Pub Date : 2025-06-01DOI: 10.1016/j.jncc.2025.02.004
Zhifei Li , Runze Li , Jianchuan Chen , Ruida Yang , Peng Li , Bin Qiu
Background
The Global Cancer Observatory (GLOBOCAN) 2022 and the Global Burden of Disease (GBD) 2021 are two primary databases for assessing the global cancer burden. This study aimed to compare the incidence and mortality rates of tracheal, bronchus, and lung (TBL) cancer reported in these databases and to analyze the observed discrepancies.
Methods
Age-standardized rates (ASRs), including age-standardized incidence rates and age-standardized mortality rates for TBL cancer, were obtained from GLOBOCAN 2022 and GBD 2021 for the most recent available year. Differences in ASRs at the national level between the two databases were quantified using pairwise differences, calculated as the absolute difference in ASRs divided by the mean of the ASRs from both sources. Correlations between macroeconomic factors and pairwise differences in ASRs were evaluated, and country features correlated with high pairwise differences were assessed. The data sources and methods used in the two databases were also compared.
Results
Strong correlations were identified between ASRs reported by GLOBOCAN 2022 and GBD 2021; however, significant differences were observed between estimates from the two data sources. African countries commonly exhibited larger pairwise differences in ASRs, whereas European countries demonstrated smaller pairwise differences in ASRs. Additionally, some populous developing countries, including China, South Africa, Brazil and India, showed smaller differences in ASRs. Countries lacking vital registration systems or high-quality population-based cancer registries displayed larger differences in ASRs. Furthermore, differences in ASRs were negatively correlated with macroeconomic factors. The data sources and estimation methods used by the two databases were inconsistent.
Conclusions
Discrepancies in TBL cancer incidence and mortality were observed between GLOBOCAN 2022 and GBD 2021. While differences in sources and methods partially explain these discrepancies, a country's cancer surveillance maturity and economic status also correlate with the accuracy of the estimates. Estimating the cancer burden in less wealthy countries remains a substantial challenge, necessitating long-term assistance and investment.
{"title":"Differences in the incidence and mortality of tracheal, bronchus, and lung cancer between the Global Cancer Observatory 2022 and the Global Burden of Disease 2021","authors":"Zhifei Li , Runze Li , Jianchuan Chen , Ruida Yang , Peng Li , Bin Qiu","doi":"10.1016/j.jncc.2025.02.004","DOIUrl":"10.1016/j.jncc.2025.02.004","url":null,"abstract":"<div><h3>Background</h3><div>The Global Cancer Observatory (GLOBOCAN) 2022 and the Global Burden of Disease (GBD) 2021 are two primary databases for assessing the global cancer burden. This study aimed to compare the incidence and mortality rates of tracheal, bronchus, and lung (TBL) cancer reported in these databases and to analyze the observed discrepancies.</div></div><div><h3>Methods</h3><div>Age-standardized rates (ASRs), including age-standardized incidence rates and age-standardized mortality rates for TBL cancer, were obtained from GLOBOCAN 2022 and GBD 2021 for the most recent available year. Differences in ASRs at the national level between the two databases were quantified using pairwise differences, calculated as the absolute difference in ASRs divided by the mean of the ASRs from both sources. Correlations between macroeconomic factors and pairwise differences in ASRs were evaluated, and country features correlated with high pairwise differences were assessed. The data sources and methods used in the two databases were also compared.</div></div><div><h3>Results</h3><div>Strong correlations were identified between ASRs reported by GLOBOCAN 2022 and GBD 2021; however, significant differences were observed between estimates from the two data sources. African countries commonly exhibited larger pairwise differences in ASRs, whereas European countries demonstrated smaller pairwise differences in ASRs. Additionally, some populous developing countries, including China, South Africa, Brazil and India, showed smaller differences in ASRs. Countries lacking vital registration systems or high-quality population-based cancer registries displayed larger differences in ASRs. Furthermore, differences in ASRs were negatively correlated with macroeconomic factors. The data sources and estimation methods used by the two databases were inconsistent.</div></div><div><h3>Conclusions</h3><div>Discrepancies in TBL cancer incidence and mortality were observed between GLOBOCAN 2022 and GBD 2021. While differences in sources and methods partially explain these discrepancies, a country's cancer surveillance maturity and economic status also correlate with the accuracy of the estimates. Estimating the cancer burden in less wealthy countries remains a substantial challenge, necessitating long-term assistance and investment.</div></div>","PeriodicalId":73987,"journal":{"name":"Journal of the National Cancer Center","volume":"5 3","pages":"Pages 267-277"},"PeriodicalIF":7.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1016/j.jncc.2025.03.001
Zhiyong Zhang , Yingwei Xie , Lei Liu , Yongtao Wang , Shuang Li , Li Chen , Xiangbo Zeng , Yuanchao Zhu , Yishan Zhang , Yongyuan Xiao , Fengjin Zhao , Bihong Xu , Xiaocen Liu , Wenbin Guo , Ganping Wang , Wenlian Xie , Wanlong Tan , Hao Ping , Zaosong Zheng
<div><h3>Background</h3><div>Genitourinary cancers constitute a significant portion of the global cancer burden and have emerged as a prominent cause of cancer-related mortality. However, there remains a paucity of up-to-date statistical analyses that meticulously examine the global and national shifts in the epidemiology of genitourinary cancers. Our study aimed to provide a comprehensive understanding of the global distribution and progression of genitourinary cancers through analyses of the recently updated 2021 Global Burden of Disease (GBD) database.</div></div><div><h3>Methods</h3><div>This study presented the incidence, mortality, disability-adjusted life years (DALYs), and their respective age-standardized rates for four genitourinary cancers (bladder, kidney, prostate, and testicular cancers) by sex, age, and location from 1990 to 2021. Estimates for these data were presented with their 95% uncertainty intervals (UIs). Estimated annual percentage changes (EAPCs) and Bayesian Age-Period-Cohort (BAPC) models were utilized to further quantify the temporal dynamics of age-standardized rates (ASRs) in genitourinary cancers. Countries and territories were categorized according to socio-demographic index (SDI) quintiles.</div></div><div><h3>Results</h3><div>Globally, with the exception of a sustained decline in age-standardized incidence rates (ASIRs) for bladder cancer (EAPC = −0.36%), the ASIRs for kidney, prostate, and testicular cancers demonstrated an upward trend from 1990 to 2021 (EAPC = 0.53%, 0.20%, and 1.43%, respectively). In terms of geographical regions, High-income North America had the highest ASIRs for both bladder (13.98 per 100,000 persons [95% UI, 12.96 to 14.61]) and prostate (47.02 per 100,000 persons [95% UI, 44.47 to 49.04]) cancers. Southern Latin America recorded the highest ASIRs for kidney (13.44 per 100,000 persons [95% UI, 12.27 to 14.73]) and testicular (4.98 per 100,000 persons [95% UI, 4.33 to 5.72]) cancers. Additionally, Central Europe (1.25% [95% CI, 1.12% to 1.38%]), East Asia (2.40% [95% CI, 2.21% to 2.59%]), Eastern Europe (3.74% [95% CI, 3.55% to 3.92%]), and the Caribbean (5.52% [95% CI, 4.32% to 6.74%]) exhibited the highest EAPCs for bladder, kidney, prostate, and testicular cancers, respectively. Unlike the ASIRs, age-standardized mortality rates (ASMRs) and age-standardized DALYs rates (ASDRs) showed a downward trend over time in all types of genitourinary cancers. The disease burdens of bladder, kidney, and prostate cancers were primarily distributed among older men, while testicular cancer mainly occurred in young men. Smoking remained the primary risk factor for bladder cancer. Meanwhile, high fasting plasma glucose and high body-mass index exerted increasingly significant impacts on bladder and kidney cancers, respectively, during the study period. Projections to 2050 suggest that the global burdens of genitourinary cancers are expected to decline to varying degrees. However, regional disparities
{"title":"Global, regional, and national burden of genitourinary cancers in 204 countries and territories, 1990–2021: a systematic analysis for the global burden of disease study 2021","authors":"Zhiyong Zhang , Yingwei Xie , Lei Liu , Yongtao Wang , Shuang Li , Li Chen , Xiangbo Zeng , Yuanchao Zhu , Yishan Zhang , Yongyuan Xiao , Fengjin Zhao , Bihong Xu , Xiaocen Liu , Wenbin Guo , Ganping Wang , Wenlian Xie , Wanlong Tan , Hao Ping , Zaosong Zheng","doi":"10.1016/j.jncc.2025.03.001","DOIUrl":"10.1016/j.jncc.2025.03.001","url":null,"abstract":"<div><h3>Background</h3><div>Genitourinary cancers constitute a significant portion of the global cancer burden and have emerged as a prominent cause of cancer-related mortality. However, there remains a paucity of up-to-date statistical analyses that meticulously examine the global and national shifts in the epidemiology of genitourinary cancers. Our study aimed to provide a comprehensive understanding of the global distribution and progression of genitourinary cancers through analyses of the recently updated 2021 Global Burden of Disease (GBD) database.</div></div><div><h3>Methods</h3><div>This study presented the incidence, mortality, disability-adjusted life years (DALYs), and their respective age-standardized rates for four genitourinary cancers (bladder, kidney, prostate, and testicular cancers) by sex, age, and location from 1990 to 2021. Estimates for these data were presented with their 95% uncertainty intervals (UIs). Estimated annual percentage changes (EAPCs) and Bayesian Age-Period-Cohort (BAPC) models were utilized to further quantify the temporal dynamics of age-standardized rates (ASRs) in genitourinary cancers. Countries and territories were categorized according to socio-demographic index (SDI) quintiles.</div></div><div><h3>Results</h3><div>Globally, with the exception of a sustained decline in age-standardized incidence rates (ASIRs) for bladder cancer (EAPC = −0.36%), the ASIRs for kidney, prostate, and testicular cancers demonstrated an upward trend from 1990 to 2021 (EAPC = 0.53%, 0.20%, and 1.43%, respectively). In terms of geographical regions, High-income North America had the highest ASIRs for both bladder (13.98 per 100,000 persons [95% UI, 12.96 to 14.61]) and prostate (47.02 per 100,000 persons [95% UI, 44.47 to 49.04]) cancers. Southern Latin America recorded the highest ASIRs for kidney (13.44 per 100,000 persons [95% UI, 12.27 to 14.73]) and testicular (4.98 per 100,000 persons [95% UI, 4.33 to 5.72]) cancers. Additionally, Central Europe (1.25% [95% CI, 1.12% to 1.38%]), East Asia (2.40% [95% CI, 2.21% to 2.59%]), Eastern Europe (3.74% [95% CI, 3.55% to 3.92%]), and the Caribbean (5.52% [95% CI, 4.32% to 6.74%]) exhibited the highest EAPCs for bladder, kidney, prostate, and testicular cancers, respectively. Unlike the ASIRs, age-standardized mortality rates (ASMRs) and age-standardized DALYs rates (ASDRs) showed a downward trend over time in all types of genitourinary cancers. The disease burdens of bladder, kidney, and prostate cancers were primarily distributed among older men, while testicular cancer mainly occurred in young men. Smoking remained the primary risk factor for bladder cancer. Meanwhile, high fasting plasma glucose and high body-mass index exerted increasingly significant impacts on bladder and kidney cancers, respectively, during the study period. Projections to 2050 suggest that the global burdens of genitourinary cancers are expected to decline to varying degrees. However, regional disparities ","PeriodicalId":73987,"journal":{"name":"Journal of the National Cancer Center","volume":"5 3","pages":"Pages 330-345"},"PeriodicalIF":7.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1016/j.jncc.2025.01.003
Yuting Ji , Yunmeng Zhang , Siwen Liu , Jingjing Li , Qianyun Jin , Jie Wu , Hongyuan Duan , Xiaomin Liu , Lei Yang , Yubei Huang
Background
Given the relatively unfavorable prognosis and significant geographic differences in lung cancer burden, it is critical to update the global landscape of lung cancer to inform local strategies.
Methods
Based on the GLOBOCAN 2022, the age-standardized incidence rate (ASIR) and mortality rate (ASMR) were compared and linked to the Human Development Index (HDI) across different populations. The temporal trends in ASIR/ASMR were characterized as estimated annual percentage change (EAPC), and demographic projections were performed up to 2050.
Results
Globally, an estimated 2,480,675 cases and 1,817,469 deaths from lung cancer occurred in 2022. Both ASIR and ASMR of lung cancer varied widely by world region, with ASIR ranging from 2.06 to 39.38 per 100,000 and ASMR from 1.95 to 31.70 per 100,000. China alone accounted for >40 % of cases and deaths worldwide. Both ASIR and ARMR of lung cancer increased with HDI (R2: 0.54 and 0.47, all P values <0.001), regardless of gender. Based on available data, both ASIR during 2001–2010 and ASMR during 2001–2015 showed decreasing trends in males (EAPC: 1.50 % and −2.22 %) but increasing trends in females (EAPC: 1.08 % and 0.07 %). Similar trends in ASIR and ASMR were observed among the elder population (≥50 years); however, downward trends were observed in the younger population (<50 years). Alongside the aging and growth of the population, estimated cases and deaths from overall lung cancer would increase by 86.2 % and 95.2 % up to 2050 as compared with estimates in 2022, respectively. Notably, increased early-onset lung cancer was only observed in transitioning countries, while decreased early-onset lung cancer was observed in transitioned countries.
Conclusion
Lung cancer maintained as the leading cancer burden worldwide. Unless timely preventive interventions in tobacco mitigation, early screening, and precise treatment, the global lung cancer burden is expected to increase in the future, especially for transitioning countries.
{"title":"The epidemiological landscape of lung cancer: current status, temporal trend and future projections based on the latest estimates from GLOBOCAN 2022","authors":"Yuting Ji , Yunmeng Zhang , Siwen Liu , Jingjing Li , Qianyun Jin , Jie Wu , Hongyuan Duan , Xiaomin Liu , Lei Yang , Yubei Huang","doi":"10.1016/j.jncc.2025.01.003","DOIUrl":"10.1016/j.jncc.2025.01.003","url":null,"abstract":"<div><h3>Background</h3><div>Given the relatively unfavorable prognosis and significant geographic differences in lung cancer burden, it is critical to update the global landscape of lung cancer to inform local strategies.</div></div><div><h3>Methods</h3><div>Based on the GLOBOCAN 2022, the age-standardized incidence rate (ASIR) and mortality rate (ASMR) were compared and linked to the Human Development Index (HDI) across different populations. The temporal trends in ASIR/ASMR were characterized as estimated annual percentage change (EAPC), and demographic projections were performed up to 2050.</div></div><div><h3>Results</h3><div>Globally, an estimated 2,480,675 cases and 1,817,469 deaths from lung cancer occurred in 2022. Both ASIR and ASMR of lung cancer varied widely by world region, with ASIR ranging from 2.06 to 39.38 per 100,000 and ASMR from 1.95 to 31.70 per 100,000. China alone accounted for >40 % of cases and deaths worldwide. Both ASIR and ARMR of lung cancer increased with HDI (<em>R<sup>2</sup></em>: 0.54 and 0.47, all <em>P</em> values <0.001), regardless of gender. Based on available data, both ASIR during 2001–2010 and ASMR during 2001–2015 showed decreasing trends in males (EAPC: 1.50 % and −2.22 %) but increasing trends in females (EAPC: 1.08 % and 0.07 %). Similar trends in ASIR and ASMR were observed among the elder population (≥50 years); however, downward trends were observed in the younger population (<50 years). Alongside the aging and growth of the population, estimated cases and deaths from overall lung cancer would increase by 86.2 % and 95.2 % up to 2050 as compared with estimates in 2022, respectively. Notably, increased early-onset lung cancer was only observed in transitioning countries, while decreased early-onset lung cancer was observed in transitioned countries.</div></div><div><h3>Conclusion</h3><div>Lung cancer maintained as the leading cancer burden worldwide. Unless timely preventive interventions in tobacco mitigation, early screening, and precise treatment, the global lung cancer burden is expected to increase in the future, especially for transitioning countries.</div></div>","PeriodicalId":73987,"journal":{"name":"Journal of the National Cancer Center","volume":"5 3","pages":"Pages 278-286"},"PeriodicalIF":7.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-28DOI: 10.1016/j.jncc.2025.03.003
Rachel Liu-Galvin , Zhigang Xie , Young-Rock Hong
Background
The US Preventive Services Task Force updated its colorectal cancer (CRC) screening guidelines in 2021, recommending screening for adults aged 45–49. This study aimed to evaluate CRC screening prevalence among this newly eligible population and assess its association with healthcare provider supply and CT colonography facility availability in 2022.
Methods
Using 2022 Behavioral Risk Factor Surveillance System data (n = 25,592), we estimated CRC screening prevalence among adults aged 45–49 and the prevalence of different screening modalities across various sociodemographic factors. We examined associations between screening rates and state-level healthcare provider supply using 2021–2022 Area Health Resources File data. Spearman rank-order correlations assessed relationships between provider supply, CT colonography facility availability, and screening prevalence.
Results
Overall CRC screening prevalence was 34.5% (95% CI: 33.4%–35.8%). Endoscopic tests were most common (74.9%), followed by stool-based tests (9.3%) and CT colonography (0.5%). Significant variations in screening modalities were observed across sociodemographic factors. Gastroenterology physician supply positively correlated with overall CRC screening prevalence (ρ = 0.42, P = 0.002) and endoscopy screening prevalence (ρ = 0.38, P = 0.005). CT colonography facility availability weakly correlated with CT colonography screening prevalence (ρ = 0.15, P = 0.316), although this was not significant.
Conclusions
CRC screening rates among newly eligible adults aged 45–49 appear to be suboptimal in 2022. Disparities in screening methods across sociodemographic factors highlight potential access barriers, particularly for endoscopic tests. The association between gastroenterology physician supply and screening rates emphasizes the importance of addressing projected workforce shortages. Targeted efforts are needed to increase CRC screening uptake in this age group and ensure equitable access to screening services.
美国预防服务工作组于2021年更新了其结直肠癌（CRC）筛查指南，建议对45-49岁的成年人进行筛查。本研究旨在评估这些新合格人群中CRC筛查的患病率，并评估其与2022年医疗保健提供者供应和CT结肠镜设备可用性的关系。方法使用2022年行为风险因素监测系统数据（n = 25,592），我们估计了45-49岁成年人的CRC筛查患病率以及不同社会人口因素中不同筛查方式的患病率。我们使用2021-2022年地区卫生资源文件数据检查了筛查率与州一级医疗保健提供者供应之间的关系。Spearman秩序相关性评估了提供者供应、CT结肠镜设备可用性和筛查流行率之间的关系。结果总体结直肠癌筛查率为34.5% （95% CI: 33.4% ~ 35.8%）。内镜检查最常见（74.9%），其次是粪便检查（9.3%）和CT结肠镜检查（0.5%）。在不同的社会人口因素中观察到筛查方式的显著差异。胃肠内科医师供应与CRC筛查总体患病率（ρ = 0.42, P = 0.002）和内镜筛查患病率（ρ = 0.38, P = 0.005）呈正相关。CT结肠镜检查设备的可用性与CT结肠镜筛查率呈弱相关（ρ = 0.15, P = 0.316），尽管这并不显著。结论2022年45-49岁新入组成人scrc筛查率不理想。不同社会人口因素筛查方法的差异突出了潜在的获取障碍，特别是内窥镜检查。胃肠内科医生供应和筛查率之间的关系强调了解决预计劳动力短缺的重要性。需要做出有针对性的努力，以提高这一年龄组对结直肠癌筛查的接受程度，并确保公平获得筛查服务。
{"title":"Colorectal cancer screening in adults aged 45–49: provider availability, CT colonography access, and screening rates","authors":"Rachel Liu-Galvin , Zhigang Xie , Young-Rock Hong","doi":"10.1016/j.jncc.2025.03.003","DOIUrl":"10.1016/j.jncc.2025.03.003","url":null,"abstract":"<div><h3>Background</h3><div>The US Preventive Services Task Force updated its colorectal cancer (CRC) screening guidelines in 2021, recommending screening for adults aged 45–49. This study aimed to evaluate CRC screening prevalence among this newly eligible population and assess its association with healthcare provider supply and CT colonography facility availability in 2022.</div></div><div><h3>Methods</h3><div>Using 2022 Behavioral Risk Factor Surveillance System data (n = 25,592), we estimated CRC screening prevalence among adults aged 45–49 and the prevalence of different screening modalities across various sociodemographic factors. We examined associations between screening rates and state-level healthcare provider supply using 2021–2022 Area Health Resources File data. Spearman rank-order correlations assessed relationships between provider supply, CT colonography facility availability, and screening prevalence.</div></div><div><h3>Results</h3><div>Overall CRC screening prevalence was 34.5% (95% CI: 33.4%–35.8%). Endoscopic tests were most common (74.9%), followed by stool-based tests (9.3%) and CT colonography (0.5%). Significant variations in screening modalities were observed across sociodemographic factors. Gastroenterology physician supply positively correlated with overall CRC screening prevalence (ρ = 0.42, <em>P</em> = 0.002) and endoscopy screening prevalence (ρ = 0.38, <em>P</em> = 0.005). CT colonography facility availability weakly correlated with CT colonography screening prevalence (ρ = 0.15, <em>P</em> = 0.316), although this was not significant.</div></div><div><h3>Conclusions</h3><div>CRC screening rates among newly eligible adults aged 45–49 appear to be suboptimal in 2022. Disparities in screening methods across sociodemographic factors highlight potential access barriers, particularly for endoscopic tests. The association between gastroenterology physician supply and screening rates emphasizes the importance of addressing projected workforce shortages. Targeted efforts are needed to increase CRC screening uptake in this age group and ensure equitable access to screening services.</div></div>","PeriodicalId":73987,"journal":{"name":"Journal of the National Cancer Center","volume":"5 4","pages":"Pages 414-425"},"PeriodicalIF":9.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-20DOI: 10.1016/j.jncc.2025.02.006
Yongsheng Wang , Xi Wang , Jiong Wu , Hong Liu , Jiuda Zhao , Jian Huang , Jianxia Liu , Youling Gong , Hao Wang , Huaqing Yang , Guorong Zou , Quchang Ouyang , Guoqin Jiang , Huijuan Liu , Sujie Ni , Binghe Xu , Jinming Yu
Background
Few studies compared the effectiveness of the 3-monthly goserelin 10.8-mg and the monthly 3.6-mg depot in inducing ovarian function suppression for premenopausal patients with hormone receptor positive (HR+) breast cancer. We conducted a large-scale real-world study (RWS) in China to validate the non-inferiority of goserelin 10.8-mg to the 3.6-mg depot.
Methods
This multicenter, retrospective-prospective, non-inferiority study compared goserelin 10.8-mg with 3.6-mg in suppressing estradiol (E2) levels in premenopausal and perimenopausal patients with HR+ breast cancer. Eligible patients were identified, and their demographic and clinical data were obtained from hospital medical records. The observation period was 28 weeks. Propensity score matching (PSM) ensured baseline comparability. The primary endpoint was the proportion of patients with E2 suppression to postmenopausal level at Week 12±4. Difference in proportions and 95 % CI was calculated by Newcombe-Wilson score method. The non-inferiority margin was -10 %. Subgroup and sensitivity analyses assessed result robustness.
Results
From 1st January, 2015 to 15th December, 2023, 15,629 patients from 16 hospitals nationwide were screened, with 1,060 eligible patients included in the full analysis set (3.6-mg group: 678; 10.8-mg group: 382). Post-PSM, the primary endpoint was analyzed in 590 patients (295 in each group). At Week 12±4, the proportion of patients with E2 suppression was 99.1 % (95 % CI: 96.9 %–99.8 %) for goserelin 10.8-mg and 95.3 % (95 % CI: 91.0 %–97.6 %) for goserelin 3.6-mg. The difference was 3.8 % (95 % CI: 0.6 %–8.1 %) with the lower limit of 95 % CI greater than the non-inferiority margin. All subgroup analyses, including those based on age (≤45 or >45 years) and previous chemotherapy (yes/no), and all sensitivity analyses on the primary endpoint were consistent with the main analysis.
Conclusions
This RWS validated the non-inferiority of goserelin 10.8-mg 3-monthly to 3.6-mg monthly in Chinese patients with HR+ breast cancer, where high E2 suppression rates were achieved in both goserelin dosage groups.
{"title":"Real-world effectiveness of goserelin 10.8-mg compared to goserelin 3.6-mg in premenopausal and perimenopausal Chinese patients with hormone receptor positive breast cancer: a cohort study","authors":"Yongsheng Wang , Xi Wang , Jiong Wu , Hong Liu , Jiuda Zhao , Jian Huang , Jianxia Liu , Youling Gong , Hao Wang , Huaqing Yang , Guorong Zou , Quchang Ouyang , Guoqin Jiang , Huijuan Liu , Sujie Ni , Binghe Xu , Jinming Yu","doi":"10.1016/j.jncc.2025.02.006","DOIUrl":"10.1016/j.jncc.2025.02.006","url":null,"abstract":"<div><h3>Background</h3><div>Few studies compared the effectiveness of the 3-monthly goserelin 10.8-mg and the monthly 3.6-mg depot in inducing ovarian function suppression for premenopausal patients with hormone receptor positive (HR+) breast cancer. We conducted a large-scale real-world study (RWS) in China to validate the non-inferiority of goserelin 10.8-mg to the 3.6-mg depot.</div></div><div><h3>Methods</h3><div>This multicenter, retrospective-prospective, non-inferiority study compared goserelin 10.8-mg with 3.6-mg in suppressing estradiol (E2) levels in premenopausal and perimenopausal patients with HR+ breast cancer. Eligible patients were identified, and their demographic and clinical data were obtained from hospital medical records. The observation period was 28 weeks. Propensity score matching (PSM) ensured baseline comparability. The primary endpoint was the proportion of patients with E2 suppression to postmenopausal level at Week 12±4. Difference in proportions and 95 % CI was calculated by Newcombe-Wilson score method. The non-inferiority margin was -10 %. Subgroup and sensitivity analyses assessed result robustness.</div></div><div><h3>Results</h3><div>From 1st January, 2015 to 15th December, 2023, 15,629 patients from 16 hospitals nationwide were screened, with 1,060 eligible patients included in the full analysis set (3.6-mg group: 678; 10.8-mg group: 382). Post-PSM, the primary endpoint was analyzed in 590 patients (295 in each group). At Week 12±4, the proportion of patients with E2 suppression was 99.1 % (95 % CI: 96.9 %–99.8 %) for goserelin 10.8-mg and 95.3 % (95 % CI: 91.0 %–97.6 %) for goserelin 3.6-mg. The difference was 3.8 % (95 % CI: 0.6 %–8.1 %) with the lower limit of 95 % CI greater than the non-inferiority margin. All subgroup analyses, including those based on age (≤45 or >45 years) and previous chemotherapy (yes/no), and all sensitivity analyses on the primary endpoint were consistent with the main analysis.</div></div><div><h3>Conclusions</h3><div>This RWS validated the non-inferiority of goserelin 10.8-mg 3-monthly to 3.6-mg monthly in Chinese patients with HR+ breast cancer, where high E2 suppression rates were achieved in both goserelin dosage groups.</div></div><div><h3>Trial registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> (NCT05184257).</div></div>","PeriodicalId":73987,"journal":{"name":"Journal of the National Cancer Center","volume":"5 4","pages":"Pages 392-401"},"PeriodicalIF":9.4,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-29DOI: 10.1016/j.jncc.2025.02.005
Yanyu Chen , Yuzhi Song , Zhonghua Han , Hui Han , Tianlan Tang , Silin Chen , Ruizhi Zhao , Cheng Huang , Guiqing Shi , Yuping Lin , Ying Wang , Liuqing Jiang , Jinhua Chen , Chunsen Xu , Fangmeng Fu , Chuan Wang , Yong Yang
Background
Metastasis to the infraclavicular and supraclavicular lymph nodes (ISLNs) is an important factor that predicts poor survival in patients with breast cancer; however, pathological nodal staging does not traditionally include ISLNs because of their non-routine surgical dissection. This study aimed to evaluate the prognostic impact of ISLN metastasis and propose a refined nodal staging system tailored for patients undergoing neoadjuvant chemotherapy (NAC).
Methods
We retrospectively reviewed 1,072 patients with breast cancer with or without ISLN metastasis who received NAC at two institutions (Fujian cohort and Hebei cohort) from 2010 to 2022. We conducted detailed survival analysis to evaluate the diagnostic consistency and prognostic significance of ISLNs.
Results
There were no survival differences among patients with ISLN involvement across different assay methodologies and patient cohorts. Among 887 patients in the Fujian cohort, 238 patients (26.8 %) with positive ISLNs had significantly inferior 3-year progression-free survival (PFS, 75.9 % vs. 90.4 %, P < 0.001) and overall survival (OS, 90.6 % vs. 95.9 %, P < 0.001). After adjusting for potential confounders, ISLN involvement persisted as an independent predictor of both PFS and OS. We propose a refined axillary classification that combines pathological axillary staging post-NAC with ISLN involvement, revealing 3-year PFS rates of 95.3 %, 87.6 %, 73.4 %, and 64.5 % for the respective four groups defined by this refined classification combining axillary stage and ISLN status.
Conclusions
Involvement of the ISLNs was associated with a worse prognosis, underscoring their prognostic value. This finding highlights the potential of ISLN status to influence decisions regarding adjuvant treatment in patients with breast cancer.
锁骨下和锁骨上淋巴结（isln）转移是预测乳腺癌患者生存不良的一个重要因素；然而，由于非常规手术解剖，传统上病理分期不包括胰岛淋巴结。本研究旨在评估ISLN转移对预后的影响，并为接受新辅助化疗（NAC）的患者提出一种精细的淋巴结分期系统。方法回顾性分析2010年至2022年福建和河北两所医院1072例合并或未合并ISLN转移的乳腺癌患者行NAC治疗。我们进行了详细的生存分析，以评估isln的诊断一致性和预后意义。结果在不同的检测方法和患者队列中，ISLN患者的生存率没有差异。在福建队列的887例患者中，238例（26.8%）isln阳性患者的3年无进展生存率(PFS, 75.9% vs. 90.4%, P <；0.001)和总生存期(OS, 90.6% vs. 95.9%, P <；0.001)。在调整了潜在的混杂因素后，ISLN累及仍然是PFS和OS的独立预测因子。我们提出了一种将nac后腋窝病理分期与ISLN累及相结合的精细腋窝分类，结果显示，根据这种结合腋窝分期和ISLN状态的精细分类，四组患者的3年PFS分别为95.3%、87.6%、73.4%和64.5%。结论累及胰岛神经网络与较差的预后相关，强调了其预后价值。这一发现强调了ISLN状态影响乳腺癌患者辅助治疗决策的潜力。
{"title":"The role of infraclavicular and supraclavicular lymph nodes in breast cancer patients receiving neoadjuvant chemotherapy: implications for regional lymph node classification","authors":"Yanyu Chen , Yuzhi Song , Zhonghua Han , Hui Han , Tianlan Tang , Silin Chen , Ruizhi Zhao , Cheng Huang , Guiqing Shi , Yuping Lin , Ying Wang , Liuqing Jiang , Jinhua Chen , Chunsen Xu , Fangmeng Fu , Chuan Wang , Yong Yang","doi":"10.1016/j.jncc.2025.02.005","DOIUrl":"10.1016/j.jncc.2025.02.005","url":null,"abstract":"<div><h3>Background</h3><div>Metastasis to the infraclavicular and supraclavicular lymph nodes (ISLNs) is an important factor that predicts poor survival in patients with breast cancer; however, pathological nodal staging does not traditionally include ISLNs because of their non-routine surgical dissection. This study aimed to evaluate the prognostic impact of ISLN metastasis and propose a refined nodal staging system tailored for patients undergoing neoadjuvant chemotherapy (NAC).</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 1,072 patients with breast cancer with or without ISLN metastasis who received NAC at two institutions (Fujian cohort and Hebei cohort) from 2010 to 2022. We conducted detailed survival analysis to evaluate the diagnostic consistency and prognostic significance of ISLNs.</div></div><div><h3>Results</h3><div>There were no survival differences among patients with ISLN involvement across different assay methodologies and patient cohorts. Among 887 patients in the Fujian cohort, 238 patients (26.8 %) with positive ISLNs had significantly inferior 3-year progression-free survival (PFS, 75.9 % vs. 90.4 %, <em>P</em> < 0.001) and overall survival (OS, 90.6 % vs. 95.9 %, <em>P</em> < 0.001). After adjusting for potential confounders, ISLN involvement persisted as an independent predictor of both PFS and OS. We propose a refined axillary classification that combines pathological axillary staging post-NAC with ISLN involvement, revealing 3-year PFS rates of 95.3 %, 87.6 %, 73.4 %, and 64.5 % for the respective four groups defined by this refined classification combining axillary stage and ISLN status.</div></div><div><h3>Conclusions</h3><div>Involvement of the ISLNs was associated with a worse prognosis, underscoring their prognostic value. This finding highlights the potential of ISLN status to influence decisions regarding adjuvant treatment in patients with breast cancer.</div></div>","PeriodicalId":73987,"journal":{"name":"Journal of the National Cancer Center","volume":"5 4","pages":"Pages 402-413"},"PeriodicalIF":9.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-28DOI: 10.1016/j.jncc.2025.04.003
Wenhao Xu , Jiahe Lu , Hailiang Zhang , Dingwei Ye
{"title":"Decoding the tumor microenvironment: insights into immunotherapy and beyond","authors":"Wenhao Xu , Jiahe Lu , Hailiang Zhang , Dingwei Ye","doi":"10.1016/j.jncc.2025.04.003","DOIUrl":"10.1016/j.jncc.2025.04.003","url":null,"abstract":"","PeriodicalId":73987,"journal":{"name":"Journal of the National Cancer Center","volume":"5 4","pages":"Pages 426-428"},"PeriodicalIF":9.4,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-19DOI: 10.1016/j.jncc.2025.01.007
Jung Yin Fong , Zhixin Phuna , Di Yang Chong , Christophorus Manuel Heryanto , Yu Shyan Low , Khang Chiang Oh , Yan Huen Lee , Allan Wee Ren Ng , Lionel Lian Aun In , Michelle Yee Mun Teo
Antibody-drug conjugates (ADCs) represent a promising approach in targeted cancer therapy, combining the targeted precision of antibodies with the potency of cytotoxic payloads to selectively target tumour cell whilst minimising off-target effects. This review provides a comprehensive analysis of ADCs, encompassing their structural components, mechanisms of action, and clinical applications. It also examines recent technological advancements, particularly in antibody engineering and linker design, aimed at enhancing therapeutic efficacy and safety. The current clinical landscape is outlined, highlighting approved ADCs and promising candidates in clinical trials, while also addressing key challenges such as stability, half-life, and systemic toxicity. This review is based on an extensive literature survey from major databases such as Scopus and Web of Science, with a focus on keywords like “antibody-drug conjugates”, “ADC advancements”, and “next-generation ADC technologies”. By integrating insights from both preclinical and clinical perspectives, we highlight the transformative potential of ADCs in advancing modern cancer therapy.
抗体-药物偶联物（adc）是一种很有前途的靶向癌症治疗方法，将抗体的靶向精度与细胞毒性有效载荷的效力相结合，选择性地靶向肿瘤细胞，同时最大限度地减少脱靶效应。这篇综述提供了adc的全面分析，包括它们的结构成分、作用机制和临床应用。它还审查了最近的技术进步，特别是在抗体工程和连接体设计方面，旨在提高治疗效果和安全性。概述了目前的临床前景，重点介绍了已批准的adc和临床试验中有希望的候选药物，同时也解决了稳定性、半衰期和全身毒性等关键挑战。本综述基于Scopus和Web of Science等主要数据库的广泛文献调查，重点关注“抗体-药物偶联物”、“ADC进展”和“下一代ADC技术”等关键词。通过整合临床前和临床视角的见解，我们强调adc在推进现代癌症治疗方面的变革潜力。
{"title":"Advancements in antibody-drug conjugates as cancer therapeutics","authors":"Jung Yin Fong , Zhixin Phuna , Di Yang Chong , Christophorus Manuel Heryanto , Yu Shyan Low , Khang Chiang Oh , Yan Huen Lee , Allan Wee Ren Ng , Lionel Lian Aun In , Michelle Yee Mun Teo","doi":"10.1016/j.jncc.2025.01.007","DOIUrl":"10.1016/j.jncc.2025.01.007","url":null,"abstract":"<div><div>Antibody-drug conjugates (ADCs) represent a promising approach in targeted cancer therapy, combining the targeted precision of antibodies with the potency of cytotoxic payloads to selectively target tumour cell whilst minimising off-target effects. This review provides a comprehensive analysis of ADCs, encompassing their structural components, mechanisms of action, and clinical applications. It also examines recent technological advancements, particularly in antibody engineering and linker design, aimed at enhancing therapeutic efficacy and safety. The current clinical landscape is outlined, highlighting approved ADCs and promising candidates in clinical trials, while also addressing key challenges such as stability, half-life, and systemic toxicity. This review is based on an extensive literature survey from major databases such as Scopus and Web of Science, with a focus on keywords like “antibody-drug conjugates”, “ADC advancements”, and “next-generation ADC technologies”. By integrating insights from both preclinical and clinical perspectives, we highlight the transformative potential of ADCs in advancing modern cancer therapy.</div></div>","PeriodicalId":73987,"journal":{"name":"Journal of the National Cancer Center","volume":"5 4","pages":"Pages 362-378"},"PeriodicalIF":9.4,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Circulating tumor DNA (ctDNA) is increasingly being used as a potential biomarker in colorectal cancer (CRC) patients. However, the role of ctDNA in CRC prognosis prediction remains unclear. The objective is to systematically assess the clinical value of ctDNA in colorectal cancer prognosis prediction throughout the treatment cycle.
Methods
PubMed, Web of Science, Embase, Cochrane Library, Scopus, and clinical trials.gov database was searched from January 2016 to April 2023. Observational studies and randomized clinical trials reporting on ctDNA and prognostic outcomes in CRC patients were included. Pooled hazard risk ratios (HRs) were calculated for the primary outcomes, relapse-free survival (RFS), and overall survival (OS). Random-effects models were preferred considering the potential heterogeneity.
Results
Sixty-five cohort studies were included. Association between ctDNA and shorter RFS or OS was significant, especially after the full-course treatment recommended by the guidelines (HR = 8.92 [ 95 % CI: 6.02–13.22], P < 0.001, I2 = 73 %; HR = 3.05 [ 95 % CI: 1.72–5.41], P < 0.001, I2 = 48 %) for all types of CRC patients. Despite the presence of heterogeneity, subgroup analyses showed that the cancer type and ctDNA detection assays may be the underlying cause. Besides, ctDNA may detect recurrence earlier than radiographic progression, but no uniform sampling time point between studies might bring bias. However, ctDNA detection did not appear to correlate with pathological complete response achievement in patients with locally advanced rectal cancer.
Conclusion
ctDNA detection was significantly associated with poorer prognosis. The potential applications in prognostic prediction are promising and remain to be evaluated in other fields.
目的循环肿瘤DNA （ctDNA）越来越多地被用作结直肠癌（CRC）患者的潜在生物标志物。然而，ctDNA在CRC预后预测中的作用尚不清楚。目的是系统评估ctDNA在整个治疗周期中预测结直肠癌预后的临床价值。方法检索2016年1月至2023年4月spubmed、Web of Science、Embase、Cochrane Library、Scopus和clinical trials.gov数据库。观察性研究和随机临床试验报告了CRC患者的ctDNA和预后结果。计算主要结局、无复发生存期（RFS）和总生存期（OS）的合并风险比（hr）。考虑到潜在的异质性，首选随机效应模型。结果纳入65项队列研究。ctDNA与较短的RFS或OS之间存在显著相关性，特别是在指南推荐的全程治疗后(HR = 8.92 [95% CI: 6.02-13.22], P <；0.001, i2 = 73%；HR = 3.05 [95% CI: 1.72-5.41], P <；0.001, I2 = 48%)。尽管存在异质性，亚组分析表明，癌症类型和ctDNA检测分析可能是潜在的原因。此外，ctDNA可能比影像学进展更早发现复发，但研究之间没有统一的采样时间点可能会带来偏差。然而，在局部晚期直肠癌患者中，ctDNA检测似乎与病理完全缓解无关。结论ctdna检测与预后不良有显著相关性。在预后预测方面的潜在应用前景广阔，在其他领域有待进一步评估。
{"title":"Circulating tumor DNA as a biomarker of prognosis prediction in colorectal cancer: a systematic review and meta‐analysis","authors":"Qingxin Zhou , Xiaowei Chen , Baoqi Zeng , Meng Zhang , Nana Guo , Shanshan Wu , Hongmei Zeng , Feng Sun","doi":"10.1016/j.jncc.2024.05.007","DOIUrl":"10.1016/j.jncc.2024.05.007","url":null,"abstract":"<div><h3>Objective</h3><div>Circulating tumor DNA (ctDNA) is increasingly being used as a potential biomarker in colorectal cancer (CRC) patients. However, the role of ctDNA in CRC prognosis prediction remains unclear. The objective is to systematically assess the clinical value of ctDNA in colorectal cancer prognosis prediction throughout the treatment cycle.</div></div><div><h3>Methods</h3><div>PubMed, Web of Science, Embase, Cochrane Library, Scopus, and clinical trials.gov database was searched from January 2016 to April 2023. Observational studies and randomized clinical trials reporting on ctDNA and prognostic outcomes in CRC patients were included. Pooled hazard risk ratios (HRs) were calculated for the primary outcomes, relapse-free survival (RFS), and overall survival (OS). Random-effects models were preferred considering the potential heterogeneity.</div></div><div><h3>Results</h3><div>Sixty-five cohort studies were included. Association between ctDNA and shorter RFS or OS was significant, especially after the full-course treatment recommended by the guidelines (HR = 8.92 [ 95 % CI: 6.02–13.22], <em>P</em> < 0.001, <em>I<sup>2</sup></em> = 73 %; HR = 3.05 [ 95 % CI: 1.72–5.41], <em>P</em> < 0.001, <em>I<sup>2</sup></em> = 48 %) for all types of CRC patients. Despite the presence of heterogeneity, subgroup analyses showed that the cancer type and ctDNA detection assays may be the underlying cause. Besides, ctDNA may detect recurrence earlier than radiographic progression, but no uniform sampling time point between studies might bring bias. However, ctDNA detection did not appear to correlate with pathological complete response achievement in patients with locally advanced rectal cancer.</div></div><div><h3>Conclusion</h3><div>ctDNA detection was significantly associated with poorer prognosis. The potential applications in prognostic prediction are promising and remain to be evaluated in other fields.</div></div>","PeriodicalId":73987,"journal":{"name":"Journal of the National Cancer Center","volume":"5 2","pages":"Pages 167-178"},"PeriodicalIF":7.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.jncc.2025.01.002
Yousheng Mao , Shuoyan Liu , Yongtao Han , Shiping Guo , Chun Chen , Shugeng Gao , Anlin Hao , Hongbing Duan , Wentao Fang , Renquan Zhang , Zhentao Yu , Xiangning Fu , Xiaofei Li , Qun Wang , Lijie Tan , Zhigang Li , Yin Li , Zhirong Zhang , Wenqiang Wei , Yan Fang , Jie He
Background
3-field lymph node dissection (3FL) frequently lead to much more perioperative complications than 2-field lymph node dissection (2FL). This study was designed as a non-inferiority trial to evaluate whether 3FL could be omitted without compromising overall survival (OS) and disease-free survival (DFS) in the patients with resectable thoracic esophageal squamous cell cancer (ESCC) and negative right recurrent laryngeal nerve lymph nodes (RRLN-LNs).
Methods
cT1b-3N0–1M0 thoracic ESCC patients were managed in 3 arms during open or minimally invasive McKeown esophagectomy according to the results of frozen section examination for RRLN-LNs: if positive, direct 3FL (RRLN[+]-3FL); if negative, 2FL (RRLN[-]-2FL) or 3FL (RRLN[-]-3FL) by randomization.
Results
Based on frozen section, of the 829 finally recruited patients, 121 (13.6 %) had positive RRLN-LNs and direct 3FL (RRLN[+]-3FL); 766 had negative RRLN-LNs and were randomized into the RRLN [-]-2FL (386 cases) or RRLN[-]-3FL (380 cases) group. The cervical LN metastasis rate in the RRLN[+]-3FL group (28.9 %) was significantly higher than that in the RRLN[-]-3FL group (8.3 %) (P<0.001). The 5-year OS and DFS were 72.2 % and 65.1 % in the RRLN[-]-3FL group and 68.8 % and 62.8 % in the RRLN[-]-2FL group (OS, P = 0.163; DFS, P = 0.378), versus 50.3 % and 41.2 % in the RRLN[+]-3FL group (both P<0.001), respectively.
Conclusions
Additional cervical lymphadenectomy can be avoided in the patients with middle or lower thoracic ESCC and negative RRLN-LNs by frozen section treated by upfront surgery.
{"title":"Three-field vs two-field lymphadenectomy in thoracic ESCC patients: a multicenter randomized study (NST 1503)","authors":"Yousheng Mao , Shuoyan Liu , Yongtao Han , Shiping Guo , Chun Chen , Shugeng Gao , Anlin Hao , Hongbing Duan , Wentao Fang , Renquan Zhang , Zhentao Yu , Xiangning Fu , Xiaofei Li , Qun Wang , Lijie Tan , Zhigang Li , Yin Li , Zhirong Zhang , Wenqiang Wei , Yan Fang , Jie He","doi":"10.1016/j.jncc.2025.01.002","DOIUrl":"10.1016/j.jncc.2025.01.002","url":null,"abstract":"<div><h3>Background</h3><div>3-field lymph node dissection (3FL) frequently lead to much more perioperative complications than 2-field lymph node dissection (2FL). This study was designed as a non-inferiority trial to evaluate whether 3FL could be omitted without compromising overall survival (OS) and disease-free survival (DFS) in the patients with resectable thoracic esophageal squamous cell cancer (ESCC) and negative right recurrent laryngeal nerve lymph nodes (RRLN-LNs).</div></div><div><h3>Methods</h3><div>cT1b-3N0–1M0 thoracic ESCC patients were managed in 3 arms during open or minimally invasive McKeown esophagectomy according to the results of frozen section examination for RRLN-LNs: if positive, direct 3FL (RRLN[+]-3FL); if negative, 2FL (RRLN[-]-2FL) or 3FL (RRLN[-]-3FL) by randomization.</div></div><div><h3>Results</h3><div>Based on frozen section, of the 829 finally recruited patients, 121 (13.6 %) had positive RRLN-LNs and direct 3FL (RRLN[+]-3FL); 766 had negative RRLN-LNs and were randomized into the RRLN [-]-2FL (386 cases) or RRLN[-]-3FL (380 cases) group. The cervical LN metastasis rate in the RRLN[+]-3FL group (28.9 %) was significantly higher than that in the RRLN[-]-3FL group (8.3 %) (<em>P</em><0.001). The 5-year OS and DFS were 72.2 % and 65.1 % in the RRLN[-]-3FL group and 68.8 % and 62.8 % in the RRLN[-]-2FL group (OS, <em>P</em> = 0.163; DFS, <em>P</em> = 0.378), versus 50.3 % and 41.2 % in the RRLN[+]-3FL group (both <em>P</em><0.001), respectively.</div></div><div><h3>Conclusions</h3><div>Additional cervical lymphadenectomy can be avoided in the patients with middle or lower thoracic ESCC and negative RRLN-LNs by frozen section treated by upfront surgery.</div><div>Trial Registration: ClinicalTrials.gov Identifier NCT02448953.</div></div>","PeriodicalId":73987,"journal":{"name":"Journal of the National Cancer Center","volume":"5 2","pages":"Pages 203-211"},"PeriodicalIF":7.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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