Cancer Control最新文献

IntroductionEarly-onset colorectal cancer (EOCRC) is increasing worldwide, with Serbia showing a similar incidence compared to global trends. Precise mutation genotyping has gained importance following the recent approval of KRAS-specific inhibitors. Although KRAS, NRAS, and BRAF testing is routinely performed in Serbia, specific mutation subtypes in EOCRC patients have not yet been published. This retrospective cohort study aimed to investigate temporal trends in EOCRC incidence in Serbia and characterize the mutational profile of KRAS, NRAS, and BRAF in EOCRC patients.MethodsNational cancer registry data from 2016 to 2022 were analyzed to assess EOCRC incidence trends. Molecular testing for KRAS, NRAS, and BRAF was performed on 681, 420, and 67 EOCRC patients, respectively, using qPCR-based diagnostic assays, complemented by Sanger sequencing on 54 cases to characterize KRAS exon 2 and BRAF V600E mutations.ResultsRegistry data revealed a consistent upward trend in EOCRC incidence, especially in the 45-49 years' age group. In the qPCR-tested cohort, KRAS mutations were detected in 44.3% (302/681), NRAS in 6.4% (27/420), and BRAF in 8.9% (6/67). In the sequenced subset, KRAS mutations were found in 20.4%, including G12D (36.4%), G13D (27.3%), G12 C (18.1%), and G12S/G12 V (9.1%) variants. BRAF V600E was detected in 3.7%.ConclusionsWe report a rise in EOCRC in Serbia, especially in ages 45-49, and recommend policy makers to lower the screening age to 45. We present the first detailed molecular profile of Serbian EOCRC and recommend that policy makers implement routine KRAS variant testing and ensure access to KRAS G12C-targeted therapies to improve personalized care.

IntroductionFinancial hardship may undermine healthy lifestyle behaviors that are important for preventing avoidable recurrence and death during survivorship after breast cancer diagnosis. Significant research has characterized these challenges and disparities, but relatively little research has identified which strategies patients and their teams may prefer to overcome these challenges. We employ an assets lens to highlight patient-identified strategies to circumvent barriers across Social-Ecological Model (SEM) levels.MethodsWe conducted a secondary qualitative analysis of semi-structured interviews with 26 Black/Latina breast cancer survivors and 10 oncology providers recruited from a single health system (2019-2020). Transcripts (English/Spanish) were coded using deductive and inductive approaches, and these codes were subsequently organized into themes and mapped to SEM levels.ResultsSurvivors used multi-level strategies to maintain healthy behaviors while navigating financial hardship. At the individual level, women budgeted proactively, substituted canned/frozen vegetables for fresh produce, and relied on home-based exercise, often supported by emotion-focused coping. Interpersonal strategies drew on family and friends for transportation, childcare, and accountability. Community-based solutions included church-based aid, food pantries, public benefits, and transportation vouchers, frequently facilitated by social workers. Organizational solutions centered on multidisciplinary survivorship clinics that provided financial navigation, consolidated appointments, and cost-tailored lifestyle counseling. Providers corroborated these strategies and emphasized clinic-level interventions (e.g., consolidated appointment scheduling, proactive financial and nutritional screening) to reduce financial hardships.ConclusionBlack and Latina breast cancer survivors and their providers deploy pragmatic strategies across multiple SEM levels to sustain healthy behaviors under financial hardship. However, community- and organization-level solutions remain underutilized in interventions, and few trials have integrated financial navigation with lifestyle interventions. Embedding proactive financial and nutrition security screening, bilingual financial navigation, and community partnerships into lifestyle interventions and survivorship care could reduce structural barriers, improve lifestyle guideline adherence, and advance equity in cancer outcomes.

IntroductionPoor diet and excess weight have been linked to increased risk for at least 13 types of cancer. Culinary medicine utilizes experiential cooking skill development to improve individuals' capacity for healthy eating. Digital communication strategies offer pathways for scalable culinary medicine interventions, but little research has explored how online cooking tools could be leveraged for cancer prevention messaging. We conducted a cross-sectional survey study exploring online cooking information-seeking habits and content preferences among participants in four cancer prevention and control cohorts to inform future digital culinary medicine interventions.MethodsA cross-sectional survey study was conducted with a convenience sample of participants from four existing cohort studies being undertaken at the University of Texas MD Anderson Cancer Center. Survey items examined current cooking practices, online cooking information-seeking behavior, digital intervention content preferences, and evaluation of three online cooking videos. Descriptive statistics were used to summarize findings, and open text comments were examined using rapid thematic analysis to add further context.ResultsMost of the 102 respondents were women (99%), with a mean age of 58 years old. Many (78.4%) reported preparing meals at home ≥4 days per week. Search engines were the most common way recipes were identified online and the majority of respondents reported cooking from online videos some or all of the time. Participants gave the highest overall ratings to the 2-4 minute cooking video and highlighted the host personality and video production as important aspects of online cooking video content.ConclusionsThe findings of this study offer insight to inform the development of digital culinary medicine tools for MD Anderson's cancer prevention and control cohorts.

IntroductionNeuroendocrine tumors (NETs) are rare and heterogeneous. Everolimus, an inhibitor of the mammalian target of rapamycin (mTOR), is widely used in gastrointestinal and pancreatic NETs (GEP-NETs). Owing to the lack of validated biomarkers, exploratory analyses of molecular pathways may help identify subgroups that derive clinical benefit from everolimus.MethodsWe conducted a retrospective observational cohort study of patients with GEP-NETs who received everolimus and underwent tumor next-generation sequencing (NGS). Genomic alterations were categorized into seven predefined signaling pathways (PI3K/AKT/mTOR, MAPK, DNA damage repair (DDR), developmental, epigenetic regulation, JAK-STAT, and cell-cycle regulation), and patients were classified as mutated (≥1 alteration) or wild-type. Clinical outcomes included objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS). Associations between pathway alterations and outcomes were assessed.ResultsTwenty-eight patients were included. Median PFS was 26.4 months (95% CI, 17.3-37.1) and median OS was 41.0 months (95% CI, 36.6-not reached [NR]). Alterations in the PI3K/AKT/mTOR pathway were associated with more favorable treatment outcomes, including a higher ORR (47.6% vs. 14.3%; OR, 5.17; 95% CI, 0.49-275.05; p=0.191) and a significantly higher DCR (85.7% vs. 28.6%; OR, 13.0; 95% CI, 1.40-199.5; p=0.009). Survival outcomes also tended to be longer in this group compared with wild-type tumors, with median OS of 59.0 vs. 40.8 months (p=0.321) and median PFS of 26.4 vs. 18.6 months (p=0.858). In contrast, alterations in DDR-related genes were associated with lower ORR and DCR, while alterations in cell-cycle regulation pathways were associated with shorter OS and PFS and numerically lower response rates. No significant differences in survival or response outcomes were observed for MAPK, JAK-STAT, epigenetic, or developmental pathways.ConclusionsPathway-level genomic alterations were associated with differential clinical benefit from everolimus in GEP-NETs, with PI3K/AKT/mTOR alterations suggesting greater benefit, while DDR and cell-cycle alterations indicated reduced benefit. Despite the small cohort, these findings support the potential of pathway-based biomarkers and warrant prospective validation.

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.

IntroductionTriple-negative breast cancer (TNBC) represents approximately 10-20% of all breast cancer cases and is frequently associated with BRCA1 mutations. Numerous studies from Western populations have investigated the prevalence of germline BRCA mutations in individuals with TNBC; however, the prevalence of BRCA1/2 mutations in TNBC patients varies widely between countries and from study to study. Evidence from Asian populations, particularly Vietnamese patients, remains limited. In this study, we determined the prevalence of germline BRCA1/2 mutations among unselected Vietnamese patients with TNBC and analyzed the clinicopathological features.MethodsWe conducted a single-center retrospective study of 68 women diagnosed with TNBC at the Vietnam National Cancer Hospital. Germline BRCA1/2 testing was performed by next-generation sequencing.ResultsOverall, 19 Vietnamese patients (27.9%) had BRCA1/2 mutations, with 14 (20.6%) in BRCA1 and 5 (7.4%) in BRCA2. Three patients (4.4%) had variants of uncertain significance (2 BRCA1 mutations and 1 BRCA2 mutation). Thirteen distinct pathogenic or likely pathogenic variants (8 BRCA1 and 5 BRCA2) were found. Among patients diagnosed at ≤60 years, the prevalence of BRCA1/2 mutations was 32.0%. The average age at diagnosis for BRCA1/2 mutation carriers was notably lower than that observed in non-carriers (43.1 vs 51.7 years, P = .021). BRCA1/2 mutation carriers were also more frequently premenopausal (78.6% vs 43.9%, P = .025).ConclusionsThere is a high prevalence of BRCA1/2 mutations among TNBC patients in Vietnam. Women with TNBC in Vietnam should be screened for mutations in BRCA1/2.

PurposeThis cross-sectional study explored associations of BMI with renal cell carcinoma (RCC) pathological grade and stage, and how these associations vary by BMI-related factors, to better understand the obesity paradox.MethodData was obtained from 2 academic institutions for this cross-sectional study of RCC patients who underwent surgical treatment. Logistic regression models were used to identify BMI-related factors and to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for diagnosis with high grade or advanced stage.ResultsA total of 1949 cases, 1526 from Roswell Park Comprehensive Cancer Center (Roswell Park) and 423 from University of Arizona Baner-University Medical Center Tucson (BUMCT), were included. In both datasets, obesity was significantly associated with lower odds of high grade compared with non-obese (OR 0.69, 95% CI 0.54-0.88 in Roswell Park, OR 0.62, 95% CI 0.41-0.94 in BUMCT). In Roswell Park, unintentional weight loss at the time of surgery was associated with higher odds of high grade (OR 3.81, 95% CI 2.38-6.09) and advanced stage (OR 4.12, 95% CI 2.74-6.20). In both datasets, older age was associated with reduced odds of obesity and higher odds of high grade, and heterogeneous associations between obesity and high grade by age group were observed (P_Interaction = 0.001) in Roswell Park. Former smokers had increased odds of obesity in BUMCT and increased odds of high grade in both datasets. In BUMCT, obesity was significantly associated with reduced odds of high grade in patients who never smoked, not in patients who have smoked, but heterogeneity by smoking status was not significant.ConclusionHigher BMI was linked to a lower likelihood of high-risk RCC pathological characteristics consistent with the obesity paradox. However, BMI-related factors, including older age and smoking, were associated with higher odds of RCC severity, potentially modifying the associations between BMI and severity.

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.