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Differences in Sentinel Node Biopsy and Targeted Axillary Dissection Following Neoadjuvant Chemotherapy. 新辅助化疗后前哨节点活检和靶向腋窝切除术的差异。
IF 28.4 1区 医学 Q1 ONCOLOGY Pub Date : 2024-10-10 DOI: 10.1001/jamaoncol.2024.4569
Mangesh A Thorat
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引用次数: 0
Natural Language Processing–Assessed Unmet Medical and Social Needs in Cancer Crowdfunding Stories 通过自然语言处理评估癌症众筹故事中未满足的医疗和社会需求
IF 28.4 1区 医学 Q1 ONCOLOGY Pub Date : 2024-10-10 DOI: 10.1001/jamaoncol.2024.4412
Zhiyuan Zheng, Shaojun Yu, Farhad Islami, Matthew P. Banegas, Jingxuan Zhao, Jing Zhang, Fumiko Chino, K. Robin Yabroff
This cross-sectional study uses a large natural language processing model to examine unmet medical and social needs based on cancer-related fundraising stories in the US.
这项横断面研究使用大型自然语言处理模型,根据美国癌症相关筹款故事,研究未得到满足的医疗和社会需求。
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引用次数: 0
Ninth Version of the AJCC and UICC Nasopharyngeal Cancer TNM Staging Classification 第九版 AJCC 和 UICC 鼻咽癌 TNM 分期分类法
IF 28.4 1区 医学 Q1 ONCOLOGY Pub Date : 2024-10-10 DOI: 10.1001/jamaoncol.2024.4354
Jian-Ji Pan, Hai-Qiang Mai, Wai Tong Ng, Chao-Su Hu, Jin-Gao Li, Xiao-Zhong Chen, James C. H. Chow, Edwin Wong, Victor Lee, Ling-Yu Ma, Qiao-Juan Guo, Qin Liu, Li-Zhi Liu, Ting-Ting Xu, Xiao-Chang Gong, Meng-Yun Qiang, Kwok-Hung Au, Tsz-Chim Liu, Chi Leung Chiang, You-Ping Xiao, Shao-Jun Lin, Yun-Bin Chen, Shan-Shan Guo, Charlene H. L. Wong, Lin-Quan Tang, Zhi-Yuan Xu, Yi-Zhen Jia, Wen-Sa Peng, Li-Ping Hu, Tian-Zhu Lu, Feng Jiang, Cai-Neng Cao, Wei Xu, Jun Ma, Pierre Blanchard, Michelle Williams, Christine M. Glastonbury, Ann D. King, Snehal G. Patel, Raja R. Seethala, A. Dimitrios Colevas, Dai-Ming Fan, Melvin L. K. Chua, Shao Hui Huang, Brian O’Sullivan, William Lydiatt, Anne W. M. Lee
ImportanceAccurate staging is a fundamental step in treating patients with nasopharyngeal carcinoma (NPC) worldwide; this is crucial not only for prognostication, but also for guiding treatment decisions. The American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) tumor-node-metastasis (TNM) system is the global language for clinicians, researchers, and cancer registries. Continual improvement that aligns with contemporary pattern of care is essential.ObjectiveTo improve the prognostic accuracy and clinical applicability of the eighth edition (TNM-8) for NPC.Design, Setting, and ParticipantsThis multicenter study analyzed patients with NPC with detailed tumor features during January 2014 and December 2015 and was reviewed by experienced radiologists. The data analysis was completed in December 2023. The findings were further confirmed with internal and external validation. Statistical analyses and clinical considerations were reviewed by the AJCC/UICC multidisciplinary head and neck panels and attained consensus. The recommendations were evaluated by the AJCC Evidence-Based Medicine Committee before final endorsement as the ninth version (TNM-9).Main Outcomes and MeasuresThe primary end point was overall survival. Adjusted hazard ratios of different subgroups were then assessed for confirmation of optimal stage grouping.ResultsOf the 4914 patients analyzed, 1264 (25.7%) were female and 3650 (74.3%) were male; the median (SD) age was 48.1 (12.0) years. Advanced radiological extranodal extension (with involvement of adjacent muscles, skin, and/or neurovascular bundles) was identified as an independent adverse factor for all end points: this was added as a criterion for N3. Patients with nonmetastatic disease were regrouped into stages I to III instead of TNM-8 stages I to IVA. Significant hazard discrimination was achieved by grouping T1-2N0-1 as stage I, T3/N2 as stage II, and T4/N3 as stage III. Although the T1-2N0-1 subgroups had comparable 5-year overall survival, subdivisions into IA (T1-T2N0) and IB (T1-T2N1) were recommended due to the distinction in adjusted hazard ratios following adjustment for chemotherapy use. Metastatic disease was exclusively classified as stage IV, and prognostication was further refined by subdivision into IVA (M1a, ≤3 lesions) and IVB (M1b, >3 lesions). TNM-9 demonstrated superiority compared with TNM-8 in major statistical aspects.Conclusion and RelevanceThe results of this diagnostic study suggest that the ninth version of TNM staging for NPC, based on robust analyses and a comprehensive review by the AJCC/UICC staging committees, provides an improved staging system for global application and a framework for future incorporation of nonanatomical factors. This will be launched for global application in January 2025.
重要性准确分期是全球鼻咽癌(NPC)患者治疗的基本步骤;这不仅对预后至关重要,而且对指导治疗决策也至关重要。美国癌症联合委员会(AJCC)/国际癌症控制联盟(UICC)的肿瘤-结节-转移(TNM)系统是临床医生、研究人员和癌症登记处的全球语言。这项多中心研究分析了 2014 年 1 月至 2015 年 12 月间具有详细肿瘤特征的鼻咽癌患者,并由经验丰富的放射科医生进行了审查。数据分析于 2023 年 12 月完成。研究结果经内部和外部验证进一步确认。AJCC/UICC头颈部多学科小组对统计分析和临床考虑进行了审查,并达成了共识。AJCC循证医学委员会对这些建议进行了评估,最终将其批准为第九版(TNM-9)。然后评估不同亚组的调整后危险比,以确认最佳分期分组。结果在分析的4914例患者中,女性1264例(25.7%),男性3650例(74.3%);中位(标清)年龄为48.1(12.0)岁。晚期放射学结节外扩展(累及邻近肌肉、皮肤和/或神经血管束)被认为是影响所有终点的一个独立不利因素:这也是N3的一个新增标准。非转移性疾病患者被重新分组为 I 至 III 期,而不是 TNM-8 I 至 IVA 期。将T1-2N0-1分为I期,将T3/N2分为II期,将T4/N3分为III期,可以显著区分危险。虽然T1-2N0-1亚组的5年总生存率相当,但由于化疗调整后的调整危险比存在差异,建议将其细分为IA(T1-T2N0)和IB(T1-T2N1)。转移性疾病完全被划分为IV期,并通过细分为IVA(M1a,≤3个病灶)和IVB(M1b,>3个病灶)进一步细化预后。这项诊断研究的结果表明,基于AJCC/UICC分期委员会的可靠分析和全面审查,第九版鼻咽癌TNM分期为全球应用提供了一个改进的分期系统,并为未来纳入非解剖学因素提供了一个框架。该系统将于 2025 年 1 月在全球推出。
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引用次数: 0
Staging and Prognosis of Nasopharyngeal Cancer: The Time for Change Is Now. 鼻咽癌的分期与预后:现在是改变的时候了。
IF 28.4 1区 医学 Q1 ONCOLOGY Pub Date : 2024-10-10 DOI: 10.1001/jamaoncol.2024.4201
Sweet Ping Ng,Darrion Mitchell
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引用次数: 0
Implementing Resource-Stratified Guidelines in LMICs—More Issues Than Solutions 在低收入与中等收入国家实施资源分层指南--问题多于解决方案
IF 28.4 1区 医学 Q1 ONCOLOGY Pub Date : 2024-10-10 DOI: 10.1001/jamaoncol.2024.4351
Shweta Baral
This Viewpoint discusses the importance of formulating more stable local treatment guidelines because international guidelines and even resource-stratified guidelines may not be as applicable in low- to middle-income countries.
本视点讨论了制定更加稳定的本地治疗指南的重要性,因为国际指南甚至是资源分级指南可能并不适用于中低收入国家。
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引用次数: 0
Error in Abstract and Methods. 摘要和方法中的错误。
IF 22.5 1区 医学 Q1 ONCOLOGY Pub Date : 2024-10-01 DOI: 10.1001/jamaoncol.2022.0062
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引用次数: 0
Oral Microbiome and Subsequent Risk of Head and Neck Squamous Cell Cancer. 口腔微生物群与罹患头颈部鳞状细胞癌的后续风险
IF 28.4 1区 医学 Q1 ONCOLOGY Pub Date : 2024-09-26 DOI: 10.1001/jamaoncol.2024.4006
Soyoung Kwak,Chan Wang,Mykhaylo Usyk,Feng Wu,Neal D Freedman,Wen-Yi Huang,Marjorie L McCullough,Caroline Y Um,Martha J Shrubsole,Qiuyin Cai,Huilin Li,Jiyoung Ahn,Richard B Hayes
ImportanceThe oral microbiota may be involved in development of head and neck squamous cell cancer (HNSCC), yet current evidence is largely limited to bacterial 16S amplicon sequencing or small retrospective case-control studies.ObjectiveTo test whether oral bacterial and fungal microbiomes are associated with subsequent risk of HNSCC development.Design, Setting, and ParticipantsProspective nested case-control study among participants providing oral samples in 3 epidemiological cohorts, the American Cancer Society Cancer Prevention Study II Nutrition Cohort, the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, and the Southern Community Cohort Study. Two hundred thirty-six patients who prospectively developed HNSCC were identified during a mean (SD) of 5.1 (3.6) years of follow-up. Control participants who remained HNSCC free were selected by 2:1 frequency matching on cohort, age, sex, race and ethnicity, and time since oral sample collection. Data analysis was conducted in 2023.ExposuresCharacterization of the oral bacterial microbiome using whole-genome shotgun sequencing and the oral fungal microbiome using internal transcribed spacer sequencing. Association of bacterial and fungal taxa with HNSCC was assessed by analysis of compositions of microbiomes with bias correction. Association with red and orange oral pathogen complexes was tested by logistic regression. A microbial risk score for HNSCC risk was calculated from risk-associated microbiota.Main Outcomes and MeasuresThe primary outcome was HNSCC incidence.ResultsThe study included 236 HNSCC case participants with a mean (SD) age of 60.9 (9.5) years and 24.6% women during a mean of 5.1 (3.6) years of follow-up, and 485 matched control participants. Overall microbiome diversity at baseline was not related to subsequent HNSCC risk; however 13 oral bacterial species were found to be differentially associated with development of HNSCC. The species included the newly identified Prevotella salivae, Streptococcus sanguinis, and Leptotrichia species, as well as several species belonging to beta and gamma Proteobacteria. The red/orange periodontal pathogen complex was moderately associated with HNSCC risk (odds ratio, 1.06 per 1 SD; 95% CI, 1.00-1.12). A 1-SD increase in microbial risk score (created based on 22 bacteria) was associated with a 50% increase in HNSCC risk (multivariate odds ratio, 1.50; 95% CI, 1.21-1.85). No fungal taxa associated with HNSCC risk were identified.Conclusions and RelevanceThis case-control study yielded compelling evidence that oral bacteria are a risk factor for HNSCC development. The identified bacteria and bacterial complexes hold promise, along with other risk factors, to identify high-risk individuals for personalized prevention of HNSCC.
重要性口腔微生物群可能与头颈部鳞状细胞癌(HNSCC)的发病有关,但目前的证据主要局限于细菌 16S 扩增子测序或小型回顾性病例对照研究。目的检测口腔细菌和真菌微生物群是否与 HNSCC 的后续发病风险有关。设计、地点和参与者在3个流行病学队列(美国癌症协会癌症预防研究II营养队列、前列腺癌、肺癌、结直肠癌和卵巢癌筛查试验以及南方社区队列研究)中提供口腔样本的参与者中进行前瞻性嵌套病例对照研究。在平均(标清)5.1(3.6)年的随访期间,共发现 236 名患者前瞻性地患上了 HNSCC。根据队列、年龄、性别、种族和民族以及口腔样本采集时间进行 2:1 频率匹配,选出了仍未患 HNSCC 的对照组参与者。数据分析于 2023 年进行。暴露使用全基因组枪式测序鉴定口腔细菌微生物组,使用内部转录间隔测序鉴定口腔真菌微生物组。细菌和真菌分类群与 HNSCC 的关系是通过分析微生物组的组成并进行偏差校正来评估的。通过逻辑回归检验了与红色和橙色口腔病原体复合物的关联性。主要结果和测量指标主要结果是HNSCC发病率。结果该研究纳入了236名HNSCC病例参与者(平均(标清)年龄为60.9(9.5)岁,24.6%为女性,平均随访5.1(3.6)年)和485名匹配的对照参与者。基线时的总体微生物组多样性与随后的 HNSCC 风险无关;但发现 13 种口腔细菌与 HNSCC 的发生有不同程度的关联。这些物种包括新发现的唾液普雷沃特氏菌、血清链球菌和Leptotrichia物种,以及属于β和γ变形菌的几个物种。红色/橙色牙周病原体复合体与 HNSCC 风险呈中度相关(几率比,1.06/1 SD;95% CI,1.00-1.12)。微生物风险评分(基于 22 种细菌)每增加 1 个标准差,HNSCC 风险就会增加 50%(多变量几率比:1.50;95% CI:1.21-1.85)。没有发现与 HNSCC 风险相关的真菌类群。已发现的细菌和细菌复合物有望与其他风险因素一起用于识别高危人群,以个性化预防 HNSCC。
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引用次数: 0
How Can Guidelines Give Clearer Guidance on Prostate Cancer Screening? 指南如何为前列腺癌筛查提供更明确的指导?
IF 28.4 1区 医学 Q1 ONCOLOGY Pub Date : 2024-09-26 DOI: 10.1001/jamaoncol.2024.3909
Sigrid V Carlsson,William K Oh
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引用次数: 0
Meta-Analysis Methods for Neoadjuvant Chemoimmunotherapy for Non-Small Cell Lung Cancer. 非小细胞肺癌新辅助化学免疫疗法的元分析方法
IF 28.4 1区 医学 Q1 ONCOLOGY Pub Date : 2024-09-26 DOI: 10.1001/jamaoncol.2024.4211
Leisheng Zhang,Jing Li,Liang Guo
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引用次数: 0
Complete Response to Locoregional Therapy Plus Immunotherapy for Hepatocellular Carcinoma. 肝细胞癌局部治疗加免疫疗法的完全应答。
IF 28.4 1区 医学 Q1 ONCOLOGY Pub Date : 2024-09-26 DOI: 10.1001/jamaoncol.2024.4085
Chi Leung Chiang,Kenneth Sik Kwan Chan,Keith Wan Hang Chiu,Francis Ann Shing Lee,Wenqi Chen,Natalie Sean Man Wong,Ryan Lok Man Ho,Venus Wan Yan Lee,Kwan Man,Feng Ming Spring Kong,Albert Chi Yan Chan
ImportancePrevious studies showed that 42% to 50% of patients with locally advanced hepatocellular carcinoma (HCC) achieved complete remission (CR) after combined locoregional therapy (LRT) plus immunotherapy (IO). However, data on predictors of CR and long-term clinical outcomes without surgery and after discontinuation of IO are lacking.ObjectiveTo assess the long-term clinical outcomes among patients with unresectable HCC who achieved CR after LRT-IO and were placed on a watch-and-wait protocol.Design, Setting, and ParticipantsThis cohort study included patients with unresectable HCC who achieved CR after LRT-IO in 2 prospective studies between January 2018 and December 2022. The time of data cutoff was June 2023. Radiologic CR was defined per modified Response Evaluation Criteria in Solid Tumors. All patients underwent close surveillance after CR without surgical interventions, and IO was discontinued.ExposureAll patients had received stereotactic body radiotherapy followed by anti-programmed cell death protein 1 or anti-programmed death ligand 1 therapy. Forty-nine patients had received a dose of transarterial chemoembolization before stereotactic body radiotherapy.Main Outcomes and MeasuresThe primary outcome was the 3-year overall survival (OS) rate. Secondary outcomes included the 3-year time-to-progression rate, 3-year local control rate, and relapse pattern. Factors associated with CR were analyzed using multivariate analyses.ResultsA total of 63 patients were enrolled (58 male [92.1%]; median age, 69 years [range, 18-90 years]); 38 patients (60.3%) had macrovascular invasion, and the median tumor diameter was 10 cm (range, 3.8-31.1 cm). The median follow-up time was 34.7 months (95% CI, 6.5-64.6 months). Twenty-nine patients (46.0%) achieved CR. The patients achieving CR had a significantly better 3-year OS rate than patients not achieving CR (75.5% [95% CI, 58.2%-98.3%] vs 28.1% [95% CI, 7.4%-29.4%]; P < .001). Among the 29 patients with CR, the 3-year time-to-progression rate was 58.7% (95% CI, 38.7%-79.1%) and the 3-year local control rate was 90.5% (95% CI, 78.2%-100%). Ten patients (34.5%) developed recurrence; among them, 6 (60.0%) with solitary intrahepatic disease relapse underwent curative surgical treatment. The absence of tumor vascular invasion (odds ratio, 0.30; 95% CI, 0.10-0.89) and the sum of the largest lesion diameters of 8 cm or less (odds ratio, 0.26; 95% CI, 0.07-0.98) were associated with CR.Conclusions and RelevanceThis cohort study of LRT-IO with long-term follow-up data found a durable response in patients with locally advanced unresectable HCC. Long-term survival was attainable in patients with radiologic CR. Further randomized clinical trials are warranted.
重要性以往的研究表明,42%到50%的局部晚期肝细胞癌(HCC)患者在联合局部区域治疗(LRT)加免疫治疗(IO)后获得了完全缓解(CR)。然而,关于CR的预测因素以及不手术和停用IO后的长期临床结果的数据尚缺乏。目的评估在LRT-IO后达到CR并被置于观察和等待方案的不可切除HCC患者的长期临床结果。设计、设置和参与者这项队列研究纳入了2018年1月至2022年12月期间在2项前瞻性研究中LRT-IO后达到CR的不可切除HCC患者。数据截止时间为 2023 年 6 月。放射学 CR 根据修改后的实体瘤反应评价标准进行定义。所有患者均接受过立体定向体放疗,随后接受了抗程序性细胞死亡蛋白1或抗程序性死亡配体1治疗。主要结果和测量指标主要结果是3年总生存率(OS)。次要结果包括3年进展时间率、3年局部控制率和复发模式。结果共有63名患者入选(58名男性[92.1%];中位年龄69岁[18-90岁]);38名患者(60.3%)有大血管侵犯,中位肿瘤直径为10厘米(3.8-31.1厘米)。中位随访时间为 34.7 个月(95% CI,6.5-64.6 个月)。29名患者(46.0%)达到了CR。获得 CR 的患者的 3 年 OS 率明显高于未获得 CR 的患者(75.5% [95% CI, 58.2%-98.3%] vs 28.1% [95% CI, 7.4%-29.4%]; P < .001)。在 29 名获得 CR 的患者中,3 年进展时间率为 58.7%(95% CI,38.7%-79.1%),3 年局部控制率为 90.5%(95% CI,78.2%-100%)。10名患者(34.5%)复发,其中6名(60.0%)肝内单发复发患者接受了根治性手术治疗。无肿瘤血管侵犯(几率比 0.30;95% CI,0.10-0.89)和最大病灶直径之和小于或等于 8 厘米(几率比 0.26;95% CI,0.07-0.98)与 CR 相关。放射学 CR 患者可获得长期生存。有必要进一步开展随机临床试验。
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引用次数: 0
期刊
JAMA Oncology
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