JNCI Journal of the National Cancer Institute最新文献

Surveillance, Epidemiology, and End Results (SEER) multiple myeloma (MM) survival statistics (https://seer.cancer.gov/statfacts/html/mulmy.html) that have been used to guide MM management and control have been systematically overestimated due to the inclusion of smoldering multiple myeloma (SMM), a premalignant condition of MM. Using the latest SEER release, we estimated the extent of such overestimation in the survival statistics. In 2016, 77.9% out of 5,495 patients reported as overall MM were symptomatic MM and 10.9% were SMM. Median survival was 65.8 months for overall MM versus 56.8 months for symptomatic MM (p < .001). Inclusion of SMM overestimated MM survival by 9 months. Five-year relative survival estimates from 2015-2021 were 61.6% for overall MM, 57.9% for symptomatic MM, and 88.3% for SMM, versus SEER's reported 62.4%. Survival statistics for symptomatic MM and SMM should be reported separately to guide MM management and prevention at the population level.

The National Cancer Policy Forum (NCPF) of the National Academies of Sciences, Engineering, and Medicine was founded in 2006 to serve as a trusted venue for identifying and addressing high-priority policy issues in cancer research and care. NPCF takes a comprehensive, multisectoral, and multidisciplinary approach to strategically consider the entire continuum of cancer research and cancer care. Over the past two decades, the Forum has served a uniquely important role in examining both long-standing and emerging policy issues that are relevant to reducing the burden of cancer, both through prevention and by improving the care and outcomes for those diagnosed with cancer, and exploring solutions from multiple perspectives. The Forum has fostered actionable dialogue among a broad range of participants, including patient advocacy organizations, federal agencies, academia, professional organizations, nonprofits, and industry. NCPF activities inform the cancer community and the general public about a wide range of scientific, clinical, and policy issues through workshops, webinars, and the proceedings published after these convenings. Forum activities have influenced policy through the resulting publications and by providing input to National Academies consensus studies, which provide consensus recommendations. This commentary summarizes the breadth of topics addressed by the Forum over the years and examples of the impact of the Forum activities on policies and procedures, programs and practices, and participants and people around the globe.

Background: Men with suspected prostate cancer (PCa) undergo MRI before biopsy. However, about 30-50% of MRIs are negative (Prostate Imaging-Reporting and Data System (PI-RADS) score 1-2), representing a challenge for MRI resource utilization. This study evaluates PCa-polygenic risk scores (PRS) and clinical markers to optimize MRI utilization.

Methods: In this prospective study, 500 cancer-suspected men of Western European descent scheduled for MRI (09/2017-12/2022) were enrolled. Exclusions included prior PCa diagnosis, missing serum prostate-specific antigen (PSA) or PSA levels ≥25 ng/mL/cc. Patient-specific PCa-PRS were calculated using genotype data obtained from saliva-derived DNA samples. Participants were grouped as MRI-negative and -positive (PI-RADS score 3-5). Logistic regression was used to calculate odds ratios (OR) and to build multivariable risk models, including age, PSA, and PRS for MRI-positivity. Clinical utility was tested in a hold-out test set using decision curve analysis.

Results: 386 men (median age: 65, interquartile range: 53-77) were eligible for analysis, which showed highly significant associations between PCa-PRS (OR 1.56 (95% CI: 1.23-1.98); p<.001) with MRI-positivity, while PSA alone did not (OR 1.17 (0.93-1.46); p=.18). The highest net benefit was shown using a multivariable age and PCa-PRS model, increasing the proportion of MRI-positive men by 14% compared to PSA alone (60%/46%; p=.011).

Conclusions: Genotype-informed risk stratification using PCa-PRS could increase the proportion of cancer-suspicious findings at MRI, while identifying those who could safely avoid unnecessary MRI.

Head and neck cancers represent a diverse group of malignancies with significant heterogeneity in biology and prognosis, for which management of advanced-stage disease remains a formidable challenge. While the incorporation of immune checkpoint inhibitors has led the way to a new era of treatment possibilities, the current state-of-the-science calls for further innovation and a nuanced approach to clinical trial design to address a number of unmet needs. This white paper from the NRG Oncology Recurrent/Metastatic Head and Neck Working Group aims to critically identify gaps in clinical practice and the scientific literature and to propose actionable recommendations for future research in the framework of recurrent/metastatic squamous cell carcinoma of the head and neck.

Pediatric Hodgkin lymphoma (pHL) is a highly curable malignancy in children, adolescents, and young adults, and current treatment strategies aim to minimize adverse late effects. Many patients are enrolled in clinical trials with centralized review for both initial and interim staging. Although academic guidelines provide a structured framework for image interpretation, real-world clinical scenarios sometimes present imaging pitfalls that require nuanced judgment. Morphologic and metabolic imaging pitfalls refer to misinterpretation of findings that occur during staging, disease evaluation, or post-treatment surveillance. In pHL, such pitfalls may result from suboptimal imaging conditions, concurrent inflammatory, infectious, or other findings. These findings do not indicate neoplastic disease but rather are manifestations of other processes specific to each tissue or organ. This Staging, Evaluation and Response Criteria Harmonization for Childhood, Adolescent, and Young Adult Hodgkin Lymphoma (SEARCH for CAYAHL) initiative represents a transatlantic collaboration among multidisciplinary professionals, aiming to disseminate the insights gained from decades of centralized review experience in North American and European clinical trials. This paper aims to optimize patient care by integrating imaging and clinical expertise in disease staging and surveillance. Although not intended as a comprehensive staging guide, it highlights recurrent imaging pitfalls that may lead to incorrect staging or response assessment. By encouraging interdisciplinary exchange, this work seeks to complement existing literature and serve as a troubleshooting guide for situations where clinical realities diverge from academic paradigms.

Background: Obesity assessed at a single time point in adulthood has shown no consistent association with prostate cancer (PCa) incidence but has been positively associated with PCa death. We investigated the association of total and age-specific adult weight trajectories with PCa aggressiveness and death.

Methods: We analysed data from 258,494 men in Sweden with at least three weight observations between ages 17 and 60. Individual weight trajectories were estimated using linear mixed-effects models with natural cubic and linear splines for age, incorporating random intercepts and slopes. These estimates were included in multivariable-adjusted Cox proportional hazards models.

Results: Over a median follow-up of 25 years, 22,055 men were diagnosed with PCa and 4,547 died from the disease. Steep weight gain was inversely associated with PCa diagnosed during the PSA testing era (1997 onwards) and via asymptomatic PSA testing, but not with aggressive PCa. Among men with PCa, steep weight gain was associated with increased risk of PCa death (HR quintile 5 vs. 1 = 1.23, 95% CI = 1.08 to 1.40), primarily driven by weight gain between ages 45 and 60 (HR per 1 kg/year = 1.31, 95% CI = 1.10 to 1.57).

Conclusions: The associations observed for incident PCa appear to be influenced by PSA testing uptake; however, the extent to which detection bias contributes remains uncertain. Conversely, late midlife weight gain was associated with an elevated risk of PCa death, underscoring the importance of weight management during this period as a potentially modifiable factor for reducing PCa death.

Background: Most recurrences after curative surgery for esophageal cancer occur within 2 years. Conventional recurrence-free survival (RFS), calculated from the time of surgery, may underestimate prognosis for patients who remain recurrence-free during the early postoperative years. This study aimed to evaluate conditional RFS and recurrence timing to inform individualized follow-up strategies.

Methods: An individual patient data (IPD) analysis was conducted using randomized controlled trials (RCTs) comparing perioperative treatments for resectable esophageal or gastroesophageal junction cancer. Conditional RFS, defined as the probability of remaining recurrence-free for an additional y years given x years already survived without recurrence (RFSy|RFSx), was estimated.

Results: IPD from 10 phase III and 1 phase II RCTs were analyzed (n = 2268 patients with R0 resection). In squamous cell carcinoma (SCC), RFS5|RFS0 was 47.9%, which increased to 63.0%, 72.5%, 78.2%, and 81.2% at RFS5|RFS1-4. Among patients who recurred, 58.8% of pN-positive cases recurred within 1 year and 81.7% within 2 years, compared with 42.8% and 69.9% in pN0. At baseline (RFS5|RFS0), patients with pN-positive disease or pM1 disease had worse 5-year RFS than those with pN0 or pM0 disease. However, among patients who remained recurrence-free for 4 years after surgery (RFS5|RFS4), the pattern was reversed, with advanced groups showing better subsequent 5-year RFS. Similar trends were observed in adenocarcinoma.

Conclusions: Conditional RFS improves over time, particularly in advanced-stage esophageal cancer. Although advanced cases are typically monitored more intensively, findings suggest comparable follow-up intensity may be appropriate once patients remain recurrence-free for a certain postoperative period.