Cancer Control最新文献

IntroductionPediatric acute leukemia is the most common childhood malignancy and one of the leading causes of cancer-related mortality worldwide, particularly, in low- and middle-income countries (LMICs), where treatment abandonment remains a major barrier to survival. Geographic accessibility and socioeconomic conditions are recognized determinants, but their combined influence in Mexico remains understudied. This study evaluated the association between geographic accessibility, socioeconomic factors, and treatment abandonment among children with acute leukemia in south-central Mexico.MethodsA prospective cohort study was conducted in Oaxaca, Puebla, and Tlaxcala from 2021 to 2023, including 574 children under 18 years diagnosed with acute lymphoblastic or myeloid leukemia. Geographic accessibility was estimated using travel distance and time from patients' residences to referral hospitals, calculated with ORS Tools in QGIS. Socioeconomic variables included public health insurance affiliation, parental education and occupation, and number of siblings. Treatment abandonment was defined per SIOP criteria as failure to initiate or discontinuation of treatment for ≥4 consecutive weeks. Multivariable logistic regression, adjusted for child's sex, age, year of diagnosis, and leukemia subtype, was used to assess associations.ResultsTreatment abandonment occurred in 16.6% of patients. In multivariable analysis, lack of public health insurance (aOR = 2.83; 95% CI: 1.39-5.76; P < 0.01) and living ≥141 km from the hospital (aOR = 1.68; 95% CI: 1.02-2.74; P = 0.03) were significantly associated with abandonment. Other factors, including number of siblings, maternal education, and fathers' occupation, were not statistically significant.ConclusionLack of public health insurance and greater distance to the hospital are key determinants of treatment abandonment in children with acute leukemia in south-central Mexico. Expanding insurance coverage, reducing indirect costs, and addressing geographic barriers are critical to improve treatment adherence and survival outcomes in this population.

Purpose: The predictive sensitivity of carbohydrate antigen 19-9 (CA19-9) in assessing the prognosis of intrahepatic cholangiocarcinoma (ICC) remains inadequate. Integrating CA19-9 with tumor volume offers a potentially viable strategy for improving prognostic accuracy. This study aimed to develop a prognostic model utilizing volume-adjusted CA19-9 (VACA) for ICC patients.

Patients and methods: A retrospective analysis was conducted on data from 436 ICC patients. These patients from two centers were divided into the training (n = 291, Center 1) and validation (n = 145, Center 2) cohorts. Using the training cohort, univariate and multivariable Cox regression analyses were employed to identify clinicopathological characteristics significantly associated with overall survival (OS) and recurrence-free survival (RFS), which enabled the construction of prognostic nomograms both with and without VACA. The nomograms' discriminatory and calibration abilities were assessed using receiver operating characteristic (ROC) curves, decision curve analysis (DCA) curves, and calibration curves, applying both training and validation cohorts.

Results: VACA emerged as an independent variable that significantly correlated with prognosis. The nomogram incorporating VACA demonstrated superior accuracy in predicting OS and RFS rates compared to the model without VACA. In the validation cohort, the nomogram with VACA yielded area under the ROC curve (AUC) values of 0.695 (95% CI = 0.597∼0.793) and 0.666 (95% CI = 0.559∼0.773) (1- year), 0.662 (95% CI = 0.518∼0.806) and 0.651 (95% CI = 0.446∼0.857) (3- years), and 0.701 (95% CI = 0.486∼0.916) and 0.703 (95% CI = 0.428∼0.978) (5- years) for OS and RFS, respectively, along with improved calibration and DCA curves.

Conclusions: VACA, formed by integrating tumor volume with CA19-9, exhibits promising prognostic capabilities. The nomogram incorporating data from two centers and utilizing VACA demonstrates robust prognostic performance and holds clinical utility.

Condensed abstract: Combining CA19-9 with tumor volume presents a potentially viable strategy for improving prognostic accuracy. The nomogram incorporating VACA demonstrates robust prognostic performance and holds clinical utility.

BackgroundLocal advanced rectal cancer (LARC) patients who achieved pathological complete response (pCR) after neoadjuvant chemoradiotherapy (NCRT) generally have a favorable prognosis. This retrospective study aimed to evaluate the prognostic value of magnetic resonance imaging (MRI) parameters and neutrophil-to-lymphocyte ratio (NLR) in LARC patients with pCR.MethodsBetween 2015 and 2019, 180 LARC patients who achieved pCR after NCRT and surgery were included. MRI parameters and NLR were evaluated as potential predictors for 5-year overall survival (OS) and disease-free survival (DFS) using the Kaplan-Meier and COX regression analysis.ResultsWith a median follow-up time of 68.3 months, the 5-year OS and DFS rates were 94.2% and 91.4%, respectively. Thirteen patients (7.2%) died, 2 (1.1%) experienced local recurrence, and 15 (8.3%) experienced distant metastases. Pretreatment MRI parameters and NLR were correlated with 5-year OS and DFS in pCR patients in the univariate analysis. The multivariate analysis identified baseline EMVI and NLR as independent predictors for 5-year OS and DFS (all P < .05). Patients in the low-risk group (EMVI-negative and/or NLR ≤ 2.8, n = 159, 88.3%) had a more favorable 5-year DFS compared to those in the high-risk group (EMVI-positive and NLR > 2.8, n = 21, 11.7%) (95.6% vs 59.4%, P < .001), with similar findings for 5-year OS (97.4% vs 70.6%, P < .001).ConclusionsThis study showed that MRI parameters and NLR were associated with long-term prognosis in patients with pCR. These findings could aid in stratifying pCR patients and guide subsequent treatment and follow-up strategies.

IntroductionNanoliposomal irinotecan (nal-IRI) plus 5-fluorouracil and leucovorin (5-FU/LV) is an established second-line therapy for metastatic pancreatic ductal adenocarcinoma (PDAC). We previously developed a prognostic model (CGMH nomogram) to predict overall survival (OS) in patients receiving second-line chemotherapy before the nal-IRI + 5-FU/LV era. Herein, we aimed to validate the CGMH nomogram in a real-world cohort treated with nal-IRI plus 5-FU/LV, the current standard second-line treatment for metastatic PDAC.MethodsA retrospective cohort of 148 patients with metastatic PDAC treated with second-line nal-IRI + 5-FU/LV was analyzed. Prognostic scores were assigned using the CGMH nomogram, with patients stratified into tertiles as good, intermediate, and poor prognostic groups. Predictive performance was assessed using the concordance index (c-index) and calibration plots.ResultsOur cohort had a median OS of 6.1 months. Patients in the good, intermediate, and poor prognostic groups had median OS of 8.7 (95% confidence interval [CI], 6.7-10.7), 5.7 (95% CI, 5.3-6.3), and 4.0 (95% CI, 2.8-5.2) months, respectively. Compared with the good group, intermediate and poor groups had hazard ratios of 1.99 (95% CI, 1.29-3.07, P = .002) and 3.18 (95% CI, 1.87-5.40, P < .001), respectively. The nomogram demonstrated strong predictive ability, with c-indices of 0.73 and 0.70 for 6- and 12-month OS predictions, respectively. Calibration plots displayed excellent agreement between predicted and observed survival.ConclusionThe CGMH nomogram reliably predicted survival outcomes in nal-IRI + 5-FU/LV-treated patients with metastatic PDAC, and validation supported its use in clinical decision-making and personalized treatment planning.

IntroductionAmerican Indians and Alaska Natives (AIANs) experience significant cancer incidence and mortality disparities, with elevated cancer risk factor exposure, lower cancer screening rates, and poorer quality of cancer care relative to non-Hispanic Whites. To address these issues, the Southeastern American Indian Cancer health Equity Partnership (SAICEP) was formed to understand and address cancer disparities among southeastern American Indians (AIs).MethodsSAICEP formed in 2021 through the Community Outreach and Engagement offices of the NCI-designated Comprehensive Cancer Centers in North Carolina (NC). The catchment areas for these cancer centers include the tribal homelands for eight state and federally recognized Tribes, representing the largest AI populations in the eastern US. SAICEP seeks to: (1) increase awareness of cancer health needs of AI populations; (2) expand access to cancer health education and build community capacity to address cancer health needs; (3) develop collaborative research relationships to better understand and address the AI cancer burden.ResultsFor Aim 1, SAICEP created a virtual speakers' series, featuring prominent AI cancer researchers and clinicians, hosted by the UNC Lineberger Cancer Network three times a year. To date, 10 webinars have been convened, with a total of 538 participants. For Aim 2, SAICEP participates in tribal events throughout the year, reaching over 3500 AIs and disseminating printed cancer educational materials and giveaways. For Aim 3, SAICEP secured funding to conduct analyses to assess cancer incidence, mortality, and care quality for NC AIs, to collect information to understand community cancer needs and culturally adapt and disseminate information on cancer screening and risk reduction.ConclusionThrough its targeted research and engagement, SAICEP has successfully moved towards achieving its goal of understanding and addressing cancer disparities among AIs in NC. Future directions will involve the development of a community advisory board and collaborations with Tribes in other states.

Introduction: Adolescent and young adult cancer survivors, especially racial/ethnic minorities and rural residents are particularly vulnerable to financial toxicity due to limited healthcare access, socioeconomic disparities, and cultural/language barriers. These social determinants of health compound financial hardship and contribute to poor healthcare transitions from pediatric to adult care, leading to worse outcomes and higher mortality rates.Methods: Our cross-sectional survey study examined racial (Black vs White) and geographic (rural vs urban) disparities in financial toxicity and healthcare transition outcomes among 260 adolescent and young adult cancer survivors through the Kentucky Cancer Registry. Survey data were collected on financial toxicity, healthcare transitions, and health-related quality of life. Financial toxicity was measured under three domains: psychological response, material conditions (e.g., loss of income, debt), and coping behaviors.Results: Results revealed moderate levels of financial toxicity and healthcare transition readiness across the sample, with strong associations between financial toxicity and anxiety, depression, and long-term effects of cancer treatment. Black participants showed higher levels of anxiety and coping behaviors compared to Whites, while urban participants experienced lower financial toxicity (as measured by material conditions) than their rural counterparts. Racial disparities were observed in global health and anxiety, even after adjusting for financial toxicity, but the relationship between financial toxicity and healthcare transitions outcomes did not vary by race or geography.Conclusion: This study highlights the importance of developing tailored strategies to mitigate the impact of cancer-related financial toxicity on the health outcomes and quality of life of underserved adolescent and young adult cancer survivors.

Background: Malignant pleural mesothelioma is the most common primary tumor of the pleura. The unique growth pattern of malignant pleural mesothelioma makes it difficult to apply the Response Evaluation Criteria for Solid Tumors (RECIST). Hence the need to use modified RECIST (mRECIST) criteria, as they better fit the unique growth pattern of malignant pleural mesothelioma. The thickness of the tumor perpendicular to the chest wall or mediastinum is measured at 2 points at 3 separate levels at least 1 cm apart on chest CT scans, and summed to obtain a one-dimensional pleural measurement. The same criterion has also been used to assess response to treatment. RECIST 1.1 represents a further update, taking into account new concepts such as revised minimum dimensions for lymph nodes and an approach to lesions that become non-measurable. Based on experience and published literature, the hypothesis of merging the 2 above-mentioned criteria in mRECIST 1.1 for mesothelioma and the use of iRECIST for the application to immune-based therapies (iRECIST) was considered. Purpose: Support the importance of studying pleural mesothelioma in a reliable and reproducible way, through a scrupulous methodology, applying the mRECIST1.1 and iRECIST criteria. Conclusions: Adoption of a standardized study metodology can make the study of PM reproducible and correct.

Objective: This systematic review and meta-analysis aims to assess the knowledge and awareness of oral cancer risk factors among medical and dental students.

Methods: This study followed the PRISMA guidelines and was registered in INPLASY (ID: 2024110035). Four databases were consulted (PubMed, Science Direct, Scopus, and Web of Science) from February 20th, 2005, to May 10th, 2024. The study selection and data extraction process was performed independently by 2 investigators. The risk of bias was assessed using the JBI tool, which can be found at: https://jbi.global/critical-appraisal-tools. A third investigator was consulted in case of disagreement. Meta-analysis results were systematically illustrated in a forest plot and expressed as odds ratio with 95% confidence interval. The I² statistic assessed heterogeneity between studies. Funnel plot and Egger regression analysis were used for bias analysis. A P value <.05 was considered significant. All statistical analyses were performed using the STATA V.15 software.

Results: After the selection process, 41 studies met the eligibility criteria, comprising a total of 14,425 participants, 22% medical students and 78% dental students, primarily female (53%). The meta-analysis showed that 98% of students demonstrated relatively good knowledge about oral cancer risk factors. The most recognized risk factor was smoking (99%), followed by advanced age (68%), UV-rays exposure (64%), and alcoholism (57%). Knowledge of several other factors was comparatively lower, with less than 50% of students recognizing them. The studies indicated significant heterogeneity (I² = 99.8%) and publication bias (P < .001).

Conclusions: These findings suggest that while medical and dental students have a strong understanding of key risk factors for oral cancer, there are gaps in knowledge regarding other important factors. Addressing these gaps through enhanced education and training is essential to improving early detection and prevention efforts.

Despite significant advances in oncology, cancer care globally continues to face critical challenges, including stark disparities in access, insufficient preventive focus, fragmented primary health care (PHC) integration, unsustainable financing models, workforce shortages, and inadequate community involvement. This paper revisits the Alma Ata Declaration's principles-health equity, universal access, preventive care, and community participation-as a conceptual framework to address these persistent issues in cancer care. We highlight opportunities to strategically integrate oncology services within strengthened PHC systems, balancing centralized specialist resources with decentralized community-based care. Evidence from diverse settings illustrates how reinforcing PHC infrastructures enhances preventive measures, early detection, and survivorship care, thus mitigating geographic and socioeconomic disparities. Sustainable financing mechanisms and targeted workforce strategies, including task-shifting and multidisciplinary training, are proposed as essential components. Effective community engagement models demonstrate improved care relevance, acceptance, and outcomes. Additionally, we emphasize the critical role of health policy alignment with universal health coverage objectives, robust pharmacoeconomic evaluations, and evidence-based national cancer control plans. Integrating Alma Ata's principles into contemporary oncology provides a viable, scalable model to advance equitable, accessible, and sustainable cancer care globally, laying the theoretical groundwork for future research initiatives and informed policy development.