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Lower Risks of New-Onset Hepatocellular Carcinoma in Patients With Type 2 Diabetes Mellitus Treated With SGLT2 Inhibitors Versus DPP4 Inhibitors. 使用 SGLT2 抑制剂和 DPP4 抑制剂治疗的 2 型糖尿病患者罹患新发肝细胞癌的风险更低。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-06-01 DOI: 10.6004/jnccn.2023.7118
Oscar Hou In Chou, Jing Ning, Raymond Ngai Chiu Chan, Cheuk To Chung, Helen Huang, Kenrick Ng, Edward Christopher Dee, Sharen Lee, Apichat Kaewdech, Ariel K Man Chow, Nancy Kwan Man, Tong Liu, Fengshi Jing, Bernard Man Yung Cheung, Gary Tse, Jiandong Zhou

Background: Type 2 diabetes mellitus (T2DM) may be a risk factor for development of hepatocellular carcinoma (HCC). The association between risk of developing HCC and treatment with sodium-glucose cotransporter-2 inhibitors (SGLT2i) versus dipeptidyl peptidase-4 inhibitors (DPP4i) is currently unknown. This study aimed to compare the risk of new-onset HCC in patients treated with SGLT2i versus DPP4i.

Methods: This was a retrospective cohort study of patients with T2DM in Hong Kong receiving either SGLT2i or DPP4i between January 1, 2015, and December 31, 2020. Patients with concurrent DPP4i and SGLT2i use were excluded. Propensity score matching (1:1 ratio) was performed by using the nearest neighbor search. Multivariable Cox regression was applied to identify significant predictors.

Results: A total of 62,699 patients were included (SGLT2i, n=22,154; DPP4i, n=40,545). After matching (n=44,308), 166 patients (0.37%) developed HCC: 36 in the SGLT2i group and 130 in the DPP4i group over 240,269 person-years. Overall, SGLT2i use was associated with lower risks of HCC (hazard ratio [HR], 0.42; 95% CI, 0.28-0.79) compared with DPP4i after adjustments. The association between SGLT2i and HCC development remained significant in patients with cirrhosis or advanced fibrosis (HR, 0.12; 95% CI, 0.04-0.41), hepatitis B virus (HBV) infection (HR, 0.32; 95% CI, 0.17-0.59), or hepatitis C virus (HCV) infection (HR, 0.41; 95% CI, 0.22-0.80). The results were consistent in different risk models, propensity score approaches, and sensitivity analyses.

Conclusions: SGLT2i use was associated with a lower risk of HCC compared with DPP4i use after adjustments, and in the context of cirrhosis, advanced fibrosis, HBV infection, and HCV infection.

背景:2型糖尿病(T2DM)可能是肝细胞癌(HCC)发病的一个风险因素。目前尚不清楚HCC发病风险与钠-葡萄糖共转运体-2抑制剂(SGLT2i)和二肽基肽酶-4抑制剂(DPP4i)治疗之间的关系。本研究旨在比较接受 SGLT2i 和 DPP4i 治疗的患者新发 HCC 的风险:这是一项回顾性队列研究,研究对象为2015年1月1日至2020年12月31日期间接受SGLT2i或DPP4i治疗的香港T2DM患者。排除了同时使用 DPP4i 和 SGLT2i 的患者。采用近邻搜索法进行倾向评分匹配(1:1 比例)。采用多变量 Cox 回归确定重要的预测因素:共纳入 62,699 名患者(SGLT2i,n=22,154;DPP4i,n=40,545)。配对后(n=44,308),在 240,269 人年中,166 名患者(0.37%)患上了 HCC:SGLT2i 组 36 人,DPP4i 组 130 人。总体而言,经调整后,与 DPP4i 相比,使用 SGLT2i 可降低 HCC 风险(危险比 [HR],0.42;95% CI,0.28-0.79)。在肝硬化或晚期肝纤维化(HR,0.12;95% CI,0.04-0.41)、乙型肝炎病毒(HBV)感染(HR,0.32;95% CI,0.17-0.59)或丙型肝炎病毒(HCV)感染(HR,0.41;95% CI,0.22-0.80)患者中,SGLT2i 与 HCC 发生之间的关系仍然显著。不同的风险模型、倾向评分方法和敏感性分析结果一致:结论:经调整后,在肝硬化、晚期肝纤维化、HBV 感染和 HCV 感染的情况下,与使用 DPP4i 相比,使用 SGLT2i 与较低的 HCC 风险相关。
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引用次数: 0
NCCN Guidelines® Insights: Systemic Mastocytosis, Version 3.2024. NCCN Guidelines® Insights:系统性肥大细胞增多症,3.2024 版。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-06-01 DOI: 10.6004/jnccn.2024.0030
Jason Gotlib, Aaron T Gerds, Peter Abdelmessieh, Haris Ali, Mariana Castells, Andrew Dunbar, Ruth Fein Revell, Tracy I George, Steven Green, Krishna Gundabolu, Elizabeth Hexner, Tania Jain, Catriona Jamieson, Paul R Kaesberg, Andrew T Kuykendall, Yazan Madanat, Naveen Manchanda, Lucia Masarova, Jori May, Brandon McMahon, Sanjay R Mohan, Kalyan V Nadiminti, Stephen Oh, Jeanne Palmer, Ami Patel, Anand A Patel, Nikolai Podoltsev, Lindsay Rein, Rachel Salit, Moshe Talpaz, Martha Wadleigh, Sarah Wall, Mary Anne Bergman, Cindy Hochstetler

Mastocytosis is a heterogeneous group of disorders comprising cutaneous mastocytosis, systemic mastocytosis, and mast cell sarcoma. It is associated with a variety of symptoms related to the release of mast cell mediators and mast cell tissue infiltration. Referral to specialized centers with expertise in the management of mastocytosis and multidisciplinary collaboration with subspecialists (eg, allergists for the management of anaphylaxis and drug hypersensitivities, anesthesiologists for invasive procedures or surgery, high-risk obstetrician for pregnancy) is recommended. The NCCN Guidelines for Systemic Mastocytosis provide evidence- and consensus-based recommendations for the diagnosis and comprehensive care of patients with systemic mastocytosis. The multidisciplinary panel of experts convenes at least once a year to review requested changes to the guidelines from both internal and external entities as well as to discuss data on existing and new therapies. These NCCN Guidelines Insights focus on some of the recent updates to the guidelines.

肥大细胞增多症是由皮肤肥大细胞增多症、全身性肥大细胞增多症和肥大细胞肉瘤组成的一组异质性疾病。它与肥大细胞介质释放和肥大细胞组织浸润有关的各种症状。建议将患者转诊至具有治疗肥大细胞增多症专业知识的专科中心,并与亚专科医师(如过敏性休克和药物过敏症治疗的过敏反应科医师、侵入性手术或外科手术的麻醉科医师、妊娠高危产科医师)进行多学科合作。NCCN 系统性肥大细胞增多症指南为系统性肥大细胞增多症患者的诊断和综合治疗提供了基于证据和共识的建议。多学科专家小组每年至少召开一次会议,审查内部和外部实体对指南提出的修改要求,并讨论有关现有疗法和新疗法的数据。这些《NCCN 指南透视》重点介绍了最近对指南进行的一些更新。
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引用次数: 0
Optimizing Ovarian Cancer Treatment and Prevention Through Parallel Germline and Somatic Genetic Testing. 通过并行种系和体细胞基因检测优化卵巢癌治疗和预防。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-06-01 DOI: 10.6004/jnccn.2024.7042
Janice S Kwon
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引用次数: 0
Colon Cancer, Version 3.2024, NCCN Clinical Practice Guidelines in Oncology. 结肠癌,3.2024 版,NCCN 肿瘤学临床实践指南。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-06-01 DOI: 10.6004/jnccn.2024.0029
Al B Benson, Alan P Venook, Mohamed Adam, George Chang, Yi-Jen Chen, Kristen K Ciombor, Stacey A Cohen, Harry S Cooper, Dustin Deming, Ignacio Garrido-Laguna, Jean L Grem, Paul Haste, J Randolph Hecht, Sarah Hoffe, Steven Hunt, Hisham Hussan, Kimberly L Johung, Nora Joseph, Natalie Kirilcuk, Smitha Krishnamurthi, Midhun Malla, Jennifer K Maratt, Wells A Messersmith, Jeffrey Meyerhardt, Eric D Miller, Mary F Mulcahy, Steven Nurkin, Michael J Overman, Aparna Parikh, Hitendra Patel, Katrina Pedersen, Leonard Saltz, Charles Schneider, David Shibata, Benjamin Shogan, John M Skibber, Constantinos T Sofocleous, Anna Tavakkoli, Christopher G Willett, Christina Wu, Lisa A Gurski, Jenna Snedeker, Frankie Jones

Colorectal cancer (CRC) is the fourth most frequently diagnosed cancer and the second leading cause of cancer death in the United States. Management of disseminated metastatic CRC involves various active drugs, either in combination or as single agents. The choice of therapy is based on consideration of the goals of therapy, the type and timing of prior therapy, the mutational profile of the tumor, and the differing toxicity profiles of the constituent drugs. This manuscript summarizes the data supporting the systemic therapy options recommended for metastatic CRC in the NCCN Guidelines for Colon Cancer.

在美国,结直肠癌(CRC)是第四大最常诊断出的癌症,也是第二大癌症死因。对扩散转移性 CRC 的治疗涉及多种活性药物,既可以是联合用药,也可以是单药治疗。选择哪种疗法取决于治疗目标、先前治疗的类型和时间、肿瘤的突变情况以及组成药物的不同毒性。本手稿总结了支持《NCCN 结肠癌指南》中推荐的转移性 CRC 系统治疗方案的数据。
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引用次数: 0
The NCCN 2024 Annual Conference. NCCN 2024 年年会。
IF 13.4 2区 医学 Q1 ONCOLOGY Pub Date : 2024-05-31 DOI: 10.6004/jnccn.2024.5001
Crystal S Denlinger, Wui-Jin Koh
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引用次数: 0
NCCN Policy Summit: Cancer Across Geography. NCCN 政策峰会:跨越地域的癌症。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-05-31 DOI: 10.6004/jnccn.2024.7025
Sean T McCarson, Alyssa Schatz, Victoria Hood, Ashley Orr, Aaron Bailey, Jesse Plascak, Ursa Brown-Glaberman, Elisa M Rodriguez, Taneal Carter, Crystal Denlinger

Geographic location of a patient directly impacts access to care, including preventive screenings and early detection. Although there is a higher prevalence of the most common cancers in urban areas, mortality rates are higher in rural communities. Notably, indigenous communities residing on tribal lands often experience heightened access issues and environmental exposure to known and probable human carcinogens. The burdens associated with a cancer diagnosis can be exacerbated by various barriers to accessing quality care; however, there are emerging best practices to overcome these barriers. Understanding the interplay between geography and a patient's access to cancer care services is crucial for addressing existing disparities and ensuring equitable health care provision across regions. By leveraging innovative policy and practice solutions, communities can begin to close care gaps and establish bidirectional trust between patients and providers across the care continuum, which is necessary to enact meaningful reforms. To advance the conversation on geographic disparities and strategies that mitigate associated barriers to care, NCCN hosted the Policy Summit "Cancer Across Geography" on June 15, 2023, at the National Press Club in Washington, DC. Through keynote addresses and multistakeholder panel discussions, this hybrid event explored care imbalances across geography, recent policy and technology advancements, and current challenges associated with cancer care. This created a forum for a diverse group of attendees to thoughtfully discuss policies and practices to advance high-quality, effective, efficient, equitable, and accessible cancer care for all. Speakers and attendees featured multidisciplinary clinicians, epidemiologists, community oncologists, researchers, payers, patient advocates, industry, providers, policymakers, and leaders representing underserved communities, among others.

患者所在的地理位置直接影响其获得医疗服务的机会,包括预防性筛查和早期发现。虽然城市地区最常见癌症的发病率较高,但农村社区的死亡率也较高。值得注意的是,居住在部落土地上的原住民社区往往面临着更多的就医问题,并且在环境中暴露于已知和可能的人类致癌物质。与癌症诊断相关的负担可能会因获得优质医疗服务的各种障碍而加重;不过,目前正在出现克服这些障碍的最佳做法。了解地理位置与患者获得癌症治疗服务之间的相互影响,对于解决现有差距和确保跨地区公平提供医疗保健服务至关重要。通过利用创新的政策和实践解决方案,社区可以开始缩小医疗差距,并在患者和医疗服务提供者之间建立双向信任,这是进行有意义的改革所必需的。为了推动关于地域差异和减少相关护理障碍的战略的讨论,NCCN 于 2023 年 6 月 15 日在华盛顿特区的国家新闻俱乐部主办了 "跨地域癌症 "政策峰会。通过主题演讲和多方利益相关者小组讨论,这一混合活动探讨了跨地域的护理不平衡、最新的政策和技术进展以及当前与癌症护理相关的挑战。这为不同的与会者创造了一个论坛,使他们能够深思熟虑地讨论各项政策和实践,以推动为所有人提供优质、有效、高效、公平和便捷的癌症护理。发言人和与会者包括多学科临床医生、流行病学家、社区肿瘤学家、研究人员、付款人、患者权益倡导者、行业、医疗服务提供者、政策制定者以及代表服务不足社区的领导人等。
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引用次数: 0
Decline in Smartphone-Assessed Physical Activity Level is Associated With Clinical Outcomes in Phase I/II Clinical Cancer Trials. 智能手机评估的体力活动水平下降与 I/II 期临床癌症试验的临床结果有关。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-05-22 DOI: 10.6004/jnccn.2024.7001
Calvin G Brouwer, Joeri A J Douma, Evelien J M Kuip, Sonja Zweegman, Niels W C J van de Donk, Maria T E Hopman, Myra E van Linde, Henk M W Verheul, Laurien M Buffart

Background: A decline in physical function may be an early predictor for complications of cancer treatment. This study examined whether repeated objective smartphone measurements of physical activity and exercise capacity in patients with cancer are feasible during early-phase clinical trials (EPCTs) and whether a decline in physical function is associated with clinical outcomes.

Methods: Physical activity (steps/day) and exercise capacity (6-minute walk test [6MWT]) were measured with a smartphone before EPCT start (T0) and after 4 weeks (T1) and 8 weeks (T2). Univariable logistic regression analyzed associations between a decline in step count (≥20%), 6MWT distance (≥10%), or deterioration of ECOG performance status (PS) and trial discontinuation at 8 weeks and 90 days. Cox proportional hazards models were used to examine associations with progression-free survival (PFS) and overall survival (OS), adjusting for trial phase (I vs II), cancer type (hematologic malignancy vs solid tumor), and PS (0 vs ≥1).

Results: Among 117 included patients, valid step count and 6MWT measurements were available for 96.6% and 76.7% of patients at T0, 74.4% and 53.3% at T1, and 89.7% and 54.4% at T2, respectively. Patients experiencing step count decline between T0 and T1 had higher odds of trial discontinuation at 8 weeks (odds ratio, 8.67; 95% CI, 1.94-61.43), and decline between T1 and T2 was associated with discontinuation at 90 days (odds ratio, 5.20; 95% CI, 1.43-21.14). Step count decline was significantly associated with shorter PFS (hazard ratio, 3.54; 95% CI, 2.06-6.08) and OS (hazard ratio, 2.31; 95% CI, 1.26-4.23). Declines in 6MWT distance or deterioration in ECOG PS were not associated with trial discontinuation or survival.

Conclusions: Repeated smartphone measurements of physical activity are feasible in patients participating in EPCTs. Additionally, physical activity decline is significantly associated with trial discontinuation, PFS, and OS. Hence, we envision that objective smartphone measurements of physical activity will contribute to optimal treatment development for patients with cancer.

背景:身体功能下降可能是癌症治疗并发症的早期预测指标。本研究探讨了在早期临床试验(EPCT)期间,用智能手机反复客观测量癌症患者的体力活动和运动能力是否可行,以及体力功能下降是否与临床结果有关:在EPCT开始前(T0)、4周后(T1)和8周后(T2)用智能手机测量体力活动(步数/天)和运动能力(6分钟步行测试[6MWT])。单变量逻辑回归分析了步数下降(≥20%)、6MWT距离下降(≥10%)或ECOG表现状态(PS)恶化与8周和90天时终止试验之间的关联。在调整试验阶段(I期 vs II期)、癌症类型(血液系统恶性肿瘤 vs 实体瘤)和PS(0 vs ≥1)后,采用Cox比例危险模型检验无进展生存期(PFS)和总生存期(OS)的相关性:在纳入的 117 名患者中,96.6% 和 76.7% 的患者在 T0 期、74.4% 和 53.3% 的患者在 T1 期、89.7% 和 54.4% 的患者在 T2 期分别进行了有效的步数和 6MWT 测量。在 T0 和 T1 之间出现步数下降的患者在 8 周时中止试验的几率更高(几率比为 8.67;95% CI,1.94-61.43),而在 T1 和 T2 之间出现步数下降与 90 天时中止试验有关(几率比为 5.20;95% CI,1.43-21.14)。步数下降与较短的 PFS(危险比,3.54;95% CI,2.06-6.08)和 OS(危险比,2.31;95% CI,1.26-4.23)明显相关。6MWT距离的下降或ECOG PS的恶化与试验终止或生存率无关:结论:用智能手机重复测量参与 EPCT 的患者的体力活动是可行的。此外,体力活动下降与试验中止、PFS 和 OS 显著相关。因此,我们认为智能手机对体力活动的客观测量将有助于癌症患者的最佳治疗方案的制定。
{"title":"Decline in Smartphone-Assessed Physical Activity Level is Associated With Clinical Outcomes in Phase I/II Clinical Cancer Trials.","authors":"Calvin G Brouwer, Joeri A J Douma, Evelien J M Kuip, Sonja Zweegman, Niels W C J van de Donk, Maria T E Hopman, Myra E van Linde, Henk M W Verheul, Laurien M Buffart","doi":"10.6004/jnccn.2024.7001","DOIUrl":"10.6004/jnccn.2024.7001","url":null,"abstract":"<p><strong>Background: </strong>A decline in physical function may be an early predictor for complications of cancer treatment. This study examined whether repeated objective smartphone measurements of physical activity and exercise capacity in patients with cancer are feasible during early-phase clinical trials (EPCTs) and whether a decline in physical function is associated with clinical outcomes.</p><p><strong>Methods: </strong>Physical activity (steps/day) and exercise capacity (6-minute walk test [6MWT]) were measured with a smartphone before EPCT start (T0) and after 4 weeks (T1) and 8 weeks (T2). Univariable logistic regression analyzed associations between a decline in step count (≥20%), 6MWT distance (≥10%), or deterioration of ECOG performance status (PS) and trial discontinuation at 8 weeks and 90 days. Cox proportional hazards models were used to examine associations with progression-free survival (PFS) and overall survival (OS), adjusting for trial phase (I vs II), cancer type (hematologic malignancy vs solid tumor), and PS (0 vs ≥1).</p><p><strong>Results: </strong>Among 117 included patients, valid step count and 6MWT measurements were available for 96.6% and 76.7% of patients at T0, 74.4% and 53.3% at T1, and 89.7% and 54.4% at T2, respectively. Patients experiencing step count decline between T0 and T1 had higher odds of trial discontinuation at 8 weeks (odds ratio, 8.67; 95% CI, 1.94-61.43), and decline between T1 and T2 was associated with discontinuation at 90 days (odds ratio, 5.20; 95% CI, 1.43-21.14). Step count decline was significantly associated with shorter PFS (hazard ratio, 3.54; 95% CI, 2.06-6.08) and OS (hazard ratio, 2.31; 95% CI, 1.26-4.23). Declines in 6MWT distance or deterioration in ECOG PS were not associated with trial discontinuation or survival.</p><p><strong>Conclusions: </strong>Repeated smartphone measurements of physical activity are feasible in patients participating in EPCTs. Additionally, physical activity decline is significantly associated with trial discontinuation, PFS, and OS. Hence, we envision that objective smartphone measurements of physical activity will contribute to optimal treatment development for patients with cancer.</p>","PeriodicalId":17483,"journal":{"name":"Journal of the National Comprehensive Cancer Network","volume":" ","pages":"323-330"},"PeriodicalIF":14.8,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141081813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Enhancing Readability of Online Patient-Facing Content: The Role of AI Chatbots in Improving Cancer Information Accessibility. 提高面向患者的在线内容的可读性:人工智能聊天机器人在提高癌症信息可读性中的作用》。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-05-15 DOI: 10.6004/jnccn.2023.7334
Andres A Abreu, Gilbert Z Murimwa, Emile Farah, James W Stewart, Lucia Zhang, Jonathan Rodriguez, John Sweetenham, Herbert J Zeh, Sam C Wang, Patricio M Polanco

Background: Internet-based health education is increasingly vital in patient care. However, the readability of online information often exceeds the average reading level of the US population, limiting accessibility and comprehension. This study investigates the use of chatbot artificial intelligence to improve the readability of cancer-related patient-facing content.

Methods: We used ChatGPT 4.0 to rewrite content about breast, colon, lung, prostate, and pancreas cancer across 34 websites associated with NCCN Member Institutions. Readability was analyzed using Fry Readability Score, Flesch-Kincaid Grade Level, Gunning Fog Index, and Simple Measure of Gobbledygook. The primary outcome was the mean readability score for the original and artificial intelligence (AI)-generated content. As secondary outcomes, we assessed the accuracy, similarity, and quality using F1 scores, cosine similarity scores, and section 2 of the DISCERN instrument, respectively.

Results: The mean readability level across the 34 websites was equivalent to a university freshman level (grade 13±1.5). However, after ChatGPT's intervention, the AI-generated outputs had a mean readability score equivalent to a high school freshman education level (grade 9±0.8). The overall F1 score for the rewritten content was 0.87, the precision score was 0.934, and the recall score was 0.814. Compared with their original counterparts, the AI-rewritten content had a cosine similarity score of 0.915 (95% CI, 0.908-0.922). The improved readability was attributed to simpler words and shorter sentences. The mean DISCERN score of the random sample of AI-generated content was equivalent to "good" (28.5±5), with no significant differences compared with their original counterparts.

Conclusions: Our study demonstrates the potential of AI chatbots to improve the readability of patient-facing content while maintaining content quality. The decrease in requisite literacy after AI revision emphasizes the potential of this technology to reduce health care disparities caused by a mismatch between educational resources available to a patient and their health literacy.

背景:基于互联网的健康教育在病人护理中越来越重要。然而,在线信息的可读性往往超过美国人口的平均阅读水平,限制了信息的获取和理解。本研究调查了聊天机器人人工智能的使用情况,以提高面向患者的癌症相关内容的可读性:我们使用 ChatGPT 4.0 重写了与 NCCN 成员机构相关的 34 个网站中有关乳腺癌、结肠癌、肺癌、前列腺癌和胰腺癌的内容。使用弗莱可读性评分、弗莱什-金凯德等级水平、Gunning Fog Index 和 Simple Measure of Gobbledygook 对可读性进行了分析。主要结果是原始内容和人工智能(AI)生成内容的平均可读性得分。作为次要结果,我们分别使用 F1 分数、余弦相似度分数和 DISCERN 工具的第 2 部分来评估准确性、相似性和质量:结果:34 个网站的平均可读性水平相当于大学新生水平(13±1.5 级)。然而,在 ChatGPT 的干预下,人工智能生成的输出结果的平均可读性得分相当于高中一年级学生的水平(9±0.8 级)。改写内容的总体 F1 得分为 0.87,精确度得分为 0.934,召回得分为 0.814。与原始内容相比,人工智能改写内容的余弦相似度为 0.915(95% CI,0.908-0.922)。可读性提高的原因是用词更简单,句子更短。随机抽样的人工智能生成内容的平均 DISCERN 分数相当于 "好"(28.5±5),与原始内容相比没有显著差异:我们的研究表明,人工智能聊天机器人有潜力在保持内容质量的同时提高面向患者的内容的可读性。经过人工智能修改后,所需文化水平有所下降,这强调了该技术在减少因患者可用教育资源与他们的健康文化水平不匹配而造成的医疗差距方面的潜力。
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引用次数: 0
Efficacy and Toxicity Analysis of mFOLFIRINOX in High-Grade Gastroenteropancreatic Neuroendocrine Neoplasms. mFOLFIRINOX治疗高级别胃肠胰神经内分泌肿瘤的疗效和毒性分析
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-05-14 DOI: 10.6004/jnccn.2024.7005
Michele Borghesani, Anna Reni, Eleonora Lauricella, Alice Rossi, Viola Moscarda, Elena Trevisani, Irene Torresan, Taymeyah Al-Toubah, Elisabetta Filoni, Claudio Luchini, Riccardo De Robertis, Luca Landoni, Aldo Scarpa, Camillo Porta, Michele Milella, Jonathan Strosberg, Mauro Cives, Sara Cingarlini

Background: High-grade neuroendocrine neoplasms (NENs) comprise both well-differentiated grade 3 neuroendocrine tumors (G3 NETs) and poorly differentiated neuroendocrine carcinomas (NECs). Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) nearly always include poorly differentiated NEC as the neuroendocrine component. The efficacy and safety of frontline mFOLFIRINOX chemotherapy has never been investigated in patients with high-grade NENs.

Patients and methods: We conducted a multi-institutional retrospective analysis of patients with advanced high-grade NEN of the gastroenteropancreatic tract or of unknown origin seen between February 2016 and April 2023 who received treatment with frontline mFOLFIRINOX.

Results: A total of 35 patients were included (G3 NETs: n=2; NECs: n=25; MiNENs: n=8; stage III: n=5; stage IV: n=30). The objective response rate was 77% (complete response: 3%; partial response: 74%). Median progression-free survival was 12 months (95% CI, 9.2-16.2 months) and median overall survival was 20.6 months (95% CI, 17.2-30.6 months). No significant differences in efficacy were seen according to primary site, histopathology, and Ki-67 proliferative index. All 5 patients with stage III disease who received mFOLFIRINOX obtained an objective response and underwent radical surgery or definitive radiotherapy with curative intent, with a recurrence rate of 40%. Grade 3 or 4 adverse events were observed in 43% of patients (mainly neutropenia and diarrhea). Females were at significantly increased risk of developing severe toxicities.

Conclusions: mFOLFIRINOX shows antitumor activity against high-grade NENs. Well-designed, prospective clinical trials are needed to assess the efficacy of mFOLFIRINOX in both the neoadjuvant and metastatic settings.

背景:高级别神经内分泌肿瘤(NENs)包括分化良好的3级神经内分泌肿瘤(G3 NETs)和分化不良的神经内分泌癌(NECs)。神经内分泌-非神经内分泌混合瘤(MiNENs)的神经内分泌成分几乎总是包括分化不良的神经内分泌癌。对于高级别 NENs 患者,前线 mFOLFIRINOX 化疗的有效性和安全性还从未进行过研究:我们对2016年2月至2023年4月期间就诊的晚期胃肠胰道高级别NEN或来源不明的高级别NEN患者进行了一项多机构回顾性分析,这些患者接受了前线mFOLFIRINOX治疗:共纳入35例患者(G3 NETs:n=2;NECs:n=25;MiNENs:n=8;III期:n=5;IV期:n=30)。客观反应率为 77%(完全反应:3%;部分反应:74%)。中位无进展生存期为12个月(95% CI,9.2-16.2个月),中位总生存期为20.6个月(95% CI,17.2-30.6个月)。根据原发部位、组织病理学和Ki-67增殖指数,疗效无明显差异。接受mFOLFIRINOX治疗的5例III期患者均获得了客观反应,并以治愈为目的接受了根治性手术或确定性放疗,复发率为40%。43%的患者出现了3级或4级不良反应(主要是中性粒细胞减少和腹泻)。结论:mFOLFIRINOX对高级别NEN具有抗肿瘤活性。需要进行精心设计的前瞻性临床试验,以评估mFOLFIRINOX在新辅助治疗和转移治疗中的疗效。
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引用次数: 0
Outcomes in Nonmetastatic Hormone Receptor-Positive HER2-Negative Pure Mucinous Breast Cancer: A Multicenter Cohort Study. 非转移性激素受体阳性 HER2 阴性纯黏液性乳腺癌的疗效:一项多中心队列研究。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-05-14 DOI: 10.6004/jnccn.2023.7121
Ryan Ying Cong Tan, Whee Sze Ong, Kyung-Hun Lee, Seri Park, Jabed Iqbal, Yeon Hee Park, Jeong Eon Lee, Jong Han Yu, Ching-Hung Lin, Yen-Shen Lu, Makiko Ono, Takayuki Ueno, Yoichi Naito, Tatsuya Onishi, Geok-Hoon Lim, Su-Ming Tan, Han-Byoel Lee, Jiwon Koh, Wonshik Han, Seock-Ah Im, Veronique Kiak Mien Tan, Nitar Phyu, Fuh-Yong Wong, Puay Hoon Tan, Yoon-Sim Yap

Background: Although considered a favorable subtype, pure mucinous breast cancer (PMBC) can recur, and evidence for adjuvant therapy is limited. We aimed to compare outcomes of nonmetastatic PMBC with invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) to address these uncertainties.

Methods: Individual patient-level data from 6 centers on stage I-III hormone receptor-positive and HER2-negative PMBC, IDC, and ILC were used to analyze recurrence-free interval (RFI), recurrence-free survival (RFS), and overall survival (OS), and to identify prognostic factors for PMBC.

Results: Data from 20,684 IDC cases, 1,475 ILC cases, and 943 PMBC cases were used. Median follow-up was 6.6 years. Five-year RFI, RFS, and OS for PMBC were 96.1%, 94.9%, and 98.1%, respectively. On multivariable Cox regression, PMBC demonstrated superior RFI (hazard ratio [HR], 0.59; 95% CI, 0.43-0.80), RFS (HR, 0.70; 95% CI, 0.56-0.89), and OS (HR, 0.71; 95% CI, 0.53-0.96) compared with IDC. ILC showed comparable outcomes to IDC. Fewer than half (48.7%) of recurrences in PMBC were distant, which was a lower rate than for IDC (67.3%) and ILC (80.6%). In contrast to RFI, RFS events were driven more by non-breast cancer deaths in older patients. Significant prognostic factors for RFI among PMBC included positive lymph node(s) (HR, 2.42; 95% CI, 1.08-5.40), radiotherapy (HR, 0.44; 95% CI, 0.23-0.85), and endocrine therapy (HR, 0.25; 95% CI, 0.09-0.70). No differential chemotherapy associations with outcomes were detected across PMBC subgroups by nodal stage, tumor size, and age. A separate SEER database analysis also did not find any association of improved survival with adjuvant chemotherapy in these subgroups.

Conclusions: Compared with IDC, PMBC demonstrated superior RFI, RFS, and OS. Lymph node negativity, adjuvant radiotherapy, and endocrine therapy were associated with superior RFI. Adjuvant chemotherapy was not associated with better outcomes.

背景:尽管纯粘液性乳腺癌(PMBC)被认为是一种有利的亚型,但它可能复发,而且辅助治疗的证据有限。我们旨在比较非转移性PMBC与浸润性导管癌(IDC)和浸润性小叶癌(ILC)的治疗效果,以解决这些不确定因素:来自6个中心的I-III期激素受体阳性和HER2阴性PMBC、IDC和ILC的患者个体水平数据被用来分析无复发间隔期(RFI)、无复发生存期(RFS)和总生存期(OS),并确定PMBC的预后因素:结果:采用了20684例IDC、1475例ILC和943例PMBC的数据。中位随访时间为 6.6 年。PMBC的五年RFI、RFS和OS分别为96.1%、94.9%和98.1%。经多变量考克斯回归,PMBC的RFI(危险比[HR],0.59;95% CI,0.43-0.80)、RFS(HR,0.70;95% CI,0.56-0.89)和OS(HR,0.71;95% CI,0.53-0.96)均优于IDC。ILC的结果与IDC相当。PMBC中不到一半(48.7%)的复发是远处复发,这一比例低于IDC(67.3%)和ILC(80.6%)。与RFI相比,RFS事件更多是由老年患者的非乳腺癌死亡引起的。PMBC患者RFI的重要预后因素包括淋巴结阳性(HR,2.42;95% CI,1.08-5.40)、放疗(HR,0.44;95% CI,0.23-0.85)和内分泌治疗(HR,0.25;95% CI,0.09-0.70)。在按结节分期、肿瘤大小和年龄划分的PMBC亚组中,未发现化疗与预后之间存在差异。一项单独的SEER数据库分析也未发现在这些亚组中辅助化疗与生存率的提高有任何关联:结论:与IDC相比,PMBC的RFI、RFS和OS均优于IDC。淋巴结阴性、辅助放疗和内分泌治疗与较高的RFI相关。辅助化疗与更好的疗效无关。
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Journal of the National Comprehensive Cancer Network
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