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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
Recurrent Fevers in a Patient With Splenomegaly. 一名脾肿大患者反复发烧。
IF 28.4 1区 医学 Q1 ONCOLOGY Pub Date : 2024-09-26 DOI: 10.1001/jamaoncol.2024.4029
Darren D'Souza,Braulio Cuesta,Jennie Y Law
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引用次数: 0
Meta-Analysis Methods for Neoadjuvant Chemoimmunotherapy for Non-Small Cell Lung Cancer-Reply. 非小细胞肺癌新辅助化学免疫疗法的 Meta 分析方法--回复。
IF 28.4 1区 医学 Q1 ONCOLOGY Pub Date : 2024-09-26 DOI: 10.1001/jamaoncol.2024.4214
Mark Sorin,Connor Prosty,Jonathan D Spicer
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引用次数: 0
Rogaratinib Plus Atezolizumab in Cisplatin-Ineligible Patients With FGFR RNA-Overexpressing Urothelial Cancer 罗格替尼联合阿特珠单抗治疗不符合顺铂治疗条件的表皮生长因子受体RNA过表达尿路上皮癌患者
IF 28.4 1区 医学 Q1 ONCOLOGY Pub Date : 2024-09-19 DOI: 10.1001/jamaoncol.2024.3900
Randy F. Sweis, Pablo Gajate, Rafael Morales-Barrera, Jae-Lyun Lee, Andrea Necchi, Filippo de Braud, Nicolas Penel, Viktor Grünwald, Marco Maruzzo, Johannes Meran, Tatiane Cristine Ishida, Weichao Bao, Yinghui Zhou, Peter Ellinghaus, Jonathan E. Rosenberg
ImportanceThe oral pan–fibroblast growth factor receptor inhibitor rogaratinib previously demonstrated encouraging safety and efficacy in a phase 1 study of patients with urothelial cancer (UC) overexpressing FGFR messenger RNA (mRNA).ObjectiveTo evaluate the safety, pharmacokinetics, and preliminary efficacy of rogaratinib in combination with the programmed cell death 1 ligand 1 (PD-L1) inhibitor atezolizumab in cisplatin-ineligible patients with FGFR mRNA-positive, locally advanced/metastatic UC.Design, Setting, and ParticipantsThe FORT-2 nonrandomized clinical trial was an open-label, single-arm, multicenter study conducted between May 15, 2018, and July 16, 2021, in 30 centers across Asia, Europe, and North America. Eligible patients had locally advanced/metastatic UC with FGFR1/3 mRNA overexpression and were ineligible for cisplatin-based chemotherapy. The data analysis was completed from July 2022 to September 2022.InterventionsPatients received rogaratinib 600 mg or rogaratinib 800 mg twice daily in combination with intravenous atezolizumab 1200 mg every 21 days.Main Outcomes and MeasuresPrimary end points included safety, tolerability, and the recommended phase 2 dose (RP2D) of rogaratinib in combination with atezolizumab.ResultsAmong 153 patients screened, 73 (48%) had tumors with FGFR1/3 mRNA overexpression, and 37 patients were enrolled and treated (median [range] age, 75.0 [47.0-85.0] years; 32 [87%] male). The most common treatment-emergent adverse events (TEAEs) included diarrhea in 23 patients (62%), hyperphosphatemia in 19 (51%), and fatigue in 15 (41%). Grade 3 or higher TEAEs were reported in 27 patients (73%), and 4 grade 5 TEAEs were reported, though unrelated to treatment. The RP2D was rogaratinib 600 mg in combination with atezolizumab 1200 mg. At the RP2D, the overall response rate was 53.8% in the rogaratinib 600 mg group, including 4 patients (15%) with complete responses; 12 responders (86%) did not have an FGFR3 gene alteration, and 11 (79%) had low PD-L1 expression.Conclusions and RelevanceIn this phase 1b nonrandomized clinical trial, rogaratinib plus atezolizumab demonstrated a manageable safety profile, with no unexpected safety signals. Efficacy for this combination at the RP2D was observed in tumors with low PD-L1 and was not dependent on FGFR3 gene alterations, suggesting broad potential benefit for patients with locally advanced/metastatic UC and FGFR mRNA overexpression.Trial RegistrationClinicalTrials.gov Identifier: NCT03473756
重要性口服泛成纤维细胞生长因子受体抑制剂罗加替尼曾在一项针对过表达FGFR信使RNA(mRNA)的尿路上皮癌(UC)患者的1期研究中显示出令人鼓舞的安全性和疗效。目的评估罗加替尼联合程序性细胞死亡 1 配体 1 (PD-L1) 抑制剂阿特珠单抗治疗不符合顺铂治疗条件的 FGFR mRNA 阳性、局部晚期/转移性 UC 患者的安全性、药代动力学和初步疗效。设计、设置和参与者FORT-2非随机临床试验是一项开放标签、单臂、多中心研究,于2018年5月15日至2021年7月16日期间在亚洲、欧洲和北美的30个中心进行。符合条件的患者为局部晚期/转移性 UC,FGFR1/3 mRNA 过表达,且不符合顺铂化疗条件。干预措施患者接受罗加替尼600毫克或罗加替尼800毫克,每天两次,联合静脉注射阿特珠单抗1200毫克,每21天一次。主要结果和测量指标主要终点包括安全性、耐受性以及罗加替尼联合阿特珠单抗的2期推荐剂量(RP2D)。结果在筛选出的153名患者中,73人(48%)的肿瘤存在FGFR1/3 mRNA过表达,37名患者入组并接受治疗(中位年龄[范围]为75.0[47.0-85.0]岁;32人[87%]为男性)。最常见的治疗突发不良事件(TEAEs)包括:23 名患者(62%)出现腹泻,19 名患者(51%)出现高磷血症,15 名患者(41%)出现疲劳。27名患者(73%)报告了3级或更高的TEAE,4名患者报告了5级TEAE,但与治疗无关。RP2D是罗加替尼600毫克联合阿特珠单抗1200毫克。在RP2D时,罗加替尼600毫克组的总应答率为53.8%,其中4例患者(15%)为完全应答;12例应答者(86%)无FGFR3基因改变,11例应答者(79%)PD-L1表达较低。在PD-L1较低的肿瘤中观察到了该组合在RP2D阶段的疗效,并且不依赖于FGFR3基因的改变,这表明局部晚期/转移性UC和FGFR mRNA过表达的患者可能会广泛受益:NCT03473756
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引用次数: 0
期刊
JAMA Oncology
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