Yongying Huang,Giola Santoni,Jessica L Petrick,Victoria Wocalewski,Ernesto Sparrelid,Shao-Hua Xie
BACKGROUNDPrevious studies have suggested a potential role of sex hormones in the development of liver cancer. This study aimed to examine whether menopausal hormone therapy (MHT) is associated with a decreased risk of liver cancer by histological type.METHODThis Swedish population-based cohort study included 217,878 women who received MHT in 2006 to 2023 and an age-matched comparison group of 1,089,390 women who did not receive MHT. Cox regression assessed the associations between use of MHT and the risk of two main subtypes of liver cancer, ie, hepatocellular carcinoma and intrahepatic cholangiocarcinoma, with adjustment for smoking- and alcohol-related diagnoses, non-alcoholic fatty liver disease, diabetes or obesity, hysterectomy, use of non-steroidal anti-inflammatory drugs or aspirin, and use of statins.RESULTSMHT users had a decreased risk of hepatocellular carcinoma (hazard ratio [HR] 0.45, 95% confidence interval [CI] 0.29 to 0.70). Decreased HRs of hepatocellular carcinoma were indicated both in users of estrogen only (HR 0.42, 95% CI 0.21 to 0.86) and estrogen combined with progestogen (HR 0.49, 95% CI 0.28 to 0.85). The risk reduction in hepatocellular carcinoma was apparently more pronounced in users aged 60 years or older (HR 0.37, 95% CI 0.19 to 0.75). Use of MHT was not associated with the risk of intrahepatic cholangiocarcinoma (HR 0.99, 95% CI 0.72 to 1.36).CONCLUSIONSMHT in women may decrease the risk of hepatocellular carcinoma, but not intrahepatic cholangiocarcinoma.
背景先前的研究表明性激素在肝癌的发展中有潜在的作用。本研究旨在探讨绝经期激素治疗（MHT）是否与组织学类型的肝癌风险降低相关。方法：这项以瑞典人群为基础的队列研究包括217,878名在2006年至2023年间接受MHT治疗的女性，以及1089,390名未接受MHT治疗的年龄匹配的对照组。Cox回归评估了MHT的使用与两种主要肝癌亚型（即肝细胞癌和肝内胆管癌）风险之间的关联，并对吸烟和酒精相关诊断、非酒精性脂肪肝、糖尿病或肥胖、子宫切除术、非甾体抗炎药或阿司匹林的使用以及他汀类药物的使用进行了调整。结果smht使用者发生肝细胞癌的风险降低（风险比[HR] 0.45, 95%可信区间[CI] 0.29 ~ 0.70）。单独使用雌激素（HR = 0.42, 95% CI = 0.21 ~ 0.86）和雌激素联合使用孕激素（HR = 0.49, 95% CI = 0.28 ~ 0.85）均可降低肝细胞癌的HR。肝细胞癌的风险降低在60岁或以上的使用者中更为明显（HR 0.37, 95% CI 0.19至0.75）。MHT的使用与肝内胆管癌的风险无关（HR 0.99, 95% CI 0.72 ~ 1.36）。结论smht可降低女性患肝细胞癌的风险，但不能降低肝内胆管癌的风险。
{"title":"Menopausal hormone therapy and risk of liver cancer in a swedish population-based cohort study.","authors":"Yongying Huang,Giola Santoni,Jessica L Petrick,Victoria Wocalewski,Ernesto Sparrelid,Shao-Hua Xie","doi":"10.1093/jnci/djag084","DOIUrl":"https://doi.org/10.1093/jnci/djag084","url":null,"abstract":"BACKGROUNDPrevious studies have suggested a potential role of sex hormones in the development of liver cancer. This study aimed to examine whether menopausal hormone therapy (MHT) is associated with a decreased risk of liver cancer by histological type.METHODThis Swedish population-based cohort study included 217,878 women who received MHT in 2006 to 2023 and an age-matched comparison group of 1,089,390 women who did not receive MHT. Cox regression assessed the associations between use of MHT and the risk of two main subtypes of liver cancer, ie, hepatocellular carcinoma and intrahepatic cholangiocarcinoma, with adjustment for smoking- and alcohol-related diagnoses, non-alcoholic fatty liver disease, diabetes or obesity, hysterectomy, use of non-steroidal anti-inflammatory drugs or aspirin, and use of statins.RESULTSMHT users had a decreased risk of hepatocellular carcinoma (hazard ratio [HR] 0.45, 95% confidence interval [CI] 0.29 to 0.70). Decreased HRs of hepatocellular carcinoma were indicated both in users of estrogen only (HR 0.42, 95% CI 0.21 to 0.86) and estrogen combined with progestogen (HR 0.49, 95% CI 0.28 to 0.85). The risk reduction in hepatocellular carcinoma was apparently more pronounced in users aged 60 years or older (HR 0.37, 95% CI 0.19 to 0.75). Use of MHT was not associated with the risk of intrahepatic cholangiocarcinoma (HR 0.99, 95% CI 0.72 to 1.36).CONCLUSIONSMHT in women may decrease the risk of hepatocellular carcinoma, but not intrahepatic cholangiocarcinoma.","PeriodicalId":501635,"journal":{"name":"Journal of the National Cancer Institute","volume":"129 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147495027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maya Aboumrad, Corinne Joshu, John Jackson, Kala Visvanathan
Background Women with major depressive disorder (MDD) who develop breast cancer have higher breast cancer recurrence compared to women without MDD. The reason for the higher recurrence is hypothesized to be multifactorial. We sought to determine whether non-adherence to antidepressants is associated with increased recurrence among women with MDD and breast cancer. Methods We established a retrospective cohort of 6,051 women (age ≥ 18 years), with and without MDD, who were diagnosed with early-stage invasive breast cancer between 2010 to 2019 with follow-up through 2022 using medical record data from the United States Veterans Affairs Healthcare System. We assessed antidepressant adherence in women with MDD over two-years prior to breast cancer diagnosis. We evaluated multiple adherence thresholds (proportion of medication days covered), ranging from ≥20%-100%. We used multivariable competing-risks regression to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the statistical interaction between MDD and antidepressant adherence on recurrence, adjusting for sociodemographic, clinical, and prognostic factors. Results Among women with MDD and breast cancer (N = 1,754), 94% initiated an antidepressant. A threshold of 60% was the minimum adherence level for there to be a statistically meaningful difference in recurrence between non-adherent and adherent women with MDD. Thirty-nine percent were non-adherent at this threshold. The association between MDD and recurrence was highest among women who did not use antidepressants (HR = 2.20; 95%CI = 1.54-3.15), followed by women who were non-adherent (HR = 1.52; 95%CI = 1.24-1.86), and lowest among women who were adherent (HR = 1.19; 95%CI = 0.99-1.42). Conclusion Adherence to antidepressants could potentially reduce recurrence in patients with breast cancer and MDD.
{"title":"Antidepressant adherence and breast cancer recurrence risk in women with major depressive disorder: a retrospective cohort","authors":"Maya Aboumrad, Corinne Joshu, John Jackson, Kala Visvanathan","doi":"10.1093/jnci/djag076","DOIUrl":"https://doi.org/10.1093/jnci/djag076","url":null,"abstract":"Background Women with major depressive disorder (MDD) who develop breast cancer have higher breast cancer recurrence compared to women without MDD. The reason for the higher recurrence is hypothesized to be multifactorial. We sought to determine whether non-adherence to antidepressants is associated with increased recurrence among women with MDD and breast cancer. Methods We established a retrospective cohort of 6,051 women (age ≥ 18 years), with and without MDD, who were diagnosed with early-stage invasive breast cancer between 2010 to 2019 with follow-up through 2022 using medical record data from the United States Veterans Affairs Healthcare System. We assessed antidepressant adherence in women with MDD over two-years prior to breast cancer diagnosis. We evaluated multiple adherence thresholds (proportion of medication days covered), ranging from ≥20%-100%. We used multivariable competing-risks regression to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the statistical interaction between MDD and antidepressant adherence on recurrence, adjusting for sociodemographic, clinical, and prognostic factors. Results Among women with MDD and breast cancer (N = 1,754), 94% initiated an antidepressant. A threshold of 60% was the minimum adherence level for there to be a statistically meaningful difference in recurrence between non-adherent and adherent women with MDD. Thirty-nine percent were non-adherent at this threshold. The association between MDD and recurrence was highest among women who did not use antidepressants (HR = 2.20; 95%CI = 1.54-3.15), followed by women who were non-adherent (HR = 1.52; 95%CI = 1.24-1.86), and lowest among women who were adherent (HR = 1.19; 95%CI = 0.99-1.42). Conclusion Adherence to antidepressants could potentially reduce recurrence in patients with breast cancer and MDD.","PeriodicalId":501635,"journal":{"name":"Journal of the National Cancer Institute","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147489362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Farhad Islami,Whitney E Zahnd,Daniel Wiese,Hyuna Sung,Elizabeth J Schafer,Rebecca L Siegel,Ahmedin Jemal
Understanding long-term trends in cancer mortality in rural and urban areas can provide additional insight into factors contributing to rural-urban disparities in cancer mortality and inform public policies. We examined trends in age-standardized cancer mortality rates (overall, lung, colorectal, female breast, and prostate cancers) by urbanicity of county of residence using National Center for Health Statistics data. During 1969-2023, the highest all-cancer mortality rates shifted from large metropolitan areas to nonmetropolitan areas with the smallest urban population. The crossover occurred in the 1990s in males and early 2000s in females, with the rural-urban mortality gap widening in subsequent years. A similar pattern was observed for lung, colorectal, and breast cancer mortality. The shift in the high cancer burden from urban to rural areas likely reflects geographic redistribution of social determinants of health, which underpins the cancer continuum from exposure to risk factors and prevention to access to high-quality diagnosis and treatment.
{"title":"Long-term trends in cancer mortality by rural-urban status, United States, 1969-2023.","authors":"Farhad Islami,Whitney E Zahnd,Daniel Wiese,Hyuna Sung,Elizabeth J Schafer,Rebecca L Siegel,Ahmedin Jemal","doi":"10.1093/jnci/djag047","DOIUrl":"https://doi.org/10.1093/jnci/djag047","url":null,"abstract":"Understanding long-term trends in cancer mortality in rural and urban areas can provide additional insight into factors contributing to rural-urban disparities in cancer mortality and inform public policies. We examined trends in age-standardized cancer mortality rates (overall, lung, colorectal, female breast, and prostate cancers) by urbanicity of county of residence using National Center for Health Statistics data. During 1969-2023, the highest all-cancer mortality rates shifted from large metropolitan areas to nonmetropolitan areas with the smallest urban population. The crossover occurred in the 1990s in males and early 2000s in females, with the rural-urban mortality gap widening in subsequent years. A similar pattern was observed for lung, colorectal, and breast cancer mortality. The shift in the high cancer burden from urban to rural areas likely reflects geographic redistribution of social determinants of health, which underpins the cancer continuum from exposure to risk factors and prevention to access to high-quality diagnosis and treatment.","PeriodicalId":501635,"journal":{"name":"Journal of the National Cancer Institute","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arthur S Hong,Michael D Dang,Vincent Merrill,Kathryn Anderson,Liyang Yuan,Isabella Joseph,Sadaf Charania,Gloria Lin,Lauren L Taylor,Angela F Bazzell,Aman Narayan,Usamah N Chaudhary,Samar Bhat,Carolina De La Porte,Nkoyo Effiom,Karina Gomez,Pranathi Pilla,D Mark Courtney,Navid Sadeghi,Ethan A Halm
BACKGROUNDMedicare's OP-35 measure tracks unplanned hospital visits within 30 days of chemotherapy and defines a subset as "potentially avoidable" using ∼300 diagnosis codes. Despite widespread adoption in policy and oncology quality reporting, the measure has not been validated with clinician review.METHODSWe identified 14,220 acute hospital visits within 30 days of chemotherapy (2016 to 2023) from 22 hospitals in three health systems (academic, safety-net, community). A 5% stratified random sample of 705 visits underwent blinded review by three clinicians, who adjudicated avoidability and assigned a clinical classification for each visit (eg non-emergent care occurring overnight; non-urgent blood product transfusion; uncontrolled symptoms requiring hospital care). The gold standard definition for an avoidable visit was based on a majority of the clinicians. We assessed the diagnostic characteristics of OP-35 using sensitivity, specificity, accuracy, and area under receiver operator curve (AUROC). We used the clinical classifications to develop a new set of Actionable Categories of avoidability and assessed its diagnostic characteristics.RESULTSClinicians judged 30.2% of visits (213/705) as avoidable. OP-35 classified a similar proportion (30.8%, 217/705), but agreement was low. Sensitivity of OP-35 was 34.7% (95% CI, 28.2 to 41.6), specificity 70.9% (95% CI, 66.7 to 74.8), and accuracy 59.9% (95% CI, 56.2 to 63.6), with AUROC of 0.53. The Actionable Categories classification performed better: sensitivity 89.7%, specificity 85.2%, accuracy 86.5%, AUROC 0.87.CONCLUSIONOP-35 showed poor agreement with clinicians for avoidable hospital visits, raising concerns about its clinical validity. An alternative classification system grouping visits into actionable clinical scenarios offered superior diagnostic accuracy.
{"title":"Clinician validation of the Medicare measure for potentially avoidable hospital visits after chemotherapy.","authors":"Arthur S Hong,Michael D Dang,Vincent Merrill,Kathryn Anderson,Liyang Yuan,Isabella Joseph,Sadaf Charania,Gloria Lin,Lauren L Taylor,Angela F Bazzell,Aman Narayan,Usamah N Chaudhary,Samar Bhat,Carolina De La Porte,Nkoyo Effiom,Karina Gomez,Pranathi Pilla,D Mark Courtney,Navid Sadeghi,Ethan A Halm","doi":"10.1093/jnci/djag081","DOIUrl":"https://doi.org/10.1093/jnci/djag081","url":null,"abstract":"BACKGROUNDMedicare's OP-35 measure tracks unplanned hospital visits within 30 days of chemotherapy and defines a subset as \"potentially avoidable\" using ∼300 diagnosis codes. Despite widespread adoption in policy and oncology quality reporting, the measure has not been validated with clinician review.METHODSWe identified 14,220 acute hospital visits within 30 days of chemotherapy (2016 to 2023) from 22 hospitals in three health systems (academic, safety-net, community). A 5% stratified random sample of 705 visits underwent blinded review by three clinicians, who adjudicated avoidability and assigned a clinical classification for each visit (eg non-emergent care occurring overnight; non-urgent blood product transfusion; uncontrolled symptoms requiring hospital care). The gold standard definition for an avoidable visit was based on a majority of the clinicians. We assessed the diagnostic characteristics of OP-35 using sensitivity, specificity, accuracy, and area under receiver operator curve (AUROC). We used the clinical classifications to develop a new set of Actionable Categories of avoidability and assessed its diagnostic characteristics.RESULTSClinicians judged 30.2% of visits (213/705) as avoidable. OP-35 classified a similar proportion (30.8%, 217/705), but agreement was low. Sensitivity of OP-35 was 34.7% (95% CI, 28.2 to 41.6), specificity 70.9% (95% CI, 66.7 to 74.8), and accuracy 59.9% (95% CI, 56.2 to 63.6), with AUROC of 0.53. The Actionable Categories classification performed better: sensitivity 89.7%, specificity 85.2%, accuracy 86.5%, AUROC 0.87.CONCLUSIONOP-35 showed poor agreement with clinicians for avoidable hospital visits, raising concerns about its clinical validity. An alternative classification system grouping visits into actionable clinical scenarios offered superior diagnostic accuracy.","PeriodicalId":501635,"journal":{"name":"Journal of the National Cancer Institute","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mahdi Nalini,Katie M O'Brien,Antonia M Calafat,Lanqing Wang,Jun Feng,Christopher M Reese,Baoyun Xia,Julianne Cook Botelho,Yuesong Wang,Tiffany Seyler,Esther J Roh,Nicole A Tashakkori,Aaron Blakney,Kerui Xu,Mitchell H Gail,Benjamin C Blount,Cindy M Chang,Christian C Abnet,Dale P Sandler,Neal D Freedman,Arash Etemadi
BACKGROUNDThe constituents of tobacco smoke that specifically contribute to lung cancer risk have yet to be fully identified. We evaluated associations between biomarkers of potentially harmful constituents-polycyclic aromatic hydrocarbons (PAHs), tobacco-specific nitrosamines (TSNAs), nicotine, and volatile organic compounds (VOCs)-and lung cancer incidence among US women.METHODSIn a case-cohort study nested within the Sister Study (women aged 35 to 74 years at baseline, enrolled 2003 to 2009), data were obtained for a random subcohort and all remaining incident lung cancers through September 2017 (median follow-up 9.6 years), stratified by race and ethnicity (Hispanic, non-Hispanic Black, non-Hispanic White, others) and smoking status (current, former, never). The analytic sample included 356 cases and 433 non-cases. We quantified 30 biomarkers in baseline urine samples and calculated hazard ratios (HRs) for associations between one-unit increase in biomarker concentrations (log-scale) and lung cancer incidence using weighted Cox regression models adjusted for urinary creatinine and demographic, health, and lifestyle factors.RESULTSAmong women who were currently smoking at enrolment, positive associations were observed for biomarkers of PAHs (naphthalene, phenanthrene, pyrene, fluorene; HRs 1.4 to 5.3), TSNAs (particularly 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK); HRs : 1.3-2.2), and VOCs (xylene, acrylamide, acrylonitrile, 1,2-dibromoethane/vinyl-chloride/ethylene-oxide/acrylonitrile, acrolein, styrene/ethylbenzene, benzene, dimethylformamide/methylisocyanate, 1,3-butadiene, crotonaldehyde, isoprene; HRs : 1.6-4.4). Associations with biomarkers of most PAHs, NNK, xylene, and dimethylformamide/methylisocyanate remained after additional adjustment for smoking frequency, duration, and nicotine metabolites. In women who did not smoke, positive associations were observed for styrene/ethylbenzene and dimethylformamide/methylisocyanate biomarkers.CONCLUSIONExposure to PAHs, TSNAs and several VOCs through tobacco smoking were associated with increased lung cancer risk among women.
{"title":"Tobacco-related urinary biomarkers and lung cancer risk in women, a case-cohort analysis.","authors":"Mahdi Nalini,Katie M O'Brien,Antonia M Calafat,Lanqing Wang,Jun Feng,Christopher M Reese,Baoyun Xia,Julianne Cook Botelho,Yuesong Wang,Tiffany Seyler,Esther J Roh,Nicole A Tashakkori,Aaron Blakney,Kerui Xu,Mitchell H Gail,Benjamin C Blount,Cindy M Chang,Christian C Abnet,Dale P Sandler,Neal D Freedman,Arash Etemadi","doi":"10.1093/jnci/djag078","DOIUrl":"https://doi.org/10.1093/jnci/djag078","url":null,"abstract":"BACKGROUNDThe constituents of tobacco smoke that specifically contribute to lung cancer risk have yet to be fully identified. We evaluated associations between biomarkers of potentially harmful constituents-polycyclic aromatic hydrocarbons (PAHs), tobacco-specific nitrosamines (TSNAs), nicotine, and volatile organic compounds (VOCs)-and lung cancer incidence among US women.METHODSIn a case-cohort study nested within the Sister Study (women aged 35 to 74 years at baseline, enrolled 2003 to 2009), data were obtained for a random subcohort and all remaining incident lung cancers through September 2017 (median follow-up 9.6 years), stratified by race and ethnicity (Hispanic, non-Hispanic Black, non-Hispanic White, others) and smoking status (current, former, never). The analytic sample included 356 cases and 433 non-cases. We quantified 30 biomarkers in baseline urine samples and calculated hazard ratios (HRs) for associations between one-unit increase in biomarker concentrations (log-scale) and lung cancer incidence using weighted Cox regression models adjusted for urinary creatinine and demographic, health, and lifestyle factors.RESULTSAmong women who were currently smoking at enrolment, positive associations were observed for biomarkers of PAHs (naphthalene, phenanthrene, pyrene, fluorene; HRs 1.4 to 5.3), TSNAs (particularly 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK); HRs : 1.3-2.2), and VOCs (xylene, acrylamide, acrylonitrile, 1,2-dibromoethane/vinyl-chloride/ethylene-oxide/acrylonitrile, acrolein, styrene/ethylbenzene, benzene, dimethylformamide/methylisocyanate, 1,3-butadiene, crotonaldehyde, isoprene; HRs : 1.6-4.4). Associations with biomarkers of most PAHs, NNK, xylene, and dimethylformamide/methylisocyanate remained after additional adjustment for smoking frequency, duration, and nicotine metabolites. In women who did not smoke, positive associations were observed for styrene/ethylbenzene and dimethylformamide/methylisocyanate biomarkers.CONCLUSIONExposure to PAHs, TSNAs and several VOCs through tobacco smoking were associated with increased lung cancer risk among women.","PeriodicalId":501635,"journal":{"name":"Journal of the National Cancer Institute","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joshua N Herb,Chung-Yuan Hu,Sharon H Giordano,George J Chang,Rebecca A Snyder
BACKGROUNDSocial determinants of health (SDOH) impact long-term cancer outcomes. Since 2015, the Centers for Medicare & Medicaid Services recommends using International Classification of Diseases diagnosis codes Z55-Z65 to document specific SDOH. We examined the association of these Z-codes with survival in patients with cancer.METHODSPatients with breast, colorectal, lung, prostate, or pancreatic cancer were identified in the SEER-Medicare database (2016 to 2019). The primary exposure was a Z-code claim in the 12 months before or 6 months after cancer diagnosis. The primary outcome was overall survival. Multivariable Cox regression was performed to examine the association of Z-code claims with overall survival, controlling for demographic and clinical covariates.RESULTSOf 210,093 patients, 4,351 (2.1%) had at least one Z-code claim. The most frequent codes were for problems with social environment (Z60 47.3%) or a primary support group (Z63: 27.2%). Codes were submitted most often by home health agencies (57.8%) and least often by inpatient facilities (1.7%). In adjusted analyses, any Z-code claim was associated with worse survival than was no claim (hazard ratio, 1.09 [95% CI, 1.05-1.14]; p < 0.01), although the associations varied by Z-code.CONCLUSIONSSDOH Z-codes are rarely submitted with billing claims for Medicare patients with cancer. Whether Z-codes reflect the social needs of patients with cancer remains unclear. With current coding, any SDOH Z-code is associated with poor survival in these patients, but individual Z-codes are not consistently associated with survival. Further studies should determine whether SDOH Z-codes enable effective risk adjustment in a value-based healthcare system.
健康的社会决定因素（SDOH）影响癌症的长期预后。自2015年以来，医疗保险和医疗补助服务中心建议使用国际疾病分类诊断代码Z55-Z65来记录特定的SDOH。我们检查了这些z码与癌症患者生存的关系。方法在SEER-Medicare数据库（2016年至2019年）中确定乳腺癌、结直肠癌、肺癌、前列腺癌或胰腺癌患者。主要暴露是在癌症诊断前12个月或癌症诊断后6个月的z码声明。主要终点是总生存期。在控制人口统计学和临床协变量的情况下，采用多变量Cox回归来检验Z-code索赔与总生存率的关系。结果210,093例患者中，有4,351例（2.1%）至少有一次z码索赔。最常见的代码是社会环境问题（Z60: 47.3%）或主要支持小组（Z63: 27.2%）。家庭保健机构提交代码的频率最高（57.8%），住院机构提交代码的频率最低（1.7%）。在调整后的分析中，任何Z-code索赔与没有索赔的生存率相关（风险比为1.09 [95% CI, 1.05-1.14]; p < 0.01），尽管Z-code的相关性有所不同。结论ssdoh z码很少与医疗保险癌症患者的账单索赔一起提交。z码是否反映了癌症患者的社会需求尚不清楚。根据目前的编码，任何SDOH Z-code都与这些患者的低生存率相关，但个别Z-code并不总是与生存率相关。进一步的研究应确定SDOH z -code是否能够在基于价值的医疗保健系统中有效地进行风险调整。
{"title":"Association of social determinants of health diagnosis codes with overall survival in Medicare-insured patients with cancer.","authors":"Joshua N Herb,Chung-Yuan Hu,Sharon H Giordano,George J Chang,Rebecca A Snyder","doi":"10.1093/jnci/djag079","DOIUrl":"https://doi.org/10.1093/jnci/djag079","url":null,"abstract":"BACKGROUNDSocial determinants of health (SDOH) impact long-term cancer outcomes. Since 2015, the Centers for Medicare & Medicaid Services recommends using International Classification of Diseases diagnosis codes Z55-Z65 to document specific SDOH. We examined the association of these Z-codes with survival in patients with cancer.METHODSPatients with breast, colorectal, lung, prostate, or pancreatic cancer were identified in the SEER-Medicare database (2016 to 2019). The primary exposure was a Z-code claim in the 12 months before or 6 months after cancer diagnosis. The primary outcome was overall survival. Multivariable Cox regression was performed to examine the association of Z-code claims with overall survival, controlling for demographic and clinical covariates.RESULTSOf 210,093 patients, 4,351 (2.1%) had at least one Z-code claim. The most frequent codes were for problems with social environment (Z60 47.3%) or a primary support group (Z63: 27.2%). Codes were submitted most often by home health agencies (57.8%) and least often by inpatient facilities (1.7%). In adjusted analyses, any Z-code claim was associated with worse survival than was no claim (hazard ratio, 1.09 [95% CI, 1.05-1.14]; p < 0.01), although the associations varied by Z-code.CONCLUSIONSSDOH Z-codes are rarely submitted with billing claims for Medicare patients with cancer. Whether Z-codes reflect the social needs of patients with cancer remains unclear. With current coding, any SDOH Z-code is associated with poor survival in these patients, but individual Z-codes are not consistently associated with survival. Further studies should determine whether SDOH Z-codes enable effective risk adjustment in a value-based healthcare system.","PeriodicalId":501635,"journal":{"name":"Journal of the National Cancer Institute","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sule Eraslan, Emine Ceren Ayhan, Michael Tvilling Madsen, Erica K Sloan, Ismail Gögenur, Adile Orhan
Background Beta-blockers are conventionally prescribed for cardiovascular indications and have potential for repurposing in oncology as adrenergic signalling promotes cancer progression. This systematic review and meta-analysis evaluated whether beta-blocker use is associated with improved survival outcomes in patients with all stages of solid cancer. Methods This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines using a predefined (PICO) framework. Four databases (PubMed, Embase, Cochrane Library, and Web of Science) were searched. Eligible studies compared beta-blocker users with non-users and reported survival outcomes in patients with solid cancer. Outcomes included overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), progression-free survival (PFS) and recurrence-free survival (RFS). Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and the Cochrane Risk of Bias 2 tool. Certainty of evidence was evaluated using GRADE. Results A total of 5122 articles were screened; 94 articles were included in the systematic review and 84 in the meta-analysis comprising 603,827 patients. Beta-blocker use in patients with solid cancers was associated with significantly improved OS (HR 0.88, 95% CI: 0.80-0.96) and PFS (HR 0.82, 95%CI: 0.69-0.97). The greatest effects on OS were observed in patients with gastrointestinal (HR 0.84, 95%CI: 0.72-0.98), lung (HR 0.84, 95%CI: 0.71-0.99), and skin cancers (HR 0.81, 95%CI: 0.73-0.89). Effects appeared stronger with post-diagnostic exposure and in certain cancer subtypes, however, heterogeneity and the observational nature of most included studies warrant cautious interpretation. Conclusion Beta-blocker use was associated with improved OS and PFS in patients with solid cancers.
{"title":"Impact of beta-blockers on prognostic outcomes in solid cancers: a systematic review and meta-analysis","authors":"Sule Eraslan, Emine Ceren Ayhan, Michael Tvilling Madsen, Erica K Sloan, Ismail Gögenur, Adile Orhan","doi":"10.1093/jnci/djag082","DOIUrl":"https://doi.org/10.1093/jnci/djag082","url":null,"abstract":"Background Beta-blockers are conventionally prescribed for cardiovascular indications and have potential for repurposing in oncology as adrenergic signalling promotes cancer progression. This systematic review and meta-analysis evaluated whether beta-blocker use is associated with improved survival outcomes in patients with all stages of solid cancer. Methods This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines using a predefined (PICO) framework. Four databases (PubMed, Embase, Cochrane Library, and Web of Science) were searched. Eligible studies compared beta-blocker users with non-users and reported survival outcomes in patients with solid cancer. Outcomes included overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), progression-free survival (PFS) and recurrence-free survival (RFS). Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and the Cochrane Risk of Bias 2 tool. Certainty of evidence was evaluated using GRADE. Results A total of 5122 articles were screened; 94 articles were included in the systematic review and 84 in the meta-analysis comprising 603,827 patients. Beta-blocker use in patients with solid cancers was associated with significantly improved OS (HR 0.88, 95% CI: 0.80-0.96) and PFS (HR 0.82, 95%CI: 0.69-0.97). The greatest effects on OS were observed in patients with gastrointestinal (HR 0.84, 95%CI: 0.72-0.98), lung (HR 0.84, 95%CI: 0.71-0.99), and skin cancers (HR 0.81, 95%CI: 0.73-0.89). Effects appeared stronger with post-diagnostic exposure and in certain cancer subtypes, however, heterogeneity and the observational nature of most included studies warrant cautious interpretation. Conclusion Beta-blocker use was associated with improved OS and PFS in patients with solid cancers.","PeriodicalId":501635,"journal":{"name":"Journal of the National Cancer Institute","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147489373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Esther N Dekker,David van Klaveren,Eva M M Verkolf,Roeland F de Wilde,Marc G Besselink,Eileen M O'Reilly,Alessandro Paniccia,Alice C Wei,Amer H Zureikat,Laura R Prakash,Matthew H G Katz,Ching-Wei D Tzeng,Bas Groot Koerkamp,
BACKGROUNDRestaging after neoadjuvant chemotherapy aims to assess treatment response, revise prognosis, and guide further management. This study investigated independent prognostic factors for overall survival (OS) after restaging in patients with localized pancreatic adenocarcinoma (PDAC).METHODSIn this retrospective international study, consecutive patients with localized PDAC who received at least one cycle of (m)FOLFIRINOX as first-line therapy were identified. Multivariable Cox regression analysis was performed with a web-based calculator to predict individualized OS.RESULTSThe TAPS cohort included 2338 patients with localized PDAC, of whom 22.6% were potentially resectable, 30.7% borderline resectable, and 46.7% locally advanced at initial staging. Several baseline characteristics remained independent prognostic factors for OS after restaging borderline resectable (HR 1.31 [95% CI 1.14-1.51]), locally advanced (HR 1.78 [95% CI 1.55-2.05]), body/tail tumor (HR 0.79 [95% CI 0.68-0.90]), and baseline WHO performance status of 1 (HR 1.18 [95% CI 1.07-1.30]) or ≥ 2 (HR 1.54 [95% CI 1.20-1.98]). Additional independent factors were metastatic disease at restaging (HR 1.57 [95% CI 1.31-1.87]), post-induction CA19-9 (HR 1.47 [95% CI 1.37-1.57]), ΔCA19-9 (HR 0.83 [95% CI 0.77-0.89]), post-induction tumor size (HR 1.22 [95% CI 1.11-1.35]), and Δtumor size (HR 0.92 [95% CI 0.87-0.98]). Patients were stratified into four risk groups, with 3-year OS after restaging ranging from 6.0% to 65.8%.CONCLUSIONSurvival at restaging after neoadjuvant chemotherapy of patients with localized PDAC is determined by eight patient, tumor and treatment response characteristics. A web-based calculator can inform clinicians and patients about individualized prognosis and guide further management.
背景：新辅助化疗后的分期旨在评估治疗反应，修正预后，指导进一步的治疗。本研究探讨了局部胰腺腺癌（PDAC）患者再移植后总生存（OS）的独立预后因素。方法在这项回顾性国际研究中，确定了连续接受至少一个周期(m)FOLFIRINOX作为一线治疗的局限性PDAC患者。使用基于网络的计算器进行多变量Cox回归分析以预测个体化OS。结果TAPS队列包括2338例局限性PDAC患者，其中22.6%可切除，30.7%可边缘切除，46.7%局部初始期晚期。几个基线特征仍然是复发边缘可切除后OS的独立预后因素（HR 1.31 [95% CI 1.14-1.51]），局部晚期（HR 1.78 [95% CI 1.55-2.05]），体/尾肿瘤（HR 0.79 [95% CI 0.68-0.90]），基线WHO表现状态为1 （HR 1.18 [95% CI 1.07-1.30]）或≥2 （HR 1.54 [95% CI 1.20-1.98]）。其他独立因素为再分期转移性疾病（HR 1.57 [95% CI 1.31-1.87]）、诱导后CA19-9 （HR 1.47 [95% CI 1.37-1.57]）、ΔCA19-9 （HR 0.83 [95% CI 0.77-0.89]）、诱导后肿瘤大小（HR 1.22 [95% CI 1.11-1.35]）和Δtumor大小（HR 0.92 [95% CI 0.87-0.98]）。患者被分为4个危险组，再手术后3年OS从6.0%到65.8%不等。结论局部PDAC患者新辅助化疗后的再分期生存取决于8个患者、肿瘤和治疗反应的特点。基于网络的计算器可以告知临床医生和患者个体化预后并指导进一步的管理。
{"title":"Restaging after neoadjuvant FOLFIRINOX for localized pancreatic cancer: a clinical calculator from the Trans-Atlantic Pancreatic Surgery consortium.","authors":"Esther N Dekker,David van Klaveren,Eva M M Verkolf,Roeland F de Wilde,Marc G Besselink,Eileen M O'Reilly,Alessandro Paniccia,Alice C Wei,Amer H Zureikat,Laura R Prakash,Matthew H G Katz,Ching-Wei D Tzeng,Bas Groot Koerkamp, ","doi":"10.1093/jnci/djag024","DOIUrl":"https://doi.org/10.1093/jnci/djag024","url":null,"abstract":"BACKGROUNDRestaging after neoadjuvant chemotherapy aims to assess treatment response, revise prognosis, and guide further management. This study investigated independent prognostic factors for overall survival (OS) after restaging in patients with localized pancreatic adenocarcinoma (PDAC).METHODSIn this retrospective international study, consecutive patients with localized PDAC who received at least one cycle of (m)FOLFIRINOX as first-line therapy were identified. Multivariable Cox regression analysis was performed with a web-based calculator to predict individualized OS.RESULTSThe TAPS cohort included 2338 patients with localized PDAC, of whom 22.6% were potentially resectable, 30.7% borderline resectable, and 46.7% locally advanced at initial staging. Several baseline characteristics remained independent prognostic factors for OS after restaging borderline resectable (HR 1.31 [95% CI 1.14-1.51]), locally advanced (HR 1.78 [95% CI 1.55-2.05]), body/tail tumor (HR 0.79 [95% CI 0.68-0.90]), and baseline WHO performance status of 1 (HR 1.18 [95% CI 1.07-1.30]) or ≥ 2 (HR 1.54 [95% CI 1.20-1.98]). Additional independent factors were metastatic disease at restaging (HR 1.57 [95% CI 1.31-1.87]), post-induction CA19-9 (HR 1.47 [95% CI 1.37-1.57]), ΔCA19-9 (HR 0.83 [95% CI 0.77-0.89]), post-induction tumor size (HR 1.22 [95% CI 1.11-1.35]), and Δtumor size (HR 0.92 [95% CI 0.87-0.98]). Patients were stratified into four risk groups, with 3-year OS after restaging ranging from 6.0% to 65.8%.CONCLUSIONSurvival at restaging after neoadjuvant chemotherapy of patients with localized PDAC is determined by eight patient, tumor and treatment response characteristics. A web-based calculator can inform clinicians and patients about individualized prognosis and guide further management.","PeriodicalId":501635,"journal":{"name":"Journal of the National Cancer Institute","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Binkai Liu,Caroline Himbert,Jane B Vaselkiv,Colleen B Mcgrath,Leeann Lucas,Yiwen Zhang,Chaoran Ma,Mingyang Song,Rebecca E Graff,Edward L Giovannucci,Meir J Stampfer,Konrad H Stopsack,Qi Sun,Lorelei A Mucci
BACKGROUND AND OBJECTIVEProstate cancer is the second leading cause of cancer death in U.S. men, yet most patients die from other causes. We examined whether adherence to healthy dietary patterns after diagnosis is associated with overall and cause-specific survival.METHODSWe analyzed 6,085 men with prostate cancer (1986 to 2016) in the Health Professionals Follow-up Study. Five dietary patterns-Alternative Healthy Eating Index (AHEI), Mediterranean diet (AMED), DASH, anti-insulinemic, and anti-inflammatory diets-were derived from validated food frequency questionnaires every 4 years. Post-diagnosis scores were cumulatively averaged, and changes from pre- to post-diagnosis were calculated. Multivariable Cox models estimated hazard ratios (HR) and 95% CIs for mortality through 2024.KEY FINDINGS AND LIMITATIONSOver 71,760 person-years, 3,710 deaths occurred (592 prostate cancer, 971 cardiovascular disease [CVD], 2,147 other). Greater post-diagnosis adherence to AHEI (Q5 vs Q1, HR 0.75, 95% CI 0.66 to 0.86) and AMED (HR 0.80, 95% CI 0.70 to 0.92) was associated with lower all-cause mortality. Increased adherence after diagnosis also predicted better survival, particularly for AHEI. Survival benefits were stronger among men with less aggressive disease. Increased AHEI adherence was associated with lower CVD mortality (HR 0.82, 95% CI 0.66 to 1.03), but no associations were observed for prostate cancer-specific survival. Limitations include the observational design and potential residual confounding.CONCLUSIONS AND CLINICAL IMPLICATIONSAdherence to healthy dietary patterns, especially AHEI and AMED, after prostate cancer diagnosis was associated with improved survival, particularly in less aggressive disease. These findings support dietary improvement as a part of survivorship care.
背景与目的前列腺癌是美国男性癌症死亡的第二大原因，然而大多数患者死于其他原因。我们研究了诊断后坚持健康饮食模式是否与总生存率和病因特异性生存率相关。方法我们分析了1986年至2016年期间6085名前列腺癌男性患者。五种饮食模式——替代健康饮食指数（AHEI）、地中海饮食（AMED）、DASH、抗胰岛素饮食和抗炎饮食——每4年从经过验证的食物频率问卷中得出。诊断后评分累积平均，并计算诊断前和诊断后的变化。多变量Cox模型估计了到2024年死亡率的风险比（HR）和95% ci。在71,760人/年的研究中，发生了3,710例死亡（592例前列腺癌，971例心血管疾病，2,147例其他疾病）。诊断后更坚持AHEI （Q5 vs Q1, HR 0.75, 95% CI 0.66 ~ 0.86）和AMED （HR 0.80, 95% CI 0.70 ~ 0.92）与更低的全因死亡率相关。诊断后依从性的提高也预示着更好的生存率，尤其是急性脑损伤患者。在疾病侵袭性较弱的男性中，生存获益更大。增加AHEI依从性与降低CVD死亡率相关（HR 0.82, 95% CI 0.66 - 1.03），但与前列腺癌特异性生存率无关联。局限性包括观察设计和潜在的残留混淆。结论和临床意义：前列腺癌诊断后坚持健康的饮食模式，特别是AHEI和AMED，与生存率的提高有关，特别是在侵袭性较低的疾病中。这些发现支持改善饮食作为生存护理的一部分。
{"title":"Healthy dietary patterns and survival among men with prostate cancer.","authors":"Binkai Liu,Caroline Himbert,Jane B Vaselkiv,Colleen B Mcgrath,Leeann Lucas,Yiwen Zhang,Chaoran Ma,Mingyang Song,Rebecca E Graff,Edward L Giovannucci,Meir J Stampfer,Konrad H Stopsack,Qi Sun,Lorelei A Mucci","doi":"10.1093/jnci/djag071","DOIUrl":"https://doi.org/10.1093/jnci/djag071","url":null,"abstract":"BACKGROUND AND OBJECTIVEProstate cancer is the second leading cause of cancer death in U.S. men, yet most patients die from other causes. We examined whether adherence to healthy dietary patterns after diagnosis is associated with overall and cause-specific survival.METHODSWe analyzed 6,085 men with prostate cancer (1986 to 2016) in the Health Professionals Follow-up Study. Five dietary patterns-Alternative Healthy Eating Index (AHEI), Mediterranean diet (AMED), DASH, anti-insulinemic, and anti-inflammatory diets-were derived from validated food frequency questionnaires every 4 years. Post-diagnosis scores were cumulatively averaged, and changes from pre- to post-diagnosis were calculated. Multivariable Cox models estimated hazard ratios (HR) and 95% CIs for mortality through 2024.KEY FINDINGS AND LIMITATIONSOver 71,760 person-years, 3,710 deaths occurred (592 prostate cancer, 971 cardiovascular disease [CVD], 2,147 other). Greater post-diagnosis adherence to AHEI (Q5 vs Q1, HR 0.75, 95% CI 0.66 to 0.86) and AMED (HR 0.80, 95% CI 0.70 to 0.92) was associated with lower all-cause mortality. Increased adherence after diagnosis also predicted better survival, particularly for AHEI. Survival benefits were stronger among men with less aggressive disease. Increased AHEI adherence was associated with lower CVD mortality (HR 0.82, 95% CI 0.66 to 1.03), but no associations were observed for prostate cancer-specific survival. Limitations include the observational design and potential residual confounding.CONCLUSIONS AND CLINICAL IMPLICATIONSAdherence to healthy dietary patterns, especially AHEI and AMED, after prostate cancer diagnosis was associated with improved survival, particularly in less aggressive disease. These findings support dietary improvement as a part of survivorship care.","PeriodicalId":501635,"journal":{"name":"Journal of the National Cancer Institute","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147461721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Victoria Wocalewski,Giola Santoni,Helgi Birgisson,My Von Euler-Chelpin,Joonas H Kauppila,Eivind Ness-Jensen,Shaohua Xie,Jesper Lagergren
BACKGROUNDThe incidence of esophago-gastric cancer has an age-dependent male predominance mirroring the physiological sex differences in sex hormonal levels. Some research suggests that menopausal hormone therapy (MHT) counteracts these tumors to occur, but larger studies with longer follow-up are needed, which prompted this study.METHODSThis population-based case-control study included women aged ≥45 years in the five Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) between 1995 to 2020. Prospectively collected data came from national registries for medications, cancer, diagnoses, total populations, and death. MHT-use was categorized as non-use (reference) and three equal-sized groups (tertiles) of defined daily doses (DDDs). Esophago-gastric cancer was divided into esophageal or cardia adenocarcinoma, esophageal squamous cell carcinoma, and gastric adenocarcinoma. Multivariable logistic regression provided odds ratios (OR) with 95% confidence intervals (CI), adjusted for multiple confounders.RESULTSThe study included 19,518 esophago-gastric cancer patients (cases) and 195,094 control participants matched for age, calendar year, and country. Compared to non-use, the adjusted ORs of esophageal or cardia adenocarcinoma were 0.74 (95% CI 0.67-0.81) for low MHT-use (<158 DDDs), 0.68 (95% CI 0.61-0.75) for intermediate MHT-use (158 to 848 DDDs), and 0.68 (95% CI 0.66-0.81) for high MHT-use (>848 DDDs). The corresponding ORs were 0.69 (95% CI 0.62-0.77), 0.70 (95% CI 0.62-0.77), and 0.71 (95% CI 0.64-0.79) for esophageal squamous cell carcinoma, and 0.90 (95% CI 0.84-0.96), 0.85 (95% CI 0.79-0.91), and 0.80 (95% CI 0.74-0.86) for gastric adenocarcinoma.CONCLUSIONMHT-users seem to have lower odds of developing esophago-gastric cancer.
背景：食管胃癌的发病率具有年龄依赖性的男性优势，反映了生理性别在性激素水平上的差异。一些研究表明，更年期激素治疗（MHT）可以抵消这些肿瘤的发生，但需要更大的研究和更长的随访时间，这促使了这项研究。方法：这项以人群为基础的病例对照研究纳入了1995年至2020年间北欧5个国家（丹麦、芬兰、冰岛、挪威和瑞典）年龄≥45岁的女性。前瞻性收集的数据来自国家药物、癌症、诊断、总人口和死亡登记处。将mht的使用分为未使用（参考）组和三个等大小的限定日剂量组（DDDs）。食管胃癌分为食管或贲门腺癌、食管鳞状细胞癌和胃腺癌。多变量逻辑回归提供了95%置信区间（CI）的优势比（OR），并对多个混杂因素进行了调整。结果该研究包括19518例食管胃癌患者（病例）和195094例对照受试者，年龄、日历年和国家相匹配。与未使用相比，低mht使用（848 DDDs）的食管癌或贲门腺癌调整后的or为0.74 （95% CI 0.67-0.81）。食管鳞状细胞癌相应的or分别为0.69 （95% CI 0.62-0.77）、0.70 （95% CI 0.62-0.77）和0.71 (95% CI 0.64-0.79)，胃腺癌相应的or分别为0.90 （95% CI 0.84-0.96）、0.85 （95% CI 0.79-0.91）和0.80 （95% CI 0.74-0.86）。结论mht使用者发生食管胃癌的几率较低。
{"title":"Menopausal hormone therapy and risk of esophageal and gastric cancer in a multi-national study.","authors":"Victoria Wocalewski,Giola Santoni,Helgi Birgisson,My Von Euler-Chelpin,Joonas H Kauppila,Eivind Ness-Jensen,Shaohua Xie,Jesper Lagergren","doi":"10.1093/jnci/djag072","DOIUrl":"https://doi.org/10.1093/jnci/djag072","url":null,"abstract":"BACKGROUNDThe incidence of esophago-gastric cancer has an age-dependent male predominance mirroring the physiological sex differences in sex hormonal levels. Some research suggests that menopausal hormone therapy (MHT) counteracts these tumors to occur, but larger studies with longer follow-up are needed, which prompted this study.METHODSThis population-based case-control study included women aged ≥45 years in the five Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) between 1995 to 2020. Prospectively collected data came from national registries for medications, cancer, diagnoses, total populations, and death. MHT-use was categorized as non-use (reference) and three equal-sized groups (tertiles) of defined daily doses (DDDs). Esophago-gastric cancer was divided into esophageal or cardia adenocarcinoma, esophageal squamous cell carcinoma, and gastric adenocarcinoma. Multivariable logistic regression provided odds ratios (OR) with 95% confidence intervals (CI), adjusted for multiple confounders.RESULTSThe study included 19,518 esophago-gastric cancer patients (cases) and 195,094 control participants matched for age, calendar year, and country. Compared to non-use, the adjusted ORs of esophageal or cardia adenocarcinoma were 0.74 (95% CI 0.67-0.81) for low MHT-use (<158 DDDs), 0.68 (95% CI 0.61-0.75) for intermediate MHT-use (158 to 848 DDDs), and 0.68 (95% CI 0.66-0.81) for high MHT-use (>848 DDDs). The corresponding ORs were 0.69 (95% CI 0.62-0.77), 0.70 (95% CI 0.62-0.77), and 0.71 (95% CI 0.64-0.79) for esophageal squamous cell carcinoma, and 0.90 (95% CI 0.84-0.96), 0.85 (95% CI 0.79-0.91), and 0.80 (95% CI 0.74-0.86) for gastric adenocarcinoma.CONCLUSIONMHT-users seem to have lower odds of developing esophago-gastric cancer.","PeriodicalId":501635,"journal":{"name":"Journal of the National Cancer Institute","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147461722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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