Cancer Control最新文献

Introduction: Precision radiotherapy relies on accurate segmentation of tumor targets and organs at risk (OARs). Clinicians manually review automatically delineated structures on a case-by-case basis, a time-consuming process dependent on reviewer experience and alertness. This study proposes a general process for automated threshold generation for structural evaluation indicators and patient-specific quality assurance (QA) for automated segmentation of nasopharyngeal carcinoma (NPC).

Methods: The patient-specific QA process for automated segmentation involves determining the confidence limit and error structure highlight stage. Three expert physicians segmented 17 OARs using computed tomography images of NPC and compared them using the Dice similarity coefficient, the maximum Hausdorff distance, and the mean distance to agreement. For each OAR, the 95% confidence interval was calculated as the confidence limit for each indicator. If two or more evaluation indicators (N2) or one or more evaluation indicators (N1) exceeded the confidence limits, the structure segmentation result was considered abnormal. The quantitative performances of these two methods were compared with those obtained by artificially introducing small/medium and serious errors.

Results: The sensitivity, specificity, balanced accuracy, and F-score values for N2 were 0.944 ± 0.052, 0.827 ± 0.149, 0.886 ± 0.076, and 0.936 ± 0.045, respectively, whereas those for N1 were 0.955 ± 0.045, 0.788 ± 0.189, 0.878 ± 0.096, and 0.948 ± 0.035, respectively. N2 and N1 had small/medium error detection rates of 97.67 ± 0.04% and 98.67 ± 0.04%, respectively, with a serious error detection rate of 100%.

Conclusion: The proposed automated patient-specific QA process effectively detected segmentation abnormalities, particularly serious errors. These are crucial for enhancing review efficiency and automated segmentation, and for improving physician confidence in automated segmentation.

Background: Serum high-density lipoprotein cholesterol (HDL-c) may influence cancer development. However, its relationship with the histological grade of pancreatic ductal adenocarcinoma (PDAC) is not well understood. This study aims to explore the potential associations between serum HDL-c levels and different histological grades of PDAC.

Methods: This retrospective study included 181 patients with pathologically confirmed PDAC who underwent radical surgery. Clinical data, blood biochemical results, imaging features, and pathological details of the patients were collected, such as age, gender, diabetes, hypertension, tumor grade, tumor size and location, high-density lipoprotein (HDL-c), low-density lipoprotein (LDL), total cholesterol (TC), triglycerides (TG), carbohydrate antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA).

Results: Patients with high-grade PDAC had significantly lower HDL-c levels compared to those with low-grade PDAC across both training and validation cohorts (P < 0.05). Significant associations were found between HDL-c levels and high-grade PDAC in the training (P < 0.001) and validation (P = 0.044) groups. Moreover, HDL-c levels were inversely related to lymph node metastasis in the training (P = 0.001) and validation (P = 0.012) sets.

Conclusions: Lower HDL-c levels are associated with high-grade PDAC and lymph node metastasis, suggesting that HDL-c may play a protective role in the progression of PDAC.

IntroductionThis study aimed to assess the predictive value of integrating ultrasonographic features, pathological characteristics, and inflammatory markers for axillary lymph node metastasis (ALNM) in early-stage breast cancer (BC), and to construct a corresponding nomogram.MethodsA retrospective review was conducted on clinical data from 287 early-stage BC patients who underwent surgery at Shenzhen Luohu People's Hospital between January 2020 and March 2024. Based on histopathological evaluation, patients were categorized into ALNM-positive (ALNM⁺) and ALNM-negative (ALNM^-) groups. Independent predictors of ALNM were identified using univariate and multivariate logistic regression analyses. These variables were used to develop a predictive nomogram. Model performance was evaluated by concordance index (C-index), receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA), assessing its accuracy, discrimination, calibration, and clinical utility.ResultsMultivariate analysis identified vascular invasion, neutrophil-to-lymphocyte ratio (NLR), lymphocyte count, tumor size, lymph node echogenicity, and margin characteristics as independent predictors of ALNM. The nomogram showed excellent discriminative ability (AUC = 0.944, 95% CI: 0.906-0.981; C-index = 0.944, 95% CI: 0.906-0.982) and good calibration (Brier score = 0.063). DCA indicated meaningful clinical benefit across relevant threshold probabilities.ConclusionThe nomogram developed in this study demonstrates strong predictive performance and clinical value for preoperative ALNM assessment in early-stage BC. It may serve as a practical tool to guide individualized surgical and therapeutic decision-making.

IntroductionIdentifying novel strategies to motivate regular physical activity in cancer survivors continues to be a critical mission, as the majority of cancer survivors are not sufficiently active to achieve the many health benefits of being regularly physically active. Providing biological feedback is one of the behavioral change techniques that shows promising effects in physical activity interventions. This study used a mixed-methods approach to test the acceptability and changes in physical activity motivation of a pilot intervention that provided personalized feedback via text messaging based on data from an activity tracker (Fitbit) and continuous glucose monitor (CGM) over a 4-week period.MethodsTwelve breast and colorectal cancer survivors completed this pilot intervention, which involved a one-on-one educational session followed by a 4-week intervention period with a Fitbit wristband and CGM. They received 2-3 weekly text messages based on their Fitbit and CGM data that aimed to increase their motivation to engage in physical activity. Participants completed surveys assessing motivational readiness before and after the intervention, and a post-intervention survey that assessed acceptability of the intervention. Exit interview was also conducted to collect their feedback and opinions toward the intervention.ResultsBoth quantitative and qualitative results suggest a high acceptability of the study devices (ie, Fitbit and CGM) as well as the intervention components (e.g., the glucose-based biological feedback). Participants reported a significant decrease in the preparation stage and an increase in the action and maintenance stages (ps < 0.05). Results from qualitative analysis further indicate participants' positive changes in physical activity motivations.ConclusionThe use of CGM along with an activity tracker is a viable method to provide personally relevant and motivating biological feedback messages to motivate physical activity in cancer survivors. Future studies can incorporate this behavior change technique into their intervention and further evaluate its impact on behavior change and related health outcomes.Clinical trial number: NCT05124405.

IntroductionThere is large inter- and intra-country variability in ovarian cancer outcomes. Individuals diagnosed with advanced stage cancer in Nova Scotia have a 3-year net survival of 31.9%, the lowest in the country. This study aimed to identify factors impacting survival, and to investigate evidence of inequities in survival from the point of diagnosis moving forward.MethodsThis population-based retrospective study included all women diagnosed with ovarian cancer in Nova Scotia from Jan 1, 2007, to Dec 31, 2016. Administrative health data were linked to gather individual, tumor, and health system characteristics. Both prognostic and equity factors potentially contributing to variations and inequities in survival were assessed using descriptive and time to event techniques.ResultsThis study found no regional differences in survival across Nova Scotia. It revealed that disparities in equity factors do not appear to be significantly associated with survival at the time of diagnosis moving forward. Instead, survival variations were attributed to legitimate prognostic factors, such as cancer stage, subtype, comorbidities, and frailty. However, notable inequities were identified between socioeconomic status and prognostic factors that may contribute to poor survival upstream, rather than at the time of diagnosis.ConclusionThough inequities do not appear to directly contribute to differences in ovarian cancer survival at the time of diagnosis, they may influence outcomes by increasing the development of prognostic factors that lead to poorer survival. Future research should capture equity factors not found in administrative data and begin making comparisons between other jurisdictions to determine why survival rates vary worldwide.

BackgroundPancreatic cancer (PC) is one of the most lethal cancers around the world. A high body mass index (BMI) is recognized as a significant and modifiable risk factor for this disease.MethodsData were obtained from the Global Burden of Disease (GBD) 2021 study. We used joinpoint regression and age-period-cohort (APC) models for trend analysis, and the Autoregressive Integrated Moving Average (ARIMA) model to forecast the burden of high BMI-related PC in 2022-2041. In addition, we used decomposition and health inequality analyses to examine causes and regional inequalities in the burden of high BMI-related PC.ResultsFrom 1990 to 2021, the total number of deaths from high BMI-related PC increased nearly tenfold. In the last 30 years, females consistently bore a greater burden of BMI-related PC, whereas the increase among males was more substantial. Deaths from high BMI-related PC escalated by 7 to 12 times in the 20-49 age group and by over sevenfold in low social development index (SDI) regions, reflecting increasing risk in younger populations and worsening global health inequalities. Furthermore, we predict that the global age-standardized mortality rate (ASMR) will continue to increase over the next 20 years.ConclusionOur findings generally revealed a sharply increased trend for the global burden of PC associated with high BMI during the past 30 years, as well as pronounced disparities by sex, age, and region. Hence, countries and nations should urgently advocate targeted public health initiatives in the future, especially in high-burden regions and populations.

IntroductionImmune checkpoint inhibitors (ICIs) have redefined cancer therapeutics. However, they may provoke immune-related adverse events (irAEs), with diabetes potentially altering their patterns. We aimed to investigate whether diabetic cancer patients exhibit a distinctive or intensified irAE pattern.MethodsWe performed a real-world, retrospective pharmacovigilance study of ICIs using the FDA Adverse Event Reporting System from 2011 to 2025. Reports listing anti-PD-1 (Nivolumab, Pembrolizumab, Cemiplimab), anti-PD-L1 (Atezolizumab, Avelumab, Durvalumab), and anti-CTLA-4 (Ipilimumab, Tremelimumab) agents as suspected drugs were extracted. Disproportionality signals were identified with 4 algorithms: Bayesian Confidence Propagation Neural Network, Reporting Odds Ratio, Proportional Reporting Ratio, and Multi-item Gamma Poisson Shrinker. Time-to-onset was calculated from therapy start to event date, modelled with Weibull distributions, and compared across subgroups with non-parametric tests.ResultsOf 22,775,812 FAERS reports, 1886 involved ICIs used in cancer patients with comorbid diabetes. 423 (22.4 %) were fatal and 1463 (77.6 %) non-fatal. Men predominated (71.5 %), and 63.0 % of patients were aged 65-85 years. Combination therapy (anti-CTLA-4 plus PD-1 or PD-L1) accounted for the highest death proportion (29.6 %). Disproportionality analysis revealed the strongest preferred-term signals for pneumonitis/interstitial lung disease, hypothyroidism, and colitis among all diabetic cancer patients receiving ICI therapy. At the system-organ-class level, endocrine, hepatobiliary, and blood/lymphatic disorders showed the most consistent risk across agents. Weibull modelling demonstrated an early-failure pattern (shape β < 1) with a median time-to-onset of 126.6 days overall, shortening to 90.9 days with combination therapy. Fatal subgroup occurred sooner than non-fatal subgroup (median 106.7 vs 132.5 days; P = 0.004).ConclusionDiabetic cancer patients experienced the full spectrum of ICI-associated toxicities, with combination treatments linked to greater lethality. Multidisciplinary surveillance during the first 3-4 months of therapy, glycemic control, and long-term follow-up may be essential to optimize benefit and minimize harm in this expanding population.

IntroductionChemotherapy is used frequently in the neoadjuvant setting for breast cancers, most commonly triple negative and human epidermal growth factor receptor 2 (HER-2) positive breast cancer. Certain hormone positive HER-2 negative cancers known as luminal B have shown response to adjuvant chemotherapy and can be considered in the neoadjuvant setting. This meta-analysis reviews survival outcomes in neoadjuvant chemotherapy in comparison to adjuvant in luminal B breast cancer.MethodsPubMed, Medline, and Embase were accessed on the 31^st of January 2024 to complete this systematic review and meta-analysis. All study types were included. Studies included compared survival rates in luminal B breast cancer patients in the neoadjuvant and adjuvant setting. All regimens of chemotherapy were included. Studies were included if they had at least median of 48 months follow up. Studies were excluded if they were non-comparative or did not report survival rates.ResultsTwo retrospective analyses comparing neoadjuvant and adjuvant chemotherapy were found from this systematic review, with a total of 4575 patients included. Of the 4575 patients, 679 received neoadjuvant chemotherapy (14.84%). Meta-analysis of these studies identified a non-significant trend of increased overall survival in the adjuvant chemotherapy arm with a hazard ratio of 1.85, confidence interval 0.98 - 3.48, (P value 0.058).DiscussionThis meta-analysis revealed a paucity of data in the comparison of neoadjuvant to adjuvant chemotherapy in luminal B breast cancer patients. Both studies identified were of a retrospective nature, and further research in this field should be considered.

IntroductionCancer patients often face challenges retaining critical information related to their diagnosis and treatment plans, with studies reporting retention rates as low as 11%-25%. This knowledge gap can negatively impact treatment adherence and increase patient anxiety. Visual communication tools may enhance patient comprehension and engagement in cancer care. To evaluate the effectiveness of MyCaregorithm, a novel digital tool, in improving patient comprehension of cancer treatment plans in a radiation oncology clinic setting.MethodsAdult patients with head and neck, prostate, or pancreatic cancers were recruited during routine clinic visits. Radiation oncologists or advanced practice providers utilized MyCaregorithm to explain the diagnosis, treatment plans, potential side effects, and follow-up care. Patients completed a survey assessing their experience with the tool. Descriptive statistics were used to analyze the data.ResultsThe study included patients with head and neck (69%), prostate (17%), and pancreatic (14%) cancers. Key findings include: 94% of patients reported improved understanding of treatment options 94% found visual images enhanced comprehension of their medical situation 85% experienced greater benefit compared to previous consultations without the tool 97% would recommend the tool to other patients.ConclusionThe digital technology tool demonstrated high effectiveness in improving patient comprehension and engagement across multiple cancer types. The consistently positive response rates highlights its potential to enhance patient-provider communication in oncology settings. Further studies with larger cohorts are needed to validate these promising results.

Introduction: Total pelvic exenteration (TPE) for clinical T4b colorectal cancer (CRC) is associated with significant morbidity. Short (0-30 days)- and intermediate (31-90 days)-term temporal analysis of complication onset is not well described, yet needed, to better counsel patients considering TPE.

Methods: A retrospective cohort study of consecutive patients with primary or recurrent clinical T4b pelvic CRC undergoing open TPE between 2014 and 2023 was conducted. Clinicopathologic variables were collected for each patient. Postoperative morbidity was classified according to the Clavien-Dindo (CD) grade system and stratified by time of onset within 90 days of surgery. Pearson's Chi-square test, Fisher's Exact test, and the Mann-Whitney U test were used to compare primary vs recurrent patient groups, and logistic regression assessed predictors of postoperative morbidity. Statistical analysis was performed using R with two-sided significance set at <0.05.

Results: Twenty-seven patients were identified of which 24 (88.9%) were male with a median age of 60.4 years (interquartile range [IQR]: 56.3-70.5). Seventeen (63.0%) patients had primary disease and 10 (37.0%) had recurrent CRC. Twenty-three (85.2%) patients experienced at least one complication within 90 days of surgery, but no mortality was observed. Ten (37.0%) patients experienced a CD ≥ 3 event, of which 40% took place beyond 30 days. The most common complication overall was anemia requiring transfusion, while the most common major complication was pelvic abscess. No clinicopathologic variables analyzed were predictive of major postoperative complication within 90 days of TPE.

Conclusion: TPE for clinical T4b CRC carries a high risk of postoperative morbidity in both the short- and intermediate-term after surgery, with a significant proportion of complications occurring after 30 days. Given the magnitude of operation, an extended recovery with high risk for complications is common. Although a single-center series, this annotated postoperative complication profile may assist patients and clinicians when reviewing informed consent for TPE.