Lancet Regional Health-Europe最新文献

英文中文

Axillary clearance and chemotherapy rates in ER+HER2− breast cancer: secondary analysis of the SENOMAC trial ER+HER2-乳腺癌的腋窝清除率和化疗率：SENOMAC 试验的二次分析

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe

Pub Date : 2024-09-26 DOI: 10.1016/j.lanepe.2024.101083

Tove Filtenborg Tvedskov , Robert Szulkin , Sara Alkner , Yvette Andersson , Leif Bergkvist , Jan Frisell , Oreste Davide Gentilini , Michalis Kontos , Thorsten Kühn , Dan Lundstedt , Birgitte Vrou Offersen , Roger Olofsson Bagge , Toralf Reimer , Malin Sund , Lisa Rydén , Peer Christiansen , Jana de Boniface

Background

Randomized trials have shown that axillary clearance (AC) can safely be omitted in patients with sentinel lymph node-positive breast cancer. At the same time, de-escalation of chemotherapy in postmenopausal patients with ER+HER2− breast cancer may depend on detailed axillary nodal stage. The aim of this pre-specified secondary analysis of the SENOMAC trial was to investigate whether the choice of axillary staging affected the proportion of patients receiving adjuvant chemotherapy, and recurrence-free survival (RFS).

Methods

Proportion receiving adjuvant chemotherapy was calculated according to AC or sentinel lymph node biopsy (SLNB) only, menopausal status, and region of inclusion, for 2168 patients with clinically node-negative ER+HER2− breast cancer and 1–2 sentinel lymph node macrometastases included in the SENOMAC trial.

Findings

In premenopausal patients, 514 out of 615 patients (83.6%) received adjuvant chemotherapy with no significant difference between randomization arms. In postmenopausal patients, the proportion receiving chemotherapy varied considerably by region and country (36.0–82.4%). In Denmark, where 194 out of 539 postmenopausal patients (36.0%) received adjuvant chemotherapy, rates differed significantly between the AC and the SLNB only arm (41.3% vs 31.4%, p = 0.019). After a median follow-up of 44.88 months for Danish postmenopausal patients, no significant difference was seen in 5-year RFS, which was 91% (85.6%–96.6%) for the SLNB only and 90.9% (86.3%–95.6%) for the AC arm (p = 0.42).

Interpretation

When omitting axillary clearance, and thus reducing the risk of long-term arm morbidity, potential under-treatment of postmenopausal patients with ER+HER2− breast cancer may require the development of new predictive and imaging tools.

Funding

Swedish Research Council, Swedish Cancer Society, Nordic Cancer Union, Swedish Breast Cancer Association.

背景随机试验表明，前哨淋巴结阳性乳腺癌患者可以安全地省略腋窝清扫（AC）。同时，绝经后ER+HER2-乳腺癌患者化疗的降级可能取决于详细的腋窝结节分期。本研究对 SENOMAC 试验进行了预先指定的二次分析，旨在研究腋窝分期的选择是否会影响接受辅助化疗的患者比例以及无复发生存率（RFS）。方法对SENOMAC试验中2168例临床结节阴性ER+HER2-乳腺癌且有1-2个前哨淋巴结大转移的患者，根据AC或仅前哨淋巴结活检（SLNB）、绝经状态和纳入地区计算接受辅助化疗的比例。在绝经后患者中，接受化疗的比例因地区和国家不同而有很大差异（36.0%-82.4%）。在丹麦，539 名绝经后患者中有 194 人（36.0%）接受了辅助化疗，其中 AC 组和仅 SLNB 组的比例差异显著（41.3% vs 31.4%，p = 0.019）。丹麦绝经后患者的中位随访时间为 44.88 个月，5 年 RFS 无明显差异，仅 SLNB 治疗组为 91% (85.6%-96.6%)，AC 治疗组为 90.9% (86.3%-95.6%)（P = 0.42）。释义当省略腋窝清扫，从而降低手臂长期发病风险时，绝经后ER+HER2-乳腺癌患者潜在的治疗不足可能需要开发新的预测和成像工具。

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引用次数: 0

Can we ensure a safe and effective integration of language models in oncology? 我们能否确保在肿瘤学中安全有效地整合语言模型？

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe

Pub Date : 2024-09-20 DOI: 10.1016/j.lanepe.2024.101081

Chiara Corti , Leo A. Celi

引用次数: 0

Long-term autonomy, professional activities, cognition, and overall survival after awake functional-based surgery in patients with IDH-mutant grade 2 gliomas: a retrospective cohort study IDH突变2级胶质瘤患者清醒功能性手术后的长期自主性、职业活动、认知能力和总生存率：一项回顾性队列研究

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe

Pub Date : 2024-09-20 DOI: 10.1016/j.lanepe.2024.101078

Sam Ng , Valérie Rigau , Sylvie Moritz-Gasser , Catherine Gozé , Amélie Darlix , Guillaume Herbet , Hugues Duffau

Background

In isocitrate dehydrogenase (IDH)-mutant low-grade gliomas (LGGs), awake functional-based resection (i.e., resection based on intraoperative functional responses rather than anatomical margins) has emerged as an efficient method to reduce tumour volume (TV) while minimizing postoperative deficits. Here, our goal was to assess the long-term onco-functional outcomes after awake functional-based resection in IDH-mutant LGGs, in conjunction with clinico-radiological and molecular factors.

Methods

We retrospectively studied a consecutive cohort (June 1997–January 2023) of 949 patients. Six hundred patients with IDH-mutant LGGs benefited from an awake functional-based resection with a median follow-up of 7.8 years (95% Confidence interval [CI]: 7.1–8.4 years). The main outcomes were the overall survival (OS), the OS with Karnofsky performance status ≥80% (OS_KPS_≥_80%), cognition measures, and professional activities at 12 months post-surgery.

Findings

600 patients were included in the cohort (274 female [46.0%], median age: 36 years [Interquartile range, IQR: 30–44 years]). The rate of return to work was 93.7%. The impact of surgery on cognition was of limited magnitude. The median postsurgical TV of 2.5 mL (IQR: 0–8.0 mL). The median OS was over 20 years (median: NA, 95% CI: 17.0-NA years). The median OS_KPS_≥_80% was 14.7 years (95% CI: 13.2–17.2 years). Factors associated with longer OS and OS_KPS_≥_P80% were 1p19q codeletion (Hazard ratio [HR]_OS: 0.27, 95% CI: 0.16–0.43, HR_KPS_≥_80%:0.25, 95% CI: 0.17–0.36), supratotal resection (HR_OS: 0.08, 95% CI: 0.005–0.40, HR_KPS_≥_80%:0.12, 95% CI: 0.03–0.34) and total resection (HR_OS: 0.31, 95% CI: 0.16–0.59, HR_KPS_≥_80%:0.21, 95% CI: 0.12–0.36). Recursive partitioning analyses established three OS and OS_KPS_≥_80% prognostic groups, highlighting the contributions of histomolecular status, extent of resection, postsurgical and presurgical TV. Further propensity-matching analyses confirmed the oncological benefits of supratotal resections.

Interpretation

Awake functional-based resection surgery in newly diagnosed IDH-mutant grade 2 LGG, was an effective strategy associated with long survival (median OS over 20 years) and long-term preservation of autonomy. More complete tumor resections favored better onco-functional outcomes across all molecularly-defined subtypes. Short-term effects were of limited magnitude regarding postoperative cognitive and professional outcomes. Supratotal functional-based resections offered additional survival benefits.

Funding

None.

背景在异柠檬酸脱氢酶（IDH）突变的低级别胶质瘤（LGG）中，基于清醒功能的切除术（即基于术中功能反应而非解剖学边缘的切除术）已成为一种有效的方法，可在减少肿瘤体积（TV）的同时最大限度地减少术后功能障碍。在此，我们的目标是结合临床放射学和分子因素，评估 IDH 突变 LGG 基于清醒功能性切除术后的长期功能性结果。600名IDH突变LGG患者接受了基于功能的清醒切除术，中位随访时间为7.8年（95% 置信区间[CI]：7.1-8.4年）。主要结果包括总生存期（OS）、Karnofsky表现状态≥80%时的OS（OSKPS≥80%）、认知指标以及术后12个月的职业活动。重返工作岗位的比例为 93.7%。手术对认知能力的影响程度有限。手术后TV的中位数为2.5毫升（IQR：0-8.0毫升）。中位OS超过20年（中位数：NA，95% CI：17.0-NA年）。OSKPS≥80%的中位数为14.7年（95% CI：13.2-17.2年）。与更长的OS和OSKPS≥P80%相关的因素是1p19q编码缺失（危险比[HR]OS：0.27，95% CI：0.16-0.43，HRKPS≥80%：0.25，95% CI：0.17-0.36）、超全切除（HROS：0.08，95% CI：0.005-0.40，HRKPS≥80%：0.12，95% CI：0.03-0.34）和全切除（HROS：0.31，95% CI：0.16-0.59，HRKPS≥80%：0.21，95% CI：0.12-0.36）。递归分区分析建立了三个OS和OSKPS≥80%预后组，强调了组织分子状态、切除范围、手术后和手术前电视的贡献。进一步的倾向匹配分析证实了超全切的肿瘤学益处。释义对于新诊断的IDH突变2级LGG，基于功能的清醒切除手术是一种有效的策略，可获得较长的生存期（中位OS超过20年）并长期保留自主权。在所有分子定义的亚型中，更彻底的肿瘤切除有利于获得更好的肿瘤功能性结果。在术后认知和职业结果方面，短期效果有限。基于功能的超全切可带来额外的生存益处。

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引用次数: 0

Physical, cognitive, and social triggers of symptom fluctuations in people living with long COVID: an intensive longitudinal cohort study 长期慢性阻塞性肺病患者症状波动的生理、认知和社会诱因：强化纵向队列研究

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe

Pub Date : 2024-09-20 DOI: 10.1016/j.lanepe.2024.101082

Darren C. Greenwood , Maedeh Mansoubi , Nawar D. Bakerly , Aishwarya Bhatia , Johnny Collett , Helen E. Davies , Joanna Dawes , Brendan Delaney , Leisle Ezekiel , Phaedra Leveridge , Ghazala Mir , Willie Muhlhausen , Clare Rayner , Flo Read , Janet T. Scott , Manoj Sivan , Ian Tucker–Bell , Himanshu Vashisht , Tomás Ward , Daryl B. O'Connor , Conor Wood

Background

Symptom fluctuations within and between individuals with long COVID are widely reported, but the extent to which severity varies following different types of activity and levels of exertion, and the timing of symptoms and recovery, have not previously been quantified. We aimed to characterise timing, severity, and nature of symptom fluctuations in response to effortful physical, social and cognitive activities, using Ecological Momentary Assessments.

Methods

We recorded activity, effort, and severity of 8 core symptoms every 3 h for up to 24 days, in cohorts from both clinic and community settings. Symptom severities were jointly modelled using autoregressive and moving average processes.

Findings

Consent was received from 376 participants providing ≥1 week's measurements (273 clinic-based, 103 community-based). Severity of all symptoms was elevated 30 min after all categories of activity. Increased effort was associated with increased symptom severity. Fatigue severity scores increased by 1.8/10 (95% CI: 1.6–1.9) following the highest physical exertions and by 1.5 (1.4–1.7) following cognitive efforts. There was evidence of only mild delayed fatigue 3 h (0.3, 0.2–0.5) or one day later (0.2, 0.0– 0.5). Fatigue severity increased as the day progressed (1.4, 1.0–1.7), and cognitive dysfunction was 0.2 lower at weekends (0.1–0.3).

Interpretation

Cognitive, social, self-care and physical activities all triggered increased severity across every symptom, consistent with associated common pathways as potential therapeutic targets. Clear patterns of symptom fluctuations emerged that support more targeted self-management.

Funding

National Institute for Health and Care Research.

背景长期慢性阻塞性肺病患者体内和之间的症状波动已被广泛报道，但不同类型的活动和不同程度的劳累后症状的严重程度会有多大差异，以及症状和恢复的时间尚未被量化。我们的目的是利用生态学瞬间评估来描述症状波动的时间、严重程度和性质，以应对费力的体力、社交和认知活动。方法我们在长达 24 天的时间里，在诊所和社区环境中每 3 小时记录一次活动、费力程度和 8 种核心症状的严重程度。结果376名参与者（273名在诊所，103名在社区）提供了≥1周的测量数据，并表示同意。在各类活动后 30 分钟，所有症状的严重程度都有所升高。活动量的增加与症状严重程度的增加有关。体力消耗最大时，疲劳严重程度得分增加 1.8/10（95% CI：1.6-1.9），认知能力消耗最大时，疲劳严重程度得分增加 1.5（1.4-1.7）。有证据表明，3 小时后（0.3，0.2-0.5）或一天后（0.2，0.0-0.5）只有轻微的延迟疲劳。随着时间的推移，疲劳的严重程度会增加（1.4，1.0-1.7），认知功能障碍在周末会降低 0.2（0.1-0.3）。症状波动的明显模式支持更有针对性的自我管理。

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引用次数: 0

Emerging data on SGLT2 benefits in acute coronary syndromes 有关 SGLT2 对急性冠状动脉综合征益处的新数据

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe

Pub Date : 2024-09-19 DOI: 10.1016/j.lanepe.2024.101085

Aidin Rawshani

引用次数: 0

Blood-based biomarkers in the oldest old: towards Alzheimer's disease detection in primary care 高龄老人血液中的生物标志物：在初级保健中检测阿尔茨海默病

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe

Pub Date : 2024-09-19 DOI: 10.1016/j.lanepe.2024.101077

José Contador , Marc Suárez-Calvet

引用次数: 0

Ultra-processed foods and type 2 diabetes: more fundamental research is needed 超加工食品与 2 型糖尿病：需要开展更多基础研究

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe

Pub Date : 2024-09-19 DOI: 10.1016/j.lanepe.2024.101084

Joseph A.M.J.L. Janssen

引用次数: 0

Getting to the heart of it: sex and gender considerations in the management of cardiovascular disease 抓住核心：心血管疾病管理中的性和性别因素

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe

Pub Date : 2024-09-18 DOI: 10.1016/j.lanepe.2024.101076

Nabilah Gulamhusein , Sofia B. Ahmed

引用次数: 0

Blood microRNA testing in participants with suspicious low-dose CT findings: follow-up of the BioMILD lung cancer screening trial 对低剂量 CT 检查结果可疑的参与者进行血液 microRNA 检测：BioMILD 肺癌筛查试验的后续研究

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe

Pub Date : 2024-09-16 DOI: 10.1016/j.lanepe.2024.101070

Mattia Boeri , Federica Sabia , Roberta E. Ledda , Maurizio Balbi , Paola Suatoni , Miriam Segale , Anna Zanghì , Anna Cantarutti , Luigi Rolli , Camilla Valsecchi , Giovanni Corrao , Alfonso Marchianò , Ugo Pastorino , Gabriella Sozzi

Background

The proper management of suspicious radiologic findings is crucial to optimize the effectiveness of low-dose computed tomography (LDCT) lung cancer screening trials. In the BioMILD study, we evaluated the utility of combining a plasma 24-microRNA signature classifier (MSC) and LDCT to define the individual risk and personalize screening strategies. Here we aim to assess the utility of repeated MSC testing during annual screening rounds in 1024 participants with suspicious LDCT findings.

Methods

The primary outcome was two-year lung cancer incidence in relation to MSC test results, reported as relative risk (RR) with 95% confidence interval (CI). Lung cancer incidence and mortality were estimated using extended Cox models for time-dependent covariates, yielding the respective hazard ratios (HR). Clinicaltrials.gov ID: NCT02247453.

Findings

With a median follow-up of 8.5 years, the full study set included 1403 indeterminate LDCT (CTind) and 584 positive LDCT (CT+) results. A lung cancer RR increase in MSC+ compared to MSC- participants was observed in both the CTind (RR: 2.5; 95% CI: 1.4–4.32) and CT+ (RR: 2.6; 95% CI: 1.81–3.74) groups and was maintained when considering stage I or resectable tumors only. A 98% negative predictive value in CTind/MSC− and a 30% positive predictive value in CT+/MSC+ lesions were recorded. At seven years’ follow-up, MSC+ participants had a cumulative HR of 4.4 (95% CI: 3.0–6.4) for lung cancer incidence and of 8.1 (95% CI: 2.7–24.5) for lung cancer mortality.

Interpretation

Our study shows that MSC can be reliably performed during LDCT screening rounds to increase the accuracy of lung cancer risk and mortality prediction and supports its clinical utility in the management of LDCT findings of uncertain malignancy.

Funding

Italian Association for Cancer Research; Italian Ministry of Health; Horizon2020; National Cancer Institute (NCI); Gensignia LifeScience.

背景对可疑的放射学发现进行适当处理对于优化低剂量计算机断层扫描（LDCT）肺癌筛查试验的效果至关重要。在 BioMILD 研究中，我们评估了结合血浆 24 微RNA 特征分类器（MSC）和 LDCT 来确定个体风险和个性化筛查策略的效用。方法主要结果是与 MSC 检测结果相关的两年肺癌发病率，以相对风险 (RR) 和 95% 置信区间 (CI) 的形式报告。肺癌发病率和死亡率采用时间依赖性协变量的扩展 Cox 模型进行估算，得出各自的危险比 (HR)。Clinicaltrials.gov ID：NCT02247453.研究结果中位随访时间为 8.5 年，整套研究包括 1403 项不确定的 LDCT (CTind) 结果和 584 项阳性 LDCT (CT+) 结果。在CTind组（RR：2.5；95% CI：1.4-4.32）和CT+组（RR：2.6；95% CI：1.81-3.74）中均观察到，与MSC-参试者相比，MSC+参试者的肺癌RR增加了，而且在仅考虑I期或可切除肿瘤时，这种增加仍保持不变。CTind/MSC-病变的阴性预测值为98%，CT+/MSC+病变的阳性预测值为30%。在七年的随访中，MSC+参与者的肺癌发病率累积HR为4.4（95% CI：3.0-6.4），肺癌死亡率累积HR为8.1（95% CI：2.7-24.5）。释义我们的研究表明，MSC可以在LDCT筛查中可靠地进行，以提高肺癌风险和死亡率预测的准确性，并支持其在处理LDCT发现的不确定恶性肿瘤中的临床实用性。

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引用次数: 0

Early intervention for obstructive sleep apnoea in Down syndrome – making a difference? 早期干预唐氏综合征患者的阻塞性睡眠呼吸暂停--效果如何？

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe

Pub Date : 2024-09-13 DOI: 10.1016/j.lanepe.2024.101074

Indra Narang , Chun Ting Au

引用次数: 0

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