Cancer Control最新文献

IntroductionThis meta-analysis aims to evaluate the impact of increasing the use of metformin in neoadjuvant treatment for breast cancer (BC) on the rate of pathological complete response (pCR) in patients.MethodsA systematic search was conducted in four electronic databases: PubMed, Web of Science, Embase, and Cochrane Library. The search scope covered all the literature from the establishment of the databases to April 2025. The risk ratio (RR) and 95% confidence interval (CI) were calculated. The outcome indicator was the pCR rate.ResultThis meta-analysis included a total of 8 randomized controlled trials (RCTs), involving 474 patients. The results showed that there was no statistically significant difference in the pCR rate between the experimental group containing metformin and the control group (RR = 1.21, 95% CI: [0.85, 1.71], P = 0.28). Subgroup analysis revealed that there were no significant differences in the pCR rate between the two groups in patients with metabolic syndrome (RR = 2.09, 95% CI [0.55, 7.85], P = 0.28), patients without metabolic syndrome (RR = 1.12, 95% CI [0.81, 1.55], P = 0.49), patients from Eastern countries (RR = 1.15, 95% CI [0.63, 2.11], P = 0.65), and patients from Western countries (RR = 1.32, 95% CI [0.75, 2.32], P = 0.34).ConclusionThis study did not observe any effect of increasing the use of metformin on the pCR rate of patients in neoadjuvant treatment for BC.

Gastric cancer remains an overlooked source of inequity in U.S. cancer prevention policy. Immigrant and underserved populations from East Asia, Eastern Europe, Latin America, and other high-incidence regions face markedly elevated rates of non-cardia gastric adenocarcinoma, yet remain outside the scope of national screening and eradication programs. This commentary calls for a migration-informed approach to gastric cancer prevention, emphasizing early-life Helicobacter pylori exposure, structural inequities, and the policy inertia that sustains avoidable disparities. Drawing on lessons from hepatitis B and colorectal cancer prevention, a multisectoral framework-linking academic centers, community organizations, and federal policy-can operationalize targeted testing, awareness, and surveillance. The recently introduced Stomach Cancer Prevention and Early Detection Act represents a historic step toward national recognition of gastric cancer as a preventable disease of equity concern. By reframing gastric cancer through a structural and immigrant health lens, the United States can begin to align research, funding, and prevention infrastructure with the populations most affected.

Background: The World Health Organization (WHO) aims to eliminate cervical cancer by 2030 through a global strategy, centred on high-risk Human papillomavirus (hrHPV)-based screening and treatment. Implementing these strategies in low-resource settings remains challenging, due to barriers associated with limited healthcare infrastructure and patient awareness. Self-sampling for hrHPV has shown higher acceptability and similar diagnostic accuracy compared to clinician-taken samples. This study proposes a protocol to evaluate the clinical efficacy of a cervical cancer screening program utilising hrHPV self-sampling in Ghana.Methods and Analysis: 1000 non-pregnant women aged 30-65 years will be invited to self-collect hrHPV samples. Those testing hrHPV positive will undergo visual inspection with acetic acid. Those diagnosed with high-grade squamous intraepithelial lesions will be offered ablation. In any case where there is a suspicion of invasion, or equivocal diagnosis, biopsies will be taken. Follow-up for women who are test positive for hrHPV and/or undergo treatment, will involve hrHPV self-sampling after 6 months. HrHPV-negative women will rescreen after 3 years. Biopsies will be taken where immediate treatment is not suitable, and women with confirmed or suspected invasive cervical carcinoma will be referred for surgical and/or oncological care. The primary outcome will be the proportion of women successfully screened, defined as the proportion of women with a valid HPV test result out of those invited to attend cervical screening. Secondary outcomes include screening uptake, disease detection rate, hrHPV genotype prevalence, treatment acceptance rate, successful treatment response, missed disease during treatment, number lost to follow-up, and disease recurrence.Discussion: In low-resource settings, hrHPV self-sampling offers an accessible method to increase screening uptake. This study will inform strategies for broader implementation of cervical cancer screening and contribute to achieving the WHO's goal of elimination by 2030.Trial Registration: Ethical approval for this study was obtained from the Kintampo Health Research Centre Institutional Ethics Committee (IEC), Bono East, Ghana, West Africa, on 24 May 2024 (IEC IRB Registration No. 0004854; Study ID: KHRCIEC/2024-03).

IntroductionWhile ultrasound-guided breast biopsy (UGBB) performed by a radiologist is the standard of care in high-income countries for diagnosing breast cancer, blind or surgical biopsy has been the norm in low-and middle-income countries (LMIC) in part because LMIC radiologists lack the skill to perform UGBB. We present the study protocol of a competency-based UGBB training program for LMIC Nigerian radiologists that leverages mobile health technology.MethodsThis institutional review board-approved prospective multi-institutional single-arm clinical trial (ClinicalTrials.gov identifier: NCT04501419) involves 13 Nigerian radiologists from eight tertiary hospitals in South West and South East Nigeria. Our training program is unique because it uses a competency-based curriculum developed specifically for LMIC radiologists. The competency-based curriculum incorporates blended learning (e-learning and trainer-led), simulation (supervised and unsupervised), and patient biopsy (supervised and unsupervised) components. The study time frame is two years: 1 year for the trainees to complete active training and patient recruitment and another 1 year for patient follow-up. Primary outcome measures include trainees' competency (measured using the Ottawa Surgical Competency Operating Room Evaluation (O-SCORE)), the radiology-pathology concordance rate, and the complication rate. Secondary outcome measures include the diagnostic interval and the positive predictive value of UGBB.ConclusionBuilding capacity for UGBB in Nigeria and other LMIC can potentially improve breast cancer outcomes through early diagnosis. This training program is part of an implementation multi-component strategy package in Nigeria to improve breast cancer outcomes. This training program can also be adapted for other image-guided procedures that could impact global cancer control through diagnosis, therapeutic intervention, and/or palliation.

ObjectiveTo investigate the risk factors for complications in breast cancer patients with totally implantable access ports (TIAPs).MethodsThis retrospective case-control study involved 471 breast cancer (BC) patients who received TIAPs during chemotherapy. We compared the demographic and clinical characteristics of patients with complications to those without, analyzed independent risk factors using binary logistic regression, and identified differences in complication rates based on catheterization site.ResultsThe most frequent complication was catheter malposition, followed by infection, thrombosis, hemothorax, and port rotation. Complications were more common in right-side BC cases (P = .026) and with left-side insertions (P = .012). Binary logistic regression identified independent risk factors for complications: catheter tip location (OR = 0.599, P = .013), and catheterization site (OR = 0.319, P = .019). Notably, left-side insertion significantly increased the risk of overall complications and catheter malposition compared to right-side insertion (OR = 3.534, P = .008; OR = 5.624, P = .004, respectively).ConclusionCatheter tip location and catheterization site independently affect complications and catheter malposition. For TIAPs implantation, particularly on the left side, a lower catheter tip location is advised to reduce complications and enhance safety.

BackgroundLimited-stage small cell lung cancer (LS-SCLC) is a highly aggressive tumor characterized by a poor prognosis. While concurrent chemoradiotherapy (CCRT) remains the standard treatment, the high rates of recurrence and poor long-term survival highlight the pressing need for novel therapeutic approaches.PurposeIn recent years, the introduction of immunotherapy, particularly immune checkpoint inhibitors (ICIs), has opened new avenues for the treatment of LS-SCLC. This review highlights the clinical advancements of ICIs in CCRT, consolidation therapy, and neoadjuvant therapy, emphasizing their potential to improve progression-free survival (PFS) and overall survival (OS). This review also discusses management of immunotherapy-related side effects.Research DesignThis is a review article that synthesizes recent research findings on immunotherapy for LS-SCLC.Study SampleNot applicable (review of existing literature).Data Collection and/or AnalysisThis review summarizes key studies exploring the application of immunotherapy in limited-stage small cell lung cancer.Additionally, it examines the role of the tumor microenvironment, tumor mutation burden (TMB), and Programmed cell death 1 ligand 1(PD-L1) as biomarkers for predicting the efficacy of immunotherapy.ResultsThis review emphasizes their potential to improve PFS and OS.ConclusionsDespite the significant advancements in research, the use of ICIs in LS-SCLC continues to face challenges, including the identification of optimal treatment regimens, validation of long-term efficacy, and development of personalized predictive biomarkers. Future research should prioritize large-scale, multicenter clinical trials to refine combination therapy strategies, establish customized treatment approaches, and enhance patient outcomes.

BackgroundThe incidence and prevalence of early-onset colorectal cancer (EO-CRC), defined as colorectal cancer diagnosed before the age of 50, are increasing globally. However, the current status and trends of the disease burden of EO-CRC in China, including incidence, prevalence, mortality, and disability-adjusted life-years (DALYs), are not well understood. This study aimed to analyze the epidemiological trends of EO-CRC in China from 1990 to 2021 and to project its future burden.MethodsWe analyzed data from the Global Burden of Disease (GBD) 2021 study to assess the trends in incidence, prevalence, mortality, and DALYs of EO-CRC in China from 1990 to 2021. Joinpoint regression analysis was used to identify significant changes in trends. Age-period-cohort (APC) analysis was conducted to disentangle the effects of age, period, and birth cohort. The Bayesian APC model was employed to project the burden of EO-CRC up to 2036.ResultsFrom 1990 to 2021, the absolute number of EO-CRC incident and prevalent cases in China increased substantially. The age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) also rose significantly, with an accelerated increase after 2007 in men and after 2015 in women. In contrast, the age-standardized mortality rate (ASMR) and age-standardized DALYs rate (AS-DALYs) generally declined; however, a concerning reversal of this trend has been observed in recent years. Incidence, prevalence, mortality and DALYs rates all showed significant age, period, and cohort effects. Projections indicate that ASIR and ASPR will continue to rise until 2036, especially in males, and the disparity in disease burden between men and women is expected to widen.ConclusionThe disease burden of EO-CRC in China has increased significantly and is rising rapidly, particularly among males. Further research is essential to fully understand the factors contributing to the increased incidence of EO-CRC and to develop effective mitigation strategies.

Background: This cohort study aimed to evaluate the impact of tumor burden (TB) on the efficacy of immunotherapy in patients with advanced non-small cell lung cancer (NSCLC).

Materials and methods: Data from the POPLAR and OAK trials were extracted as the training and validation cohorts, respectively. TB was defined as the sum of the longest dimensions (blSLD) of measurable target lesions as per RECIST v1.1. The Kaplan-Meier curves and multivariate Cox regression analyses were performed to assess the association between TB with blood-tested tumor mutation burden (bTMB), PD-L1 expression, and survival outcomes. Additionally, random forest algorithms analysis was performed to evaluate the accuracy of TB in predicting 12-month mortality of NSCLC patients received atezolizumab.

Results: A total of 105 patients from the POPLAR trial and 322 patients from the OAK trial were recruited in the training and validation sets, respectively. Patients with TB-L have significantly better OS than those with TB-H in the training (mOS: 15.8 months vs 6.93 months) as well as the validation (mOS: 16.0 months vs 7.59 months) cohort. The multivariate Cox regression analysis indicated that TB is an independent biomarker for OS prediction, regardless of bTMB, PD-L1 expression, and number of metastasis sites. The impact of TB on 12-month mortality was expected to be stronger with the increase of TB, suggesting that patients with a high tumor burden experienced a detrimental effect on 12-month mortality.

Conclusion: TB may act as a prognostic biomarker for clinical benefit in NSCLC patients treated with immunotherapy alone. This may be potentially effective for predicting the efficacy of immunotherapy-based regimens.

Background: "Crawling-type" early gastric carcinoma (EGC) is a rare subtype of gastric cancer (GC) that is challenging to diagnose at an early stage due to its low-grade nuclear heterogeneity and morphology that mimics intestinal metaplasia. This study aimed to explore the clinical characteristics and pathological features of patients with crawling-type EGC.

Methods: This case series study retrospectively included patients with crawling-type EGC who underwent endoscopic submucosal dissection (ESD) or gastrectomy at the East Hospital Affiliated to Tongji University between January 2019 and March 2022.

Results: 8 patients (mean age 63.5 ± 7.8 years) were included: 4 underwent ESD, and 4 underwent partial gastrectomy. In 4 patients, the tumors were primarily located in the gastric cardia and the basal gland area of the upper stomach, while the other 4 patients had tumors in the antral region. Preoperative gastroscopy revealed atrophic gastritis and intestinal metaplasia in all patients. The lesions were generally flat in morphology. Submucosal infiltration was found in only one case. Signet ring cells were present in the tumors of 5 patients. The mucinous type was observed in 7 patients. Seven tumors were of the gastrointestinal mixed type. Curative resection was achieved in all patients. No recurrence events were observed in any patient at 1 year after surgery.

Conclusions: The crawling-type EGC may exhibit distinct clinical characteristics and pathological features compared with classical GC. Curative resection was achieved in all patients. The short-term prognosis of surgical treatment may be favorable.

Background: This study compared anatomical imaging features between high-risk and non-high-risk groups in neuroblastoma with at least one image-defined risk factor (IDRF). It also assessed the diagnostic performance of these features in identifying the high-risk group.

Methods: A retrospective analysis of neuroblastoma patients with at least one IDRF was conducted. Imaging features, including estimated tumor volume and IDRFs, were compared between the two groups. The diagnostic performance of these features was assessed using receiver operating characteristic (ROC) curves, and the areas under the ROC curves (AUCs) along with their 95% confidence intervals (CIs) were calculated. Additionally, to internally validate their diagnostic performance, the bootstrap resampling method with 1000 bootstrap resamples was employed.

Results: The study included 255 patients (185 high-risk cases, 70 non-high-risk cases). Significant differences were found in estimated tumor volume and IDRF number between the high-risk and non-high-risk groups (P < 0.001). The estimated tumor volume and the IDRF number-based cluster were independent risk factors, and their combination achieved an AUC of 0.801 (95% CI: 0.747-0.848) for high-risk group diagnosis, with the average AUC of the 1000 bootstrap samples of 0.800 (95% CI: 0.798-0.802). In abdominal lesions, specific IDRF categories differed between high-risk and non-high-risk groups (P < 0.05).

Conclusion: Our study reveals anatomical imaging differences between high-risk and non-high-risk groups in neuroblastoma with at least one IDRF.