Acta Oncologica最新文献

Background: There is a lack of comprehensive reports on time trends in synchronous prostate and rectal cancers. To address this, we conducted the largest cohort study to date to assess these trends in a population-based setting.

Methods: We included all adult (ages 18-99) men with incident prostate cancer in the Swedish Cancer Register in 1993-2019. Age-standardized incidence rates (ASIRs) of prostate cancer per 100,000 male population per year were calculated and compared to the ASIR of synchronous (± 6 months from rectal cancer diagnosis) prostate cancer. Age-adjusted synchronous-to-general incidence rate ratios (IRRs) were predicted using Poisson regression. As a sensitivity analysis to assess the effect of incidental findings due to the anatomical proximity, we investigated synchronous prostate and non-sigmoid colon cancers.

Results: Among 238,252 prostate cancer cases, 594 were synchronous with rectal cancer. The incidence of synchronous prostate cancer increased over the study period, with mean ASIR rising from 418/100,000 (1993-2001) to 788/100,000 (year 2011-2019). The synchronous-to-general IRR increased from 1.92 (95% confidence interval (CI) 1.60-2.31) to 2.61 (95% CI 2.32-2.95) over the same periods. Prostate cancer was also more commonly diagnosed in conjunction with non-sigmoid colon cancer than in the overall male population, but no time trend was observed.

Interpretation: The incidence of synchronous prostate and rectal cancers has increased over the past 20 years in Sweden, with no signs of plateauing. Future studies are warranted to explore factors contributing to prostate cancer overdiagnosis and to optimize clinical management strategies for this complex patient group.

Background and purpose: Sexual dysfunction is a common late effect of cancer reducing quality of life. This study investigated sexual health in cancer survivors shortly after diagnosis and at long-term follow-up compared to the general population.

Methods: A nationwide survey stratified by sex and age was distributed to a representative sample of the Norwegian population. Of the 5,135 respondents (33% response rate), 453 were cancer survivors, and 4,682 were cancer-free controls. Time since cancer diagnosis was divided into two categories: 2 years or less (short-term) and over 2 years (long-term). Sexual health was evaluated using the EORTC questionnaires SHQ-22 and the sexual domains of the QLQ-BR23/QLQ-BR45. Multivariable linear regression analyses compared sexual health between cancer survivors and cancer-free controls, and between short- and long-term cancer survivors.

Results: Cancer survivors reported significantly poorer sexual health outcomes than cancer-free controls, except for the importance of maintaining a sexually active life, rated equally important. There were minimal differences in sexual health between short-term and long-term cancer survivors. Interestingly, male cancer survivors appeared to be more affected by sexual health challenges than females, when compared to their cancer-free controls.

Interpretation: This study is the first to utilize the EORTC SHQ-22 questionnaire to assess sexual health in cancer survivors and controls. Sexual health was found to be significantly worse in cancer survivors compared to age-matched controls. It is imperative to address this overlooked health issue in the follow-up programs for cancer survivors.

Background and purpose: Persons with severe mental illnesses (SMIs) have reduced participation in colorectal cancer (CRC) screening programs, higher odds of advanced stage at diagnosis, and are less likely to receive adequate treatment than the general population. It remains unclear to what extent these factors impact CRC outcomes for persons with SMI. The aim of this scoping review was to describe and quantify CRC mortality for persons with SMI compared with the general population.

Patients/materials and methods: We followed the JBI Manual for Evidence Synthesis and PRISMA guidelines in a systematic search of four databases from inception until April 29th, 2024. We included studies that provided CRC mortality estimates for adults with preexisting clinical diagnosis of SMI. We synthesized the results descriptively and pooled the data to estimate the magnitude of the associations.

Results: Twenty-four original studies were identified with a total of 16.4 million persons. Most studies reported increased CRC mortality for persons with SMI compared with persons without SMI. The meta-analysis demonstrated a 25% increased CRC mortality for persons with SMI (e.g. pooled hazard ratio 1.25; 95% confidence interval 1.13 to 1.39; n = 13,178,161).

Interpretation: The evidence points consistently to an increased CRC mortality for persons with SMI compared with persons without SMI. Furthermore, this evidence supports the idea that persons with SMI are a heterogenous population, and as such, any future initiatives to improve CRC outcomes for persons with SMI would warrant a tailored approach to potentiate individual resources, to mitigate stigma and structural discrimination.

Background and purpose: This study aimed to assess current treatment strategies for metastatic triple-negative breast cancer (mTNBC) and the perceptions of clinical experts in Sweden, Denmark, Norway, Finland, and Iceland, comparing them to international guidelines to provide insights into how these therapies are implemented and adapted to national Nordic guidelines.

Methods: A three-round modified Delphi method was followed with consensus defined as 70% agreement. A steering committee selected 20 experienced oncologists as panellists and developed the questionnaires. Questions included items related to treatment preferences in different treatment lines with different clinical scenarios in mTNBC patients.

Results: In the first round, eight out of 33 questions on clinical treatment reached consensus with 14 out of 27 in the second round reaching consensus. In round three, eight out of eight questions reached consensus. The preferred treatment for mTNBC patients with PD-L1 positive was checkpoint inhibitors (CPI) in combination with chemotherapy. For patients with germline BRCA mutation and PD-L1 negative disease, PARP-inhibitors were preferred as 1L and sacituzumab govitecan (SG) in both 2L and later lines. Disagreement was observed for chemotherapy in later lines where evidence is sparse or lacking.

Interpretation: The high level of consensus for new treatment strategies, such as CPI and PARP-inhibitors in 1L and SG in 2L or later lines, in comparison with the limited consensus for older treatments, such as chemotherapy, may reflect the growing academic evidence for different treatment strategies. Understanding the treatment patterns across different countries contributes to gaining consensus on the upcoming therapeutic advances.

Background and purpose: Knowledge regarding the risk factors for early death in patients with head and neck squamous cell carcinoma (HNSCC) is scarce. This study aims to evaluate the rate of early death (during or within 6 months of treatment) and its associated risk factors in HNSCC patients treated with curative intent.

Materials and methods: A retrospective, population-based analysis of all HNSCC patients (n = 762) treated with curative intent at the Helsinki University Hospital (Helsinki, Finland) during 2012-2015 was conducted. Using the chi-square test, associations between categorical variables were assessed. Univariate and multivariate analyses were performed to identify independent factors for early death.

Results: The rate of early death was 10.1% with a median age of 70 years at diagnosis. Advanced stage, smoking > 40 pack-years, and heavy alcohol consumption were associated with increased odds of early death. Elevated thrombocyte levels > 380 (× 10⁹L) were observed more frequently in the early-death group when comparing the levels with the late-death group (p < 0.01). However, only age (odds ratio [OR] 1.05; 95% confidence interval [CI]:1.02-1.08), T4 class (OR 5.98; 95% CI: 2.60-13.74), N2 class (OR 2.98; 95% CI: 2.60-13.74), and N3 class (OR 12.24; 95% CI: 2.99-50.19) emerged as independent risk factors for early death.

Interpretation: Early death risk is increased in older patients and those with advanced-stage HNSCC. Elevated thrombocyte count requires further studies to assess its utility as a potential clinical marker.

Background and purpose: Radical prostatectomy can cause erectile dysfunction; however, subsequent treatment with, e.g., phosphodiesterase-5 inhibitors may improve sexual function in the patients. We aim to examine prescriptions for erectile dysfunction after radical prostatectomy and to identify factors that may affect the prescription rate.

Patients and methods: A study based on men included in the Danish Prostate Registry (DanProst) in 1995-2021, and information on prescriptions for erectile dysfunction (ATC: G04BE) from the Danish Prescription Registry. We calculated the proportion of prescriptions per month from 1 year before to 2 years after the initial biopsy and odds ratios (ORs) with 95% confidence intervals (CIs) for the risk of having a prescription.

Results: We included 9,286 men with radical prostatectomy, 4,221 men managed on active surveillance, and 47,572 men with nonmalignant biopsies for comparison. The proportion of prescriptions increased significantly after biopsy among men with radical prostatectomy compared to men with nonmalignant biopsies and active surveillance. Patients with prior prescriptions for erectile dysfunction had an OR of 3.49 (95% CI, 2.98-4.08) of new prescriptions 6 months after the initial biopsy. Compared to patients treated with bilateral nerve-sparing surgery, patients with unilateral nerve-sparing surgery had an OR of 1.23 (95% CI, 1.06-1.43), whereas patients without nerve-sparing surgery had an OR of 0.40 (95% CI, 0.34-0.46).

Interpretation: The observed patterns of prescriptions demonstrate a high demand for the treatment of erectile dysfunction following radical prostatectomy. The group of prostate cancer survivors is large, and, thus, a strong clinical focus on managing erectile dysfunction is needed.

Background and purpose: Early lymphedema detection is crucial to timely treatment, and home-based monitoring holds promise for early detection of leg lymphedema among at-risk cancer survivors. We developed a self-measurement protocol for home-based leg circumference measurements and tested its reliability in men with prostate cancer at risk of lymphedema.

Patients/material and methods: This cross-sectional study recruited men with prostate cancer from the Department of Urology, Copenhagen University Hospital, Denmark. Circumference measurements were taken at four points on both legs, from which leg volume was calculated. Intrarater reliability was assessed by comparing self-measurements taken at home and in the hospital. Interrater reliability was evaluated by comparing hospital self-measurements to those of a blinded physiotherapist. Statistical power required 13 participants for the detection of a good (>0.8) intraclass correlation coefficient (ICC).

Results: Forty-three men were included (median age 69 [63-76] years). Intrarater reliability (n = 39) was good to excellent for six out of eight measurement points (ICC ≥ 0.79, p < 0.01) and moderate for two (ICC ≥ 0.55, p < 0.01). Intrarater reliability for leg volume was excellent (ICC ≥ 0.96, p < 0.01). Similarly, interrater reliability (n = 23) was excellent for all measurement points and leg volumes (ICC ≥ 0.91, p < 0.01). Forty-one of 43 participants performed the measurements independently, found them easy to do, and were willing to conduct self-measurements if recommended by their doctor.

Interpretation: Self-measured leg circumference among men with prostate cancer is highly reliable and acceptable. This low-cost approach for home-based monitoring for lymphedema offers potential for early detection and timely management of the condition.

Background: Majority of vestibular schwannoma (VS) patients have undergone gamma-knife radiosurgery (GKRS) with favorable results. Clinical evidence is derived from doses calculated with a type-a algorithm, which in this case assumes all material to be water. A type-b algorithm (Convolution algorithm [CA]) taking tissue heterogeneity into account is available. Historically, body contour is defined using a 16-point approximation, whereas modern softwares generate the body from Magnetic Resonance Imaging (MRI). The accuracy in dose-calculation algorithms (DCA) and contouring method (CM) will have a significant influence in the relation between clinical outcome and dosimetric data. The objective was to investigate the impact of DCA and CMs on dose distribution while preserving treatment conditions.

Methods: Treatment plans for 16 VS patients were recalculated in terms of DCA and CM. The difference in the dose covering 99% of the VS (DVS99%) depending on CM and DCA was estimated. The difference in DVS99% was used to adopt the prescription of new CA-based plans. CA-plans were recalculated to TMR10 to evaluate clinical treatability, as clinical evidence is derived from TMR10-doses.

Results: Both CM and DCA had a significant impact on the dose to VS and surrounding structures. CM altered the doses homogenously by 2.1-3.3%, whereas DCA heterogeneously by 5.0-10.7%. An increase of 9.1[8.1, 10.0]% was found for DVS99% and the CA-plans recalculated into TMR10 resulted in clinically treatable plans.

Interpretation: We conclude that transferring to more modern algorithms that take tissue heterogeneity into account heterogeneously alter dose distributions. This work establishes a safe pathway to adopt prescription dose for VS while preserving clinical treatability.

Background: Rectal metastasis from gastric cancer (GC), also known as Schnitzler's metastasis, is a rare phenomenon. The clinicopathological characteristics, outcomes, and prognostic factors of this condition remain poorly understood.

Methods: We describe a case of GC causing Schnitzler's metastasis and present a systematic review on case reports and case series. Data extracted and analyzed include clinicopathological features, treatment modalities received, outcomes, and follow-up.

Results: A total of 34 records, including our own, encompassing 41 cases were incorporated into the study. The median age of patients at admission was 59 years, with females accounting for 53.7% of cases. The predominant histological subtype of Schnitzler's metastasis was moderate-to-poorly differentiated adenocarcinoma, representing 31 cases (86.1%). Among the patients in this cohort, 38.9% exhibited signet-ring cell carcinoma. Regarding the initial diagnosis of GC, 28.6% were categorized as stage IIIA, and 28.6% were classified as stage IV. The median overall survival (OS) time was 72 months (95% confidence interval [CI]: 27-NA), while the median OS since the diagnosis of metastatic cancer was 16 months (95% CI: 9-NA).

Interpretation: Schnitzler's metastasis presents a challenge in the pathology of colorectal endoscopy and may lead to treatment delays. Imaging features such as increased thickness of the intestinal wall and significant layered enhancement can aid in diagnosis; however, deep core biopsy of intestinal lesions remains the gold standard for diagnosing rectal metastases. Accurately distinguishing rectal metastases from primary rectal cancer is crucial for preventing unnecessary therapeutic interventions.

Background: Large B-cell lymphomas (LBCLs) form a notable subgroup of lymphomas; however, their associated long-term comorbidities and mortality rates remain under-researched in real-world settings.

Material and methods: This nationwide Finnish population-based matched cohort study included virtually all LBCL patients (N = 7,019) diagnosed from 2008 to 2019, alongside age, sex, and region-matched controls (1:1 ratio) without lymphoma. Diagnoses of LBCLs were obtained from the Finnish Cancer Registry, with data linked to additional nationwide registries. Baseline characteristics were summarised using descriptive statistics. Overall survival (OS) was estimated using the Kaplan-Meier method, while Cox regression was used to analyse factors associated with OS and evaluate the risk and associated factors of comorbidities considering the competing risk of death.

Results: The 5-year survival rate for LBCL patients, median age 70.7 years and 52.7% male, was 50.0% (95% Confidence Interval [CI] 48.7% - 51.3%), compared to 82.6% (95% CI 81.5% - 83.6%) for controls. Among LBCL patients, older age and a higher Charlson comorbidity index were associated with increased mortality. Conversely, female sex, later diagnosis year, and radiation therapy were associated with improved survival. Patients with LBCL exhibited an elevated risk of long-term comorbidities, including solid tumours, hematological and skin cancers, lung and thyroid diseases, mental and behavioral disorders, and cardiovascular diseases. After 12 years of follow-up, lymphoma accounted for the primary cause of death in approximately 43% of LBCL patients.

Interpretation: Large B-cell lymphomas are linked with significant long-term comorbidities and elevated mortality rates.