JCO Global Oncology最新文献

Purpose: Cancer burden in sub-Saharan Africa is high, driven by infections and behavioral risks. Nigeria had Africa's second-highest number of new cancers in 2022. This study estimated the proportion of new cancers attributable to alcohol, tobacco, and human papillomavirus (HPV) infection in Edo State, Nigeria.

Methods: We analyzed cancer incidence data from the Edo-Benin Cancer Registry (EBCR; 2009-2018) for cancer sites associated with alcohol consumption, tobacco use, and HPV infection, as outlined in the International Agency for Research on Cancer Monographs. For each site, we calculated the number of attributable cancers and the population attributable fraction for the three exposures by sex, using country-specific exposure prevalence and relative risk estimates from previous research.

Results: Between 2009 and 2018, the EBCR reported 4,937 cancer cases (2,069 men [41.9%] and 2,868 women [58.1%]). Nine alcohol-associated sites accounted for 30.1% of all cases (12.3% in men and 43% in women), 13 tobacco-related sites accounted for 27.5% (18.4% in men and 34.1% in women), and six HPV-related sites accounted for 15.2% (4% in men and 34.1% in women). Of alcohol-associated cancers (n = 1,488), 25.6% (381/1,488) were attributable to alcohol use; 5.3% (72/1,359) of smoking-related cancers were attributable to tobacco use, and high-risk HPV genotypes were estimated to cause 77.5% (581/750) of HPV-related cancers.

Conclusion: Our study suggests that nearly three fourths of HPV- and about one fourth of alcohol-associated cancers could be prevented through targeted and evidence-based interventions in Edo State, Nigeria. These findings highlight the need for strengthening both individual and policy-level prevention efforts, prioritizing high-impact risk factors to achieve measurable reductions in cancer burden.

Purpose: Treatment completion (TC), defined by completing the recommended treatment regimen, and treatment adherence (TA), defined by completing the prescribed treatment in the expected time frame, are critical for improving breast cancer (BC) mortality. Therefore, we conducted this study to measure TC and TA in Tanzania.

Methods: BC treatment data from 2019 to 2020 at Ocean Road Cancer Institute (ORCI) were collected. Demographic, socioeconomic, and clinical profiles were identified. TC and TA were measured by comparing chemotherapy and radiotherapy prescribed regimens to received treatment.

Results: Overall, 813 patients were seen at ORCI between 2019 and 2020. Mean age of patients was 51 ± 12.5 years; 97.9% identified as female; and 67.6% resided outside of Dar es Salaam. Stage III/IV disease was identified in 43.8% patients, with 24.1% showing clinical evidence of metastasis on arrival. TC across treatments ranged between 46.8% and 47.4%, while overall TA was 21.2%. TC was associated with not having metastasis on arrival (P = .01) and residing in proximity to ORCI (P = .04). TA was associated with having insurance (P < .0001) and attending a follow-up appointment after treatment (P < .0001).

Conclusion: Poor TC and TA rates in Tanzania pose a significant risk to treatment efficacy. Interventions are needed to specifically target patients with advanced-stage disease and greater geographic distance to treatment to increase treatment compliance.

Purpose: In 2021, Ministry of Health conducted a pilot study to screen 50,000 women with human papillomavirus (HPV) testing in Uzbekistan and assess the feasibility of national implementation. The present article describes organization of the pilot, evaluation of the program using key performance indicators (KPIs), and lessons learned.

Methods: Women age 30-55 years were invited for HPV screening via a communication campaign at 11 polyclinics in Karakalpakstan province. Samples were collected and analyzed locally in nine polyclinics using GeneXpert test. HPV-positive women were triaged with colposcopy, although colposcopists were not trained to obtain biopsies or perform treatment. Abnormal results led to further diagnostic colposcopy and treatment. Pilot data were managed using an Excel database, with quality assurance through regular monitoring visits and estimation of KPIs.

Results: Over 10 months, 50,000 women were tested for HPV, with 98% yielding satisfactory results and a 6.8% positivity rate. Of the HPV-positive women, 93.9% underwent triaging colposcopy, revealing abnormalities in 32.5%, although results varied by district. Diagnostic colposcopy and histopathology data were available for 87.9% of referrals. Treatment adherence was not systematically tracked. An external review showed 64.6% agreement with local histopathology, and the correlation between diagnostic colposcopy and histopathology was 53.2%.

Conclusion: The pilot successfully recruited a large number of women and ensured high participation of the HPV-positive women in triage and diagnostic evaluation. Key strengths were the use of existing health infrastructure, and decentralization of services. However, challenges were identified in HPV test procurement, referral pathways, quality of pathology and colposcopy, and adequate data collection. Addressing these issues is critical to the future success of cervical cancer screening in Uzbekistan.

Purpose: This multicenter observational study conducted in Poland aims to analyze referral patterns and clinical practice in patients with unresectable stage III non-small cell lung cancer (NSCLC), during the early stage of the national implementation of consolidation immunotherapy, focusing on the use of concurrent chemoradiotherapy (cCRT), sequential chemoradiotherapy (sCRT), and definitive radiotherapy (dRT).

Materials and methods: Adult patients with unresectable stage III NSCLC treated with curative-intent radiotherapy between April 1, 2021, and March 31, 2022, were included. Descriptive analyses were performed per the registered protocol. Group comparisons used Fisher's exact test, the chi-squared test, the Kruskal-Wallis test, and Pearson's chi-squared test.

Results: Among 273 patients, cCRT and sCRT were administered with equal frequency (37.7% each), followed by dRT (16.5%) and overlapping chemoradiotherapy (8.1%). Groups differed in performance status (PS) and age but not in Union for International Cancer Control-Tumor, Node, Metastasis (UICC-TNM) classification. PS and disease extent influenced the treatment choice. The cCRT was primarily chosen because of the tumor location, whereas sCRT was chosen mainly because of large tumor mass. Complication rates were similar, except for grade 3-4 hematologic toxicity, more frequent with cCRT.

Conclusion: In Poland, cCRT and sCRT are equally used. Treatment decisions are primarily driven by PS and tumor characteristics rather than UICC-TNM staging.

Purpose: The Pediatric Oncology East and Mediterranean (POEM) Biennial Conference serves as a regional platform to advance childhood cancer care through scientific exchange, collaborative research, capacity building, and policy engagement. The 2025 Fourth Scientific Meeting aimed to showcase regional innovations, strengthen partnerships, and align strategies with the WHO Global Initiative for Childhood Cancer (GICC).

Methods: This report summarizes the scientific, clinical, and educational content of the 4th POEM Biennial Conference, held April 30-May 3, 2025, in Amman, Jordan, under the theme Harnessing Regional Strengths to Improve Equity, Access, and Quality Care. The program included plenary lectures, symposia, oral abstracts, posters, expert sessions, and focused workshops.

Results: The meeting attracted 351 delegates from 24 countries, including physicians, nurses, researchers, policymakers, and advocates. Scientific highlights featured the first regional multicenter outcomes of chimeric antigen receptor T-cell (CAR-T) therapy in low- and middle-income settings, updated survival data in acute lymphoblastic leukemia, and advances in hematopoietic cell transplantation using haploidentical and αβ T-cell-depleted grafts. Special sessions addressed CNS tumors, lymphomas, survivorship, gene therapy, and qualitative research. Advocacy panels highlighted equity and access for displaced and conflict-affected populations. Regional initiatives included strengthening the POEM Palliative Care and achieving consensus on early cancer detection strategies aligned with the WHO GICC. Pre- and post-conference workshops on artificial intelligence, sarcoma management, nursing leadership, and retinoblastoma delivered hands-on training and reinforced regional capacity building. Workshop evaluations demonstrated strong learning outcomes and a high likelihood of practice change.

Conclusion: The 2025 POEM Biennial Conference reaffirmed the network's role as a catalyst for advancing childhood cancer care across the Eastern Mediterranean. By integrating scientific advances with strategies for equity, access, and policy reform, POEM continues to accelerate progress toward the global target of achieving at least 60% survival for all children with cancer by 2030.

Purpose: Breast cancer imposes a substantial disease burden on the Brazilian population. Furthermore, the potential unnecessary use of adjuvant chemotherapy exposes patients to risks and adverse effects without significant therapeutic benefits. The purpose of this study is to determine the extent to which genomic testing for treatment selection, particularly in early stages, is a cost-effective strategy for optimizing care, while minimizing costs and unnecessary interventions.

Methods: We estimated the economic impact of the Oncotype DX test to guide the decision about prescribing adjuvant chemotherapy. The model integrates a decision tree and a Markov model with transitions between the health states of recurrence-free survival, distant recurrence, acute myeloid leukemia, and death. The probabilities of distant recurrence were derived from the TAILORx and RxPONDER clinical trials, combined with local evidence regarding utility and overall survival estimates. The analysis was conducted from the perspective of the Brazilian private health care system, which covers about one quarter of the Brazilian population. Scenario and sensitivity analyses with Monte Carlo simulations were performed.

Results: Compared with clinicopathologic risk assessment alone, use of the Oncotype DX test for both node-negative (N0) and node-positive (N1) leads to an increase in quality-adjusted life-years (QALYs) at lower costs (0.15 QALYs and $-3,975.59 US dollars [USD]). The main impact drivers were chemotherapy costs, chemotherapy prescription probabilities, and Oncotype DX test cost. Considering the Brazilian official cost-effectiveness thresholds ($8,000.00 USD to $24,000.00 USD per QALY), the probabilistic sensitivity analysis indicated a high probability of the test being cost-effective across all analyzed scenarios and indications.

Conclusion: Oncotype DX could be a cost-saving strategy in the Brazilian private health care perspective. Alternative scenarios and testing indications did not alter these conclusions.

Purpose: Combined-modality therapy (CMT) improves survival in patients with early-stage extranodal natural killer-/T-cell lymphoma (ENKTCL) compared with radiotherapy (RT) alone. However, the effect is inadequate for low-risk patients as defined by nomogram-revised risk index (NRI). As such, it remains unclear whether the survival benefits outweigh the additional costs.

Materials and methods: A Markov model was constructed to compare CMT versus RT alone for patients with early-stage ENKTCL, according to five risk groups defined by NRI model. Transition probabilities, effectiveness, and cost data were derived from the China Lymphoma Collaborative Group cohort, while health utility data were estimated from adverse effects. Life-years, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios were calculated from the perspective of Chinese payers. Evaluations for customized countries or settings can be accomplished using a web-based tool.

Results: Over the 6-year horizon, CMT increased life-years by 5.47, 5.19, 4.82, 4.62, and 4.49 years at $517,472 US dollars (USD)/QALY, $22,871 USD/QALY, $7,865 USD/QALY, $4,598 USD/QALY, and $2,278 USD/QALY for the low-risk (NRI = 0), intermediate-low-risk (NRI = 1), intermediate-high-risk (NRI = 2), high-risk (NRI = 3), and very high-risk (NRI = 4) groups, respectively. The probabilities of cost-effectiveness at a willingness-to-pay threshold of $5,208 USD/QALY were 0.00%, 0.01%, 7.40%, 72.07%, and 99.10% for each risk group. Over the lifetime horizon, all risk groups, except for low-risk group, had a probability of over 90% of being cost-effective. Estimates were varied according to country settings, integrated through a web-based customized analysis.

Conclusion: CMT is unlikely to be cost-effective for low-risk patients but highly likely to be cost-effective for high-risk and very high-risk patients. As for intermediate-low or intermediate-high-risk patients, the cost-effectiveness of CMT varies depending on the time horizon and willingness-to-pay threshold.