Cancer Control最新文献

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.

IntroductionColorectal cancer (CRC) has a lengthy cellular mutation period and early onset (EOCRC) is linked to lifestyle-related factors. Primary prevention approaches earlier in the life course are needed. Emerging adulthood (age 18-25) is a critical stage for shaping health trajectories, and future orientation influences health behavior decisions. Little is known about emerging adults' consideration of future cancer risk (CFC-Cancer), or perceived CRC risk. This study characterizes emerging adult CFC-Cancer, perceived CRC risk, and how they relate to EOCRC lifestyle related factors and cancer prevention behaviors.MethodsWe conducted a cross-sectional survey of college students at a public university. Measures included demographics, stress, family cancer history, and CRC knowledge. Previously validated measures for diet, sedentariness, smoking, alcohol consumption, and stress management assessed adherence with lifestyle prevention guidelines. HPV vaccination and skin checks appraised cancer prevention. Outcomes included perceived CRC risk (0%-100%) and CFC-Cancer adapted scale. Adjusted linear regression models examined CFC-Cancer and perceived CRC risk predictability.ResultsThe sample (N = 282) mean age was 20 years, 77% were female, 40% were White, and 67% had family cancer history. CRC knowledge μ = 14, and current stress was moderate. 18% completed both cancer prevention behaviors, and protective lifestyle behavior scores ranged between 2-15, μ = 8. Perceived CRC risk = 28%, and CFC-Cancer was moderate (μ = 61). CFC-Cancer model included significant predictors of GPA, CRC knowledge, and lifestyle health behavior score, while Perceived CRC Risk model included age and being employed.ConclusionEmerging adults overestimate CRC risk but also have moderate CFC-Cancer. Accurate CRC knowledge provided to this age group may help redirect CRC health trajectories through integration of EOCRC protective lifestyle health behaviors and sustaining them into adulthood.

Introduction: Small-cell lung cancer (SCLC) is a leading cause of cancer-related mortality worldwide, with limited therapeutic outcomes and poor prognosis. Accurate diagnosis and optimal surgical decision-making remain critical challenges. This study aimed to develop and validate a clinical-radiomics nomogram integrating computed tomography (CT) radiomic features of the peritumoral region and clinical factors to improve SCLC diagnosis and guide surgical planning.Methods: A retrospective cohort of 113 patients (54 SCLC, 59 non-small cell lung cancer) was analyzed. CT images were processed to extract 1050 radiomic features from both intratumoral and peritumoral (2-mm expanded) ROIs. Feature selection was performed using t-tests, LASSO regression, and mRMR analysis. Logistic regression models were constructed for original and expanded ROIs, and a clinical-radiomics nomogram was developed by combining significant radiomic features with independent clinical predictors (gender, smoking history, tumor diameter, glitch, and neuron-specific enolase levels). Model performance was evaluated using ROC curves, AUC, sensitivity, specificity, and CIC curves.Results: The expanded ROI radiomics model outperformed the original ROI and clinical models, achieving higher accuracy (0.83 vs 0.76/0.70), sensitivity (0.80 vs 0.74/0.77), specificity (0.85 vs 0.75/0.65), and AUC (0.85 vs 0.76/0.71). The clinical-radiomics nomogram demonstrated superior diagnostic performance, with an AUC of 0.96 (95% CI: 0.88-1.00), accuracy of 0.91, sensitivity of 0.92, and specificity of 0.90. CIC analysis confirmed its clinical utility for surgical decision-making at intermediate-risk thresholds.Conclusion: The integration of peritumoral radiomic features and clinical factors into a nomogram provides a non-invasive tool for SCLC diagnosis and surgical planning. The superiority of the expanded model substantiates the potential presence of SCLC in peri-tumoral tissues that may be imperceptible through conventional imaging, thereby offering guidance for surgical decision-making. This approach has potential for improving treatment outcomes and warrants further validation in multicenter studies.

Breast cancer remains the malignant tumor with the highest incidence among female patients globally, and its treatment represents a well-recognized clinical challenge. Recent studies have demonstrated that the tumor microenvironment (TME) exerts a substantial influence on breast cancer progression, whereby alterations in its internal molecular components ultimately impact disease outcomes. Key factors implicated in this process include adipokines and microRNAs (miRNAs). This review provides a detailed description of how different adipocytokines exert specific mechanistic effects on breast cancer cells. By integrating adipokines with miRNAs, the discussion explores their combined roles in the initiation and progression of breast cancer, addressing a previously unaddressed research gap in studies focusing solely on individual adipokines. Furthermore, by examining the interactions between miRNAs and signaling pathways, this analysis offers a holistic perspective on the TME network, thereby fostering new therapeutic insights for breast cancer management.

IntroductionHepatitis B and C (HBV/HCV) are bloodborne infections, with individuals who have histories of substance use and homelessness bearing a disproportionate risk. Long-standing difficulties in engaging these populations have made testing and treatment challenging. This retrospective observational study describes a community-based approach to HBV/HCV prevention and treatment, comparing the effectiveness of different engagement site types in reaching and engaging this high-need population.MethodsGRASSROOTS HEALTH was launched in 2018 to improve HBV/HCV care by providing on-site testing, HBV vaccination, treatment navigation, and adherence support across various housing and drop-in centers. Outcomes were tracked through REDCap and analyzed by engagement site.ResultsGRASSROOTS HEALTH reached nearly 2000 clients, with the greatest needs for HCV treatment in drop-in centers and HBV vaccination in low-income/permanent supportive housing. All sites demonstrated a relatively high return on effort, as evidenced by the percentage of participants needing HBV vaccination or HCV/HBV treatment.ConclusionEngaging individuals through housing and service centers effectively reached a high-need community, with findings suggesting that different engagement points may enhance outreach based on the primary focus (HCV treatment vs HBV vaccination).

IntroductionThis retrospective study compares the outcomes of right hemicolectomy (RHC) and extended right hemicolectomy (ERHC) in patients with hepatic flexure and proximal transverse colon tumors.MethodsData from 85 patients who underwent surgery for colonic adenocarcinoma between January 2015 and December 2023 were analyzed retrospectively. Patients who had hepatic flexure and proximal transverse colon tumors were included in the analysis. Patients were divided into two groups: RHC and ERHC. The primary endpoints were overall survival (OS) and disease-free survival (DFS), with secondary outcomes including postoperative complications and pathological data.ResultsThe RHC group comprised 46 patients, while the EHRC group had 39 patients. The study found no significant difference in 5-year OS (77% RHC vs 69% ERHC, P = 0.135) or 5-year DFS (87% RHC vs 81% ERHC, P = 0.388) between the two groups. Although the ERHC group had a higher number of harvested lymph nodes (27 vs 22, P = 0.022), this did not correlate with improved survival outcomes. Tumor localization was identified as a significant factor influencing OS, with hepatic flexure tumors showing better survival compared to proximal transverse colon tumors. No significant differences were observed between the groups regarding postoperative complications.ConclusionOur study suggests that while ERHC leads to a higher lymph node yield, it does not significantly improve survival outcomes compared to RHC in patients with hepatic flexure and proximal transverse colon tumors. Further research is needed to optimize surgical strategies and improve patient outcomes.

BackgroundPatients with liver cirrhosis are at a higher risk of developing non-hepatic cancers (NHC) than general population. Considering that NHC causes poor outcomes, it is necessary to explore the prevalence of NHC in such patients and identify its associated risk factors.MethodsPatients with a diagnosis of liver cirrhosis who were consecutively admitted to our hospital between January 1, 2010 and June 30, 2014 were retrospectively screened. They were divided into NHC, primary liver cancer (PLC), and non-cancer groups. After adjusting for age and sex, logistic regression analyses were performed to explore the risk factors of NHC in patients with cirrhosis. Adjusted odds ratios (aORs) with their 95% confidence intervals (CIs) were calculated.ResultsOverall, 2509 patients with cirrhosis were included. Prevalence of NHC and PLC was 6.22% (156/2509) and 22.20% (557/2509), respectively. After adjusting for age and sex, the NHC group had a significantly higher proportion of history of smoking (aOR = 1.994; 95% CI = 1.231-3.231, P = 0.005), but lower proportions of history of encephalopathy (aOR = 0.344; 95% CI = 0.147- 0.804, P = 0.014) and history of heart disease (aOR = 0.300; 95% CI = 0.173-0.519, P < 0.001) as compared to the non-cancer group. Hepatitis B virus infection (aOR = 0.863; 95% CI = 0.581-1.281, P = 0.465), hepatitis C virus infection (aOR = 0.908; 95% CI = 0.503-1.642, P = 0.750), and alcohol abuse alone (aOR = 1.254; 95% CI = 0.779-2.017, P = 0.351) as the etiology of liver cirrhosis were not significantly associated with the risk of NHC.ConclusionsSmoking may be associated with a higher probability of NHC in patients with cirrhosis, but the probability of NHC may be compromised by encephalopathy or heart disease.

IntroductionCancer screening programs are pivotal in facilitating early tumor detection and reducing cancer-related mortality. However, the reliance on individual performance indicators may not offer a fully integrated perspective of screening effectiveness. This study aimed to develop a composite indicator that consolidates key screening metrics using Principal Component Analysis (PCA) to derive objective weights.MethodsData were drawn from the annual collection of breast and colorectal cancer screening activities conducted in 2023 by the eight regional health authorities (ATSs) of Lombardy, Italy. Indicators spanning structural, organizational, clinical-diagnostic, and impact dimensions were standardized and analyzed using PCA. The resulting factor loadings informed weights for computing a weighted arithmetic mean of the z-scored indicators. Robustness was evaluated through sensitivity analyses involving alternative normalization techniques. Additionally, comparisons were made against an equally weighted arithmetic mean of the same indicators.ResultsThe composite indicator identified marked geographical variations in screening performance across Lombardy's ATSs. Structural and organizational factors, particularly examination coverage and participation rates, exerted the greatest influence on overall effectiveness in both breast and colorectal screening programs. In contrast, clinical-diagnostic and impact measures, as well as invitation coverage, contributed less substantially. High correlations in the sensitivity analyses affirmed the reliability of the proposed methodology.ConclusionsAdopting a composite indicator can substantially improve the evaluation of cancer screening initiatives by integrating diverse metrics into a cohesive, objective framework. In doing so, it enables more effective resource allocation, enhances adherence strategies, and guides targeted interventions aimed at bolstering screening success.

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.