Journal of the National Comprehensive Cancer Network最新文献

Background: Diet quality and adherence to dietary guidelines are strong predictors of positive cancer outcomes among survivors.

Methods: A cross-sectional analysis was conducted using 2-day dietary recalls from a nationwide sample of 818 survivors of 9 obesity-related cancers with ≥70% 5-year survival who expressed interest in a web-based diet and exercise trial. Total diet quality scores and component subscores were generated using the Health Eating Index-2020 (HEI-2020). Subgroup analyses examined differences by cancer diagnosis and treatment, body weight status, and sociodemographic factors.

Results: The mean [SD] HEI-2020 score among survivors was 51.6 [12.05] out of 100-approximately 10 points below norms for comparably aged Americans in the general population. Clinically meaningful deficits were observed for intakes of fruits, vegetables, dairy products, and protein (especially from plant and seafood sources). Survivors' intakes also included excessive amounts of refined grains. Compared with the general population, however, survivors' intakes more closely aligned with guidelines in terms of higher whole grain intake and lower consumption of sodium, saturated fat, and sugar (including sugar-sweetened beverages). Overall diet quality and/or component scores were significantly lower among younger survivors (age <65 years) and those within 5 years of diagnosis, with obesity (body mass index ≥30 kg/m2), of lower education (high school diploma or less), and residing in areas of higher socioeconomic deprivation (Area Deprivation Index ≥50th percentile) (all P<.05). No significant subgroup differences were detected by cancer type or treatment.

Conclusions: Diet quality among survivors of obesity-related cancers is notably suboptimal. Clinicians should leverage survivors' interest in diet and exercise interventions to provide support and referrals targeting identified areas of need, particularly for those at highest risk, such as individuals with obesity, within 5 years of diagnosis, aged <65 years, with a high school diploma or less, and residing in areas of higher socioeconomic deprivation.

Background: PREDICT Breast version 3 (v3) is the latest updated prognostication tool, developed using data from approximately 35,000 women diagnosed with breast cancer between 2000 and 2018 in the United Kingdom. Although an earlier version of PREDICT was tested in the United States, the performance of the latest version remains unknown. This study aims to validate PREDICT Breast v3 using newly released SEER outcome data for patients with breast cancer in the United States and to address potential health disparities.

Methods: A total of 615,865 female patients diagnosed with primary breast cancer between 2000 and 2018 and followed for at least 10 years were selected from the SEER database. Predicted and observed 10- and 15-year breast cancer-specific survival outcomes were compared for the overall cohort, stratified by estrogen receptor (ER) status and predefined subgroups. Discriminatory accuracy was evaluated using the area under the receiver operating characteristic curve (AUC).

Results: PREDICT Breast v3 demonstrated good calibration and discrimination for long-term breast cancer-specific survival. It provided accurate mortality estimates (within ±10% absolute error) across the US population for 10-year (-10% in ER-positive and 2% in ER-negative breast cancer) and 15-year (4% in ER-positive and 3% in ER-negative breast cancer) all-cause mortality, for both ER statuses. The model also showed good performance for 10- and 15-year all-cause mortality across the US population, with AUC values of 0.769 and 0.794 for ER-positive breast cancer as well as AUC of 0.738 and 0.746 for ER-negative breast cancer, respectively, indicating good discriminatory ability. However, recalibration is needed for specific groups, including non-Hispanic Asian and non-Hispanic Black patients with ER-negative disease.

Conclusions: PREDICT v3 accurately predicts 10- and 15-year breast cancer-specific survival in contemporary US patients with breast cancer. Future efforts should focus addressing disparities observed in predictive tools to promote equitable care.

Accurate and timely detection of clinically relevant genetic abnormalities, such as CBFB::MYH11 or inversion(16) [inv(16)], is critical for the diagnosis and management of patients with acute myeloid leukemia (AML). Notably, CBFB::MYH11 is a disease-defining mutation in AML and is associated with a favorable prognosis. The current standard-of-care workup, which includes a combination of conventional G-banding karyotyping, fluorescence in situ hybridization (FISH), and/or reverse-transcriptase PCR, poses challenges in detecting variant CBFB::MYH11 translocations. High-resolution, genome-wide technologies capable of accurate and unbiased detection of chromosomal structural aberrations at the gene/exon level, such as optical genome mapping (OGM), will be helpful for the timely detection of clinically actionable abnormalities. This case report presents a patient initially diagnosed with therapy-related myelodysplastic syndrome (MDS) following cytotoxic therapy and treated with a hypomethylating agent, who later experienced progression to AML with CBFB::MYH11. Retrospective analysis of the initial diagnostic sample using OGM revealed a cryptic CBFB::MYH11 abnormality at the time of the first presentation. Furthermore, OGM enabled comprehensive characterization of this novel CBFB::MYH11 transcript with noncanonical breakpoints, which were not detected by standard molecular techniques. This case highlights a critical diagnostic blind spot in the detection of CBF::MYH11 AML, representing a missed opportunity to offer effective frontline therapy to a patient with potentially curable AML-an aberration not recognized by conventional karyotype or FISH at the time of initial diagnosis. The implementation of genome-wide technologies such as OGM as a first-tier diagnostic tool in clinical laboratories for the workup of MDS/AML is essential for detecting clinically impactful cryptic genomic alterations. The discovery of this novel alternate CBFB::MYH11 transcript with noncanonical breakpoints underscores a major limitation in current standard-of-care techniques, warranting further prospective studies to evaluate its clinical actionability in guiding personalized therapies.

Background: Data on the severity, management, and outcomes of Clostridioides difficile infection (CDI) in patients presenting with diarrhea while receiving immune checkpoint inhibitors (ICIs) are limited. This study aimed to evaluate the course of CDI in this population and the overlapping diagnosis of immune-related enterocolitis (irEC).

Methods: This retrospective cohort included ICI-treated patients who presented with diarrhea and underwent CDI stool nucleic acid amplification PCR testing at Memorial Sloan Kettering Cancer Center between July 2015 and July 2021. Primary outcomes included CDI frequency, treatment regimens, and the need for immunosuppression for irEC.

Results: Among 605 ICI-treated patients presenting with diarrhea, 111 (18%) tested positive for CDI. Of these, 84 (76%) were successfully treated with antibiotics alone, whereas 27 (24%) received additional immunosuppressive therapy for suspected or confirmed irEC. Compared with CDI-negative patients, those with CDI had higher rates of prior antibiotic exposure, abdominal pain, fever, bloody stools, and more severe diarrhea and colitis. However, they had lower rates of irEC requiring immunosuppression. Factors associated with the receipt of immunosuppression included CTLA-4-based immunotherapy and grade 3-4 diarrhea and colitis. The CDI recurrence rate was 20%, regardless of the treatment regimen used.

Conclusions: In the largest cohort to date of ICI-treated patients with diarrhea, CDI was identified in 18% of cases and was associated with prior antibiotic therapy. Most patients responded to antibiotics alone; however, 24% required immunosuppression for concurrent irEC, and 20% experienced CDI recurrence. Prompt CDI testing and thoughtful clinical treatment and monitoring may improve outcomes in this population.

The NCCN Guidelines for Multiple Myeloma (MM) provide recommendations for diagnosis, initial workup, treatment, follow-up, and supportive care for patients with MM. These NCCN Guidelines Insights highlight the important updates and changes specific to systemic therapy for patients with newly diagnosed as well as previously treated MM included in Version 1.2025 of the NCCN Guidelines for MM.

Surgical resection remains the backbone of curative treatment for localized esophageal adenocarcinoma. However, resection alone carries a significant risk of recurrence and is no longer considered an acceptable approach for patients with locally advanced disease. Strategies incorporating perioperative chemotherapy, neoadjuvant chemoradiotherapy, and adjuvant immune checkpoint blockade have significantly improved survival. However, despite these advances, approximately half of all patients with locally advanced disease will experience recurrence and ultimately succumb to their disease. To overcome this innate resistance to cytotoxic therapy, novel strategies are being developed. This review discusses both evidence-based and emerging perioperative approaches and explores potential risk-adapted strategies to individualize perioperative therapy.

Gastric cancer is the fifth leading cause of cancer-related deaths worldwide. Over 95% of gastric cancers are adenocarcinomas, which are typically classified based on anatomic location and histologic type. Gastric cancer generally carries a poor prognosis because it is often diagnosed at an advanced stage. Systemic therapy can provide palliation, improve survival, and enhance the quality of life in patients with locally advanced or metastatic disease. The implementation of biomarker testing has had a significant impact on clinical practice and patient care. Targeted therapies have demonstrated encouraging results in clinical trials for the treatment of patients with locally advanced or metastatic disease. This selection from the NCCN Clinical Practice Guidelines in Oncology for Gastric Cancer highlights recommendations for biomarker testing and discusses updates for the treatment of advanced disease, including peritoneal carcinoma as only disease and unresectable locally advanced, recurrent, or metastatic disease.