Pub Date : 2025-10-31DOI: 10.1016/j.canep.2025.102954
Lena Friederike Kopplin, Isabelle Kaiser
The number of melanoma cases has been rising over the past decades. Hence, screening is essential to provide early and effective patient management. However, screening for risk factors binds medical resources and may be conducted by patients. To evaluate the quality and validity of such a self-assessment, a systematic review of patient-expert agreement in dermatologic examinations is presented. A systematic review of studies examining participant-expert agreement on melanoma risk factors that were published until May 2025 was conducted. Included sources were retrieved from PubMed, the Web of Science Core Collection, and Scopus. Publications in languages other than English were excluded from the analysis. Of the 3562 records identified, 29 were eligible for evaluation. Six melanoma risk factors dominated the results: Typical and atypical nevi, skin phototype, freckles, hair and eye color., with typical nevi being the most frequently assessed risk factor (22 studies). Agreement is highly heterogeneous, ranging from predominantly weaker to scarcely reported substantial agreement, casting doubts on whether individuals should be tasked with self-assessment. Individual self-assessment may currently serve as a first indication of elevated melanoma risk but cannot substitute for dermatologic screening.
在过去的几十年里，黑色素瘤病例的数量一直在上升。因此，筛查对于提供早期和有效的患者管理至关重要。然而，筛查危险因素限制了医疗资源，可能由患者进行。为了评估这种自我评估的质量和有效性，提出了皮肤病检查中患者-专家协议的系统综述。对截至2025年5月发表的关于黑色素瘤风险因素的参与者-专家共识的研究进行了系统回顾。纳入的来源检索自PubMed、Web of Science Core Collection和Scopus。以英文以外语文出版的出版物不包括在分析之内。在确定的3562个记录中，有29个有资格进行评估。结果显示，6个黑色素瘤风险因素占主导地位：典型和非典型痣、皮肤光型、雀斑、头发和眼睛颜色。典型痣是最常被评估的风险因素（22项研究）。共识是高度异质的，从明显较弱到几乎没有报道的实质性共识，这让人怀疑个人是否应该承担自我评估的任务。个体自我评估目前可以作为黑色素瘤风险升高的第一个指标，但不能代替皮肤科筛查。
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Pub Date : 2025-10-30DOI: 10.1016/j.canep.2025.102951
Bhawani Yasassri Alvitigala, Lallindra Viranjan Gooneratne, Chandu de Silva
Background
Globally, lymphoma incidence has been steadily rising, with notable regional and gender-based variations. Understanding these trends in developing countries like Sri Lanka is essential to address cancer control strategies.
Methodology
Cancer incidence and mortality data from the National Cancer Control Program (NCCP) registries (2005–2021) were analyzed. Temporal trends in age-standardized rates (ASR) were assessed using Joinpoint Regression to estimate annual percent change (APC) and average APC (AAPC).
Results
A total of new 15,577 lymphoma cases were reported with male predominance (60 %, n = 9346) and non-Hodgkin lymphoma (NHL) being the predominant subtype (79 %, n = 9561). The overall incidence increased significantly over 16 years (AAPC: 4.1 %; p < 0.05), with a 1.4-fold rise in both sexes and a marked rise among 0–19-year-olds, exclusively post-2019 (p < 0.05). NHL incidence was highest in individuals aged ≥ 60 years, with a 2-fold rise in both gender (APC: 3.2; 95 % CI: 0.4 – 6.1; p < 0.05) during 2011–2021. Hodgkin lymphoma (HL) showed a significant 3-fold increase in females, while trends in males fluctuated, with a significant average AAPC in both sexes from 2011 to 2021 (p < 0.05). Despite the non-significant rise in female incidence across most age groups, males in 40–59 and > 60 years age groups showed a decline. A significant rise in NHL-related deaths among males (p < 0.05) was noted, with a non-significant increase in females.
Conclusions
Our findings indicate an apparent rising burden of lymphoma in Sri Lanka, particularly among males and the elderly. However, this observed increase may be partly attributable to improvements in cancer diagnostics and NCCP reporting over time. Additionally, evolving WHO classifications and their gradual adoption may also have influenced the observed trends.
{"title":"Epidemiological trends of lymphoma in Sri Lanka: A national cancer registry study (2005–2021)","authors":"Bhawani Yasassri Alvitigala, Lallindra Viranjan Gooneratne, Chandu de Silva","doi":"10.1016/j.canep.2025.102951","DOIUrl":"10.1016/j.canep.2025.102951","url":null,"abstract":"<div><h3>Background</h3><div>Globally, lymphoma incidence has been steadily rising, with notable regional and gender-based variations. Understanding these trends in developing countries like Sri Lanka is essential to address cancer control strategies.</div></div><div><h3>Methodology</h3><div>Cancer incidence and mortality data from the National Cancer Control Program (NCCP) registries (2005–2021) were analyzed. Temporal trends in age-standardized rates (ASR) were assessed using Joinpoint Regression to estimate annual percent change (APC) and average APC (AAPC).</div></div><div><h3>Results</h3><div>A total of new 15,577 lymphoma cases were reported with male predominance (60 %, n = 9346) and non-Hodgkin lymphoma (NHL) being the predominant subtype (79 %, n = 9561). The overall incidence increased significantly over 16 years (AAPC: 4.1 %; p < 0.05), with a 1.4-fold rise in both sexes and a marked rise among 0–19-year-olds, exclusively post-2019 (p < 0.05). NHL incidence was highest in individuals aged ≥ 60 years, with a 2-fold rise in both gender (APC: 3.2; 95 % CI: 0.4 – 6.1; p < 0.05) during 2011–2021. Hodgkin lymphoma (HL) showed a significant 3-fold increase in females, while trends in males fluctuated, with a significant average AAPC in both sexes from 2011 to 2021 (p < 0.05). Despite the non-significant rise in female incidence across most age groups, males in 40–59 and > 60 years age groups showed a decline. A significant rise in NHL-related deaths among males (p < 0.05) was noted, with a non-significant increase in females.</div></div><div><h3>Conclusions</h3><div>Our findings indicate an apparent rising burden of lymphoma in Sri Lanka, particularly among males and the elderly. However, this observed increase may be partly attributable to improvements in cancer diagnostics and NCCP reporting over time. Additionally, evolving WHO classifications and their gradual adoption may also have influenced the observed trends.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"99 ","pages":"Article 102951"},"PeriodicalIF":2.3,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-25DOI: 10.1016/j.canep.2025.102948
Chih-Wen Wang , Pinpin Lin , Yu-Cheng Chen , Yueh-Hsia Luo , Chih-Da Wu , Ching-Chun Li , Chun-Hung Richard Lin
Background
Limited evidence exists regarding the relationship between air pollution and all-cause mortality in colorectal cancer stratified by clinical stages.
Methods
In this retrospective cohort study, initiated in 2010, we included patients with pathologically confirmed colorectal carcinoma. Each participant's address was geocoded to the corresponding village/borough or township, for accurate matching with estimated air pollution concentrations. The risk of all-cause mortality was assessed using Kaplan–Meier analysis and Cox proportional hazards regression models.
Results
Our study enrolled 5126 colorectal cancer patients, with a median survival time of 72.0 months. Higher exposures were associated with greater all-cause mortality: PM2.5₅ tertile 3 vs tertile 1—HR 1.32 (95 % CI 1.14–1.52) and SO₂ tertile 3 vs tertile 1—HR 1.22 (95 % CI 1.06–1.40). Stage-stratified results showed PM2.5 remained significant in stages 0–I (HR 1.62, 95 % CI 1.01–2.58) and III (HR 1.39, 95 % CI 1.11–1.73), whereas SO₂ was significant in stages II (HR 1.62, 95 % CI 1.03–2.53) and III (HR 1.34, 95 % CI 1.07–1.67). In multiplicative interactions, each unit increase in PM2.5 was linked to a 1 % higher hazard (HR = 1.01; 95 % CI, 1.01–1.02), and each unit increase in SO₂ to a 5 % higher hazard (HR = 1.05; 95 % CI, 1.04–1.05). When stage was included additively, the per-unit effects were larger—7 % for PM2.5 (HR = 1.07; 95 % CI, 1.05–1.10) and 14 % for SO₂ (HR = 1.14; 95 % CI, 1.11–1.17). Overall, pollutant levels and clinical stage jointly heightened all-cause mortality.
Conclusions
Elevated PM2.5 and SO2 exposures were significantly associated with higher all-cause mortality, with effect sizes varying by stage and generally stronger in stages 0–I and II–III. Clinical stage interacted both associations, and joint exposure–stage categories showed higher risks, underscoring the need to reduce pollution exposure in high-risk patients.
背景：空气污染与按临床分期分层的结直肠癌全因死亡率之间的关系证据有限。方法本回顾性队列研究始于2010年，纳入病理确诊的结直肠癌患者。每个参与者的地址都被地理编码到相应的村/区或乡镇，以便与估计的空气污染浓度准确匹配。采用Kaplan-Meier分析和Cox比例风险回归模型评估全因死亡风险。结果本研究共纳入5126例结直肠癌患者，中位生存期为72.0个月。更高的暴露与更高的全因死亡率相关：PM2.5₅tertile 3 vs tertile 1-HR 1.32（95 % CI 1.14-1.52）和SO₂tertile 3 vs tertile 1-HR 1.22（95 % CI 1.06-1.40）。分期分层结果显示，PM2.5在0-I期（HR 1.62, 95 % CI 1.01-2.58）和III期（HR 1.39, 95 % CI 1.11-1.73）仍然显著，而SO₂在II期（HR 1.62, 95 % CI 1.03-2.53）和III期（HR 1.34, 95 % CI 1.07-1.67）显著。在乘法相互作用中，PM2.5每增加一个单位，危害增加1 % (HR = 1.01; 95 % CI, 1.01 - 1.02)，二氧化硫每增加一个单位，危害增加5 % （HR = 1.05; 95 % CI, 1.04-1.05）。当附加阶段时，单位效应更大，PM2.5为7 % (HR = 1.07; 95 % CI, 1.05-1.10)，二氧化硫为14 % （HR = 1.14; 95 % CI, 1.11-1.17）。总体而言，污染物水平和临床分期共同提高了全因死亡率。结论PM2.5和SO2暴露升高与较高的全因死亡率显著相关，且不同阶段的效应大小不同，一般在0-I期和II-III期更强。临床阶段与这两种关联相互作用，联合暴露阶段类别显示出更高的风险，强调需要减少高风险患者的污染暴露。
{"title":"Long-term air pollution exposure and mortality outcomes in colorectal cancer patients: Evidence from a multicenter longitudinal study","authors":"Chih-Wen Wang , Pinpin Lin , Yu-Cheng Chen , Yueh-Hsia Luo , Chih-Da Wu , Ching-Chun Li , Chun-Hung Richard Lin","doi":"10.1016/j.canep.2025.102948","DOIUrl":"10.1016/j.canep.2025.102948","url":null,"abstract":"<div><h3>Background</h3><div>Limited evidence exists regarding the relationship between air pollution and all-cause mortality in colorectal cancer stratified by clinical stages.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, initiated in 2010, we included patients with pathologically confirmed colorectal carcinoma. Each participant's address was geocoded to the corresponding village/borough or township, for accurate matching with estimated air pollution concentrations. The risk of all-cause mortality was assessed using Kaplan–Meier analysis and Cox proportional hazards regression models.</div></div><div><h3>Results</h3><div>Our study enrolled 5126 colorectal cancer patients, with a median survival time of 72.0 months. Higher exposures were associated with greater all-cause mortality: PM<sub>2.5</sub>₅ tertile 3 vs tertile 1—HR 1.32 (95 % CI 1.14–1.52) and SO₂ tertile 3 vs tertile 1—HR 1.22 (95 % CI 1.06–1.40). Stage-stratified results showed PM<sub>2.5</sub> remained significant in stages 0–I (HR 1.62, 95 % CI 1.01–2.58) and III (HR 1.39, 95 % CI 1.11–1.73), whereas SO₂ was significant in stages II (HR 1.62, 95 % CI 1.03–2.53) and III (HR 1.34, 95 % CI 1.07–1.67). In multiplicative interactions, each unit increase in PM<sub>2.5</sub> was linked to a 1 % higher hazard (HR = 1.01; 95 % CI, 1.01–1.02), and each unit increase in SO₂ to a 5 % higher hazard (HR = 1.05; 95 % CI, 1.04–1.05). When stage was included additively, the per-unit effects were larger—7 % for PM<sub>2.5</sub> (HR = 1.07; 95 % CI, 1.05–1.10) and 14 % for SO₂ (HR = 1.14; 95 % CI, 1.11–1.17). Overall, pollutant levels and clinical stage jointly heightened all-cause mortality.</div></div><div><h3>Conclusions</h3><div>Elevated PM<sub>2.5</sub> and SO<sub>2</sub> exposures were significantly associated with higher all-cause mortality, with effect sizes varying by stage and generally stronger in stages 0–I and II–III. Clinical stage interacted both associations, and joint exposure–stage categories showed higher risks, underscoring the need to reduce pollution exposure in high-risk patients.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"99 ","pages":"Article 102948"},"PeriodicalIF":2.3,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-24DOI: 10.1016/j.canep.2025.102947
Enrica Santelli , Gemma Gatta , Fabio Savoia , Sabrina Fabiano , Francesco Cuccaro , Viviana Perotti , Andrea Tittarelli , Tiziana Scuderi , Rosalba Amodio , Walter Mazzucco , Fabrizio Stracci , Ilaria Cozzi , AIRTUM Working Group
Background
Paediatric cancers are rare, yet, Italy has previously shown some of the highest incidence rates in Europe as a leading cause of death in children and adolescents. This study updates data from Italy for 2008–2017, analyses trends from 1998, and compares findings with other European regions.
Methods
A population-based approach was used, leveraging data from the Italian Association of Cancer Registries (AIRTUM). Thirty-one cancer registries covering 77 % of the Italian paediatric population contributed data on tumour type, age, sex, residence, and diagnosis date. Cancers were classified using the International Classification of Childhood Cancer, Third Edition (ICCC-3). Age-specific (IR) and age-standardized incidence rates (ASR) were computed, while trends were analysed with Joinpoint regression to estimate annual (APC) and average annual percentage change (AAPC).
Results
From 2008–2017, 17,322 malignant paediatric cancer cases were reported in Italy. The age-standardized incidence rate (ASR) was 166.8 per million for ages 0–14 and 294.3 per million for adolescents 15–19. Over the study period, incidence rates were generally stable, but a significant increase was observed for bone tumours in children and thyroid and melanoma in adolescents. Central Italy showed higher incidence rates compared to other Italian regions. Italy still shows one of the highest incidence rates in Europe.
Conclusion
While the study confirms overall stable incidence trends in Italy, it also highlights an increase in specific cancers such as melanoma and thyroid tumours in adolescents. Central Italy exhibited higher incidence rates, potentially due to environmental and/or diagnostic factors. Continuous monitoring and further research are needed to clarify regional variations and evaluate the impact of early diagnosis and environmental exposures.
{"title":"Incidence rates and trends of paediatric cancer in Italy, 2008–2017","authors":"Enrica Santelli , Gemma Gatta , Fabio Savoia , Sabrina Fabiano , Francesco Cuccaro , Viviana Perotti , Andrea Tittarelli , Tiziana Scuderi , Rosalba Amodio , Walter Mazzucco , Fabrizio Stracci , Ilaria Cozzi , AIRTUM Working Group","doi":"10.1016/j.canep.2025.102947","DOIUrl":"10.1016/j.canep.2025.102947","url":null,"abstract":"<div><h3>Background</h3><div>Paediatric cancers are rare, yet, Italy has previously shown some of the highest incidence rates in Europe as a leading cause of death in children and adolescents. This study updates data from Italy for 2008–2017, analyses trends from 1998, and compares findings with other European regions.</div></div><div><h3>Methods</h3><div>A population-based approach was used, leveraging data from the Italian Association of Cancer Registries (AIRTUM). Thirty-one cancer registries covering 77 % of the Italian paediatric population contributed data on tumour type, age, sex, residence, and diagnosis date. Cancers were classified using the International Classification of Childhood Cancer, Third Edition (ICCC-3). Age-specific (IR) and age-standardized incidence rates (ASR) were computed, while trends were analysed with Joinpoint regression to estimate annual (APC) and average annual percentage change (AAPC).</div></div><div><h3>Results</h3><div>From 2008–2017, 17,322 malignant paediatric cancer cases were reported in Italy. The age-standardized incidence rate (ASR) was 166.8 per million for ages 0–14 and 294.3 per million for adolescents 15–19. Over the study period, incidence rates were generally stable, but a significant increase was observed for bone tumours in children and thyroid and melanoma in adolescents. Central Italy showed higher incidence rates compared to other Italian regions. Italy still shows one of the highest incidence rates in Europe.</div></div><div><h3>Conclusion</h3><div>While the study confirms overall stable incidence trends in Italy, it also highlights an increase in specific cancers such as melanoma and thyroid tumours in adolescents. Central Italy exhibited higher incidence rates, potentially due to environmental and/or diagnostic factors. Continuous monitoring and further research are needed to clarify regional variations and evaluate the impact of early diagnosis and environmental exposures.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"99 ","pages":"Article 102947"},"PeriodicalIF":2.3,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-24DOI: 10.1016/j.canep.2025.102946
Mariana Cavalheiro Magri , Victória Gonçalves de Paula , Marina Rossi de Camargo Pinto , Débora Bignotto Rosane Battaglia , Rafael de Oliveira , Gustavo Manoel Ferreira , Fátima Mitiko Tengan , Edson Abdala
Background
Hepatitis B virus reactivation may occur in cancer patients, leading to liver damage and early discontinuation of treatment. To evaluate vaccine-induced immunity to hepatitis B, this study investigated the prevalence of anti-HBs antibodies from patients with solid tumors or hematological malignancies.
Methods
All cancer patients who underwent serological testing for anti-HBs from 2011 to 2023 and had negative anti-HBc results at the Instituto do Cancer do Estado de Sao Paulo, Brazil, were included. The prevalence of vaccine-induced immunity to hepatitis B during those years was assessed by using linear regression. Characteristics associated with presence of anti-HBs and anti-HBs titers (strongly positive: ≥ 100 IU/L; weakly positive: 10–99 IU/L) were evaluated by using multivariable logistic regression.
Results
A total of 23,854 patients were evaluated, 17,249 with solid tumors and 5114 with hematological malignancies. The prevalence of vaccine-induced immunity to hepatitis B was 22.1 %, with a significant linear increase over time (p < 0.001). The presence of vaccine-induced immunity to hepatitis B was associated with younger age (OR=7.23, 95 % CI: 6.55–7.98), female sex (OR=1.25, 95 % CI: 1.15–1.36), non-white patients (OR=1.13, 95 % CI: 1.04–1.22), and patients with hematological malignancies (OR=1.16, 95 %CI: 1.07–1.27). Additionally, the variables younger age (OR=1.64, 95 % CI: 1.39–1.94) and female sex (OR=1.39, 95 % CI: 1.20–1.60) were associated with strongly protective anti-HBs titers (≥ 100 IU/L).
Conclusions
This finding indicates that approximately one-quarter of a large population with cancer was protected against HBV infection through serological evidence of anti-HBs. Preventive strategies are needed for cancer patients, who may benefit from hepatitis B vaccination.
背景：乙型肝炎病毒再激活可能发生在癌症患者中，导致肝损伤和早期停止治疗。为了评估疫苗诱导的乙型肝炎免疫，本研究调查了实体瘤或血液恶性肿瘤患者中抗乙型肝炎抗体的流行情况。方法纳入2011年至2023年在巴西圣保罗州癌症研究所（Instituto do cancer do Estado de Sao Paulo）接受抗hbc血清学检测且抗hbc结果阴性的所有癌症患者。在这些年中，通过线性回归评估了疫苗诱导的乙型肝炎免疫的流行情况。使用多变量logistic回归评估与抗- hbs存在和抗- hbs滴度相关的特征（强阳性：≥100 IU/L；弱阳性：10-99 IU/L）。结果共检查了23854例患者，其中实体瘤17249例，血液系统恶性肿瘤5114例。疫苗诱导的乙型肝炎免疫患病率为22.1% %，随着时间的推移呈显著线性增长（p <； 0.001）。疫苗诱导乙肝免疫的存在与年龄较小（OR=7.23, 95 %CI: 6.55-7.98）、女性（OR=1.25, 95 %CI: 1.15-1.36）、非白人患者（OR=1.13, 95 %CI: 1.04-1.22）和血液恶性肿瘤患者（OR=1.16, 95 %CI: 1.07-1.27）相关。此外，年龄较小（OR=1.64, 95 % CI: 1.39 - 1.94）和女性（OR=1.39, 95 % CI: 1.20-1.60）与强保护性抗hbs滴度（≥100 IU/L）相关。结论：这一发现表明，大约四分之一的癌症患者通过血清学证据显示抗HBV感染。癌症患者需要预防策略，他们可能从乙肝疫苗接种中受益。
{"title":"Prevalence of vaccine-induced immunity to hepatitis B in cancer patients: A 13-year analysis in a quaternary oncological center","authors":"Mariana Cavalheiro Magri , Victória Gonçalves de Paula , Marina Rossi de Camargo Pinto , Débora Bignotto Rosane Battaglia , Rafael de Oliveira , Gustavo Manoel Ferreira , Fátima Mitiko Tengan , Edson Abdala","doi":"10.1016/j.canep.2025.102946","DOIUrl":"10.1016/j.canep.2025.102946","url":null,"abstract":"<div><h3>Background</h3><div>Hepatitis B virus reactivation may occur in cancer patients, leading to liver damage and early discontinuation of treatment. To evaluate vaccine-induced immunity to hepatitis B, this study investigated the prevalence of anti-HBs antibodies from patients with solid tumors or hematological malignancies.</div></div><div><h3>Methods</h3><div>All cancer patients who underwent serological testing for anti-HBs from 2011 to 2023 and had negative anti-HBc results at the Instituto do Cancer do Estado de Sao Paulo, Brazil, were included. The prevalence of vaccine-induced immunity to hepatitis B during those years was assessed by using linear regression. Characteristics associated with presence of anti-HBs and anti-HBs titers (strongly positive: ≥ 100 IU/L; weakly positive: 10–99 IU/L) were evaluated by using multivariable logistic regression.</div></div><div><h3>Results</h3><div>A total of 23,854 patients were evaluated, 17,249 with solid tumors and 5114 with hematological malignancies. The prevalence of vaccine-induced immunity to hepatitis B was 22.1 %, with a significant linear increase over time (p < 0.001). The presence of vaccine-induced immunity to hepatitis B was associated with younger age (OR=7.23, 95 % CI: 6.55–7.98), female sex (OR=1.25, 95 % CI: 1.15–1.36), non-white patients (OR=1.13, 95 % CI: 1.04–1.22), and patients with hematological malignancies (OR=1.16, 95 %CI: 1.07–1.27). Additionally, the variables younger age (OR=1.64, 95 % CI: 1.39–1.94) and female sex (OR=1.39, 95 % CI: 1.20–1.60) were associated with strongly protective anti-HBs titers (≥ 100 IU/L).</div></div><div><h3>Conclusions</h3><div>This finding indicates that approximately one-quarter of a large population with cancer was protected against HBV infection through serological evidence of anti-HBs. Preventive strategies are needed for cancer patients, who may benefit from hepatitis B vaccination.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"99 ","pages":"Article 102946"},"PeriodicalIF":2.3,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-17DOI: 10.1016/j.canep.2025.102945
Sebastian Respicio , Daniel Ryan , Christopher Bine , Stone Zhang , Peter Silberstein , Marco DiBlasi
Objectives
To characterize the prognostic profile of head and neck Mucoepidermoid Carcinoma (MEC) and correlate findings with survival and surgical likelihood.
Methods
This retrospective cohort study queried the National Cancer Database from 2004 to 2021 for all head and neck structures with histologically confirmed MEC. Using SPSS and GraphPad Prism, statistical analyses were conducted via Kaplan Meier Survival with Log-Rank Pairwise Comparisons, Cox Proportional Hazards Regressions, and Binomial and Multinomial Logistic Regressions.
Results
A total of 17,713 patients were included. Significant findings include worsened overall survival (OS) and hazard ratios (HR) in relation to male sex, white race, non-Hispanic ethnicity, non-Private Insurances, non-Academic/Research treatment facilities, and not undergoing surgery. MEC in the Gum & Other Mouth and in the Lip had better OS and HR while MEC of the Nose, Nasal Cavity, & Middle Ear, MEC of the Tongue, and MEC of the Pharynx had worsened OS and HR in comparison to Salivary Gland MEC. Gum & Other Mouth MEC patients had significantly increased likelihood for Local Tumor Excision and Partial Organ Removal surgeries. Tongue MEC had significantly increased likelihood for Partial Organ Removal. Nose, Nasal Cavity, & Middle Ear MEC and Pharynx MEC had significantly decreased likelihoods for Local Tumor Excision or Total/Radical Organ Removal Surgeries.
Conclusion
By identifying key determinants of survival and surgical likelihood, this work provides valuable clinical insight into patient management and outcomes for a clinically significant malignancy. Additionally, this study comments on the role of accessible surgical care and social determinants of health regarding MEC.
{"title":"Prognostic factors of Mucoepidermoid Carcinoma within the head and neck: A NCDB analysis","authors":"Sebastian Respicio , Daniel Ryan , Christopher Bine , Stone Zhang , Peter Silberstein , Marco DiBlasi","doi":"10.1016/j.canep.2025.102945","DOIUrl":"10.1016/j.canep.2025.102945","url":null,"abstract":"<div><h3>Objectives</h3><div>To characterize the prognostic profile of head and neck Mucoepidermoid Carcinoma (MEC) and correlate findings with survival and surgical likelihood.</div></div><div><h3>Methods</h3><div>This retrospective cohort study queried the National Cancer Database from 2004 to 2021 for all head and neck structures with histologically confirmed MEC. Using SPSS and GraphPad Prism, statistical analyses were conducted via Kaplan Meier Survival with Log-Rank Pairwise Comparisons, Cox Proportional Hazards Regressions, and Binomial and Multinomial Logistic Regressions.</div></div><div><h3>Results</h3><div>A total of 17,713 patients were included. Significant findings include worsened overall survival (OS) and hazard ratios (HR) in relation to male sex, white race, non-Hispanic ethnicity, non-Private Insurances, non-Academic/Research treatment facilities, and not undergoing surgery. MEC in the Gum & Other Mouth and in the Lip had better OS and HR while MEC of the Nose, Nasal Cavity, & Middle Ear, MEC of the Tongue, and MEC of the Pharynx had worsened OS and HR in comparison to Salivary Gland MEC. Gum & Other Mouth MEC patients had significantly increased likelihood for Local Tumor Excision and Partial Organ Removal surgeries. Tongue MEC had significantly increased likelihood for Partial Organ Removal. Nose, Nasal Cavity, & Middle Ear MEC and Pharynx MEC had significantly decreased likelihoods for Local Tumor Excision or Total/Radical Organ Removal Surgeries.</div></div><div><h3>Conclusion</h3><div>By identifying key determinants of survival and surgical likelihood, this work provides valuable clinical insight into patient management and outcomes for a clinically significant malignancy. Additionally, this study comments on the role of accessible surgical care and social determinants of health regarding MEC.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"99 ","pages":"Article 102945"},"PeriodicalIF":2.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-17DOI: 10.1016/j.canep.2025.102944
Todd Burus , Uriel Kim , Johnie Rose , Siran M. Koroukian , Krystle A. Lang Kuhs
Background
Disruptions to cancer diagnoses were widely reported in the US during the early COVID-19 pandemic. Whether any cases remained unaccounted-for by the end of the pandemic has not been fully assessed.
Methods
We collected data on invasive cancer diagnoses occurring among individuals aged 20–89 years between January 2020 and December 2022 from the Surveillance, Epidemiology, and End Results database. Expected cancer case counts and incidence rates with 95 % credibility intervals (95 %CrIs) were estimated for 2020–2022 from pre-pandemic trends (2005–2019) using Bayesian Age-Period-Cohort models. We compared observed rates with expected rates, and estimated unaccounted-for cases. Additional site-, stage-, and subgroup-specific analyses were performed.
Results
Among 2260,704 cancer cases diagnosed in 2020–2022, the observed incidence rate was 595.5 per 100,000 persons (95 %CI, 594.7–596.2), which was 6.7 % lower than the expected rate of 638.1 (95 %CrI, 620.1–656.1) and corresponded to 160,475 fewer-than-expected cases (95 %CrI, 99,777–221,174). Annual observed rates were significantly lower than expected in 2020 (565.8 vs. 630.7), with recovery in 2021 and 2022, though not enough to overcome the existing case deficit. Incidence rates for persons aged ≥ 65 years, nonmetropolitan residents, and non-Hispanic White individuals, as well as site-specific rates for lung and kidney cancers and non-Hodgkin lymphoma, remained below expected levels beyond 2020. Early-stage colorectal cancer diagnoses were 14.2 % lower than expected over the period.
Conclusion
While annual cancer incidence rates returned to expected levels by the end of the COVID-19 pandemic, substantial numbers of unaccounted-for cases remained, raising concerns for future increases in cancer morbidity and mortality.
{"title":"A cross-sectional assessment of US cancer diagnoses during the COVID-19 pandemic","authors":"Todd Burus , Uriel Kim , Johnie Rose , Siran M. Koroukian , Krystle A. Lang Kuhs","doi":"10.1016/j.canep.2025.102944","DOIUrl":"10.1016/j.canep.2025.102944","url":null,"abstract":"<div><h3>Background</h3><div>Disruptions to cancer diagnoses were widely reported in the US during the early COVID-19 pandemic. Whether any cases remained unaccounted-for by the end of the pandemic has not been fully assessed.</div></div><div><h3>Methods</h3><div>We collected data on invasive cancer diagnoses occurring among individuals aged 20–89 years between January 2020 and December 2022 from the Surveillance, Epidemiology, and End Results database. Expected cancer case counts and incidence rates with 95 % credibility intervals (95 %CrIs) were estimated for 2020–2022 from pre-pandemic trends (2005–2019) using Bayesian Age-Period-Cohort models. We compared observed rates with expected rates, and estimated unaccounted-for cases. Additional site-, stage-, and subgroup-specific analyses were performed.</div></div><div><h3>Results</h3><div>Among 2260,704 cancer cases diagnosed in 2020–2022, the observed incidence rate was 595.5 per 100,000 persons (95 %CI, 594.7–596.2), which was 6.7 % lower than the expected rate of 638.1 (95 %CrI, 620.1–656.1) and corresponded to 160,475 fewer-than-expected cases (95 %CrI, 99,777–221,174). Annual observed rates were significantly lower than expected in 2020 (565.8 vs. 630.7), with recovery in 2021 and 2022, though not enough to overcome the existing case deficit. Incidence rates for persons aged ≥ 65 years, nonmetropolitan residents, and non-Hispanic White individuals, as well as site-specific rates for lung and kidney cancers and non-Hodgkin lymphoma, remained below expected levels beyond 2020. Early-stage colorectal cancer diagnoses were 14.2 % lower than expected over the period.</div></div><div><h3>Conclusion</h3><div>While annual cancer incidence rates returned to expected levels by the end of the COVID-19 pandemic, substantial numbers of unaccounted-for cases remained, raising concerns for future increases in cancer morbidity and mortality.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"99 ","pages":"Article 102944"},"PeriodicalIF":2.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-16DOI: 10.1016/j.canep.2025.102926
Shibaji Gupta , Priyadharshini Babu , Debdutta Haldar , Subhadip Bag , Ilham Zaidi , Sonu Goel
Background
The convergence of climate change and cancer is an emerging research area with significant implications for public health. This bibliometric analysis aimed to map the growth, trends, contributors, collaboration networks, and thematic areas related to this field.
Methods
We systematically searched PubMed and Scopus databases for peer-reviewed literature published between 2000 and 2024 using predefined keywords. One-hundred and nineteen eligible articles were analyzed for metrics like co-authorship networks and keywords co-occurrence.
Results
The volume of research has seen a significant rise since the 2010s. The United States, China, and the United Kingdom were leading contributors, while the Low- and Middle-Income Countries were underrepresented. Dominant research themes included climate change and cancer, pollution and cancer, sun exposure, temperature and skin cancer, and air pollution and climate change. Air pollution and particulate matter were identified as high-density and centrality motor themes.
Conclusion
This analysis provides a first-of-its-kind mapping of 2 decades of global research at the intersection of climate change and cancer. Future research should prioritize global South perspectives, context-specific investigations, and longitudinal studies integrating registry data for in-depth studies to elucidate the causal relationships between climate change and cancer types. The oncology community should engage in climate action through mitigation and adaptation strategies.
{"title":"The intersection of climate change and cancer across global populations: A bibliometric analysis (2000–2024)","authors":"Shibaji Gupta , Priyadharshini Babu , Debdutta Haldar , Subhadip Bag , Ilham Zaidi , Sonu Goel","doi":"10.1016/j.canep.2025.102926","DOIUrl":"10.1016/j.canep.2025.102926","url":null,"abstract":"<div><h3>Background</h3><div>The convergence of climate change and cancer is an emerging research area with significant implications for public health. This bibliometric analysis aimed to map the growth, trends, contributors, collaboration networks, and thematic areas related to this field.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed and Scopus databases for peer-reviewed literature published between 2000 and 2024 using predefined keywords. One-hundred and nineteen eligible articles were analyzed for metrics like co-authorship networks and keywords co-occurrence.</div></div><div><h3>Results</h3><div>The volume of research has seen a significant rise since the 2010s. The United States, China, and the United Kingdom were leading contributors, while the Low- and Middle-Income Countries were underrepresented. Dominant research themes included climate change and cancer, pollution and cancer, sun exposure, temperature and skin cancer, and air pollution and climate change. Air pollution and particulate matter were identified as high-density and centrality motor themes.</div></div><div><h3>Conclusion</h3><div>This analysis provides a first-of-its-kind mapping of 2 decades of global research at the intersection of climate change and cancer. Future research should prioritize global South perspectives, context-specific investigations, and longitudinal studies integrating registry data for in-depth studies to elucidate the causal relationships between climate change and cancer types. The oncology community should engage in climate action through mitigation and adaptation strategies.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"99 ","pages":"Article 102926"},"PeriodicalIF":2.3,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-16DOI: 10.1016/j.canep.2025.102943
Pascale J.M. Schafrat , Felice N. van Erning , Koos Zwinderman , Evelien Dekker , Arantza Farina Sarasqueta , Judith de Vos-Geelen , Stefan A.W. Bouwense , Ruben S.A. Goedegebuure , Louis Vermeulen , Ignace H.J.T. de Hingh , Dirkje W. Sommeijer
Background
Malignancies of the small intestine are rare and understudied. Improved knowledge about trends in incidence and distribution of specific subtypes might guide clinicians and researchers to further improve diagnostic and treatment strategies and ultimately improve prognosis.
Methods
This nationwide retrospective cohort study from the Netherlands Cancer Registry included all patients diagnosed with a malignancy of the small intestine in the Netherlands between 2000 and 2022. Malignancies were divided into seven subgroups: adenocarcinomas, neuroendocrine neoplasms (NENs), lymphomas, gastrointestinal stromal tumors (GISTs), other sarcomas, metastases, and “other”. Age-standardized incidence rates, overall- and relative survival were reported.
Results
A total of 11.194 patients with a malignancy of the small intestine were included. Age-standardized incidence rates (per 100.000 person-years) more than doubled between 2000 and 2020 (1.88–3.94, p < 0.001), with the largest increase in NENs (0.53–1.57, p < 0.001), followed by adenocarcinomas (0.78–1.22, p = 0.004). The most prevalent malignancy in the small intestine shifted from adenocarcinomas to NENs from 2017 onwards. NENs were mostly located in the ileum and adenocarcinomas were most frequently diagnosed in the duodenum. Survival varied significantly between subgroups. Survival of patients with lymphomas and GISTs improved over time, in contrast with patients with adenocarcinomas and NENs.
Conclusion
The incidence of malignancies of the small intestine in the Netherlands has more than doubled over the past two decades, mostly due to an increase in NENs and adenocarcinomas. Survival outcomes for these malignancies did not improve, highlighting the urgent need to further study these rare cancer subtypes in the small intestine.
{"title":"Malignancies of the small intestine: incidence and trends in a nationwide registry","authors":"Pascale J.M. Schafrat , Felice N. van Erning , Koos Zwinderman , Evelien Dekker , Arantza Farina Sarasqueta , Judith de Vos-Geelen , Stefan A.W. Bouwense , Ruben S.A. Goedegebuure , Louis Vermeulen , Ignace H.J.T. de Hingh , Dirkje W. Sommeijer","doi":"10.1016/j.canep.2025.102943","DOIUrl":"10.1016/j.canep.2025.102943","url":null,"abstract":"<div><h3>Background</h3><div>Malignancies of the small intestine are rare and understudied. Improved knowledge about trends in incidence and distribution of specific subtypes might guide clinicians and researchers to further improve diagnostic and treatment strategies and ultimately improve prognosis.</div></div><div><h3>Methods</h3><div>This nationwide retrospective cohort study from the Netherlands Cancer Registry included all patients diagnosed with a malignancy of the small intestine in the Netherlands between 2000 and 2022. Malignancies were divided into seven subgroups: adenocarcinomas, neuroendocrine neoplasms (NENs), lymphomas, gastrointestinal stromal tumors (GISTs), other sarcomas, metastases, and “other”. Age-standardized incidence rates, overall- and relative survival were reported.</div></div><div><h3>Results</h3><div>A total of 11.194 patients with a malignancy of the small intestine were included. Age-standardized incidence rates (per 100.000 person-years) more than doubled between 2000 and 2020 (1.88–3.94, <em>p < 0.001</em>), with the largest increase in NENs (0.53–1.57, <em>p < 0.001</em>), followed by adenocarcinomas (0.78–1.22, <em>p</em> = 0.004). The most prevalent malignancy in the small intestine shifted from adenocarcinomas to NENs from 2017 onwards. NENs were mostly located in the ileum and adenocarcinomas were most frequently diagnosed in the duodenum. Survival varied significantly between subgroups. Survival of patients with lymphomas and GISTs improved over time, in contrast with patients with adenocarcinomas and NENs.</div></div><div><h3>Conclusion</h3><div>The incidence of malignancies of the small intestine in the Netherlands has more than doubled over the past two decades, mostly due to an increase in NENs and adenocarcinomas. Survival outcomes for these malignancies did not improve, highlighting the urgent need to further study these rare cancer subtypes in the small intestine.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"99 ","pages":"Article 102943"},"PeriodicalIF":2.3,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-15DOI: 10.1016/j.canep.2025.102942
Sarah R. Haile , Miriam Wanner , Dimitri Korol , Sabine Rohrmann
Background
We aimed to compare various common approaches for handling missing vital status or follow-up time. As a case study for application of these methods, we estimated incidence of metachronous contralateral breast cancer (CBC).
Methods
For 1980–2016, incidence of metachronous CBC with follow-up through 2024 was estimated using Poisson regression with overdispersion, by age at incidence, year of incidence, histology and follow-up period. Missing follow-up time was ignored in the naive approach, simulated once using the average hazard derived from published Swiss cancer registry data, or multiply imputed using 3 different imputation models.
Results
24,612 women aged 20–84 had unilateral breast cancer between 1980 and 2016 in the Swiss cantons of Zurich and Zug. Of those, 5 % (n = 1264) were lost to follow-up. Over 291,463 person-years, 1145 contralateral breast malignancies were diagnosed, corresponding to 393 per 100,000 person-years (95 % CI 353–438). Incidence rates have been decreasing over time to 238 (171−333) for the incidence period 2010–2016. The same overall pattern was observed regardless of how we handled missing follow-up times. However, using a single imputation generally produced lower incidence rates compared to the naive approach, with multiple imputation giving higher estimates. The most complex multiple imputation model gave incidence estimates that were very similar to those from the naive approach.
Conclusion
Different methods to handle missing follow-up times yielded similar results: that CBC incidence has declined in recent decades. Multiple imputation is likely an appropriate method to handle missing follow-up data, enabling researchers to include all eligible individuals in the analysis.
背景：我们的目的是比较各种常见的方法来处理遗漏的生命状态或随访时间。作为应用这些方法的一个案例研究，我们估计了异时性对侧乳腺癌（CBC）的发病率。方法：对1980-2016年随访至2024年的异时性CBC发病率，采用过分散泊松回归，按发病年龄、发病年份、组织学和随访时间进行估计。在幼稚的方法中忽略了随访时间的缺失，使用从瑞士癌症登记数据中得出的平均风险进行一次模拟，或使用3种不同的估算模型进行多次估算。结果：1980年至2016年间，瑞士苏黎世和楚格州有24,612名年龄在20-84岁之间的女性患有单侧乳腺癌。其中5 % （n = 1264）失访。在291,463人/年中，诊断出1145例对侧乳腺恶性肿瘤，相当于每10万人/年393例（95 % CI 353-438）。随着时间的推移，发病率一直在下降，2010-2016年发病率为238（171-333）。无论我们如何处理缺失的随访时间，观察到的总体模式都是一样的。然而，与单纯的方法相比，使用单一输入通常产生较低的发病率，而多次输入则给出较高的估计值。最复杂的多重imputation模型给出的发生率估计与朴素方法非常相似。结论：不同方法处理缺失随访时间的结果相似：近几十年来，CBC发病率有所下降。多重输入可能是处理缺失的随访数据的合适方法，使研究人员能够在分析中包括所有符合条件的个体。
{"title":"Approaches to handle missing follow-up time: A comparative analysis of contralateral breast cancer incidence","authors":"Sarah R. Haile , Miriam Wanner , Dimitri Korol , Sabine Rohrmann","doi":"10.1016/j.canep.2025.102942","DOIUrl":"10.1016/j.canep.2025.102942","url":null,"abstract":"<div><h3>Background</h3><div>We aimed to compare various common approaches for handling missing vital status or follow-up time. As a case study for application of these methods, we estimated incidence of metachronous contralateral breast cancer (CBC).</div></div><div><h3>Methods</h3><div>For 1980–2016, incidence of metachronous CBC with follow-up through 2024 was estimated using Poisson regression with overdispersion, by age at incidence, year of incidence, histology and follow-up period. Missing follow-up time was ignored in the naive approach, simulated once using the average hazard derived from published Swiss cancer registry data, or multiply imputed using 3 different imputation models.</div></div><div><h3>Results</h3><div>24,612 women aged 20–84 had unilateral breast cancer between 1980 and 2016 in the Swiss cantons of Zurich and Zug. Of those, 5 % (n = 1264) were lost to follow-up. Over 291,463 person-years, 1145 contralateral breast malignancies were diagnosed, corresponding to 393 per 100,000 person-years (95 % CI 353–438). Incidence rates have been decreasing over time to 238 (171−333) for the incidence period 2010–2016. The same overall pattern was observed regardless of how we handled missing follow-up times. However, using a single imputation generally produced lower incidence rates compared to the naive approach, with multiple imputation giving higher estimates. The most complex multiple imputation model gave incidence estimates that were very similar to those from the naive approach.</div></div><div><h3>Conclusion</h3><div>Different methods to handle missing follow-up times yielded similar results: that CBC incidence has declined in recent decades. Multiple imputation is likely an appropriate method to handle missing follow-up data, enabling researchers to include all eligible individuals in the analysis.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"99 ","pages":"Article 102942"},"PeriodicalIF":2.3,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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