Pub Date : 2024-11-21DOI: 10.1016/s0140-6736(24)01967-6
Cristian Udovicich, Andrew Loblaw
No Abstract
无摘要
{"title":"Prostate radiotherapy in the era of intensified systemic treatment of metastatic prostate cancer","authors":"Cristian Udovicich, Andrew Loblaw","doi":"10.1016/s0140-6736(24)01967-6","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)01967-6","url":null,"abstract":"No Abstract","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-21DOI: 10.1016/s0140-6736(24)02136-6
Steven H Woolf
No Abstract
无摘要
{"title":"Understanding disparities in life expectancy","authors":"Steven H Woolf","doi":"10.1016/s0140-6736(24)02136-6","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)02136-6","url":null,"abstract":"No Abstract","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"254 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-21DOI: 10.1016/s0140-6736(24)02077-4
Abdullah A Al Rabeeah, Ziad A Memish
No Abstract
无摘要
{"title":"The UN World Conjoined Twins Day—a call to global action","authors":"Abdullah A Al Rabeeah, Ziad A Memish","doi":"10.1016/s0140-6736(24)02077-4","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)02077-4","url":null,"abstract":"No Abstract","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-21DOI: 10.1016/s0140-6736(24)02376-6
Howard Lopes Ribeiro Junior
No Abstract
无摘要
{"title":"AI ethics in medical research: the 2024 Declaration of Helsinki","authors":"Howard Lopes Ribeiro Junior","doi":"10.1016/s0140-6736(24)02376-6","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)02376-6","url":null,"abstract":"No Abstract","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-21DOI: 10.1016/s0140-6736(24)01495-8
Laura Dwyer-Lindgren, Mathew M Baumann, Zhuochen Li, Yekaterina O Kelly, Chris Schmidt, Chloe Searchinger, Wichada La Motte-Kerr, Thomas J Bollyky, Ali H Mokdad, Christopher JL Murray
<h3>Background</h3>Nearly two decades ago, the Eight Americas study offered a novel lens for examining health inequities in the USA by partitioning the US population into eight groups based on geography, race, urbanicity, income per capita, and homicide rate. That study found gaps of 12·8 years for females and 15·4 years for males in life expectancy in 2001 across these eight groups. In this study, we aimed to update and expand the original Eight Americas study, examining trends in life expectancy from 2000 to 2021 for ten Americas (analogues to the original eight, plus two additional groups comprising the US Latino population), by year, sex, and age group.<h3>Methods</h3>In this systematic analysis, we defined ten mutually exclusive and collectively exhaustive Americas comprising the entire US population, starting with all combinations of county and race and ethnicity, and assigning each to one of the ten Americas based on race and ethnicity and a variable combination of geographical location, metropolitan status, income, and Black–White residential segregation. We adjusted deaths from the National Vital Statistics System to account for misreporting of race and ethnicity on death certificates. We then tabulated deaths from the National Vital Statistics System and population estimates from the US Census Bureau and the National Center for Health Statistics from Jan 1, 2000, to Dec 31, 2021, by America, year, sex, and age, and calculated age-specific mortality rates in each of these strata. Finally, we constructed abridged life tables for each America, year, and sex, and extracted life expectancy at birth, partial life expectancy within five age groups (0–4, 5–24, 25–44, 45–64, and 65–84 years), and remaining life expectancy at age 85 years.<h3>Findings</h3>We defined the ten Americas as: America 1—Asian individuals; America 2—Latino individuals in other counties; America 3—White (majority), Asian, and American Indian or Alaska Native (AIAN) individuals in other counties; America 4—White individuals in non-metropolitan and low-income Northlands; America 5—Latino individuals in the Southwest; America 6—Black individuals in other counties; America 7—Black individuals in highly segregated metropolitan areas; America 8—White individuals in low-income Appalachia and Lower Mississippi Valley; America 9—Black individuals in the non-metropolitan and low-income South; and America 10—AIAN individuals in the West. Large disparities in life expectancy between the Americas were apparent throughout the study period but grew more substantial over time, particularly during the first 2 years of the COVID-19 pandemic. In 2000, life expectancy ranged 12·6 years (95% uncertainty interval 12·2–13·1), from 70·5 years (70·3–70·7) for America 9 to 83·1 years (82·7–83·5) for America 1. The gap between Americas with the lowest and highest life expectancies increased to 13·9 years (12·6–15·2) in 2010, 15·8 years (14·4–17·1) in 2019, 18·9 years (17·7–20·2) in 2020, and 20·4 y
{"title":"Ten Americas: a systematic analysis of life expectancy disparities in the USA","authors":"Laura Dwyer-Lindgren, Mathew M Baumann, Zhuochen Li, Yekaterina O Kelly, Chris Schmidt, Chloe Searchinger, Wichada La Motte-Kerr, Thomas J Bollyky, Ali H Mokdad, Christopher JL Murray","doi":"10.1016/s0140-6736(24)01495-8","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)01495-8","url":null,"abstract":"<h3>Background</h3>Nearly two decades ago, the Eight Americas study offered a novel lens for examining health inequities in the USA by partitioning the US population into eight groups based on geography, race, urbanicity, income per capita, and homicide rate. That study found gaps of 12·8 years for females and 15·4 years for males in life expectancy in 2001 across these eight groups. In this study, we aimed to update and expand the original Eight Americas study, examining trends in life expectancy from 2000 to 2021 for ten Americas (analogues to the original eight, plus two additional groups comprising the US Latino population), by year, sex, and age group.<h3>Methods</h3>In this systematic analysis, we defined ten mutually exclusive and collectively exhaustive Americas comprising the entire US population, starting with all combinations of county and race and ethnicity, and assigning each to one of the ten Americas based on race and ethnicity and a variable combination of geographical location, metropolitan status, income, and Black–White residential segregation. We adjusted deaths from the National Vital Statistics System to account for misreporting of race and ethnicity on death certificates. We then tabulated deaths from the National Vital Statistics System and population estimates from the US Census Bureau and the National Center for Health Statistics from Jan 1, 2000, to Dec 31, 2021, by America, year, sex, and age, and calculated age-specific mortality rates in each of these strata. Finally, we constructed abridged life tables for each America, year, and sex, and extracted life expectancy at birth, partial life expectancy within five age groups (0–4, 5–24, 25–44, 45–64, and 65–84 years), and remaining life expectancy at age 85 years.<h3>Findings</h3>We defined the ten Americas as: America 1—Asian individuals; America 2—Latino individuals in other counties; America 3—White (majority), Asian, and American Indian or Alaska Native (AIAN) individuals in other counties; America 4—White individuals in non-metropolitan and low-income Northlands; America 5—Latino individuals in the Southwest; America 6—Black individuals in other counties; America 7—Black individuals in highly segregated metropolitan areas; America 8—White individuals in low-income Appalachia and Lower Mississippi Valley; America 9—Black individuals in the non-metropolitan and low-income South; and America 10—AIAN individuals in the West. Large disparities in life expectancy between the Americas were apparent throughout the study period but grew more substantial over time, particularly during the first 2 years of the COVID-19 pandemic. In 2000, life expectancy ranged 12·6 years (95% uncertainty interval 12·2–13·1), from 70·5 years (70·3–70·7) for America 9 to 83·1 years (82·7–83·5) for America 1. The gap between Americas with the lowest and highest life expectancies increased to 13·9 years (12·6–15·2) in 2010, 15·8 years (14·4–17·1) in 2019, 18·9 years (17·7–20·2) in 2020, and 20·4 y","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-21DOI: 10.1016/s0140-6736(24)01865-8
Alberto Bossi, Stéphanie Foulon, Xavier Maldonado, Paul Sargos, Ray MacDermott, Paul Kelly, Aude Fléchon, Bertrand Tombal, Stephane Supiot, Dominik Berthold, Philippe Ronchin, Gabriel Kacso, Naji Salem, Fabio Calabro, Jean-François Berdah, Ali Hasbini, Marlon Silva, Jihane Boustani, Hélène Ribault, Karim Fizazi, Karim Fizazi
<h3>Background</h3>The 2 × 2 PEACE-1 study showed that combining androgen-deprivation therapy with docetaxel and abiraterone improved overall and radiographic progression-free survival in patients with de novo metastatic castration-sensitive prostate cancer. We aimed to examine the efficacy and safety of adding radiotherapy in this population.<h3>Methods</h3>We conducted an open-label, randomised, controlled, phase 3 trial with a 2 × 2 factorial design (PEACE-1) at 77 hospitals across Europe. Eligible participants were male patients (aged ≥18 years) with de novo metastatic castration-sensitive prostate cancer confirmed by bone scan, CT, or MRI, and an Eastern Cooperative Oncology Group performance status of 0–1 (or 2 in the case of bone pain). Participants were randomly assigned (1:1:1:1) to standard of care (androgen-deprivation therapy alone or with six cycles of intravenous docetaxel 75 mg/m<sup>2</sup> every 3 weeks), standard of care plus abiraterone (oral 1000 mg abiraterone once daily plus oral 5 mg prednisone twice daily), standard of care plus radiotherapy (74 Gy in 37 fractions to the prostate), or standard of care plus radiotherapy and abiraterone. Participants and investigators were not masked to treatment allocation. The coprimary endpoints were radiographic progression-free survival and overall survival, analysed by intention to treat in patients with low-volume metastatic disease and in the overall study population. This ongoing study is registered with EudraCT, 2012-000142-35.<h3>Findings</h3>Between Nov 27, 2013, and Dec 20, 2018, 1173 patients were enrolled and 1172 were randomly assigned to receive standard of care (n=296 [25·3%]), standard of care plus abiraterone (n=292 [24·9%]), standard of care plus radiotherapy (n=293 [25·0%]), and standard of care plus abiraterone and radiotherapy (n=291 [24·8%]). Median follow-up was 6·0 years (IQR 5·1–7·0) at the time of radiographic progression-free survival and overall survival analysis. A qualitative interaction between radiotherapy and abiraterone for radiographic progression-free survival in the population of patients with low-volume disease prevented the pooling of intervention groups for analysis (p=0·026). Adding radiotherapy to standard of care improved radiographic progression-free survival in patients with low-volume disease treated with abiraterone (median 4·4 years [99·9% CI 2·5–7·3] in the standard of care plus abiraterone group <em>vs</em> 7·5 years [4·0–not reached] in the standard of care plus abiraterone and radiotherapy group; adjusted hazard ratio [HR] 0·65 [99·9% CI 0·36–1·19]; p=0·019), but not in patients not treated with abiraterone (median 3·0 years [99·9% CI 2·3–4·8] in the standard of care group <em>vs</em> 2·6 years [1·7–4·6] in the standard of care plus radiotherapy group; 1·08 [0·65–1·80]; p=0·61). For overall survival, the predefined threshold for a statistical interaction was not reached (p=0·12); therefore, the two intervention groups receiving radiother
背景2 × 2 PEACE-1研究显示，在新发转移性阉割敏感性前列腺癌患者中，将雄激素剥夺疗法与多西他赛和阿比特龙联合使用可提高患者的总生存期和无放疗进展生存期。我们在欧洲 77 家医院开展了一项开放标签、随机对照、3 期试验，采用 2 × 2 因式设计（PEACE-1）。符合条件的参与者为男性患者（年龄≥18岁），经骨扫描、CT或核磁共振成像确认为新发转移性阉割敏感性前列腺癌，且东部合作肿瘤学组表现状态为0-1（骨痛患者为2）。参与者被随机分配（1:1:1:1:1）到标准疗法（单独雄激素剥夺疗法或静脉注射多西他赛75毫克/平方米，每3周1次，共6个周期）、标准疗法加阿比特龙（口服1000毫克阿比特龙，每天1次，外加口服5毫克泼尼松，每天2次）、标准疗法加放疗（前列腺74 Gy，37次/分）或标准疗法加放疗和阿比特龙。参与者和研究人员不对治疗分配进行蒙蔽。主要终点是无放射进展生存期和总生存期，对低体积转移性疾病患者和整个研究人群进行意向治疗分析。研究结果2013年11月27日至2018年12月20日，1173名患者入组，1172名患者被随机分配接受标准治疗（n=296 [25-3%]）、标准治疗加阿比特龙（n=292 [24-9%]）、标准治疗加放疗（n=293 [25-0%]）以及标准治疗加阿比特龙和放疗（n=291 [24-8%]）。在进行无放射进展生存期和总生存期分析时，中位随访时间为6-0年（IQR为5-1-7-0）。由于放疗与阿比特龙对低容量患者放射学无进展生存期的定性交互作用，因此无法将干预组集中进行分析（P=0-026）。在阿比特龙治疗的低容量疾病患者中，在标准治疗的基础上增加放疗可提高无放射学进展生存期（标准治疗加阿比特龙组的中位生存期为4-4年[99-9% CI 2-5-7-3]，标准治疗加阿比特龙和放疗组为7-5年[4-0-未达到]；调整后危险比[HR] 0-65 [99-9% CI 0-36-1-19]；P=0-019），但未接受阿比特龙治疗的患者则没有（标准治疗组的中位生存期为3-0年[99-9% CI 2-3-4-8]，标准治疗加放疗组为2-6年[1-7-4-6]；1-08 [0-65-1-80]；P=0-61）。在总生存期方面，未达到统计学交互作用的预定阈值（P=0-12）；因此，接受放疗的两个干预组被集中在一起进行分析。在低容量疾病患者中，放疗对总生存期没有影响（使用或不使用阿比特龙的标准疗法的中位生存期为6-9年 [95-1% CI 5-9-7-5] vs 使用或不使用阿比特龙的标准疗法加放疗的中位生存期为7-5年 [6-0-未达到]；HR 0-98 [95-1% CI 0-74-1-28]；P=0-86）。在总体安全性人群中，604例未接受放疗的患者中有339例（56-1%）接受了放疗，560例接受放疗的患者中有329例（58-8%）发生了至少一次严重不良事件（≥3级），最常见的不良事件是高血压（无论是否使用阿比特龙的标准治疗组中有110例[18-2%]患者，而无论是否使用阿比特龙的标准治疗加放疗组中有127例[22-7%]患者）和中性粒细胞减少症（40例[6-6%]和29例[5-2%]）。在低容量新发转移性阉割敏感性前列腺癌患者中，放疗与标准治疗加阿比特龙相结合可提高无放射进展生存期和无阉割耐药生存期，但不能提高总生存期。无论转移负荷如何，放疗都能减少严重泌尿生殖系统事件的发生，而且不会增加总体毒性，因此可以成为高容量和低容量新发转移性阉割敏感性前列腺癌患者标准治疗的一部分。
{"title":"Efficacy and safety of prostate radiotherapy in de novo metastatic castration-sensitive prostate cancer (PEACE-1): a multicentre, open-label, randomised, phase 3 study with a 2 × 2 factorial design","authors":"Alberto Bossi, Stéphanie Foulon, Xavier Maldonado, Paul Sargos, Ray MacDermott, Paul Kelly, Aude Fléchon, Bertrand Tombal, Stephane Supiot, Dominik Berthold, Philippe Ronchin, Gabriel Kacso, Naji Salem, Fabio Calabro, Jean-François Berdah, Ali Hasbini, Marlon Silva, Jihane Boustani, Hélène Ribault, Karim Fizazi, Karim Fizazi","doi":"10.1016/s0140-6736(24)01865-8","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)01865-8","url":null,"abstract":"<h3>Background</h3>The 2 × 2 PEACE-1 study showed that combining androgen-deprivation therapy with docetaxel and abiraterone improved overall and radiographic progression-free survival in patients with de novo metastatic castration-sensitive prostate cancer. We aimed to examine the efficacy and safety of adding radiotherapy in this population.<h3>Methods</h3>We conducted an open-label, randomised, controlled, phase 3 trial with a 2 × 2 factorial design (PEACE-1) at 77 hospitals across Europe. Eligible participants were male patients (aged ≥18 years) with de novo metastatic castration-sensitive prostate cancer confirmed by bone scan, CT, or MRI, and an Eastern Cooperative Oncology Group performance status of 0–1 (or 2 in the case of bone pain). Participants were randomly assigned (1:1:1:1) to standard of care (androgen-deprivation therapy alone or with six cycles of intravenous docetaxel 75 mg/m<sup>2</sup> every 3 weeks), standard of care plus abiraterone (oral 1000 mg abiraterone once daily plus oral 5 mg prednisone twice daily), standard of care plus radiotherapy (74 Gy in 37 fractions to the prostate), or standard of care plus radiotherapy and abiraterone. Participants and investigators were not masked to treatment allocation. The coprimary endpoints were radiographic progression-free survival and overall survival, analysed by intention to treat in patients with low-volume metastatic disease and in the overall study population. This ongoing study is registered with EudraCT, 2012-000142-35.<h3>Findings</h3>Between Nov 27, 2013, and Dec 20, 2018, 1173 patients were enrolled and 1172 were randomly assigned to receive standard of care (n=296 [25·3%]), standard of care plus abiraterone (n=292 [24·9%]), standard of care plus radiotherapy (n=293 [25·0%]), and standard of care plus abiraterone and radiotherapy (n=291 [24·8%]). Median follow-up was 6·0 years (IQR 5·1–7·0) at the time of radiographic progression-free survival and overall survival analysis. A qualitative interaction between radiotherapy and abiraterone for radiographic progression-free survival in the population of patients with low-volume disease prevented the pooling of intervention groups for analysis (p=0·026). Adding radiotherapy to standard of care improved radiographic progression-free survival in patients with low-volume disease treated with abiraterone (median 4·4 years [99·9% CI 2·5–7·3] in the standard of care plus abiraterone group <em>vs</em> 7·5 years [4·0–not reached] in the standard of care plus abiraterone and radiotherapy group; adjusted hazard ratio [HR] 0·65 [99·9% CI 0·36–1·19]; p=0·019), but not in patients not treated with abiraterone (median 3·0 years [99·9% CI 2·3–4·8] in the standard of care group <em>vs</em> 2·6 years [1·7–4·6] in the standard of care plus radiotherapy group; 1·08 [0·65–1·80]; p=0·61). For overall survival, the predefined threshold for a statistical interaction was not reached (p=0·12); therefore, the two intervention groups receiving radiother","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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