dietary Quality and Intake of Cancer Caregivers: A Systematic Review of Quantitative Studies and Recommendations for Future Research","authors":"Susannah K. Ayre, Katelyn E. Collins, Xanthia E. Bourdaniotis, Grace L. Rose, Gosia Boardman, Constantina Depaune, Belinda C. Goodwin, Elizabeth A. Johnston","doi":"10.1002/cam4.70668","DOIUrl":"https://doi.org/10.1002/cam4.70668","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>As more people live with and beyond a cancer diagnosis, the role of informal caregivers becomes increasingly vital. Despite emotional, physical, and financial challenges, the impact of caregiving on health behaviors, including diet, has been largely overlooked. This systematic review synthesized quantitative evidence on dietary quality and intake among cancer caregivers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Five databases (CINAHL, Embase, PubMed, PsycINFO, Web of Science) were searched in February 2024 using keywords including cancer, caregiver, and diet. Articles published since 2013 that quantitatively assessed the dietary quality or intake of cancer caregivers were eligible. Articles were independently screened in Rayaan by two authors, with discrepancies resolved by a third author. Data on study design, aims, methods, sample characteristics, and results were extracted and summarized using descriptive analyses. One author performed data extraction, with a second author reviewing results for accuracy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 12,584 records identified, 22 met eligibility criteria. Most studies were conducted in the United States (68%), were cross-sectional (77%), and included caregivers who were partners (68%) of people with cancer. Four (18%) studies reported on energy or nutrient intakes, 13 (59%) reported on food or food group intakes, and 10 (45%) reported on diet quality or dietary patterns. Results varied widely due to differences in assessment methods used. Dietary changes due to caregiving were described in 8 (36%) studies, mostly using retrospective self-reported data. Negative, positive, and no dietary changes were reported in 7 (32%), 5 (23%), and 4 (18%) studies, respectively. Two (9%) studies did not specify the direction of change. Eight (36%) studies assessed adherence to dietary recommendations, with mixed results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Evidence of the dietary quality and intake of cancer caregivers is inconclusive. Larger, longitudinal studies using validated measures, repeated observations, and comparison to dietary guidelines are needed to better understand the impacts of caregiving on diet.</p>\u0000 </section>\u0000 </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 3","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70668","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380432","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}
Philip Vestergaard Munch, Mette Nørgaard, Simon Kok Jensen, Henrik Birn, Henrik Schmidt, Christian Fynbo Christiansen
Background
Acute kidney injury (AKI) can be a severe complication in cancer patients. However, uncertainty remains regarding the risk of and prognosis after AKI following cancer treatments. We therefore aimed to examine the risk of and mortality after AKI following a wide range of specific cancer treatments, including surgical procedures, anticancer drugs, and hematopoietic stem cell transplantations (HSCTs).
Methods
We conducted a nationwide population-based cohort study. We included adult patients receiving cancer treatment in Denmark from 2010 to 2024. We calculated the risk of AKI within 7 days after surgeries, 1 year after initiation of anticancer drugs, and 100 days after HSCTs. Furthermore, we examined the 1-year mortality in patients with and without AKI following cancer treatment.
Results
We identified 357,870 cancer patients. The 7-day risk of AKI after surgery ranged from 0.3% (breast cancer surgery) to 68.9% (radical nephrectomy in kidney cancer) while the 1-year risk following anticancer drug treatment ranged from 3.5% (cyclophosphamide in breast cancer) to 79.3% (all drugs in acute lymphatic leukemia). The 100-day AKI risk following HSCT ranged from 20.7% (multiple myeloma) to 81.8% (leukemia). For most treatments, AKI was associated with a higher 1-year hazard ratio and risk of death, with exceptions including radical nephrectomy in kidney cancer.
Conclusion
In conclusion, several cancer treatments were associated with a high risk of AKI, and AKI was associated with increased mortality in most treatments. These findings highlight the prognostic value of assessing kidney function following specific cancer treatments in clinical practice.
{"title":"Risk of and Mortality After Acute Kidney Injury Following Cancer Treatment: A Cohort Study","authors":"Philip Vestergaard Munch, Mette Nørgaard, Simon Kok Jensen, Henrik Birn, Henrik Schmidt, Christian Fynbo Christiansen","doi":"10.1002/cam4.70646","DOIUrl":"https://doi.org/10.1002/cam4.70646","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Acute kidney injury (AKI) can be a severe complication in cancer patients. However, uncertainty remains regarding the risk of and prognosis after AKI following cancer treatments. We therefore aimed to examine the risk of and mortality after AKI following a wide range of specific cancer treatments, including surgical procedures, anticancer drugs, and hematopoietic stem cell transplantations (HSCTs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a nationwide population-based cohort study. We included adult patients receiving cancer treatment in Denmark from 2010 to 2024. We calculated the risk of AKI within 7 days after surgeries, 1 year after initiation of anticancer drugs, and 100 days after HSCTs. Furthermore, we examined the 1-year mortality in patients with and without AKI following cancer treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 357,870 cancer patients. The 7-day risk of AKI after surgery ranged from 0.3% (breast cancer surgery) to 68.9% (radical nephrectomy in kidney cancer) while the 1-year risk following anticancer drug treatment ranged from 3.5% (cyclophosphamide in breast cancer) to 79.3% (all drugs in acute lymphatic leukemia). The 100-day AKI risk following HSCT ranged from 20.7% (multiple myeloma) to 81.8% (leukemia). For most treatments, AKI was associated with a higher 1-year hazard ratio and risk of death, with exceptions including radical nephrectomy in kidney cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In conclusion, several cancer treatments were associated with a high risk of AKI, and AKI was associated with increased mortality in most treatments. These findings highlight the prognostic value of assessing kidney function following specific cancer treatments in clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 3","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70646","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380024","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}
Lung cancer is among the most common and deadliest malignant tumors worldwide. It is often detected at late stages, resulting in unfavorable outcomes, with tumor cell heterogeneity and medication resistance. Tumor-associated macrophages are among the key cells contributing to cancer progression. They are categorized into two primary phenotypes: Proinflammatory (M1) and anti-inflammatory (M2) which are involved in the onset and progression of NSCLC. The role of common cytokines secreted by macrophages in the progression of lung cancer are described, and the effects of various substances such as RNA or protein on the differentiation and polarization of two phenotypes of macrophages are highlighted to characterize the impact of the immune state of tumors on therapeutic effect of treatments and patient prognosis. Researchers have primarily aimed to investigate innovative carriers and strategies based on macrophages to modify the tumor microenvironment.
Objectives
These approaches are often integrated with other treatments, particularly immunotherapy, to enhance therapeutic efficacy.
Methods
A comprehensive review was carried out by systematically synthesizing existing literature on PubMed, using the combination of the keywords “TAMs”, “NSCLC”, “Drug resistance”, and “therapy”. The available studies were screened for selection based on quality and relevance.
Conclusions
TAMs promote tumor invasion, growth, and metastasis by promoting angiogenesis and EMT. In addition, they contribute to the development of drug resistance and the immunosuppressive microenvironment establishment. The immunosuppressive factors secreted by TAM can weaken the activity of immune cells, inhibit their killing effect on tumors, leading to immune suppression and hindering the effectiveness of treatment. Therefore, TAM is a key target for the development of cancer immunotherapy. Various strategies are being explored, including reducing the recruitment of TAMs and influencing their polarization to treat NSCLC. In addition, TAMs based treatment systems can achieve precise delivery of drugs or gene interfering molecules without causing side effects.
{"title":"Tumor-Associated Macrophages: Key Players in the Non-Small Cell Lung Cancer Tumor Microenvironment","authors":"Tongtong Lv, Rui Fan, Jiaqi Wu, Haolan Gong, Xiaoru Gao, Xin Liu, Yixin Gong, Bo Luo, Yanhua Zhang, Xiaochun Peng, Gai Liang","doi":"10.1002/cam4.70670","DOIUrl":"https://doi.org/10.1002/cam4.70670","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Lung cancer is among the most common and deadliest malignant tumors worldwide. It is often detected at late stages, resulting in unfavorable outcomes, with tumor cell heterogeneity and medication resistance. Tumor-associated macrophages are among the key cells contributing to cancer progression. They are categorized into two primary phenotypes: Proinflammatory (M1) and anti-inflammatory (M2) which are involved in the onset and progression of NSCLC. The role of common cytokines secreted by macrophages in the progression of lung cancer are described, and the effects of various substances such as RNA or protein on the differentiation and polarization of two phenotypes of macrophages are highlighted to characterize the impact of the immune state of tumors on therapeutic effect of treatments and patient prognosis. Researchers have primarily aimed to investigate innovative carriers and strategies based on macrophages to modify the tumor microenvironment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>These approaches are often integrated with other treatments, particularly immunotherapy, to enhance therapeutic efficacy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive review was carried out by systematically synthesizing existing literature on PubMed, using the combination of the keywords “TAMs”, “NSCLC”, “Drug resistance”, and “therapy”. The available studies were screened for selection based on quality and relevance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>TAMs promote tumor invasion, growth, and metastasis by promoting angiogenesis and EMT. In addition, they contribute to the development of drug resistance and the immunosuppressive microenvironment establishment. The immunosuppressive factors secreted by TAM can weaken the activity of immune cells, inhibit their killing effect on tumors, leading to immune suppression and hindering the effectiveness of treatment. Therefore, TAM is a key target for the development of cancer immunotherapy. Various strategies are being explored, including reducing the recruitment of TAMs and influencing their polarization to treat NSCLC. In addition, TAMs based treatment systems can achieve precise delivery of drugs or gene interfering molecules without causing side effects.</p>\u0000 </section>\u0000 </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 3","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70670","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380431","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}
Vaia Florou, Michelle F. Jacobs, Ruth Casey, Denisse Evans, Becky Owens, Margarita Raygada, Sara Rothschild, Samantha E. Greenberg
Gastrointestinal Stromal Tumors (GISTs) have seen significant advancements in their diagnosis and management, driven by targeted therapeutic development and molecular testing. The identification of mutations in genes such as KIT and PDGFRA has transformed treatment approaches, particularly through targeted therapies like imatinib, which have improved patient outcomes. This review explores the critical role of genomic testing in GIST, highlighting its importance in accurate diagnosis, treatment planning, and long-term surveillance for KIT/PDGFRA negative, SDH-deficient GISTs. SDH-deficient GISTs arise from mutations or epigenetic changes affecting the succinate dehydrogenase complex. The complexity of SDH-deficient GISTs, including their association with hereditary syndromes such as Hereditary Paraganglioma-Pheochromocytoma and/or hypermethylation of the SDHC promoter, underscores the need for comprehensive germline testing. Despite the availability of guidelines, variability exists in genomic testing recommendations across different regions, necessitating a unified approach. This review proposes a simplified algorithm for the genomic workup of GIST, and suggests all individuals with SDH-deficient GIST, regardless of germline testing result, require monitoring for additional SDHx-related tumors, given the lack of widely available methylation and full gene SDHA analysis.
{"title":"A Review of Genomic Testing and SDH- Deficiency in Gastrointestinal Stromal Tumors: Getting to the GIST","authors":"Vaia Florou, Michelle F. Jacobs, Ruth Casey, Denisse Evans, Becky Owens, Margarita Raygada, Sara Rothschild, Samantha E. Greenberg","doi":"10.1002/cam4.70669","DOIUrl":"https://doi.org/10.1002/cam4.70669","url":null,"abstract":"<p>Gastrointestinal Stromal Tumors (GISTs) have seen significant advancements in their diagnosis and management, driven by targeted therapeutic development and molecular testing. The identification of mutations in genes such as KIT and PDGFRA has transformed treatment approaches, particularly through targeted therapies like imatinib, which have improved patient outcomes. This review explores the critical role of genomic testing in GIST, highlighting its importance in accurate diagnosis, treatment planning, and long-term surveillance for KIT/PDGFRA negative, SDH-deficient GISTs. SDH-deficient GISTs arise from mutations or epigenetic changes affecting the succinate dehydrogenase complex. The complexity of SDH-deficient GISTs, including their association with hereditary syndromes such as Hereditary Paraganglioma-Pheochromocytoma and/or hypermethylation of the <i>SDHC</i> promoter, underscores the need for comprehensive germline testing. Despite the availability of guidelines, variability exists in genomic testing recommendations across different regions, necessitating a unified approach. This review proposes a simplified algorithm for the genomic workup of GIST, and suggests all individuals with SDH-deficient GIST, regardless of germline testing result, require monitoring for additional <i>SDHx</i>-related tumors, given the lack of widely available methylation and full gene <i>SDHA</i> analysis.</p>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 3","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70669","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380433","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}
Kato K, Doki Y, Chau I, et al. Nivolumab Plus Chemotherapy or Ipilimumab Versus Chemotherapy in Patients with Advanced Esophageal Squamous Cell Carcinoma (CheckMate 648): 29-Month Follow-Up from a Randomized, Open-Label, Phase III Trial. Cancer Med. 2024;13(9):e7235, https://doi.org/10.1002/cam4.7235.
In paragraph 11 of the “Results” section, certain data were incorrectly cited in the statement: “Among patients with tumor cell PD-L1 expression <1% treated with nivolumab plus chemotherapy, the median OS by response status at week 18 per BICR was 21.8 months (95% CI 15.7–28.1) for responders versus 9.5 months (95% CI 7.8–12.1) for non-responders (HR 0.42 [95% CI 0.28–0.62]) (Figure S5); 36.0 months (95% CI 22.8 to not estimable) for responders versus 15.0 months (95% CI 11.7–17.2) for non-responders (HR 0.40 [95% CI 0.23–0.71]) with nivolumab plus ipilimumab; and 21.8 months (95% CI 15.7–28.1) for responders versus 9.5 months (95% CI 7.8–12.1) for non-responders (HR 0.42 [95% CI 0.28–0.62]) with chemotherapy alone.”
This should have read: “Among patients with tumor cell PD-L1 expression < 1% treated with nivolumab plus chemotherapy, the median OS by response status at week 18 per BICR was 21.8 months (95% CI 15.7–28.1) for responders versus 9.5 months (95% CI 7.8–12.1) for non-responders (HR 0.42 [95% CI 0.28–0.62]) (Figure S5); 36.0 months (95% CI 22.8 to not estimable) for responders versus 15.0 months (95% CI 11.7–17.2) for non-responders (HR 0.41 [95% CI 0.23–0.71]) with nivolumab plus ipilimumab; and 24.8 months (95% CI 16.4–34.0) for responders versus 11.7 months (95% CI 9.4–13.7) for non-responders (HR 0.44 [95% CI 0.29–0.66]) with chemotherapy alone.”
We apologize for this error.
{"title":"Correction to “Nivolumab Plus Chemotherapy or Ipilimumab Versus Chemotherapy in Patients With Advanced Esophageal Squamous Cell Carcinoma (CheckMate 648): 29-Month Follow-Up From a Randomized, Open-Label, Phase III Trial”","authors":"","doi":"10.1002/cam4.70652","DOIUrl":"https://doi.org/10.1002/cam4.70652","url":null,"abstract":"<p>Kato K, Doki Y, Chau I, et al. Nivolumab Plus Chemotherapy or Ipilimumab Versus Chemotherapy in Patients with Advanced Esophageal Squamous Cell Carcinoma (CheckMate 648): 29-Month Follow-Up from a Randomized, Open-Label, Phase III Trial. <i>Cancer Med</i>. 2024;13(9):e7235, https://doi.org/10.1002/cam4.7235.</p><p>In paragraph 11 of the “Results” section, certain data were incorrectly cited in the statement: “Among patients with tumor cell PD-L1 expression <1% treated with nivolumab plus chemotherapy, the median OS by response status at week 18 per BICR was 21.8 months (95% CI 15.7–28.1) for responders versus 9.5 months (95% CI 7.8–12.1) for non-responders (HR 0.42 [95% CI 0.28–0.62]) (Figure S5); 36.0 months (95% CI 22.8 to not estimable) for responders versus 15.0 months (95% CI 11.7–17.2) for non-responders (HR 0.40 [95% CI 0.23–0.71]) with nivolumab plus ipilimumab; and 21.8 months (95% CI 15.7–28.1) for responders versus 9.5 months (95% CI 7.8–12.1) for non-responders (HR 0.42 [95% CI 0.28–0.62]) with chemotherapy alone.”</p><p>This should have read: “Among patients with tumor cell PD-L1 expression < 1% treated with nivolumab plus chemotherapy, the median OS by response status at week 18 per BICR was 21.8 months (95% CI 15.7–28.1) for responders versus 9.5 months (95% CI 7.8–12.1) for non-responders (HR 0.42 [95% CI 0.28–0.62]) (Figure S5); 36.0 months (95% CI 22.8 to not estimable) for responders versus 15.0 months (95% CI 11.7–17.2) for non-responders (HR 0.41 [95% CI 0.23–0.71]) with nivolumab plus ipilimumab; and 24.8 months (95% CI 16.4–34.0) for responders versus 11.7 months (95% CI 9.4–13.7) for non-responders (HR 0.44 [95% CI 0.29–0.66]) with chemotherapy alone.”</p><p>We apologize for this error.</p>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 3","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70652","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380435","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}
<div> <section> <h3> Background</h3> <p>Although the global burden of lung cancer has generally declined in recent decades, the variation in onset age-related trends remains insufficiently explored. In the current study, we aimed to systematically evaluate the most update temporal trends in incidence, mortality and DALYs of early, middle, and late-onset lung cancer (EOLC, MOLC, and LOLC) from 1990 to 2021, with stratifications of gender, location, and socio-demographic development.</p> </section> <section> <h3> Methods</h3> <p>We retrieved cross-sectional data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The global, regional, and national burden of lung cancer from 1990 to 2021 was evaluated primarily by age-standardized rates of incidence (ASIR), mortality (ASMR), and DALYs (ASDR). Joinpoint regression analysis was employed to assess temporal trends and turning point years. Frontier analysis was applied to examine the lowest achievable DALYs, and cross-country inequalities were evaluated sing the slope index of inequality (SII) and concentration index. We also forecasted the burden from 2022 to 2035.</p> </section> <section> <h3> Results</h3> <p>The global ASIR of EOLC decreased from 4.81 per 100,000 in 1990 to 3.13 in 2021 (AAPC: −1.38, 95% confidence interval [CI]: −1.53 to −1.22, <i>p</i> < 0.001), with a steeper decline in males (AAPC: −1.79) compared to females (AAPC: -0.63). MOLC incidence also declined from 92.77 to 72.47 per 100,000 (AAPC: -0.81, 95% CI: −0.9 to −0.73, <i>p</i> < 0.01), while LOLC demonstrated a slight increase from 195.39 to 225.8 per (AAPC: 0.43, 95% CI: 0.37 to 0.5, <i>p</i> < 0.01). Notably, LOLC in females showed a consistent rise in incidence rate (AAPC: 1.13, 95% CI: 1.05 to 1.21, <i>p</i> < 0.01). In contrast to EOLC and MOLC, 11, 10, and 9 out of 21 GBD regions showed a rising trend for ASIR, ASMR, and ASDR of LOLC, respectively. East Asia showed the steepest increase in ASIR (from 229.26 in 1990 to 375.90 in 2021, AAPC = 1.6, 95% CI: 1.31 to 1.89, <i>p</i> < 0.001) of LOLC. Moreover, according to socio-demographic index (SDI) quintiles, the middle SDI region demonstrated the largest rise in ASIR of LOLC. Frontier analysis revealed that countries with higher SDIs had a greater capacity for reducing lung cancer burdens. Cross-country inequalities of lung cancer burden in females were found to improve much slower than in males. The projections implied that, although lung cancer would generally decline in the next decade, the incidence, mortality, and DALY rates of LOLC in females might remarkably increase.</p> </section> <sect
{"title":"Global Trends of Early, Middle, and Late-Onset Lung Cancer From 1990 to 2021: Results From the Global Burden of Disease Study 2021","authors":"Zongyuan Li, Cheng Yu, Jianqi Hao, Nanzhi Luo, Haoning Peng, Jian Zhang, Qiang Pu, Lunxu Liu","doi":"10.1002/cam4.70639","DOIUrl":"https://doi.org/10.1002/cam4.70639","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although the global burden of lung cancer has generally declined in recent decades, the variation in onset age-related trends remains insufficiently explored. In the current study, we aimed to systematically evaluate the most update temporal trends in incidence, mortality and DALYs of early, middle, and late-onset lung cancer (EOLC, MOLC, and LOLC) from 1990 to 2021, with stratifications of gender, location, and socio-demographic development.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrieved cross-sectional data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The global, regional, and national burden of lung cancer from 1990 to 2021 was evaluated primarily by age-standardized rates of incidence (ASIR), mortality (ASMR), and DALYs (ASDR). Joinpoint regression analysis was employed to assess temporal trends and turning point years. Frontier analysis was applied to examine the lowest achievable DALYs, and cross-country inequalities were evaluated sing the slope index of inequality (SII) and concentration index. We also forecasted the burden from 2022 to 2035.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The global ASIR of EOLC decreased from 4.81 per 100,000 in 1990 to 3.13 in 2021 (AAPC: −1.38, 95% confidence interval [CI]: −1.53 to −1.22, <i>p</i> < 0.001), with a steeper decline in males (AAPC: −1.79) compared to females (AAPC: -0.63). MOLC incidence also declined from 92.77 to 72.47 per 100,000 (AAPC: -0.81, 95% CI: −0.9 to −0.73, <i>p</i> < 0.01), while LOLC demonstrated a slight increase from 195.39 to 225.8 per (AAPC: 0.43, 95% CI: 0.37 to 0.5, <i>p</i> < 0.01). Notably, LOLC in females showed a consistent rise in incidence rate (AAPC: 1.13, 95% CI: 1.05 to 1.21, <i>p</i> < 0.01). In contrast to EOLC and MOLC, 11, 10, and 9 out of 21 GBD regions showed a rising trend for ASIR, ASMR, and ASDR of LOLC, respectively. East Asia showed the steepest increase in ASIR (from 229.26 in 1990 to 375.90 in 2021, AAPC = 1.6, 95% CI: 1.31 to 1.89, <i>p</i> < 0.001) of LOLC. Moreover, according to socio-demographic index (SDI) quintiles, the middle SDI region demonstrated the largest rise in ASIR of LOLC. Frontier analysis revealed that countries with higher SDIs had a greater capacity for reducing lung cancer burdens. Cross-country inequalities of lung cancer burden in females were found to improve much slower than in males. The projections implied that, although lung cancer would generally decline in the next decade, the incidence, mortality, and DALY rates of LOLC in females might remarkably increase.</p>\u0000 </section>\u0000 \u0000 <sect","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/cam4.70639","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362459","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}
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}
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