Cancer Control最新文献

Introduction: The use of antibiotic (Abx) is common in gastric cancer (GC) patients undergoing radical resection; however, the prognostic value of the use of these agents in stage I-III patients remains largely unknown.Methods: Data concerning the use of Abx in GC patients during surgery including the cumulative defined daily dose (cDDD) and types of Abx, were collected retrospectively. Differences in clinical features between cDDD subgroups and type subgroups were compared. Overall survival (OS) differences were tested via the Kaplan-Meier method, and risk factors for survival were validated by a Cox proportional hazards model.Results: Of 162 patients enrolled, 81 were assigned to the low-cDDD and 81 to the high-cDDD group. Among them, 19 patients were assigned to ≤2 types and 143 to ≥3 types. The low- and high-cDDD subgroups of patients presented no significant difference in OS (log rank = 2.21, P = 0.137). Patients receiving ≥3 types presented significantly better OS (log rank = 4.58, P = 0.032) than those receiving ≤2 types. The low- and high-cDDD subgroups (log rank = 3.83, P = 0.050), but not the ≤2 and ≥3 type subgroups (log rank<0.01, P = 0.982), presented a significant difference in OS in patients undergoing total gastrectomy. These differences were maintained in patients without total gastrectomy (cDDD: log rank = 7.92, P = 0.005; types: log rank = 6.52, P = 0.011). The use of multiple Abx types was validated as an independent factor for OS (HR = 0.46, 95% CI: 0.24-0.90; P = 0.024).Conclusions: Abx use during surgery in patients with stage I-III GC may potentially correlate with the prognosis. Patients with ≥3 types of Abx were more likely to have good outcomes, particularly in those without total gastrectomy.

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.

IntroductionVulvar squamous cell carcinoma (VSCC) is a rare but increasingly prevalent gynecological malignancy. This study aimed to identify risk factors for stage I VSCC, which accounts for approximately 70% of VSCC patients, and to develop a nomogram to predict cancer-specific survival (CSS) for this large subgroup.MethodsThis study analyzed the datasets consisting of public training and independent external validation sets of patients diagnosed with stage I VSCC between 2010 and 2019. Prognostic factors were discerned through Cox regression analyses and the least absolute shrinkage and selection operator (LASSO) method. A nomogram for CSS was developed and evaluated using the C-index, Kaplan-Meier curves, and decision curve analysis (DCA) plots.ResultsOur analysis revealed variations in predictors of CSS and overall survival (OS) in stage I VSCC cases from the Surveillance, Epidemiology, and End Results (SEER) database. The multivariate Cox model suggested associations between CSS and age, grade, and number of tumors (NMT), while the LASSO model indicated potential roles for age, stage, invasion depth, NMT, and surgical method. The nomogram showed reasonable discriminative ability in the training (C-index: 0.785) and validation cohorts (C-index: 0.729), with supporting Kaplan-Meier and DCA analyses.ConclusionThis study proposes a prognostic model for CSS in stage I VSCC, identifying exploratory associations with multifocal tumors and surgical extent. Further prospective studies are needed to validate these findings and clarify their clinical implications.

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.