Pub Date : 2025-02-01DOI: 10.1016/j.lanwpc.2024.101378
Ang Zheng , Junlin He , Muyao Li , Fan Yao , Feng Jin , Bo Chen , Xin Wang
<div><h3>Background</h3><div>HER2-low breast cancer represents a distinct biological subtype, and its clinical characteristics and prognostic outcomes require further exploration. This study aimed to investigate disparities in short- and long-term outcomes between HER2-0 and HER2-low breast cancer patients undergoing neoadjuvant chemotherapy (NAC) in a Chinese cohort.</div></div><div><h3>Methods</h3><div>This retrospective multicenter cohort study included 711 breast cancer patients diagnosed between 2016 and 2020 in four tertiary hospitals in China. Participants were categorised into HER2-0 and HER2-low subgroups based on immunohistochemical analysis. Logistic and Cox regression analyses, incorporating propensity score-based inverse probability of treatment weighting (IPTW), were used to evaluate treatment outcomes, including real-world overall survival (rwOS), breast pathological complete response (bpCR), and objective response rate (ORR) at 24 weeks.</div></div><div><h3>Findings</h3><div>Out of 303 patients included in the final analysis, 213 were classified as HER2-low and 90 as HER2-0. The majority were hormone receptor (HR)-positive, with varying TNM stages, Ki-67 expression levels, and menopausal status. Inclusion criteria were based on neoadjuvant chemotherapy treatment and immunohistochemistry results. The overall rwOS rate for all patients was 86.1% (HER2-low: 87.3% vs. HER2-0: 83.3%). Kaplan-Meier survival curves showed no significant difference in rwOS between the HER2-low and HER2-0 groups before or after applying the IPTW method (log-rank P = 0.17, IPTW-weighted log-rank P = 0.45). Multivariate Cox regression analysis confirmed no significant difference in rwOS between the groups (IPTW-adjusted hazard ratio [HR]: 1.60; 95% confidence interval [CI]: 0.78–3.31). For breast pathological complete response (bpCR), 45 patients (21.1%) in the HER2-low group achieved bpCR compared to 16 patients (17.8%) in the HER2-0 group (adjusted odds ratio [OR]: 1.26; 95% CI: 0.6–2.75). Similarly, no significant difference was observed in the odds of bpCR between the groups when adjusted using IPTW (OR: 1.08; 95% CI: 0.72–1.64). Objective response rates (ORR) at 24 weeks were also comparable, with 137 patients (57.4%) in the HER2-low group and 61 patients (67.8%) in the HER2-0 group achieving a response. The IPTW-adjusted OR for ORR was 1.1 (95% CI: 0.77–1.57). Subgroup analysis revealed that in HR-negative patients, the HER2-low group exhibited significantly better outcomes compared to the HER2-0 group, with an rwOS HR of 0.42 (95% CI: 0.23–0.77; P < 0.001) and bpCR odds of 2.6 (95% CI: 1.14–6.29; P = 0.027). Conversely, among HR-positive patients, HER2-0 patients had a better rwOS than HER2-low patients (P < 0.001).</div></div><div><h3>Interpretation</h3><div>HER2-low breast cancer should be considered a distinct subtype with differing outcomes based on hormone receptor (HR) status. HR-negative patients with HER2-low tumors showed better overall
{"title":"Clinical characteristics and prognostic implications in patients with HER2-low breast cancer undergoing neoadjuvant chemotherapy: a retrospective cohort study","authors":"Ang Zheng , Junlin He , Muyao Li , Fan Yao , Feng Jin , Bo Chen , Xin Wang","doi":"10.1016/j.lanwpc.2024.101378","DOIUrl":"10.1016/j.lanwpc.2024.101378","url":null,"abstract":"<div><h3>Background</h3><div>HER2-low breast cancer represents a distinct biological subtype, and its clinical characteristics and prognostic outcomes require further exploration. This study aimed to investigate disparities in short- and long-term outcomes between HER2-0 and HER2-low breast cancer patients undergoing neoadjuvant chemotherapy (NAC) in a Chinese cohort.</div></div><div><h3>Methods</h3><div>This retrospective multicenter cohort study included 711 breast cancer patients diagnosed between 2016 and 2020 in four tertiary hospitals in China. Participants were categorised into HER2-0 and HER2-low subgroups based on immunohistochemical analysis. Logistic and Cox regression analyses, incorporating propensity score-based inverse probability of treatment weighting (IPTW), were used to evaluate treatment outcomes, including real-world overall survival (rwOS), breast pathological complete response (bpCR), and objective response rate (ORR) at 24 weeks.</div></div><div><h3>Findings</h3><div>Out of 303 patients included in the final analysis, 213 were classified as HER2-low and 90 as HER2-0. The majority were hormone receptor (HR)-positive, with varying TNM stages, Ki-67 expression levels, and menopausal status. Inclusion criteria were based on neoadjuvant chemotherapy treatment and immunohistochemistry results. The overall rwOS rate for all patients was 86.1% (HER2-low: 87.3% vs. HER2-0: 83.3%). Kaplan-Meier survival curves showed no significant difference in rwOS between the HER2-low and HER2-0 groups before or after applying the IPTW method (log-rank P = 0.17, IPTW-weighted log-rank P = 0.45). Multivariate Cox regression analysis confirmed no significant difference in rwOS between the groups (IPTW-adjusted hazard ratio [HR]: 1.60; 95% confidence interval [CI]: 0.78–3.31). For breast pathological complete response (bpCR), 45 patients (21.1%) in the HER2-low group achieved bpCR compared to 16 patients (17.8%) in the HER2-0 group (adjusted odds ratio [OR]: 1.26; 95% CI: 0.6–2.75). Similarly, no significant difference was observed in the odds of bpCR between the groups when adjusted using IPTW (OR: 1.08; 95% CI: 0.72–1.64). Objective response rates (ORR) at 24 weeks were also comparable, with 137 patients (57.4%) in the HER2-low group and 61 patients (67.8%) in the HER2-0 group achieving a response. The IPTW-adjusted OR for ORR was 1.1 (95% CI: 0.77–1.57). Subgroup analysis revealed that in HR-negative patients, the HER2-low group exhibited significantly better outcomes compared to the HER2-0 group, with an rwOS HR of 0.42 (95% CI: 0.23–0.77; P < 0.001) and bpCR odds of 2.6 (95% CI: 1.14–6.29; P = 0.027). Conversely, among HR-positive patients, HER2-0 patients had a better rwOS than HER2-low patients (P < 0.001).</div></div><div><h3>Interpretation</h3><div>HER2-low breast cancer should be considered a distinct subtype with differing outcomes based on hormone receptor (HR) status. HR-negative patients with HER2-low tumors showed better overall","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101378"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Background</h3><div>Breast cancer constitutes the most common cancer among women and has been a major, life-threatening, public health concern. The knowledge, attitude and practice towards breast cancer and screening among women should be assessed in order to guide current breast cancer interventions, especially under the background that many cities in China are carrying out free breast cancer screening programs for urban and rural women.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was conducted from July 2023 to September 2024, in nearly 100 medical institutions in Xi’an, the largest city in northwestern China. All women asking for medical services related to breast diseases were invited to participate in the survey. Descriptive statistics, multiple linear regressions, and binary logistic regressions were performed.</div></div><div><h3>Findings</h3><div>Of 26,586 women aged 20-60 years, the average knowledge scores on risk factors, signs and symptoms, and prevention methods of breast cancer were 6.20 (S.D. 3.98, range 0-10), 4.65 (S.D. 2.89, range 0-7), and 6.58 (S.D. 3.40, range 0-9), respectively. The average score on the overall knowledge of breast cancer was 17.44 (S.D. 9.63, range 0-26). However, 17.1% (4,553)-21.8% (5,801) of women still had no knowledge of risk factors, signs and symptoms, and prevention methods of breast cancer. The average score of attitudes towards breast cancer screening was 4.11 (S.D. 1.13, range 1-5). 56.2% of women had received breast cancer screening services. After adjusting for potential confounding factors, having a higher knowledge score of breast cancer was significantly associated with a more positive attitude towards breast cancer screening among women (<em>b</em> 0.01, <em>t</em> 8.72), and women who had a higher knowledge score of breast cancer (OR 1.01, 95% CI 1.00-1.01) and had a more positive attitude towards breast cancer screening (OR 1.19, 95% CI 1.16-1.21) were more likely to receive breast cancer screening services. Meanwhile, women’s attitudes towards breast cancer screening played a partial mediating role in the association between their knowledge of breast cancer and having received breast cancer screening services. Besides, education and occupation are two significant influencing factors associated with the knowledge, attitude and practice towards breast cancer and screening among women.</div></div><div><h3>Interpretation</h3><div>The study revealed a lack of awareness and comprehensive knowledge about breast, as well as low self-risk perception and low uptake of breast cancer screening services among women in Xi’an. The scaling-up of breast cancer information and dissemination should be prioritized by the government, hence improving the uptake of breast cancer screening services.</div></div><div><h3>Funding</h3><div>National Natural Science Foundation of China (72204199); Research Project of Humanities and Social Sciences of the <span>Ministry of Education of China<
{"title":"Knowledge, attitude and practice towards breast cancer and screening among women in northwestern China: a cross-sectional study","authors":"Jinlin Liu , Xizhu Qian , Xiaohan Huang , Zhuqing Duan","doi":"10.1016/j.lanwpc.2024.101294","DOIUrl":"10.1016/j.lanwpc.2024.101294","url":null,"abstract":"<div><h3>Background</h3><div>Breast cancer constitutes the most common cancer among women and has been a major, life-threatening, public health concern. The knowledge, attitude and practice towards breast cancer and screening among women should be assessed in order to guide current breast cancer interventions, especially under the background that many cities in China are carrying out free breast cancer screening programs for urban and rural women.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was conducted from July 2023 to September 2024, in nearly 100 medical institutions in Xi’an, the largest city in northwestern China. All women asking for medical services related to breast diseases were invited to participate in the survey. Descriptive statistics, multiple linear regressions, and binary logistic regressions were performed.</div></div><div><h3>Findings</h3><div>Of 26,586 women aged 20-60 years, the average knowledge scores on risk factors, signs and symptoms, and prevention methods of breast cancer were 6.20 (S.D. 3.98, range 0-10), 4.65 (S.D. 2.89, range 0-7), and 6.58 (S.D. 3.40, range 0-9), respectively. The average score on the overall knowledge of breast cancer was 17.44 (S.D. 9.63, range 0-26). However, 17.1% (4,553)-21.8% (5,801) of women still had no knowledge of risk factors, signs and symptoms, and prevention methods of breast cancer. The average score of attitudes towards breast cancer screening was 4.11 (S.D. 1.13, range 1-5). 56.2% of women had received breast cancer screening services. After adjusting for potential confounding factors, having a higher knowledge score of breast cancer was significantly associated with a more positive attitude towards breast cancer screening among women (<em>b</em> 0.01, <em>t</em> 8.72), and women who had a higher knowledge score of breast cancer (OR 1.01, 95% CI 1.00-1.01) and had a more positive attitude towards breast cancer screening (OR 1.19, 95% CI 1.16-1.21) were more likely to receive breast cancer screening services. Meanwhile, women’s attitudes towards breast cancer screening played a partial mediating role in the association between their knowledge of breast cancer and having received breast cancer screening services. Besides, education and occupation are two significant influencing factors associated with the knowledge, attitude and practice towards breast cancer and screening among women.</div></div><div><h3>Interpretation</h3><div>The study revealed a lack of awareness and comprehensive knowledge about breast, as well as low self-risk perception and low uptake of breast cancer screening services among women in Xi’an. The scaling-up of breast cancer information and dissemination should be prioritized by the government, hence improving the uptake of breast cancer screening services.</div></div><div><h3>Funding</h3><div>National Natural Science Foundation of China (72204199); Research Project of Humanities and Social Sciences of the <span>Ministry of Education of China<","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101294"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Background</h3><div>Checkpoint Inhibitor Pneumonitis (CIP) poses a grave risk as a life-threatening complication defined by emerging lung infiltrates in cancer patients undergoing immune checkpoint inhibitor treatment. This study aims to investigate the value of bronchoalveolar lavage (BAL) combined with metagenomic next-generation sequencing (mNGS) in the diagnosis and precision treatment of CIP for providing evidence-based medicine.</div></div><div><h3>Methods</h3><div>This study enrolled a total of 93 patients with Checkpoint Inhibitor Pneumonitis (CIP) from a prospective clinical cohort (NCT06192303), including 35 cases of pure-type CIP (PT-CIP) and 58 cases of mixed-type CIP (MT-CIP). Logistic regression analysis was employed to identify independent risk factors for mixed-type CIP and to construct a corresponding nomogram predictive model for MT-CIP. A comprehensive microbiota atlas was further used to display the microbiota characteristics of patients with different types of CIP. Additionally, we assessed the value of BAL combined with mNGS in guiding CIP treatment by comparing the 7-day effectiveness of treatment, the intensity of antibiotic use during hospitalization, the total time to relief to grade I or below, and the proportion of resolution within three months.</div></div><div><h3>Findings</h3><div>Univariate and multivariate logistic regression analyses indicated that the history of COPD, dyspnea, CRP, and ALC are independent risk factors for mixed-type CIP. The area under the ROC curve (AUROC) of the MT-CIP prediction model, which was constructed based on clinical indicators and BAL mNGS results, reached 0.895 (95% CI: 0.805 – 0.985, Sensitivity: 0.871, Specificity: 0.9). BALF microbiota analysis suggested the potential of porphyromonas as a characteristic genus in mixed-type CIP, showing a significant negative correlation with Absolute Eosinophil Count (AEC) in the blood. The BAL mNGS group exhibited significantly higher efficacy rates at 7 days of treatment (90.2% vs 69.0%, P<0.05) and a markedly greater resolution rate within three months compared to the non BAL mNGS group (58.1% vs 32.3%, P<0.05). Moreover, BAL mNGS demonstrated valuable clinical guidance for antibiotic usage in severe cases of CIP.</div></div><div><h3>Interpretation</h3><div>BAL mNGS holds valuable clinical guidance significance for the precise diagnosis and treatment of CIP. Employing a strategy of risk stratification for MT-CIP through the integration of clinical indicators and BAL mNGS contributes to further optimizing the therapeutic management of CIP patients.</div></div><div><h3>Funding</h3><div>The study is jointly funded by the <span>National Natural Science Foundation of China</span> (NO.82272729 and NO.81870026), the <span>Natural Science Foundation of Guangdong Province</span> (NO.2022A1515010509 and NO.2023A1515010285), Clinical Research Startup Program of <span>Southern Medical University</span> by High-level University Construction
{"title":"Bronchoalveolar lavage combined with metagenomics next-generation sequencing enhances the diagnostic and therapeutic efficacy of immune checkpoint inhibitor pneumonia: result from a prospective cohort study","authors":"Zhenhua Zhou, Xintong Huang, Jiaxin Li, Jihong Huang, Lu Yuan, Wenxia Xie, Junyi Lu, Wenqi Huang, Shangwen He, Dong Yu, Hailin Zhang, Jian Guan, Laiyu Liu","doi":"10.1016/j.lanwpc.2024.101296","DOIUrl":"10.1016/j.lanwpc.2024.101296","url":null,"abstract":"<div><h3>Background</h3><div>Checkpoint Inhibitor Pneumonitis (CIP) poses a grave risk as a life-threatening complication defined by emerging lung infiltrates in cancer patients undergoing immune checkpoint inhibitor treatment. This study aims to investigate the value of bronchoalveolar lavage (BAL) combined with metagenomic next-generation sequencing (mNGS) in the diagnosis and precision treatment of CIP for providing evidence-based medicine.</div></div><div><h3>Methods</h3><div>This study enrolled a total of 93 patients with Checkpoint Inhibitor Pneumonitis (CIP) from a prospective clinical cohort (NCT06192303), including 35 cases of pure-type CIP (PT-CIP) and 58 cases of mixed-type CIP (MT-CIP). Logistic regression analysis was employed to identify independent risk factors for mixed-type CIP and to construct a corresponding nomogram predictive model for MT-CIP. A comprehensive microbiota atlas was further used to display the microbiota characteristics of patients with different types of CIP. Additionally, we assessed the value of BAL combined with mNGS in guiding CIP treatment by comparing the 7-day effectiveness of treatment, the intensity of antibiotic use during hospitalization, the total time to relief to grade I or below, and the proportion of resolution within three months.</div></div><div><h3>Findings</h3><div>Univariate and multivariate logistic regression analyses indicated that the history of COPD, dyspnea, CRP, and ALC are independent risk factors for mixed-type CIP. The area under the ROC curve (AUROC) of the MT-CIP prediction model, which was constructed based on clinical indicators and BAL mNGS results, reached 0.895 (95% CI: 0.805 – 0.985, Sensitivity: 0.871, Specificity: 0.9). BALF microbiota analysis suggested the potential of porphyromonas as a characteristic genus in mixed-type CIP, showing a significant negative correlation with Absolute Eosinophil Count (AEC) in the blood. The BAL mNGS group exhibited significantly higher efficacy rates at 7 days of treatment (90.2% vs 69.0%, P<0.05) and a markedly greater resolution rate within three months compared to the non BAL mNGS group (58.1% vs 32.3%, P<0.05). Moreover, BAL mNGS demonstrated valuable clinical guidance for antibiotic usage in severe cases of CIP.</div></div><div><h3>Interpretation</h3><div>BAL mNGS holds valuable clinical guidance significance for the precise diagnosis and treatment of CIP. Employing a strategy of risk stratification for MT-CIP through the integration of clinical indicators and BAL mNGS contributes to further optimizing the therapeutic management of CIP patients.</div></div><div><h3>Funding</h3><div>The study is jointly funded by the <span>National Natural Science Foundation of China</span> (NO.82272729 and NO.81870026), the <span>Natural Science Foundation of Guangdong Province</span> (NO.2022A1515010509 and NO.2023A1515010285), Clinical Research Startup Program of <span>Southern Medical University</span> by High-level University Construction","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101296"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.lanwpc.2024.101338
Fanshu Yan, Zhe Liu, Peng Yin
Background
Colorectal cancer was the fourth leading cause of cancer death in China in 2020, and mortality due to colorectal cancer increased in economically developed regions between 2005 and 2020. This study aimed to explore the temporal trends in loss of life expectancy due to colorectal cancer in China and all mainland provinces from 2005 to 2020.
Methods
The mortality data were obtained from the China National Mortality Surveillance System (NMSS), which covers a population of more than 300 million people in 31 provincial-level administrations with provincial-level representativeness. Under-reporting rate was used to adjust for death rates from all cause and colorectal cancer. The demographic data were obtained from the National Bureau of Statistic. We used the abbreviated life table method to calculate life expectancy. Loss of life expectancy due to colorectal cancer was calculated as the life expectancy after excluding colorectal cancer deaths in the whole population by gender and provinces. Underlying cause of death coded as colorectal cancer based on the International Classification of Diseases, 10th edition (ICD-10) was used (C18.0-C18.9). The study was approved by the Ethics Committee of The National Center for Chronic and Noncommunicable Disease Control and Prevention.
Findings
The loss of life expectancy due to colorectal cancer in China in 2020 was 0.15 years, slightly higher in men (0.154 years) than in women (0.147 years). Loss of life expectancy due to colorectal cancer is on an increasing trend between 2005 and 2020, for both genders, with a higher increase for men (0.03) than for women (0.02). The provinces with the highest loss of life expectancy due to colorectal cancer in 2020 were Beijing (0.30), Zhejiang (0.26), and Shanghai (0.26), and the lowest were Tibet (0.04), Hebei (0.09), and Henan (0.10). Among all 31 mainland provinces, 3 provinces (Hebei, Henan and Jiangxi) showed a decreasing trend for loss of life expectancy due to colorectal cancer. For the remaining provinces, Tianjin (96.97%), Fujian 80.28%), and Beijing (70.28%) had the highest increase in loss of life expectancy due to colorectal cancer during the study period.
Interpretation
The loss of life expectancy due to colorectal cancer is increasing during 2005-2020, indicating it remains a major public health problem in China, particularly in economically developed provinces. The strengths of this study are the use of loss of life expectancy as the indicator to measure the burden caused by colorectal cancer and its temporal trend based on nationwide data. The limitation of this study is that we were unable to analyze the associated factors for the variations between different provinces.
{"title":"Loss of life expectancy due to colorectal cancer at national and subnational level in China, 2005-2020: a retrospective population-based study from China national mortality surveillance system","authors":"Fanshu Yan, Zhe Liu, Peng Yin","doi":"10.1016/j.lanwpc.2024.101338","DOIUrl":"10.1016/j.lanwpc.2024.101338","url":null,"abstract":"<div><h3>Background</h3><div>Colorectal cancer was the fourth leading cause of cancer death in China in 2020, and mortality due to colorectal cancer increased in economically developed regions between 2005 and 2020. This study aimed to explore the temporal trends in loss of life expectancy due to colorectal cancer in China and all mainland provinces from 2005 to 2020.</div></div><div><h3>Methods</h3><div>The mortality data were obtained from the China National Mortality Surveillance System (NMSS), which covers a population of more than 300 million people in 31 provincial-level administrations with provincial-level representativeness. Under-reporting rate was used to adjust for death rates from all cause and colorectal cancer. The demographic data were obtained from the National Bureau of Statistic. We used the abbreviated life table method to calculate life expectancy. Loss of life expectancy due to colorectal cancer was calculated as the life expectancy after excluding colorectal cancer deaths in the whole population by gender and provinces. Underlying cause of death coded as colorectal cancer based on the International Classification of Diseases, 10th edition (ICD-10) was used (C18.0-C18.9). The study was approved by the Ethics Committee of The National Center for Chronic and Noncommunicable Disease Control and Prevention.</div></div><div><h3>Findings</h3><div>The loss of life expectancy due to colorectal cancer in China in 2020 was 0.15 years, slightly higher in men (0.154 years) than in women (0.147 years). Loss of life expectancy due to colorectal cancer is on an increasing trend between 2005 and 2020, for both genders, with a higher increase for men (0.03) than for women (0.02). The provinces with the highest loss of life expectancy due to colorectal cancer in 2020 were Beijing (0.30), Zhejiang (0.26), and Shanghai (0.26), and the lowest were Tibet (0.04), Hebei (0.09), and Henan (0.10). Among all 31 mainland provinces, 3 provinces (Hebei, Henan and Jiangxi) showed a decreasing trend for loss of life expectancy due to colorectal cancer. For the remaining provinces, Tianjin (96.97%), Fujian 80.28%), and Beijing (70.28%) had the highest increase in loss of life expectancy due to colorectal cancer during the study period.</div></div><div><h3>Interpretation</h3><div>The loss of life expectancy due to colorectal cancer is increasing during 2005-2020, indicating it remains a major public health problem in China, particularly in economically developed provinces. The strengths of this study are the use of loss of life expectancy as the indicator to measure the burden caused by colorectal cancer and its temporal trend based on nationwide data. The limitation of this study is that we were unable to analyze the associated factors for the variations between different provinces.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101338"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.lanwpc.2024.101302
Victor Ho-Fun Lee , Tiffany Cho-Lam Wong , Varut Vardhanabhuti , Ka-On Lam , Horace Cheuk-Wai Choi , Keith Wan-Hang Chiu , Patty Pui-Ying Ho , Dennis Kwok-Chuen Leung , Matthew Ho-Man Szeto , Kwok-Fung Choi , See-Ching Chan , To-Wai Leung , Pek-Lan Khong , Chung-Mau Lo
<div><h3>Background</h3><div>Stereotactic body radiation therapy (SBRT) is effective for hepatocellular carcinoma (HCC). Its role as a bridging therapy before deceased-donor liver transplantation (DDLT) remains unclear.</div></div><div><h3>Methods</h3><div>Our institution conducted a prospective study on SBRT before DDLT for 32 HCC patients within University of California, San Francisco (UCSF) criteria as the first cohort, staged with gadoxetate disodium-enhanced MRI and 11C-acetate (ACC) and 18F-fluorodeoxyglucose (FDG) (dual-tracer) positron-emission tomography with computed tomography (PET-CT), followed by SBRT of 35–50 Gy in 5 fractions. They were followed up with the same imaging modalities afterwards while awaiting DDLT. The results were published in June 2024. In view of the encouraging treatment outcomes, SBRT before DDLT has become a routine clinical practice in our institution and the study has been carried on without dual-tracer PET-CT imaging for all subsequent patients recruited prospectively for another 39 patients following revised sample size estimation. Co-primary end points were progression-free survival (PFS) and objective response rates (ORRs) by RECIST 1.1 and mRECIST. Secondary end points were overall survival (OS), safety, and others. The trial is registered with <span><span>clinicaltrials.gov</span><svg><path></path></svg></span>, <span><span>NCT04186234</span><svg><path></path></svg></span>.</div></div><div><h3>Findings</h3><div>Between July 1, 2015 until October 31, 2023, 71 patients with 118 HCC lesions were recruited with a median follow-up duration of 62.9 months (IQR 36.5–95.0). The median dose of SBRT was 45Gy (IQR 37.5–50). Both the median PFS and OS were not reached. The 5-year PFS and OS were 57.2% (95% CI 44.3%–70.1%) and 62.3% (95% CI 49.8%–74.8%), respectively. In terms of number of patients, ORRs were in 73.2% (53 patients) by RECIST 1.1 and 77.5% (55 patients) by mRECIST. In terms of number of lesions, ORRs were 78.0% (92 lesions) by RECIST 1.1 and 82.2% (97 lesions) by mRECIST. Thirty-four patients (47.9%) with 54 lesions (45.8%) received DDLT, of whom 14 patients (41.1%) with 31 lesions (57.4%) exhibited pathologic complete response. Univariable analyses revealed ≤2 lesions (vs 3) (p=0.046), partial response (PR) by either RECIST 1.1 or mRECIST after SBRT (p=0.001), and DDLT (p=0.001) were prognostic of PFS, while tumours within Milan’s criteria (p=0.004), PR after SBRT (p=0.013) and DDLT (p<0.001) were prognostic of OS. Multivariable analyses revealed that PR after SBRT (HR 0.26, 95% CI 0.11–0.55; p=0.002) and DDLT (HR 0.27, 95% CI 0.12–0.64; p=0.001) was prognostic of PFS, while tumours within Milan’s criteria (HR 0.33, 95% 0.17–0.71; p=0.011), PR after SBRT (HR 0.35, 95% CI 0.17–0.80; p=0.011), and DDLT (HR 0.15, 95% CI 0.06–0.41; p<0.001) were prognostic of OS. One patient developed grade 3 peptic ulcer treated with distal gastrectomy during DDLT and one patient had grade 3 ascites after SBRT res
{"title":"Prospective study on stereotactic body radiation therapy before liver transplantation for hepatocellular carcinoma","authors":"Victor Ho-Fun Lee , Tiffany Cho-Lam Wong , Varut Vardhanabhuti , Ka-On Lam , Horace Cheuk-Wai Choi , Keith Wan-Hang Chiu , Patty Pui-Ying Ho , Dennis Kwok-Chuen Leung , Matthew Ho-Man Szeto , Kwok-Fung Choi , See-Ching Chan , To-Wai Leung , Pek-Lan Khong , Chung-Mau Lo","doi":"10.1016/j.lanwpc.2024.101302","DOIUrl":"10.1016/j.lanwpc.2024.101302","url":null,"abstract":"<div><h3>Background</h3><div>Stereotactic body radiation therapy (SBRT) is effective for hepatocellular carcinoma (HCC). Its role as a bridging therapy before deceased-donor liver transplantation (DDLT) remains unclear.</div></div><div><h3>Methods</h3><div>Our institution conducted a prospective study on SBRT before DDLT for 32 HCC patients within University of California, San Francisco (UCSF) criteria as the first cohort, staged with gadoxetate disodium-enhanced MRI and 11C-acetate (ACC) and 18F-fluorodeoxyglucose (FDG) (dual-tracer) positron-emission tomography with computed tomography (PET-CT), followed by SBRT of 35–50 Gy in 5 fractions. They were followed up with the same imaging modalities afterwards while awaiting DDLT. The results were published in June 2024. In view of the encouraging treatment outcomes, SBRT before DDLT has become a routine clinical practice in our institution and the study has been carried on without dual-tracer PET-CT imaging for all subsequent patients recruited prospectively for another 39 patients following revised sample size estimation. Co-primary end points were progression-free survival (PFS) and objective response rates (ORRs) by RECIST 1.1 and mRECIST. Secondary end points were overall survival (OS), safety, and others. The trial is registered with <span><span>clinicaltrials.gov</span><svg><path></path></svg></span>, <span><span>NCT04186234</span><svg><path></path></svg></span>.</div></div><div><h3>Findings</h3><div>Between July 1, 2015 until October 31, 2023, 71 patients with 118 HCC lesions were recruited with a median follow-up duration of 62.9 months (IQR 36.5–95.0). The median dose of SBRT was 45Gy (IQR 37.5–50). Both the median PFS and OS were not reached. The 5-year PFS and OS were 57.2% (95% CI 44.3%–70.1%) and 62.3% (95% CI 49.8%–74.8%), respectively. In terms of number of patients, ORRs were in 73.2% (53 patients) by RECIST 1.1 and 77.5% (55 patients) by mRECIST. In terms of number of lesions, ORRs were 78.0% (92 lesions) by RECIST 1.1 and 82.2% (97 lesions) by mRECIST. Thirty-four patients (47.9%) with 54 lesions (45.8%) received DDLT, of whom 14 patients (41.1%) with 31 lesions (57.4%) exhibited pathologic complete response. Univariable analyses revealed ≤2 lesions (vs 3) (p=0.046), partial response (PR) by either RECIST 1.1 or mRECIST after SBRT (p=0.001), and DDLT (p=0.001) were prognostic of PFS, while tumours within Milan’s criteria (p=0.004), PR after SBRT (p=0.013) and DDLT (p<0.001) were prognostic of OS. Multivariable analyses revealed that PR after SBRT (HR 0.26, 95% CI 0.11–0.55; p=0.002) and DDLT (HR 0.27, 95% CI 0.12–0.64; p=0.001) was prognostic of PFS, while tumours within Milan’s criteria (HR 0.33, 95% 0.17–0.71; p=0.011), PR after SBRT (HR 0.35, 95% CI 0.17–0.80; p=0.011), and DDLT (HR 0.15, 95% CI 0.06–0.41; p<0.001) were prognostic of OS. One patient developed grade 3 peptic ulcer treated with distal gastrectomy during DDLT and one patient had grade 3 ascites after SBRT res","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101302"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.lanwpc.2024.101327
Jiashu Han , Zhijia Xia , Mingyang Xue , Liming Pan , Fang Yang , Yanfang Ye , Jun Cao , Zhicheng Xue , Ran Wei , Cuiping Liang , Ling Yin , Yuanyuan Wan , Xiaoqing Lin , Yue Hu , Fengtao Liu , Jingsi Mei , Xiujuan Gui , Xiangyu Zhai , Yiming Xiong , Peishan Ning , Wenyi Jin
<div><h3>Background</h3><div>Liver cancer (LC) is a major global health issue, with China accounting for nearly half of global cases. Key contributors include chronic hepatitis B virus (HBV) infection, aflatoxin exposure, and modifiable lifestyle risk factors. With significant global implications, China's high LC incidence and mortality underscore the need for focused research.</div></div><div><h3>Methods</h3><div>This study analyses age- and sex-specific LC trends and risk factors across China's 34 provincial-level administrative regions using GBD 2021 data. LC metrics examined include incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost(YLLs). We also examined the relationship between these metrics and gross-domestic-product-per-capita (GDPPC). An attentive deep-learning pipeline was developed to provide long-term scenario forecasts with scenarios simulation.</div></div><div><h3>Findings</h3><div>Between 1990 and 2021, LC incidence and prevalence in China escalated (except in Fujian, Shanghai, and Zhejiang), reaching 196,637 new cases and 265,539 total cases in 2021, predominantly affecting individuals aged 45+ years. In 2021, LC attributed to HBV recorded the highest age-standardised incidence rate (ASIR), whereas increases in ASIR were most pronounced for cases due to alcohol use and non-alcoholic steatohepatitis (NASH) from 1990-to-2021. The national age-standardised death rate (ASDR) declined from 10.8 to 8.4 per 100,000 from 1990 to 2021. Notably, hepatoblastoma showed the most significant drop in ASDR, plummeting by 79.7%, with subsequent declines in LC due to HBV, HCV, and alcohol use. Conversely, LC due to NASH saw a marginal increase of 0.8%. Trends in age-standardised DALYs, YLDs, and YLLs moderately mirrored those of the ASDR. Men, particularly those over 20 years old, faced higher LC burdens across all provincial regions compared to women. Provincially, the lowest LC burdens were observed in high-GDPPC regions, such as Beijing and Shanghai. In 2021, smoking emerged as the leading risk factor for LC-related mortality and disability in men, especially in HBV-associated cases. Men under 20 years displayed distinct patterns, with high alcohol use being the predominant fatal risk factor. For women, inappropriate drug use was the foremost risk factor for LC-related mortality and disability, especially in HCV-related cases. Without targeted interventions, forecasts from 2021 to 2040 predict declines in age-standardized LC rates: incidence by 9.5%, mortality by 4.7%, DALYs by 6.5%, YLLs by 4.3%, and YLDs by 13%. However, the incidence of LC due to alcohol use is expected to significantly increase among those under 20 years old in all provinces except Tibet, indicating a worrying trend towards younger onset. Targeted interventions, including tobacco control, appropriate medication use, alcohol use restriction, and regular physical activity, are projected to signi
{"title":"Age-sex-specific burden of liver cancer attributable to risk factors in China and its provincial regions, 1990–2021, and forecasts with scenarios simulation: a systematic analysis for the Global Burden of Disease Study 2021","authors":"Jiashu Han , Zhijia Xia , Mingyang Xue , Liming Pan , Fang Yang , Yanfang Ye , Jun Cao , Zhicheng Xue , Ran Wei , Cuiping Liang , Ling Yin , Yuanyuan Wan , Xiaoqing Lin , Yue Hu , Fengtao Liu , Jingsi Mei , Xiujuan Gui , Xiangyu Zhai , Yiming Xiong , Peishan Ning , Wenyi Jin","doi":"10.1016/j.lanwpc.2024.101327","DOIUrl":"10.1016/j.lanwpc.2024.101327","url":null,"abstract":"<div><h3>Background</h3><div>Liver cancer (LC) is a major global health issue, with China accounting for nearly half of global cases. Key contributors include chronic hepatitis B virus (HBV) infection, aflatoxin exposure, and modifiable lifestyle risk factors. With significant global implications, China's high LC incidence and mortality underscore the need for focused research.</div></div><div><h3>Methods</h3><div>This study analyses age- and sex-specific LC trends and risk factors across China's 34 provincial-level administrative regions using GBD 2021 data. LC metrics examined include incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost(YLLs). We also examined the relationship between these metrics and gross-domestic-product-per-capita (GDPPC). An attentive deep-learning pipeline was developed to provide long-term scenario forecasts with scenarios simulation.</div></div><div><h3>Findings</h3><div>Between 1990 and 2021, LC incidence and prevalence in China escalated (except in Fujian, Shanghai, and Zhejiang), reaching 196,637 new cases and 265,539 total cases in 2021, predominantly affecting individuals aged 45+ years. In 2021, LC attributed to HBV recorded the highest age-standardised incidence rate (ASIR), whereas increases in ASIR were most pronounced for cases due to alcohol use and non-alcoholic steatohepatitis (NASH) from 1990-to-2021. The national age-standardised death rate (ASDR) declined from 10.8 to 8.4 per 100,000 from 1990 to 2021. Notably, hepatoblastoma showed the most significant drop in ASDR, plummeting by 79.7%, with subsequent declines in LC due to HBV, HCV, and alcohol use. Conversely, LC due to NASH saw a marginal increase of 0.8%. Trends in age-standardised DALYs, YLDs, and YLLs moderately mirrored those of the ASDR. Men, particularly those over 20 years old, faced higher LC burdens across all provincial regions compared to women. Provincially, the lowest LC burdens were observed in high-GDPPC regions, such as Beijing and Shanghai. In 2021, smoking emerged as the leading risk factor for LC-related mortality and disability in men, especially in HBV-associated cases. Men under 20 years displayed distinct patterns, with high alcohol use being the predominant fatal risk factor. For women, inappropriate drug use was the foremost risk factor for LC-related mortality and disability, especially in HCV-related cases. Without targeted interventions, forecasts from 2021 to 2040 predict declines in age-standardized LC rates: incidence by 9.5%, mortality by 4.7%, DALYs by 6.5%, YLLs by 4.3%, and YLDs by 13%. However, the incidence of LC due to alcohol use is expected to significantly increase among those under 20 years old in all provinces except Tibet, indicating a worrying trend towards younger onset. Targeted interventions, including tobacco control, appropriate medication use, alcohol use restriction, and regular physical activity, are projected to signi","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101327"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.lanwpc.2024.101322
Juan Zhu , Yida Huang , Bin Liu , Xue Li , Li Yuan , Le Wang , Kun Qian , Yingying Mao , Lingbin Du , Xiangdong Cheng
<div><h3>Background</h3><div>Gastric cancer (GC) is the fifth most prevalent and the fifth deadliest cancer worldwide, and timely diagnosis of GC contributes to an increased survival rate. However, current detection methods for GC mainly rely on gastroscopy examination, limited by relatively low compliance. We attempted to identify plasma metabolite biomarkers and develop a diagnostic model for GC.</div></div><div><h3>Methods</h3><div>A total of 597 subjects, including healthy controls and GC patients were recruited from multiple centers in China. Ultra-performance liquid chromatography–mass spectrometry–based metabolomics methods were used to characterize the subjects’ plasma metabolic profiles and to screen and validate the GC biomarkers. Five machine learning algorithms (neural network, support vector machine, ridge regression, lasso regression and Naïve Bayes) were used to build a diagnostic model. We compared the performance of the metabolic panel with risk factors and clinical protein biomarkers (CA724, CA199, CA242, CA125, CEA and AFP), involving sensitivity, specificity, accuracy, AUC and clinical net benefit.</div></div><div><h3>Findings</h3><div>A plasma metabolite biomarker panel consisting of 6 metabolites was constructed and identified for GC diagnosis. Among the five machine learning algorithms, the neural network algorithm demonstrated the best diagnostic performance, achieving AUC of 0.982 (95% CI: 0.965–0.998) and 0.951 (95% CI: 0.931–0.970) in the discovery and validation dataset, respectively. The panel's sensitivity, specificity, and accuracy (95% CI) were 0.940 (0.825–0.984), 0.936 (0.861–0.974), and 0.938 (0.881–0.969) in the discovery set, and 0.925 (0.881–0.954), 0.867 (0.814–0.907), and 0.896 (0.864–0.922) in the validation set, respectively. The panel also exhibited superior diagnostic performance in detecting early-stage GC, with the ridge regression algorithm achieving the best performance (AUC: 0.982, 95% CI: 0.965–0.998 and 0.951, 0.931–0.970 in the discovery and validation dataset). This panel significantly outperforms clinical protein biomarkers in sensitivity. For instance, CA724, the most sensitive clinical biomarker for GC, showed sensitivities of only 0.240 (95% CI: 0.131–0.382) in the discovery dataset and 0.148 (95% CI: 0.103–0.203) in the validation dataset.</div></div><div><h3>Interpretation</h3><div>The discovered and validated serum metabolite biomarker panel exhibits good diagnostic performance for the early detection of GC, highlighting the potential in clinical practice for GC diagnosis and offering insights into the metabolic characterization of diseases including but not limited to GC.</div></div><div><h3>Funding</h3><div>This study was supported by grants from the <span>Medical and Health Research Project of Zhejiang Province</span> (2024KY050), <span>Zhejiang Cancer Hospital's National Natural Science Foundation</span> Cultivation Fund (PY2022042) and <span>Zhejiang Cancer Hospital Youth Research F
{"title":"Plasma metabolite biomarker identification study for the early detection of gastric cancer","authors":"Juan Zhu , Yida Huang , Bin Liu , Xue Li , Li Yuan , Le Wang , Kun Qian , Yingying Mao , Lingbin Du , Xiangdong Cheng","doi":"10.1016/j.lanwpc.2024.101322","DOIUrl":"10.1016/j.lanwpc.2024.101322","url":null,"abstract":"<div><h3>Background</h3><div>Gastric cancer (GC) is the fifth most prevalent and the fifth deadliest cancer worldwide, and timely diagnosis of GC contributes to an increased survival rate. However, current detection methods for GC mainly rely on gastroscopy examination, limited by relatively low compliance. We attempted to identify plasma metabolite biomarkers and develop a diagnostic model for GC.</div></div><div><h3>Methods</h3><div>A total of 597 subjects, including healthy controls and GC patients were recruited from multiple centers in China. Ultra-performance liquid chromatography–mass spectrometry–based metabolomics methods were used to characterize the subjects’ plasma metabolic profiles and to screen and validate the GC biomarkers. Five machine learning algorithms (neural network, support vector machine, ridge regression, lasso regression and Naïve Bayes) were used to build a diagnostic model. We compared the performance of the metabolic panel with risk factors and clinical protein biomarkers (CA724, CA199, CA242, CA125, CEA and AFP), involving sensitivity, specificity, accuracy, AUC and clinical net benefit.</div></div><div><h3>Findings</h3><div>A plasma metabolite biomarker panel consisting of 6 metabolites was constructed and identified for GC diagnosis. Among the five machine learning algorithms, the neural network algorithm demonstrated the best diagnostic performance, achieving AUC of 0.982 (95% CI: 0.965–0.998) and 0.951 (95% CI: 0.931–0.970) in the discovery and validation dataset, respectively. The panel's sensitivity, specificity, and accuracy (95% CI) were 0.940 (0.825–0.984), 0.936 (0.861–0.974), and 0.938 (0.881–0.969) in the discovery set, and 0.925 (0.881–0.954), 0.867 (0.814–0.907), and 0.896 (0.864–0.922) in the validation set, respectively. The panel also exhibited superior diagnostic performance in detecting early-stage GC, with the ridge regression algorithm achieving the best performance (AUC: 0.982, 95% CI: 0.965–0.998 and 0.951, 0.931–0.970 in the discovery and validation dataset). This panel significantly outperforms clinical protein biomarkers in sensitivity. For instance, CA724, the most sensitive clinical biomarker for GC, showed sensitivities of only 0.240 (95% CI: 0.131–0.382) in the discovery dataset and 0.148 (95% CI: 0.103–0.203) in the validation dataset.</div></div><div><h3>Interpretation</h3><div>The discovered and validated serum metabolite biomarker panel exhibits good diagnostic performance for the early detection of GC, highlighting the potential in clinical practice for GC diagnosis and offering insights into the metabolic characterization of diseases including but not limited to GC.</div></div><div><h3>Funding</h3><div>This study was supported by grants from the <span>Medical and Health Research Project of Zhejiang Province</span> (2024KY050), <span>Zhejiang Cancer Hospital's National Natural Science Foundation</span> Cultivation Fund (PY2022042) and <span>Zhejiang Cancer Hospital Youth Research F","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101322"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.lanwpc.2024.101371
Hongcheng Zhu , Veronica Di Carlo , Fatima Baloch , Claudia Allemani , Michel Coleman
<div><h3>Background</h3><div>In 2015, the CONCORD programme initiated global surveillance of trends in population-based cancer survival as an indicator of health system performance and to support the formulation of global cancer control policies. In 2018, the third cycle of the programme, CONCORD-3, extended the worldwide monitoring of cancer survival trends to include data up to 2014. CONCORD-3 analysed survival data for over 37 million adults (15-99 years) who were diagnosed with one of 18 common cancers between 2000 and 2014, including 6.1 million individuals diagnosed with lung cancer. Anonymised individual patient records were contributed by 290 population-based cancer registries in 61 countries, including 21 in China.</div></div><div><h3>Methods</h3><div>Tumours were classified into three major groups based on ICD-O-3 morphology codes: small-cell lung cancer (SCLC), non-small cell lung cancer (NSCLC) (comprising adenocarcinoma, large cell carcinoma, and squamous cell carcinoma), and lung cancer not otherwise specified (NOS). Trends in 5-year net survival in each morphology group were estimated for patients diagnosed during 2000-2004, 2005-2009 and 2010-2014, using the non-parametric Pohar Perme estimator. Background mortality was adjusted using life tables of all-cause mortality rates by single year of age, sex, single calendar year and, where available, race/ethnicity, for each country or region. All-ages survival estimates were standardised using the International Cancer Survival Standard weights. Survival trends have also been compared between China, the Western Pacific region and other countries.</div></div><div><h3>Findings</h3><div>The proportion of non-small cell lung cancers ranged from 36% in China to over 80% in Guadeloupe, Martinique and Taiwan. Small-cell lung cancers accounted for 13% overall, with an international range from 3% to 17%. Almost one-fifth (19%) of lung cancers tumours were assigned a non-specific morphology (NOS), with the proportion varying from 8% in Belgium to over 50% in China, India, and Thailand. For patients diagnosed during 2010-2014, age-standardised 5-year net survival for NSCLC was below 10% in Bulgaria, Chile and Guadeloupe, but reached 39% in Japan. Age-standardized 5-year net survival for SCLC was consistently below 15% in all countries. Between 2000-2004 and 2010-2014, 5-year survival changed very little in each morphology group and in most countries. However, 5-year survival for NSCLC improved by 10% or more in Korea (from 16% in 2000–2004 to 29% in 2010–2014) and Taiwan (from 13% to 23%).</div></div><div><h3>Interpretation</h3><div>These findings provide a global overview of lung cancer survival trends by morphology, derived from population-based cancer registries. They can inform public health strategies aimed at reducing disparities in outcomes. Lung cancer survival varies widely between China and other Western-Pacific countries. Accurate pathological classification is critical for improved ana
{"title":"Lung cancer survival in China and world-wide: results from CONCORD-3","authors":"Hongcheng Zhu , Veronica Di Carlo , Fatima Baloch , Claudia Allemani , Michel Coleman","doi":"10.1016/j.lanwpc.2024.101371","DOIUrl":"10.1016/j.lanwpc.2024.101371","url":null,"abstract":"<div><h3>Background</h3><div>In 2015, the CONCORD programme initiated global surveillance of trends in population-based cancer survival as an indicator of health system performance and to support the formulation of global cancer control policies. In 2018, the third cycle of the programme, CONCORD-3, extended the worldwide monitoring of cancer survival trends to include data up to 2014. CONCORD-3 analysed survival data for over 37 million adults (15-99 years) who were diagnosed with one of 18 common cancers between 2000 and 2014, including 6.1 million individuals diagnosed with lung cancer. Anonymised individual patient records were contributed by 290 population-based cancer registries in 61 countries, including 21 in China.</div></div><div><h3>Methods</h3><div>Tumours were classified into three major groups based on ICD-O-3 morphology codes: small-cell lung cancer (SCLC), non-small cell lung cancer (NSCLC) (comprising adenocarcinoma, large cell carcinoma, and squamous cell carcinoma), and lung cancer not otherwise specified (NOS). Trends in 5-year net survival in each morphology group were estimated for patients diagnosed during 2000-2004, 2005-2009 and 2010-2014, using the non-parametric Pohar Perme estimator. Background mortality was adjusted using life tables of all-cause mortality rates by single year of age, sex, single calendar year and, where available, race/ethnicity, for each country or region. All-ages survival estimates were standardised using the International Cancer Survival Standard weights. Survival trends have also been compared between China, the Western Pacific region and other countries.</div></div><div><h3>Findings</h3><div>The proportion of non-small cell lung cancers ranged from 36% in China to over 80% in Guadeloupe, Martinique and Taiwan. Small-cell lung cancers accounted for 13% overall, with an international range from 3% to 17%. Almost one-fifth (19%) of lung cancers tumours were assigned a non-specific morphology (NOS), with the proportion varying from 8% in Belgium to over 50% in China, India, and Thailand. For patients diagnosed during 2010-2014, age-standardised 5-year net survival for NSCLC was below 10% in Bulgaria, Chile and Guadeloupe, but reached 39% in Japan. Age-standardized 5-year net survival for SCLC was consistently below 15% in all countries. Between 2000-2004 and 2010-2014, 5-year survival changed very little in each morphology group and in most countries. However, 5-year survival for NSCLC improved by 10% or more in Korea (from 16% in 2000–2004 to 29% in 2010–2014) and Taiwan (from 13% to 23%).</div></div><div><h3>Interpretation</h3><div>These findings provide a global overview of lung cancer survival trends by morphology, derived from population-based cancer registries. They can inform public health strategies aimed at reducing disparities in outcomes. Lung cancer survival varies widely between China and other Western-Pacific countries. Accurate pathological classification is critical for improved ana","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101371"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.lanwpc.2025.101464
Yuji Hiromatsu , Eri Ishikawa , Ai Kozaki , Yasuhiro Takahashi , Mika Tanabe , Ken Hayashi , Yukihiro Imagawa , Kazutoyo Kaneda , Masashi Mimura , Xiaoxian Dai , Tomoko Hayashida , Takashi Akamizu
Background
Teprotumumab significantly improved proptosis and diplopia in patients with active, moderate-to-severe thyroid eye disease (TED) in previous North American and European studies. This is the first evaluation of efficacy and safety of teprotumumab for active, moderate-to-severe TED in Japanese patients.
Methods
This randomised, double-masked, placebo-controlled trial was conducted in 16 centres in Japan. Main inclusion criteria were as follows: age 20–80 years; Graves’ disease, in a euthyroid or mild hypo/hyperthyroid state; clinical activity score (CAS) ≥3; moderate-to-severe TED; ≥3-mm increase in proptosis before TED onset and/or proptosis ≥18 mm at baseline; and TED duration ≤9 months. Patients were randomised (1:1, stratified by smoking status) to either teprotumumab or placebo. Patients received eight intravenous infusions, one every three weeks for 24 weeks. Patients, investigators, site personnel (except formulating pharmacists) were masked. Primary endpoint was proptosis responder rate (percentage of patients with ≥2-mm proptosis reduction from baseline) at week 24 in the intent-to-treat population. Adverse events were assessed in all patients. This trial was registered at Japan Registry for Clinical Trials (jRCT2031210453).
Findings
Fifty-four patients were randomised (teprotumumab, 27; placebo, 27) between February and November 2022. All patients completed the randomised period, although one teprotumumab patient and two placebo patients missed ≥2 doses. At week 24, the proportion of patients with proptosis response was higher in the teprotumumab group (89%, 24/27) compared with the placebo group (11%, 3/27), 95% confidence interval, 61–95; P<0.0001. Study drug-related adverse events (AEs) occurred in 14 patients (52%) in the teprotumumab group and two patients (7%) in the placebo group; hyperglycaemia-related events were reported in six (22%) and one patient (4%), and hearing impairment in four (15%) and one (4%) patient, respectively. Study drug-related serious AEs and deaths were not reported.
Interpretation
Teprotumumab significantly improved proptosis compared with placebo in Japanese patients with active TED. No study drug-related serious AEs were observed.
Funding
Horizon Therapeutics plc (now Amgen).
{"title":"A randomised, double-masked, placebo-controlled trial evaluating the efficacy and safety of teprotumumab for active thyroid eye disease in Japanese patients","authors":"Yuji Hiromatsu , Eri Ishikawa , Ai Kozaki , Yasuhiro Takahashi , Mika Tanabe , Ken Hayashi , Yukihiro Imagawa , Kazutoyo Kaneda , Masashi Mimura , Xiaoxian Dai , Tomoko Hayashida , Takashi Akamizu","doi":"10.1016/j.lanwpc.2025.101464","DOIUrl":"10.1016/j.lanwpc.2025.101464","url":null,"abstract":"<div><h3>Background</h3><div>Teprotumumab significantly improved proptosis and diplopia in patients with active, moderate-to-severe thyroid eye disease (TED) in previous North American and European studies. This is the first evaluation of efficacy and safety of teprotumumab for active, moderate-to-severe TED in Japanese patients.</div></div><div><h3>Methods</h3><div>This randomised, double-masked, placebo-controlled trial was conducted in 16 centres in Japan. Main inclusion criteria were as follows: age 20–80 years; Graves’ disease, in a euthyroid or mild hypo/hyperthyroid state; clinical activity score (CAS) ≥3; moderate-to-severe TED; ≥3-mm increase in proptosis before TED onset and/or proptosis ≥18 mm at baseline; and TED duration ≤9 months. Patients were randomised (1:1, stratified by smoking status) to either teprotumumab or placebo. Patients received eight intravenous infusions, one every three weeks for 24 weeks. Patients, investigators, site personnel (except formulating pharmacists) were masked. Primary endpoint was proptosis responder rate (percentage of patients with ≥2-mm proptosis reduction from baseline) at week 24 in the intent-to-treat population. Adverse events were assessed in all patients. This trial was registered at Japan Registry for Clinical Trials (jRCT2031210453).</div></div><div><h3>Findings</h3><div>Fifty-four patients were randomised (teprotumumab, 27; placebo, 27) between February and November 2022. All patients completed the randomised period, although one teprotumumab patient and two placebo patients missed ≥2 doses. At week 24, the proportion of patients with proptosis response was higher in the teprotumumab group (89%, 24/27) compared with the placebo group (11%, 3/27), 95% confidence interval, 61–95; P<0.0001. Study drug-related adverse events (AEs) occurred in 14 patients (52%) in the teprotumumab group and two patients (7%) in the placebo group; hyperglycaemia-related events were reported in six (22%) and one patient (4%), and hearing impairment in four (15%) and one (4%) patient, respectively. Study drug-related serious AEs and deaths were not reported.</div></div><div><h3>Interpretation</h3><div>Teprotumumab significantly improved proptosis compared with placebo in Japanese patients with active TED. No study drug-related serious AEs were observed.</div></div><div><h3>Funding</h3><div><span>Horizon Therapeutics plc</span> (now Amgen).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101464"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.lanwpc.2025.101478
Ruoling Chen
{"title":"Adverse childhood experiences, their co-occurrence profiles, and mental disorders in adults in China","authors":"Ruoling Chen","doi":"10.1016/j.lanwpc.2025.101478","DOIUrl":"10.1016/j.lanwpc.2025.101478","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101478"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143178034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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