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Sociodemographic and Socioeconomic Factors Correlate with Late-Stage Pediatric Hodgkin Lymphoma and Rhabdomyosarcoma: A Report from the Children's Oncology Group Registries. 社会人口因素与晚期小儿霍奇金淋巴瘤和横纹肌肉瘤的关系:儿童肿瘤学组登记报告》。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-10-02 DOI: 10.1158/1055-9965.EPI-24-0510
Judy Y Ou, Heydon K Kaddas, Todd A Alonzo, Logan G Spector, Negar Fallahazad, Emily Owens, Lindsay J Collin, Adam L Green, Anne C Kirchhoff

Background: We examined the association between late-stage diagnosis and individual- and community-level sociodemographic and socioeconomic characteristics among patients with pediatric Hodgkin lymphoma and rhabdomyosarcoma (RMS).

Methods: We obtained Children's Oncology Group data from 1999 to 2021 including summary stage [local (L), regional (R), and distant (D)], tumor subtype, demographics, and ZIP Code at diagnosis. We linked ZIP Codes to county-level redlining scores (C, D = greatest redlining), the Child Opportunity Index, and measures of segregation (racial dissimilarity indices). Logistic regressions calculated odds ratios for late-stage diagnosis and by race within tumor subtype.

Results: In total, 5,956 patients with Hodgkin lymphoma and 2,800 patients with RMS were included. Late-stage diagnosis of Hodgkin lymphoma was correlated with Black race [ORDistant(D) vs. regional/local (R&L) = 1.38 (1.13-1.68)], being uninsured [ORD vs. R&L = 1.38 (1.09-1.75)], and subtype [nodular sclerosis vs. Other Hodgkin lymphoma: ORD vs. R&L = 1.64 (1.34-2.01), Untyped: ORD vs. R&L = 1.30 (1.04-1.63)]. Late-stage RMS was correlated with bilingual households [ORDistant/regional(D&R) vs. local(L) = 2.66 (1.03-6.91)] and tumor type [alveolar vs. embryonal ORD vs. R&L = 6.16 (5.00-7.58)]. Community-level factors associated with late-stage Hodgkin lymphoma were greater Black (OR80-100% = 1.83; 95% CI = 1.11-3.02) and Hispanic (OR60-79% = 1.30; 95% CI = 1.05-1.60) dissimilarity indices. Late-stage diagnosis for RMS was associated with more redlined census tracts within counties (OR = 1.54; 95% CI = 1.02-2.35) and low/very low Child Opportunity Index (OR = 1.21; 95% CI = 1.02-1.45).

Conclusions: Novel markers of community deprivation, such as redlining and racial segregation, were correlated with cancer outcomes for children with Hodgkin lymphoma and RMS in this first disparities study using Children's Oncology Group registries.

Impact: The interplay of multilevel risk factors provides important consideration for efforts to improve early detection of pediatric cancer diagnosis.

背景:我们研究了小儿霍奇金淋巴瘤(HL)和横纹肌肉瘤(RMS)患者晚期诊断与个人和社区特征之间的关系:我们研究了小儿霍奇金淋巴瘤(HL)和横纹肌肉瘤(RMS)患者的晚期诊断与个人和社区特征之间的关系:我们获得了儿童肿瘤学组(Children's Oncology Group,COG)1999-2021 年的数据,包括诊断时的简要分期(局部分期(L)、区域分期(R)、远处分期(D))、肿瘤亚型、人口统计学特征和邮政编码。我们将邮政编码与县级红线分数(C,D=最大红线)、儿童机会指数(COI)和种族隔离度量(种族差异指数(DI))联系起来。逻辑回归计算了晚期诊断的几率比,以及肿瘤亚型中的种族几率比:结果:共纳入 5,933 例 HL 和 2,800 例 RMS 患者。HL的晚期诊断与黑人种族(ORDistant(D) vs regional/local(R&L)=1.38 [1.13-1.68])、无保险(ORD vs R&L=1.38 [1.09-1.75])和亚型(结节性硬化 vs 其他HL:ORD vs R&L=1.64 [1.34-2.01],未分型:ORD vs R&L=1.30[1.04-1.63])。晚期横纹肌肉瘤与双语家庭(ORDistant/ regional(D&R) vs local(L)=2.66 [1.03-6.91])和肿瘤类型(肺泡型 vs 胚胎型 ORD vs R&L=6.16 [5.00-7.58])相关。与晚期HL相关的社区因素是黑人(OR80-100%=1.83;95%CI=1.11-3.02)和西班牙裔(OR60-79%=1.30;95%CI=1.05-1.60)DI较高。晚期RMS诊断与县内更多的红线人口普查区(OR=1.54;95% CI=1.02-2.35)和低/极低COI(OR=1.21;95% CI=1.02-1.45)有关:结论:在这项首次使用COG登记进行的差异研究中,社区贫困的新标志物(如红线和种族隔离)可能会影响HL和RMS患儿的癌症预后:影响:多层次风险因素的相互作用为改善儿科癌症诊断的早期发现提供了重要的考虑因素。
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引用次数: 0
Patient Characteristics Associated with Intended Nonguideline Chemotherapy in Women with Stage I to IIIA Breast Cancer. 与 I-IIIA 期乳腺癌女性患者非指南化疗相关的患者特征。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-10-02 DOI: 10.1158/1055-9965.EPI-24-0360
Jenna Bhimani, Kelli O'Connell, Sonia Persaud, Victoria Blinder, Rachael P Burganowski-Doud, Isaac J Ergas, Grace B Gallagher, Jennifer J Griggs, Narre Heon, Tatjana Kolevska, Yuriy Kotsurovskyy, Candyce H Kroenke, Cecile A Laurent, Raymond Liu, Kanichi G Nakata, Donna R Rivera, Janise M Roh, Sara Tabatabai, Emily Valice, Elisa V Bandera, Erin J Aiello Bowles, Lawrence H Kushi, Elizabeth D Kantor

Background: Guidelines informing chemotherapy regimen selection are based on clinical trials with participants who do not necessarily represent general populations with breast cancer. Understanding who receives nonguideline regimens is important for understanding real-world chemotherapy administration and how it relates to patient outcomes.

Methods: Using data from the Optimal Breast Cancer Chemotherapy Dosing (OBCD) study, based at Kaiser Permanente Northern California (2006-2019) and Kaiser Permanente Washington (2004-2015), we use logistic regression to examine the associations between patient characteristics and receipt of nonguideline chemotherapy regimens among 11,293 women with primary stage I to IIIA breast cancer receiving chemotherapy.

Results: The use of nonguideline regimens was strongly associated with several factors, including older age [≥80 vs. 18-39 years: OR, 5.25; 95% confidence interval (CI), 3.06-9.00; P-trend = 0.002] and HER2 status (HER2+ vs. HER2-: OR, 3.44; 95% CI, 3.06-3.87) and was less likely in women with larger tumor size (>5 cm vs. 0.1 to ≤0.5 cm: OR, 0.56; 95% CI, 0.36-0.87; P-trend = 0.01) and diagnosed in later years (2012-2019 vs. 2005-2011: OR, 0.80; 95% CI, 0.71-0.90). Factors associated varied by type of nonguideline regimens. For example, women with comorbidity and older age were more likely to receive nonguideline drug combinations in particular, whereas women with larger tumor size were less likely to receive nonguideline administration schedules.

Conclusions: Nonguideline chemotherapy regimens are more likely in certain patient populations.

Impact: These associations highlight that vulnerable patient populations may be less likely to receive guideline care, and thus, real-world studies are essential for understanding how the use of nonguideline regimens impacts patient outcomes in these groups.

背景:化疗方案选择指南以临床试验为基础,而临床试验的参与者并不一定代表乳腺癌患者的总体情况。了解哪些患者接受了非指南方案对于了解现实世界中的化疗管理及其与患者预后的关系非常重要:利用北加州凯泽医疗集团(Kaiser Permanente Northern California,2006-2019 年)和华盛顿凯泽医疗集团(Kaiser Permanente Washington,2004-2015 年)的最佳乳腺癌化疗剂量(Optimal Breast Cancer Chemotherapy Dosing,OBCD)队列研究的数据,我们使用逻辑回归法研究了 11,293 名接受化疗的 I-IIIA 期原发性乳腺癌女性患者中,患者特征与接受非 NCCN 指南化疗之间的关联:结果:非指南方案的使用与几个因素密切相关,包括年龄较大(OR≥80 vs 18-39:5.25,95%CI:3.06-9.00)(p-trend=0.002)和人类表皮生长因子-2状态(ORHER2+ vs HER2-:3.44;95%CI:3.06-3.87),且肿瘤尺寸较大(OR>5cm vs 0.1-≤0.5cm:0.56;95%CI:0.36-0.87)(P-趋势=0.01)和确诊时间较晚(OR2012-2019 vs 2005-2011:0.80;95%CI:0.71-0.90)的女性患病几率较低。相关因素因非指南方案的类型而异。例如,患有合并症和年龄较大的女性接受非指南药物组合的可能性更大,而肿瘤体积较大的女性接受非指南给药方案的可能性较小:结论:某些患者更有可能接受非指南化疗方案:影响:这些关联凸显了弱势患者群体可能较少接受指南护理,因此真实世界研究对于了解非指南方案的使用如何影响这些群体的患者预后至关重要。
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引用次数: 0
Adiposity throughout Adulthood and Risk of Young Onset Breast Cancer Tumor Subtypes in the Young Women's Health History Study. 年轻女性健康史研究》中成年后的肥胖与年轻乳腺癌肿瘤亚型的风险。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-10-02 DOI: 10.1158/1055-9965.EPI-24-1067
Lydia Marcus Post, Dorothy R Pathak, Ann S Hamilton, Kelly A Hirko, Richard T Houang, Emily H Guseman, Dan Sanfelippo, Nicole Bohme Carnegie, L Karl Olson, Hallgeir Rui, Ann G Schwartz, Ellen M Velie

Background: The role of adult adiposity in young-onset breast cancer (YOBC) subtype risk is not well understood.

Methods: In this population-based case(n=1812)-control(n=1381) study of invasive YOBC (aged <50 years), cases were identified from the Los Angeles County and Metropolitan Detroit SEER registries, 2010-2015. Area-based, frequency-matched controls were sampled from the 2010 Census. General adiposity (body mass index (BMI)) and central adiposity (waist circumference (WC), waist-to-height ratio (WHtR)) across adulthood and covariates were collected from in-person interviews and measurements. Odds ratios (ORs) and 95% confidence intervals (CIs) for adiposity and YOBC tumor subtypes (i.e., luminal A, luminal B, HER2+, triple negative (TN)) were calculated, overall and by parity, using multivariable weighted logistic regression.

Results: Obese young adult BMI was inversely associated with luminal A YOBC (OR=0.35, 95% CI 0.16-0.79); other subtype associations were non-significant. Similarly, adult overweight and obese BMIs were inversely associated with luminal A (respectively OR=0.66, 95% CI 0.48-0.91 and OR=0.59, 95% CI 0.46-0.87), but not other subtypes. Conversely, larger WC was associated with higher odds of luminal B and TN YOBC (respectively OR=1.48, 95% CI 1.01-2.15 and OR=2.48, 95% CI 1.52-3.88), but not other subtypes (with similar results for WHtR); highest odds were among parous women.

Conclusions: Findings show greater general adult adiposity is associated with reduced odds of luminal A YOBC, while greater central adiposity is associated with increased odds of luminal B and TN YOBC, particularly among parous women.

Impact: Additional studies of central adiposity and YOBC subtype risk, especially incorporating pregnancy history, are warranted.

背景:成人脂肪在年轻乳腺癌(YOBC)亚型风险中的作用尚不清楚:成人脂肪在年轻乳腺癌(YOBC)亚型风险中的作用尚不十分清楚:在这项以人群为基础的病例(1812 例)-对照(1381 例)研究中,研究对象为浸润性 YOBC(年龄:20 岁 结果:肥胖的年轻成人 BMI 与管腔 A 型 YOBC 成反比:肥胖的年轻成人体重指数与管腔A型YOBC成反比(OR=0.35,95% CI 0.16-0.79);其他亚型的相关性不显著。同样,成人超重和肥胖的体重指数与管腔 A 成反比(分别为 OR=0.66,95% CI 0.48-0.91 和 OR=0.59,95% CI 0.46-0.87),但与其他亚型无关。相反,较大的腹围与较高的管腔B型和TN型YOBC几率相关(分别为OR=1.48,95% CI 1.01-2.15和OR=2.48,95% CI 1.52-3.88),但与其他亚型无关(WHtR的结果类似);奇数女性的几率最高:结论:研究结果表明,成人总体脂肪过多与管腔A型YOBC几率降低有关,而中心脂肪过多与管腔B型和TN型YOBC几率增加有关,特别是在奇偶女性中:影响:有必要对中心脂肪率和 YOBC 亚型风险进行更多研究,尤其是结合妊娠史。
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引用次数: 0
Radiodensities of Skeletal Muscle and Visceral Adipose Tissues Are Prognostic Factors in Clear-Cell Renal Cell Carcinoma. 骨骼肌和内脏脂肪组织的放射密度是透明细胞肾细胞癌的预后因素。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-10-02 DOI: 10.1158/1055-9965.EPI-24-0306
Patrick T Bradshaw, Linnea T Olsson, Alejandro Sanchez, Andrea Knezevic, Oguz Akin, Jessica M Scott, A Ari Hakimi, Paul Russo, Bette J Caan, Marina Mourtzakis, Helena Furberg

Background: Body composition may be related to survival in patients with clear-cell renal cell carcinoma (ccRCC), but studies have not simultaneously considered adipose and muscle tissue quantity and radiodensity.

Methods: We analyzed data from 1,022 patients with ccRCC who underwent nephrectomy between 2000 and 2020 at Memorial Sloan Kettering Cancer Center. Skeletal muscle, visceral adipose tissue, and subcutaneous adipose tissue indexes (cm2/m2) and radiodensities [Hounsfield units (HU)] were assessed from noncontrast presurgical CT scans; clinical and demographic characteristics were available from the time of surgery. HRs and confidence intervals were estimated for overall (OS) and disease-free survival (DFS) through March 2023 in multivariable models that simultaneously accounted for all body composition measures.

Results: The median age of the patients was 58 years, 69% were male, and 90% were White. There were 169 OS events over 8,392 person-years and 253 DFS events over 7,753 person-years of follow-up. In adjusted analyses, poor OS was associated with lower skeletal muscle radiodensity [-10 HU, HR (95% confidence interval), 1.37 (1.05-1.77)] and greater visceral adipose tissue radiodensity [+10 HU, 1.66 (1.06-2.59)], with similar findings for DFS. Poor survival was also associated with greater visceral adipose tissue index [+40 cm2/m2, OS: 1.32 (0.97, 1.79); DFS: 1.33 (1.04, 1.71)]. Associations with skeletal muscle radiodensity were limited to patients with stage 1/2 disease.

Conclusions: Radiodensities of skeletal muscle and visceral adipose tissues may be novel presurgical prognostic factors for patients with ccRCC.

Impact: The findings underscore the importance of evaluating the full range of body composition features simultaneously in multivariable models.

背景:身体成分可能与透明细胞肾细胞癌(ccRCC)患者的存活率有关,但研究并未同时考虑脂肪和肌肉组织的数量以及放射密度:身体成分可能与透明细胞肾细胞癌(ccRCC)患者的存活率有关,但研究并未同时考虑脂肪和肌肉组织的数量及放射密度:我们分析了2000-2020年间在纪念斯隆-凯特琳癌症中心接受肾切除术的1022名ccRCC患者的数据。骨骼肌、内脏脂肪和皮下脂肪组织指数(SMI、VATI、SATI,分别为 cm2/m2)和放射密度(SMD、VATD、SATD,分别为 Hounsfield Units [HU])通过手术前的非对比计算机断层扫描进行评估;临床和人口统计学特征可在手术时获得。在同时考虑所有身体成分指标的多变量模型中,估算了到2023年3月的总生存期(OS)和无病生存期(DFS)的危险比(HR)和置信区间(CI):中位年龄为 58 岁,69% 为男性,90% 为白人。在8392人年的随访过程中发生了169起OS事件,在7753人年的随访过程中发生了253起DFS事件。在调整分析中,较差的 OS 与较低的 SMD(-10 HU,HR (95% CI):1.37 [1.05, 1.77])和较大的 VATD(+10 HU:1.66 [1.06, 2.59])相关,DFS 也有类似的结果。生存率差也与VATI越大有关(+40 cm2/m2,OS:1.32 [0.97,1.79];DFS:1.33 [1.04,1.71])。与SMD的关系仅限于1/2期患者:结论:骨骼肌和内脏脂肪组织的放射性密度可能是ccRCC患者手术前预后的新因素:影响:研究结果强调了在多变量模型中同时评估各种身体成分特征的重要性。
{"title":"Radiodensities of Skeletal Muscle and Visceral Adipose Tissues Are Prognostic Factors in Clear-Cell Renal Cell Carcinoma.","authors":"Patrick T Bradshaw, Linnea T Olsson, Alejandro Sanchez, Andrea Knezevic, Oguz Akin, Jessica M Scott, A Ari Hakimi, Paul Russo, Bette J Caan, Marina Mourtzakis, Helena Furberg","doi":"10.1158/1055-9965.EPI-24-0306","DOIUrl":"10.1158/1055-9965.EPI-24-0306","url":null,"abstract":"<p><strong>Background: </strong>Body composition may be related to survival in patients with clear-cell renal cell carcinoma (ccRCC), but studies have not simultaneously considered adipose and muscle tissue quantity and radiodensity.</p><p><strong>Methods: </strong>We analyzed data from 1,022 patients with ccRCC who underwent nephrectomy between 2000 and 2020 at Memorial Sloan Kettering Cancer Center. Skeletal muscle, visceral adipose tissue, and subcutaneous adipose tissue indexes (cm2/m2) and radiodensities [Hounsfield units (HU)] were assessed from noncontrast presurgical CT scans; clinical and demographic characteristics were available from the time of surgery. HRs and confidence intervals were estimated for overall (OS) and disease-free survival (DFS) through March 2023 in multivariable models that simultaneously accounted for all body composition measures.</p><p><strong>Results: </strong>The median age of the patients was 58 years, 69% were male, and 90% were White. There were 169 OS events over 8,392 person-years and 253 DFS events over 7,753 person-years of follow-up. In adjusted analyses, poor OS was associated with lower skeletal muscle radiodensity [-10 HU, HR (95% confidence interval), 1.37 (1.05-1.77)] and greater visceral adipose tissue radiodensity [+10 HU, 1.66 (1.06-2.59)], with similar findings for DFS. Poor survival was also associated with greater visceral adipose tissue index [+40 cm2/m2, OS: 1.32 (0.97, 1.79); DFS: 1.33 (1.04, 1.71)]. Associations with skeletal muscle radiodensity were limited to patients with stage 1/2 disease.</p><p><strong>Conclusions: </strong>Radiodensities of skeletal muscle and visceral adipose tissues may be novel presurgical prognostic factors for patients with ccRCC.</p><p><strong>Impact: </strong>The findings underscore the importance of evaluating the full range of body composition features simultaneously in multivariable models.</p>","PeriodicalId":9458,"journal":{"name":"Cancer Epidemiology Biomarkers & Prevention","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Liver Cancer: Progress and Priorities. 肝癌:进展与优先事项。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-10-02 DOI: 10.1158/1055-9965.EPI-24-0686
Katherine A McGlynn, Jessica L Petrick, John D Groopman

Liver cancer, the sixth most frequently occurring cancer in the world and the third most common cause of cancer mortality, has wide geographical variation in both incidence and mortality rates. At the end of the 20th century, incidence rates began declining in some high-rate areas and increasing in some lower-rate areas. These trends were undoubtedly driven by the shifting contributions of both well-established and more novel risk factors. While notable strides have been made in combating some major risk factors, such as hepatitis B virus and hepatitis C virus, the emergence of metabolic conditions as important drivers of liver cancer risk indicates that much work remains to be done in prevention. As liver cancer is strongly associated with economic and social deprivation, research, early-diagnosis, and treatment among disadvantaged populations are of paramount importance.

肝癌是世界上发病率第六高的癌症,也是导致癌症死亡的第三大常见病因,其发病率和死亡率的地域差异很大。20 世纪末,一些高发病率地区的发病率开始下降,而一些低发病率地区的发病率则开始上升。毫无疑问,这些趋势是由已确立的风险因素和较新的风险因素共同作用的结果。虽然在应对乙肝病毒和丙肝病毒等一些主要风险因素方面取得了显著进展,但新陈代谢条件成为肝癌风险的重要驱动因素,这表明在预防方面仍有许多工作要做。由于肝癌与经济和社会贫困密切相关,因此对弱势群体进行研究、早期诊断和治疗至关重要。
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引用次数: 0
Blood Magnesium Level and Risk of Hepatocellular Carcinoma in a Prospective Liver Cirrhosis Cohort. 前瞻性肝硬化队列中的血镁水平与肝细胞癌风险。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-10-02 DOI: 10.1158/1055-9965.EPI-24-0327
Xinyuan Zhang, Longgang Zhao, Qi Dai, Tao Hou, Christopher J Danford, Michelle Lai, Xuehong Zhang

Background: Higher magnesium intake was linked to a lower risk of hepatocellular carcinoma (HCC). However, the relationship between blood magnesium level and HCC has not been fully characterized, especially among patients with liver cirrhosis who are at a higher risk for HCC.

Methods: In the Mass General Brigham Biobank, we developed a new prospective cohort of 1,430 patients with liver cirrhosis without liver cancer history using the validated International Classification of Diseases codes. We used Cox proportional hazards models to generate hazard ratios (HRs) with 95% confidence intervals (CI) for incident HCC and used generalized estimating equations to compare changes in liver biomarkers according to baseline blood magnesium, adjusting for age, sex, race, lifestyles, body mass index, type 2 diabetes, model for end-stage liver disease score, and hepatitis infection.

Results: During a median follow-up period of 4.26 years, 109 patients developed HCC. Magnesium deficiency (<1.70 mg/dL; N = 158) was associated with a higher risk of HCC (HR = 1.93; 95% CI, 1.12-3.30) compared with magnesium sufficiency (≥1.70 mg/dL; N = 1282). This association remained robust in the 1-year lag analysis (HR = 2.18; 95% CI, 1.11-4.28) and in sensitivity analysis excluding patients with alcoholic liver disease (HR = 2.41; 95% CI, 1.23-4.74). Magnesium in the lowest quartile was associated with a faster increase in alanine transaminase (β = 4.35; 95% CI, 1.06-7.63), aspartate aminotransferase (β = 6.46; 95% CI, 0.28-12.6), direct bilirubin (β = 0.18; 95% CI, 0.01-0.35), and total bilirubin (β = 0.21; 95% CI, 0.03-0.39), compared with the highest quartile.

Conclusions: Lower blood magnesium level is associated with higher HCC risk and unfavorable liver biomarker changes.

Impact: If confirmed, our findings may potentially enable better identification of high-risk patients for HCC and inform better management strategies for liver cirrhosis.

背景:较高的镁摄入量与较低的肝细胞癌(HCC)风险有关。然而,血镁水平与 HCC 之间的关系尚未完全定性,尤其是在 HCC 风险较高的肝硬化患者中:在麻省总医院布里格姆生物库中,我们使用有效的国际疾病分类代码建立了一个新的前瞻性队列,其中包括 1460 名无肝癌病史的肝硬化患者。我们使用 Cox 比例危险模型得出了发生 HCC 的危险比(HRs)及 95% 置信区间(CIs),并使用广义估计方程比较了肝脏生物标志物随基线血镁变化的情况,同时调整了年龄、性别、种族、生活方式、体重指数、2 型糖尿病、终末期肝病评分模型和肝炎感染等因素:在中位 4.26 年的随访期间,109 人罹患 HCC。镁缺乏血镁水平较低与较高的 HCC 风险和不利的肝脏生物标志物变化有关:如果得到证实,我们的研究结果可能有助于更好地识别HCC高风险患者,并为肝硬化的更好管理策略提供依据。
{"title":"Blood Magnesium Level and Risk of Hepatocellular Carcinoma in a Prospective Liver Cirrhosis Cohort.","authors":"Xinyuan Zhang, Longgang Zhao, Qi Dai, Tao Hou, Christopher J Danford, Michelle Lai, Xuehong Zhang","doi":"10.1158/1055-9965.EPI-24-0327","DOIUrl":"10.1158/1055-9965.EPI-24-0327","url":null,"abstract":"<p><strong>Background: </strong>Higher magnesium intake was linked to a lower risk of hepatocellular carcinoma (HCC). However, the relationship between blood magnesium level and HCC has not been fully characterized, especially among patients with liver cirrhosis who are at a higher risk for HCC.</p><p><strong>Methods: </strong>In the Mass General Brigham Biobank, we developed a new prospective cohort of 1,430 patients with liver cirrhosis without liver cancer history using the validated International Classification of Diseases codes. We used Cox proportional hazards models to generate hazard ratios (HRs) with 95% confidence intervals (CI) for incident HCC and used generalized estimating equations to compare changes in liver biomarkers according to baseline blood magnesium, adjusting for age, sex, race, lifestyles, body mass index, type 2 diabetes, model for end-stage liver disease score, and hepatitis infection.</p><p><strong>Results: </strong>During a median follow-up period of 4.26 years, 109 patients developed HCC. Magnesium deficiency (<1.70 mg/dL; N = 158) was associated with a higher risk of HCC (HR = 1.93; 95% CI, 1.12-3.30) compared with magnesium sufficiency (≥1.70 mg/dL; N = 1282). This association remained robust in the 1-year lag analysis (HR = 2.18; 95% CI, 1.11-4.28) and in sensitivity analysis excluding patients with alcoholic liver disease (HR = 2.41; 95% CI, 1.23-4.74). Magnesium in the lowest quartile was associated with a faster increase in alanine transaminase (β = 4.35; 95% CI, 1.06-7.63), aspartate aminotransferase (β = 6.46; 95% CI, 0.28-12.6), direct bilirubin (β = 0.18; 95% CI, 0.01-0.35), and total bilirubin (β = 0.21; 95% CI, 0.03-0.39), compared with the highest quartile.</p><p><strong>Conclusions: </strong>Lower blood magnesium level is associated with higher HCC risk and unfavorable liver biomarker changes.</p><p><strong>Impact: </strong>If confirmed, our findings may potentially enable better identification of high-risk patients for HCC and inform better management strategies for liver cirrhosis.</p>","PeriodicalId":9458,"journal":{"name":"Cancer Epidemiology Biomarkers & Prevention","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733566","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}
引用次数: 0
Are women's breast cancer risk appraisals in line with updated clinical risk estimates communicated? Results from a UK Family History Risk and Prevention Clinic. 妇女的乳腺癌风险评估是否与最新的临床风险评估一致?英国家族史风险与预防诊所的研究结果。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-10-02 DOI: 10.1158/1055-9965.EPI-24-0581
Victoria G Woof, Anthony Howell, Lynne Fox, Lorna McWilliams, D Gareth R Evans, David P French

Background: The incorporation of breast density and a polygenic risk score (PRS) into breast cancer risk prediction models can alter previously communicated risk estimates. Previous research finds that risk communication does not usually change personal risk appraisals. This study aimed to examine how women from the Family History Risk (FH-Risk) study appraise their breast cancer risk following communication of an updated risk estimate.

Methods: In the FH-Risk study 323 women attended a consultation to receive an updated breast cancer risk estimate. A subset (n=190) completed a questionnaire, assessing their subjective breast cancer risk appraisals, satisfaction with the information provided and cancer related worry. One hundred and three were notified of a decrease risk, 34 an increase and 53 an unchanged risk.

Results: Women's subjective risk appraisals were in line with the updated risk estimates provided, with age, a PRS and breast density explaining most of the variance in these appraisals. Those notified of an increased risk demonstrated higher subjective risk perceptions compared to those whose risk remained unchanged or decreased.

Conclusions: Women's subjective breast cancer risk appraisals are amenable to change following updated risk feedback, with new information breast density and a PRS accepted and integrated into existing risk appraisals. Trust in the service, the analogies and visual communication strategies used may have positively influenced the integration of this new information.

Impact: Further research is warranted to assess whether similar patterns emerge for other illnesses and in different clinical contexts to determine the best strategies for communicating updated risk estimates.

背景:将乳房密度和多基因风险评分(PRS)纳入乳腺癌风险预测模型可能会改变之前通报的风险估计值。以往的研究发现,风险交流通常不会改变个人的风险评估。本研究旨在探讨家族史风险(FH-Risk)研究中的女性在获悉最新风险评估后如何评估其乳腺癌风险:在 "家族史风险 "研究中,有 323 名妇女参加了咨询会,接受了最新的乳腺癌风险评估。其中一部分人(190 人)填写了一份问卷,评估她们对乳腺癌风险的主观评价、对所提供信息的满意度以及与癌症有关的担忧。有 103 名妇女被告知风险降低,34 名妇女被告知风险升高,53 名妇女被告知风险不变:结果:妇女的主观风险评估与提供的最新风险估计值一致,年龄、PRS 和乳房密度解释了这些评估中的大部分差异。与风险保持不变或降低的妇女相比,那些被告知风险增加的妇女表现出更高的主观风险感知:结论:妇女对乳腺癌风险的主观评估可根据最新的风险反馈进行改变,新信息乳腺密度和 PRS 可被接受并纳入现有的风险评估中。对服务的信任、所使用的类比和视觉交流策略可能会对这些新信息的整合产生积极影响:影响:有必要开展进一步研究,以评估其他疾病和不同临床情况下是否会出现类似的模式,从而确定传达最新风险评估的最佳策略。
{"title":"Are women's breast cancer risk appraisals in line with updated clinical risk estimates communicated? Results from a UK Family History Risk and Prevention Clinic.","authors":"Victoria G Woof, Anthony Howell, Lynne Fox, Lorna McWilliams, D Gareth R Evans, David P French","doi":"10.1158/1055-9965.EPI-24-0581","DOIUrl":"10.1158/1055-9965.EPI-24-0581","url":null,"abstract":"<p><strong>Background: </strong>The incorporation of breast density and a polygenic risk score (PRS) into breast cancer risk prediction models can alter previously communicated risk estimates. Previous research finds that risk communication does not usually change personal risk appraisals. This study aimed to examine how women from the Family History Risk (FH-Risk) study appraise their breast cancer risk following communication of an updated risk estimate.</p><p><strong>Methods: </strong>In the FH-Risk study 323 women attended a consultation to receive an updated breast cancer risk estimate. A subset (n=190) completed a questionnaire, assessing their subjective breast cancer risk appraisals, satisfaction with the information provided and cancer related worry. One hundred and three were notified of a decrease risk, 34 an increase and 53 an unchanged risk.</p><p><strong>Results: </strong>Women's subjective risk appraisals were in line with the updated risk estimates provided, with age, a PRS and breast density explaining most of the variance in these appraisals. Those notified of an increased risk demonstrated higher subjective risk perceptions compared to those whose risk remained unchanged or decreased.</p><p><strong>Conclusions: </strong>Women's subjective breast cancer risk appraisals are amenable to change following updated risk feedback, with new information breast density and a PRS accepted and integrated into existing risk appraisals. Trust in the service, the analogies and visual communication strategies used may have positively influenced the integration of this new information.</p><p><strong>Impact: </strong>Further research is warranted to assess whether similar patterns emerge for other illnesses and in different clinical contexts to determine the best strategies for communicating updated risk estimates.</p>","PeriodicalId":9458,"journal":{"name":"Cancer Epidemiology Biomarkers & Prevention","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7616752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Systematic Review and Meta-Analysis of Lifestyle and Reproductive Factors Associated with Risk of Breast Cancer in Asian Women. 与亚洲女性乳腺癌风险相关的生活方式和生殖因素的系统回顾和荟萃分析。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-10-02 DOI: 10.1158/1055-9965.EPI-24-0005
Boon Hong Ang, Soo-Hwang Teo, Weang-Kee Ho

Background: Assessing breast cancer risks from lifestyle and reproductive factors is critical for developing population-specific risk prediction tools. However, limited studies have evaluated these risks in recent Asian birth cohorts.

Methods: We systematically reviewed articles published from January 2010 to December 2023, examining breast cancer risk factors in Asian women. Data were described narratively, estimates pooled, and prevalence and attributable proportions compared across Asian populations.

Results: Of the 128 studies reviewed, 103 reported adjusted effect sizes for meta-analysis. Lifestyle and reproductive factors were predictive of breast cancer risk in Asian women, with varying impacts on premenopausal and postmenopausal women. Relative risks were similar within Asian populations and in comparison to European populations, except for menarche, menopause, and hormone receptor therapy. However, risk factor distributions differed across populations. While alcohol intake (21%) and oral contraceptive use (20%) emerged as the most attributable modifiable risk factors in Europeans, passive smoking (24%) and higher BMI (17%, ≥24 kg/m2 among postmenopausal women) were predominant in Asians.

Conclusions: Our study shows that while the effects of lifestyle and reproductive breast cancer risk factors are largely similar across different populations, their distributions vary.

Impact: Our analysis underscores the importance of considering population-specific risk factor distributions when developing risk prediction tools for Asian populations.

导言:评估生活方式和生殖因素导致的乳腺癌风险对于开发针对特定人群的风险预测工具至关重要。然而,在最近的亚洲出生队列中,对这些风险进行评估的研究非常有限:我们系统回顾了 2010 年 1 月至 2023 年 12 月期间发表的研究亚洲女性乳腺癌风险因素的文章。我们对数据进行了叙述性描述,对估计值进行了汇总,并对不同亚洲人群的患病率和可归因比例进行了比较:结果:在所审查的 128 项研究中,有 103 项报告了用于荟萃分析的调整效应大小。生活方式和生殖因素可预测亚洲女性患乳腺癌的风险,对绝经前和绝经后女性的影响各不相同。除初潮、绝经和激素受体治疗外,亚洲人群的相对风险与欧洲人群相似。不过,不同人群的风险因素分布有所不同。在欧洲人中,酒精摄入量(21%)和口服避孕药(20%)是最容易改变的风险因素,而在亚洲人中,被动吸烟(24%)和较高的体重指数(17%,绝经后妇女≥24kg/m2)则是最主要的风险因素:我们的研究表明,虽然生活方式和生殖系统乳腺癌风险因素对不同人群的影响大体相似,但其分布却各不相同:我们的分析强调了在为亚洲人群开发风险预测工具时考虑特定人群风险因素分布的重要性。
{"title":"Systematic Review and Meta-Analysis of Lifestyle and Reproductive Factors Associated with Risk of Breast Cancer in Asian Women.","authors":"Boon Hong Ang, Soo-Hwang Teo, Weang-Kee Ho","doi":"10.1158/1055-9965.EPI-24-0005","DOIUrl":"10.1158/1055-9965.EPI-24-0005","url":null,"abstract":"<p><strong>Background: </strong>Assessing breast cancer risks from lifestyle and reproductive factors is critical for developing population-specific risk prediction tools. However, limited studies have evaluated these risks in recent Asian birth cohorts.</p><p><strong>Methods: </strong>We systematically reviewed articles published from January 2010 to December 2023, examining breast cancer risk factors in Asian women. Data were described narratively, estimates pooled, and prevalence and attributable proportions compared across Asian populations.</p><p><strong>Results: </strong>Of the 128 studies reviewed, 103 reported adjusted effect sizes for meta-analysis. Lifestyle and reproductive factors were predictive of breast cancer risk in Asian women, with varying impacts on premenopausal and postmenopausal women. Relative risks were similar within Asian populations and in comparison to European populations, except for menarche, menopause, and hormone receptor therapy. However, risk factor distributions differed across populations. While alcohol intake (21%) and oral contraceptive use (20%) emerged as the most attributable modifiable risk factors in Europeans, passive smoking (24%) and higher BMI (17%, ≥24 kg/m2 among postmenopausal women) were predominant in Asians.</p><p><strong>Conclusions: </strong>Our study shows that while the effects of lifestyle and reproductive breast cancer risk factors are largely similar across different populations, their distributions vary.</p><p><strong>Impact: </strong>Our analysis underscores the importance of considering population-specific risk factor distributions when developing risk prediction tools for Asian populations.</p>","PeriodicalId":9458,"journal":{"name":"Cancer Epidemiology Biomarkers & Prevention","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632702","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}
引用次数: 0
The Disconnect between Clinical Guidelines and Reality: The Case of Trastuzumab. 临床指南与现实之间的脱节:曲妥珠单抗案例
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-10-02 DOI: 10.1158/1055-9965.EPI-24-0906
Alejandro Aranda-Gutierrez, Enrique Soto-Perez-de-Celis

HER2-positive breast cancer accounts for 10% to 20% of all breast cancer diagnoses. The mAb trastuzumab is crucial in treating this disease, significantly improving survival outcomes. Despite its inclusion in the World Health Organization's Model List of Essential Medicines, access to trastuzumab remains limited worldwide. In this issue of the journal, Norris and colleagues report that only 45% of eligible patients with HER2-positive breast cancer in the United Kingdom received trastuzumab between 2012 and 2017. This finding in a high-income country with universal health care is worrisome and points toward even greater barriers to access in developing nations. Some solutions to improve accessibility, which we discuss, include shorter durations of trastuzumab treatment and encouraging the registration and availability of biosimilars. The data presented by Norris and colleagues point toward a disconnect between the academic oncology landscape, focused on expensive drugs with marginal benefits, and everyday practice in which even essential interventions may not be available. Ensuring the accessibility to proven, essential medicines should be as relevant as innovation to improve patient outcomes and create a more sustainable healthcare system. See related article by Norris et al., p. 1298.

HER2阳性乳腺癌占所有乳腺癌诊断的10%至20%。mAb 曲妥珠单抗是治疗这种疾病的关键药物,能显著改善患者的生存状况。尽管曲妥珠单抗已被列入世界卫生组织的《基本药物示范目录》,但全球范围内获得曲妥珠单抗的途径仍然有限。诺里斯及其同事在本期杂志上报告说,2012年至2017年间,英国只有45%符合条件的HER2阳性乳腺癌患者接受了曲妥珠单抗治疗。在一个拥有全民医疗保健的高收入国家,这一发现令人担忧,也表明发展中国家在获得治疗方面存在更大的障碍。我们讨论的一些提高可及性的解决方案包括缩短曲妥珠单抗的治疗时间,以及鼓励生物仿制药的注册和供应。诺里斯及其同事提供的数据表明,肿瘤学术界关注的重点是具有边际效益的昂贵药物,而在日常实践中,即使是必要的干预措施也可能无法获得,这两者之间存在脱节。要改善患者的治疗效果并建立一个更可持续发展的医疗保健系统,确保患者能够获得经过验证的基本药物与创新同样重要。参见 Norris 等人的相关文章,第 1298 页。
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引用次数: 0
Prospective Analysis of Circulating Biomarkers and Ovarian Cancer Risk in the UK Biobank. 英国生物库中循环生物标志物与卵巢癌风险的前瞻性分析。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-10-02 DOI: 10.1158/1055-9965.EPI-24-0319
Naoko Sasamoto, Cassandra A Hathaway, Mary K Townsend, Kathryn L Terry, Britton Trabert, Shelley S Tworoger

Background: Risk factors have a limited ability to predict individuals at high risk of developing ovarian cancer among average-risk women, highlighting the need for discovery of novel biomarkers. In the UK Biobank, we investigated serum biomarkers commonly measured in clinical laboratory tests and ovarian cancer risk.

Methods: We conducted a prospective analysis of 20 serum biomarkers and ovarian cancer risk in 232,037 female UK Biobank participants (including 1,122 incident ovarian cancer cases diagnosed from 2006 to 2020). Multivariable adjusted Cox proportional hazards models were used to examine associations between biomarkers and ovarian cancer risk overall and by histotype. FDR was used to account for multiple testing.

Results: Overall, higher levels of insulin-like growth factor (IGF)-1 [RRquartile 4 vs. 1 = 0.73; 95% confidence interval (CI), 0.60-0.87; P-trend = 0.002/FDR = 0.04], HbA1c (RRquartile 4 vs. 1 = 0.74; 95% CI, 0.62-0.89; P-trend = 0.002/FDR = 0.04), and alanine aminotransferase (RRquartile 4 vs. 1 = 0.76; 95% CI, 0.63-0.91; P-trend = 0.002/FDR = 0.04) were significantly associated with lower ovarian cancer risk. When stratified by histotype, higher IGF1 levels were associated with lower risk of serous (RRquartile 4 vs. 1 = 0.73; 95% CI, 0.58-0.91; P-trend = 0.01/FDR = 0.20) and clear cell tumors (RRquartile 4 vs. 1 = 0.18; 95% CI, 0.07-0.49; P-trend = 0.001/FDR = 0.02), and higher HbA1c levels were associated with lower risk of serous tumors (RRquartile 4 vs. 1 = 0.73; 95% CI, 0.59-0.90; P-trend = 0.004/FDR = 0.08).

Conclusions: We observed that higher levels of circulating IGF1, HbA1c, and alanine aminotransferase were associated with lower ovarian cancer risk.

Impact: These results suggest metabolism of glucose/amino acid and insulin/IGF1 signaling pathway may be contributing to ovarian carcinogenesis. Further research is needed to replicate our findings and elucidate how systemic changes in metabolism impact ovarian carcinogenesis.

背景:在普通风险女性中,风险因素预测卵巢癌高风险个体的能力有限,这凸显了发现新型生物标志物的必要性。在英国生物库中,我们调查了临床实验室检测中常用的血清生物标志物和卵巢癌风险:我们对 232,037 名英国生物库女性参与者(包括 2006-2020 年间诊断出的 1,122 例卵巢癌病例)的 20 种血清生物标志物和卵巢癌风险进行了前瞻性分析。多变量调整考克斯比例危险模型用于研究生物标志物与总体卵巢癌风险和不同组织类型卵巢癌风险之间的关系。假发现率用于考虑多重检验:总体而言,IGF-1(RRquartile 4 vs. 1=0.73,95%CI=0.60-0.87;p-trend=0.002/FDR=0.04)、HbA1c(RRquartile 4 vs. 1=0.74,95%CI=0.62-0.89;p-trend=0.002/FDR=0.04)和丙氨酸氨基转移酶(RRquartile 4 vs. 1=0.76,95%CI=0.63-0.91;p-trend=0.002/FDR=0.04)与较低的卵巢癌风险显著相关。按组织类型分层时,较高的IGF-1水平与较低的浆液性肿瘤(RR四分位数4 vs. 1=0.73,95%CI=0.58-0.91;p-趋势=0.01/FDR=0.20)和透明细胞肿瘤(RR四分位数4 vs. 1=0.18,95%CI=0.58-0.91;p-趋势=0.01/FDR=0.04)风险相关。1=0.18,95%CI=0.07-0.49;p-trend=0.001/FDR=0.02),HbA1c水平越高,患浆液性肿瘤的风险越低(RRquartile 4 vs. 1=0.73,95%CI=0.59-0.90;p-trend=0.004/FDR=0.08):我们观察到,较高水平的循环 IGF-1、HbA1c 和丙氨酸氨基转移酶与较低的卵巢癌风险相关:这些结果表明,葡萄糖/氨基酸代谢和胰岛素/IGF-1 信号通路可能会导致卵巢癌的发生。我们需要进一步研究,以复制我们的发现,并阐明新陈代谢的系统性变化如何影响卵巢癌的发生。
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Cancer Epidemiology Biomarkers & Prevention
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