Acta Oncologica最新文献

Background and purpose: The objective of this systematic review was to establish an overview of changes in body composition as a result of early breast cancer treatment. Patient/material and methods: Five databases (PubMed, CINAHL, Embase, Web of Science and Cochrane Library) were used for identifying studies and papers. Selection criteria included: > 18 years, early breast cancer stage 0-III and measurement of body composition with either dual X-ray absorptiometry (DXA), magnetic resonance imaging (MRI) or computed tomography (CT). Studies using only bioelectrical impedance were excluded.

Results: A total of 734 studies were screened; 29 studies were full-text reviewed, and 10 studies were included in this systematic review, with a total of n = 1,062. Included studies were published from 2018 to 2024. This review found consistent increases in fat mass between 3.3 and 9.2% across the studies. Results for lean body mass were less consistent. Two studies examined visceral fat mass, yet both found statistically significant increases.

Interpretation: This systematic review identified consistent increases in total fat mass and visceral fat across the included studies, regardless of whether the treatment involved chemotherapy, endocrine therapy or a combination of both. In contrast, findings related to lean body mass were considerably less consistent. The results highlight the potential implications following breast cancer treatment and emphasise the importance of metabolic monitoring, diet and exercise to increase quality of life and prevent recurrence. This review also highlights the need for more research on the topic, as the included studies exhibit substantial heterogeneity, making it difficult to draw definitive conclusions.

Background and purpose: L1CAM (CD171) is suggested to play a critical role in cancer. Because of its expression in only few normal tissues and its membranous nature, L1CAM is a promising drug target. Patient/material and methods: To clarify the role of L1CAM expression in different cancer types, a tissue microarray containing 20,079 samples from 135 different tumor entities and 608 samples of 76 different normal tissue types was analyzed by immunohistochemistry.

Results: Membranous L1CAM staining was found in 1,175 (9.1%) of 12,888 interpretable tumor samples, including 301 (2.3%) with weak, 569 (4.4%) with moderate, and 305 (2.4%) with strong positivity. 74 of 135 tumor entities showed L1CAM staining, and 36 tumor categories included at least one case with strong L1CAM staining. The frequency of L1CAM positivity was high in subtypes of neural and neuroendocrine neoplasms (up to 100%), endometrium carcinoma (24.1-31.3%), ovarian cancer (10.0-33.1%), cervical adenocarcinoma (9.1%), malignant melanoma (24.1-31.3%), malignant mesothelioma (16.7-20.8%), adenocarcinomas of the gastrointestinal and biliopancreatic tract (4.9-14.1%), and in urothelial tumors (up to 10.3%). High L1CAM expression was associated with invasive tumor growth (pTa vs. pT2-4) in urothelial carcinoma of the bladder (p<0.0001) and with mismatch repair deficiency in colorectal adenocarcinoma (p=0.0064). However, L1CAM staining was unrelated to tumor phenotype in seven other tumor entities.

Interpretation: The results highlighted a small number of tumor entities that could be targeted by anti-L1CAM drugs, once these are proved to be sufficiently safe and efficient. L1CAM expression does not appear to confer an aggressive phenotype to affected cancer cells.

Background and purpose: Colorectal cancer (CRC) can affect return to work and sustained work  participation. While employment rates have been studied, less is known about how survivors manage work demands after returning, despite frequent long-term symptoms. This study investigated work participation and perceived work functioning 12 and 24 months after surgery. Patient/material and methods: Data stemmed from a Danish late sequelae screening programme including CRC patients aged ≥18 years who were affiliated with the labour market at diagnosis (2021-2024). Participants reported employment status, work role functioning, and work ability. Clinical data were retrieved from a national database. Multivariable logistic regression models, adjusted for cancer type, sex, and age, assessed factors associated with work functioning.

Results: At 12 months (n = 474) and 24 months (n = 257), 76% and 78% were employed. Just over half reported high work role functioning, and the majority reported high work ability at both follow-up points. Bowel-related problems were associated with lower work role functioning (12 months: odds ratio [OR] 0.35, 95% confidence interval [CI] 0.20-0.62; 24 months: OR 0.40, 95% CI 0.18-0.86) and lower work ability (12 months: OR 0.26, 95% CI 0.15-0.46; 24 months: OR 0.20, 95% CI 0.08-0.51). More advanced cancer stage was also linked to lower work ability.

Interpretation: Most survivors return to work within two years; however, persistent bowel-related problems are associated with reduced work functioning. Rehabilitation should address long-term symptoms to support sustained work participation.

Background and purpose: Advances in lymphoma treatment lead to a growing population of lymphoma survivors in childbearing ages who might be concerned about the impact of their disease on their children's health. In this study, we aim to explore healthcare utilisation patterns that were associated with parental history of lymphoma.

Patients/material and methods: Children born to lymphoma survivors (diagnosed over the period 2000-2018) were identified by linking the Swedish Cancer Register to national population registers. Each child born to a lymphoma survivor was matched on maternal age at childbirth to five children born to lymphoma-free parents. Information on in- and outpatient diagnoses and drug dispensations up to age five were obtained for all children.

Results: We identified a total of 1,424 children born to lymphoma survivors and 7,120 matched children born to lymphoma-free parents. Children born to lymphoma survivors had a 8% higher healthcare utilisation rate (rate ratio: 1.08, 95% confidence intervals: 1.06-1.10) than other children. The panorama of diseases requiring healthcare utilisation was diverse and only one disease (International Classification of Diseases-10: H66, otitis media, unspecified) and one drug cluster (Anatomical Therapeutic Chemical: J07BC20, combination vaccine against hepatitis A and hepatitis B) was associated with a systematic difference (p < 0.05) when applying tree-based scan statistics.

Interpretation: Children born to lymphoma survivors had slightly increased healthcare utilisation during early childhood. However, no strong or consistent disease- or drug-specific clusters explained this increase. Findings therefore suggest that the elevated healthcare use may reflect heightened health-seeking behaviour among cancer survivors, rather than underlying morbidity in their children. These results provide reassurance for lymphoma survivors considering parenthood.

Background and purpose: Hormone-receptor-positive/HER2-negative (HR+/HER2-) early-stage breast cancers (EBCs) display heterogenous responses to neoadjuvant chemotherapy (NACT) warranting biomarkers to tailor optimal treatment for individual patients.

Patients/material and methods: Women with HR+/HER2- EBC (N = 178) included in the Swedish Sweden Cancerome Analysis Network-Breast (SCAN-B) population-based cohort (2010-2019) treated with NACT were included. We analyzed rates of pathologic complete response (pCR), objective response (OR), breast conserving surgery (BCS), and recurrence-free interval (RFI) in subgroups defined by baseline clinicopathological and molecular characteristics.

Results: The pCR rate was low (6%); nonetheless, after a median follow-up of 5.41 years, all patients who achieved pCR remained recurrence-free despite uniform baseline predicted high PAM50 risk of recurrence (ROR). Younger age (≤ 40 years), cT1, ER% positivity (≤ 66%), and negative PR (≤ 10%) were conventional clinicopathological factors positively associated with increased pCR. Molecular predictors of pCR included negative HR status by gene-expression signatures and non-luminal PAM50 subtypes. Tumor shrinkage ≥ 30%, i.e., OR and BCS, was achieved in 59% and 34%, respectively. No factor was significantly associated with ORR, whereas non-lobular histology and cT1 were positively associated with BCS. In addition, only 1/49 patients who underwent BCS experienced a recurrence during follow-up. Low/intermediate ER% positivity, PR negativity, and non-luminal PAM50 subtype were baseline factors univariately prognostic for inferior long-term outcome in case of residual disease.

Interpretation: Baseline characteristics indicative of reduced hormonal signaling and non-luminal tumor biology assessed more precisely using mRNA profiling can guide optimal tailoring of NACT for patients with high-risk HR+/HER2-tumors. Baseline molecular biology did not predict surgical outcomes following NACT.

Background and purpose: Social inequality is a growing problem throughout the cancer trajectory. Since 2019, the Danish Research Center for Equality in Cancer (COMPAS) has therefore, through seven work packages developed and tested various methodologies, approaches, and interventions to promote social equality in cancer from diagnosis to end of life. This study aimed to synthesize the knowledge generated across the work packages to provide guiding principles for promoting social equity across the cancer trajectory.

Material and methods: A group concept mapping study was conducted in Denmark between February and June 2023. Twenty-two employees from all COMPAS work packages brainstormed ideas on how to promote social equality across the cancer trajectory. Fourteen participants subsequently sorted and rated the ideas by importance. Multidimensional scaling analysis and hierarchical cluster analysis were used to generate a cluster rating map outlining principles for promoting social equality in cancer. These principles were validated by 10 participants during an in-person validation meeting. Discussions from both the brainstorming and validation meeting were recorded, transcribed verbatim, and analysed.

Results: Eight principles comprising 162 ideas were identified. Four principles focused on the patient-provider level: (1) Person-centred approach, (2) Supportive interventions targeting vulnerable patients, (3) Communication, and (4) Screening for vulnerability. Four addressed the organizational and policy level: (5) Skills development and implementation, (6) Coherence across, (7) Organizational and cultural factors, and (8) Transportation and accessibility.

Interpretation: Integrating these principles into future research and clinical practice may support efforts to reduce social inequities across the cancer trajectory.

Purpose: The aim of this systematic review was to analyze the effects of upper, lower and upper-lower extremity combined resistance training (RT) in breast cancer survivors.

Methods: A systematic literature search was performed using ClinicalTrials.gov, Cochrane Library, PubMed, Scopus, EBSCO, and Web of Science databases. Randomized controlled trials published between 1970 and April 30, 2025 comparing upper extremity RT, lower extremity RT and combined upper and lower extremity RT; comparing upper extremity RT and/or lower extremity RT in the experimental group and no RT in the control group or the sham group in the control group were examined.

Results: We included 16 studies with 1,207 participants. Upper extremity RT training programs reduce shoulder pain, arm disability and improve upper limb muscle strength. Lower extremity RT training programs improve maximum strength, level of physical activity (PA), 6-minute walking test (6MWT) distance, muscle fatigue indicators and maximal voluntary isometric contraction values. Combined upper-lower extremity RT trainings enhance 6MWT distance, muscular strength, walking speed, body image, and reaction time.

Interpretation: Upper, lower, and combined upper-lower extremity RT programs can be beneficial rehabilitation therapies for breast cancer survivors. As the effects of the type of RT are different from each other, the specific needs of each patient should be considered while designing the ideal RT in breast cancer survivors.

Background and purpose: c-Met (also known as MET) protein is encoded by the MET proto-oncogene. In non-small cell lung cancer (NSCLC), c-Met protein overexpression (OE) drives tumorigenesis and is a therapeutic target, given recent US Food and Drug Administration approval of telisotuzumab vedotin-tllv. This retrospective analysis of tumor samples and clinical data from real-world patients with non-squamous NSCLC characterized the prevalence of c-Met protein OE, its association with messenger ribonucleic acid (mRNA) expression, MET gene amplification, programmed-death ligand 1 (PD-L1) expression, and its impact on prognosis.

Patients and methods: A patient cohort was selected for manual abstraction of clinical data from electronic health records. Patients were selected based on the availability of sufficient remnant tissue for biomarker analyses, including c-Met immunohistochemistry (IHC). Comparative assessments were conducted for c-Met protein expression by IHC, MET gene amplification, mRNA expression, and PD-L1 expression levels by IHC.

Results: In total, 305 and 84 patients were included in the biomarker prevalence and outcome analyses, respectively. Overall, c-Met protein OE was detected in 25% of tissue samples. Of the 212 samples with fluorescence in situ hybridization data, MET amplification was seen in 9%. Concordance of c-Met protein OE with MET mRNA levels was observed with area under the concentration-time curve values of 0.738 and 0.736 in MET OE or MET high OE, respectively, using Receiver Operating Characteristic analysis. c-Met protein OE was associated with poor prognosis (unadjusted hazard ratio for death of 2.04).

Interpretation: These data suggest that c-Met protein OE is associated with MET mRNA expression, shows limited overlap with other MET aberrations, and may be linked to poor prognosis in NSCLC.