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Pediatric Adrenocortical Carcinoma: The Nuts and Bolts of Diagnosis and Treatment and Avenues for Future Discovery 小儿肾上腺皮质癌:诊断和治疗的要点以及未来探索的途径
IF 3.3 4区 医学 Q3 ONCOLOGY Pub Date : 2024-09-07 DOI: 10.2147/cmar.s348725
Allison F O'Neill, Raul C Ribeiro, Emilia M Pinto, Michael R Clay, Gerard P Zambetti, Brent A Orr, Christopher B Weldon, Carlos Rodriguez-Galindo
Abstract: Adrenocortical tumors (ACTs) are infrequent neoplasms in children and adolescents and are typically associated with clinical symptoms reflective of androgen overproduction. Pediatric ACTs typically occur in the context of a germline TP53 mutation, can be cured when diagnosed at an early stage, but are difficult to treat when advanced or associated with concurrent TP53 and ATRX alterations. Recent work has demonstrated DNA methylation patterns suggestive of prognostic significance. While current treatment standards rely heavily upon surgical resection, chemotherapy, and hormonal modulation, small cohort studies suggest promise for multi-tyrosine kinases targeting anti-angiogenic pathways or immunomodulatory therapies. Future work will focus on novel risk stratification algorithms and combination therapies intended to mitigate toxicity for patients with perceived low-risk disease while intensifying therapy or accelerating discoveries aimed at improving survival for patients with difficult-to-treat disease.

Keywords: adrenocortical, pediatric, management, discovery, carcinoma, tumors
摘要:肾上腺皮质肿瘤(ACTs)是儿童和青少年中不常见的肿瘤,通常伴有反映雄激素过度分泌的临床症状。小儿肾上腺皮质肿瘤通常发生在TP53基因突变的情况下,早期诊断可以治愈,但晚期或同时伴有TP53和ATRX基因改变时则难以治疗。最近的研究表明,DNA 甲基化模式提示了预后意义。虽然目前的治疗标准主要依赖于手术切除、化疗和激素调节,但小规模队列研究表明,针对抗血管生成途径或免疫调节疗法的多酪氨酸激酶疗法大有可为。未来的工作将集中在新的风险分层算法和联合疗法上,旨在减轻低风险疾病患者的毒性,同时加强治疗或加速发现旨在改善难治性疾病患者生存率的疗法。
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引用次数: 0
Systematic Review of the Cost-Effectiveness of Home-Based Palliative Care Interventions in Patients with Cancer: A Critical Analysis 癌症患者居家姑息关怀干预成本效益的系统性回顾:批判性分析
IF 3.3 4区 医学 Q3 ONCOLOGY Pub Date : 2024-09-06 DOI: 10.2147/cmar.s472649
Petra Maresova, Jan Hruška, Kristina Randlova, Lukas Rezny, María Teresa Carrillo-de-la-Peña, Kamil Kuca
Background: The increased prevalence of cancer and the negative impact of pain on the quality of life of patients underscore the need to implement efficient palliative care interventions and management of pain. The cost-effectiveness of palliative care interventions for cancer, mostly pharmacological and delivered through home-based palliative care services, is unclear. Most of the studies do not take into account indirect costs nor consider variations across different geographical regions.
Objective: To describe existing and cutting-edge knowledge on cost-effectiveness or item costs related to palliative home-based care for patients with cancer. We evaluated various costs, including direct medical, non-medical, and indirect costs in different geographical regions and analysed how different options for care affect the patients’ quality of life and associated expenses.
Methods: This Prospero-registered systematic review (CRD42023404217) adhered to the PRISMA criteria. Following a multistep selection process, we selected 22 articles published between 2013 and 2023 focused on quality of life outcomes and cost-effectiveness of home-based palliative care for cancer patients.
Results: Home-based palliative care decreases the number of hospital visits, while its influence on patients quality of life is currently difficult to demonstrate across geographic regions based on available evidence. Overall, home care decreases the costs associated to the palliative care of patients with cancer. The cost structure analysis revealed that besides healthcare costs, informal care expenses and productivity losses represent a significant proportion of overall expenses). In Europe, the direct medical, non-medical, and indirect costs (in purchasing power parity) were on average &dollar1,941, &dollar842, and &dollar1,241, per month per person, respectively. In the USA and Asia, direct medical and indirect costs are on average &dollar1,095 (USA) vs &dollar1,444 (Asia) and &dollar2,192 (USA) vs &dollar1,162 (Asia).
Conclusion: In conclusion, the studies reviewed highlight significant cost variations and potential savings associated with palliative home-based care for cancer patients. Home-based palliative care, particularly involving medications, has shown favorable cost-effectiveness compared to hospital care. Specialized palliative home care, psychological interventions, and outpatient services further contribute to overall cost savings. However, the economic impact varies across different geographical contexts and cost categories, emphasizing the need for tailored approaches in palliative care planning and implementation.

背景:癌症发病率的增加以及疼痛对患者生活质量的负面影响突出表明,有必要实施有效的姑息治疗干预措施和疼痛管理。癌症姑息治疗干预措施的成本效益尚不明确,这些干预措施大多是通过家庭姑息治疗服务提供的药物治疗。大多数研究既未考虑间接成本,也未考虑不同地理区域的差异:描述与癌症患者居家姑息治疗相关的成本效益或项目成本方面的现有知识和前沿知识。我们评估了不同地区的各种成本,包括直接医疗成本、非医疗成本和间接成本,并分析了不同护理方案对患者生活质量和相关费用的影响:这篇在 Prospero 注册的系统性综述(CRD42023404217)遵循了 PRISMA 标准。经过多步筛选,我们选取了 2013 年至 2023 年间发表的 22 篇文章,这些文章关注癌症患者居家姑息治疗的生活质量结果和成本效益:结果:居家姑息治疗减少了患者到医院就诊的次数,但根据现有证据,居家姑息治疗对患者生活质量的影响目前还很难在不同地区体现出来。总体而言,居家姑息治疗降低了癌症患者姑息治疗的相关成本。成本结构分析表明,除医疗费用外,非正规护理费用和生产力损失在总支出中也占有很大比例)。在欧洲,每人每月的直接医疗、非医疗和间接成本(按购买力平价计算)平均分别为 1941 美元、842 美元和 1241 美元。在美国和亚洲,直接医疗和间接成本分别为平均 1,095 美元(美国)和 1,444 美元(亚洲),以及 2,192 美元(美国)和 1,162 美元(亚洲):总之,所审查的研究强调了与癌症患者居家姑息关怀相关的显著成本差异和潜在节约。与医院治疗相比,居家姑息治疗,尤其是药物治疗,显示出良好的成本效益。专门的居家姑息治疗、心理干预和门诊服务进一步促进了总体成本的节约。然而,在不同的地理环境和成本类别中,其经济影响也不尽相同,这就强调了在规划和实施姑息关怀时需要采取量身定制的方法。
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引用次数: 0
Machine Learning Prediction of Residual and Recurrent High-Grade CIN Post-LEEP 睡眠后残留和复发高级别 CIN 的机器学习预测
IF 3.3 4区 医学 Q3 ONCOLOGY Pub Date : 2024-09-06 DOI: 10.2147/cmar.s484057
Furui Zhai, Shanshan Mu, Yinghui Song, Min Zhang, Cui Zhang, Ze Lv
Purpose: This study aims to develop a machine learning (ML) model to predict the risk of residual or recurrent high-grade cervical intraepithelial neoplasia (CIN) after loop electrosurgical excision procedure (LEEP), addressing a critical gap in personalized follow-up care.
Methods: A retrospective analysis of 532 patients who underwent LEEP for high-grade CIN at Cangzhou Central Hospital (2016– 2020) was conducted. In the final analysis, 99 women (18.6%) were found to have residual or recurrent high-grade CIN (CIN2 or worse) within five years of follow-up. Four feature selection methods identified significant predictors of residual or recurrent CIN. Eight ML algorithms were evaluated using performance metrics such as AUROC, accuracy, sensitivity, specificity, PPV, NPV, F1 score, calibration curve, and decision curve analysis. Fivefold cross-validation optimized and validated the model, and SHAP analysis assessed feature importance.
Results: The XGBoost algorithm demonstrated the highest predictive performance with the best AUROC. The optimized model included six key predictors: age, ThinPrep cytologic test (TCT) results, HPV classification, CIN severity, glandular involvement, and margin status. SHAP analysis identified CIN severity and margin status as the most influential predictors. An online prediction tool was developed for real-time risk assessment.
Conclusion: This ML-based predictive model for post-LEEP high-grade CIN provides a significant advancement in gynecologic oncology, enhancing personalized patient care and facilitating early intervention and informed clinical decision-making.

Keywords: cervical intraepithelial neoplasia, loop electrosurgical excision procedure, residual or recurrent, machine learning, predictive modeling
目的:本研究旨在开发一种机器学习(ML)模型,用于预测环状电切术(LEEP)后残留或复发高级别宫颈上皮内瘤变(CIN)的风险,解决个性化随访护理中的一个关键缺口:方法:对沧州市中心医院(2016-2020年)接受LEEP术治疗高级别CIN的532名患者进行回顾性分析。在最终分析中,发现99名女性(18.6%)在随访五年内有残留或复发高级别CIN(CIN2或更差)。四种特征选择方法确定了残留或复发 CIN 的重要预测因素。使用 AUROC、准确度、灵敏度、特异性、PPV、NPV、F1 分数、校准曲线和决策曲线分析等性能指标对八种 ML 算法进行了评估。五倍交叉验证对模型进行了优化和验证,SHAP分析评估了特征的重要性:结果:XGBoost 算法具有最高的预测性能和最佳的 AUROC。优化模型包括六个关键预测因素:年龄、ThinPrep 细胞学检测(TCT)结果、HPV 分类、CIN 严重程度、腺体受累和边缘状态。SHAP 分析确定 CIN 严重程度和边缘状态是最有影响力的预测因素。我们还开发了一个在线预测工具,用于实时风险评估:这个基于 ML 的 LEEP 术后高级别 CIN 预测模型为妇科肿瘤学提供了一个重要的进步,加强了对患者的个性化护理,促进了早期干预和知情的临床决策。
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引用次数: 0
Key Cell-in-Cell Related Genes are Identified by Bioinformatics and Experiments in Glioblastoma 通过生物信息学和实验发现胶质母细胞瘤中细胞内相关的关键基因
IF 3.3 4区 医学 Q3 ONCOLOGY Pub Date : 2024-09-05 DOI: 10.2147/cmar.s475513
Fenglin Zhang, Jingliang Ye, Junle Zhu, Wenbo Qian, Haoheng Wang, Chun Luo
Purpose: This study aimed to explore the roles of cell-in-cell (CIC)-related genes in glioblastoma (GBM) using bioinformatics and experimental strategies.
Patients and Methods: The ssGSEA algorithm was used to calculate the CIC score for each patient. Subsequently, differentially expressed genes (DEGs) between the CIClow and CIChigh groups and between the tumor and control samples were screened using the limma R package. Key CIC-related genes (CICRGs) were further filtered using univariate Cox and LASSO analyses, followed by the construction of a CIC-related risk score model. The performance of the risk score model in predicting GBM prognosis was evaluated using ROC curves and an external validation cohort. Moreover, their location and differentiation trajectory in GBM were analyzed at the single-cell level using the Seurat R package. Finally, the expression of key CICRGs in clinical samples was examined by qPCR.
Results: In the current study, we found that CIC scorelow group had a significantly better survival in the TCGA-GBM cohort, supporting the important role of CICRGs in GBM. Using univariate Cox and LASSO analyses, PTX3, TIMP1, IGFBP2, SNCAIP, LOXL1, SLC47A2, and LGALS3 were identified as key CICRGs. Based on this data, a CIC-related prognostic risk score model was built using the TCGA-GBM cohort and validated in the CGGA-GBM cohort. Further mechanistic analyses showed that the CIC-related risk score is closely related to immune and inflammatory responses. Interestingly, at the single-cell level, key CICRGs were expressed in the neurons and myeloids of tumor tissues and exhibited unique temporal dynamics of expression changes. Finally, the expression of key CICRGs was validated by qPCR using clinical samples from GBM patients.
Conclusion: We identified novel CIC-related genes and built a reliable prognostic prediction model for GBM, which will provide further basic clues for studying the exact molecular mechanisms of GBM pathogenesis from a CIC perspective.

Keywords: glioblastoma, bioinformatics, cell-in-cell, prognosis
目的:本研究旨在利用生物信息学和实验策略探索胶质母细胞瘤(GBM)中细胞内(CIC)相关基因的作用:采用ssGSEA算法计算每位患者的CIC得分。随后,使用 limma R 软件包筛选 CIC 低组和 CIC 高组之间以及肿瘤样本和对照样本之间的差异表达基因(DEGs)。利用单变量 Cox 分析和 LASSO 分析进一步筛选关键的 CIC 相关基因(CICRGs),然后构建 CIC 相关风险评分模型。利用 ROC 曲线和外部验证队列评估了风险评分模型在预测 GBM 预后方面的性能。此外,还使用 Seurat R 软件包在单细胞水平上分析了它们在 GBM 中的位置和分化轨迹。最后,通过 qPCR 检测了关键 CICRGs 在临床样本中的表达情况:在本研究中,我们发现 CIC scorelow 组在 TCGA-GBM 队列中的生存率明显更高,这支持了 CICRGs 在 GBM 中的重要作用。通过单变量 Cox 和 LASSO 分析,我们发现 PTX3、TIMP1、IGFBP2、SNCAIP、LOXL1、SLC47A2 和 LGALS3 是关键的 CICRGs。基于这些数据,利用 TCGA-GBM 队列建立了 CIC 相关预后风险评分模型,并在 CGGA-GBM 队列中进行了验证。进一步的机理分析表明,CIC 相关风险评分与免疫和炎症反应密切相关。有趣的是,在单细胞水平上,关键的 CICRGs 在肿瘤组织的神经元和骨髓中表达,并表现出独特的表达时间动态变化。最后,利用 GBM 患者的临床样本通过 qPCR 验证了关键 CICRGs 的表达:我们发现了新的 CIC 相关基因,并建立了可靠的 GBM 预后预测模型,这将为从 CIC 角度研究 GBM 发病的确切分子机制提供进一步的基础线索。
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引用次数: 0
Impact of COVID-19 Pandemic on the Clinical and Pathologic Characteristics of Colorectal Cancer: A Retrospective Multicenter Study in South Korea. COVID-19 大流行对结直肠癌临床和病理特征的影响:韩国一项回顾性多中心研究。
IF 2.5 4区 医学 Q3 ONCOLOGY Pub Date : 2024-09-04 eCollection Date: 2024-01-01 DOI: 10.2147/CMAR.S478056
Jae Hyun Kang, Il Tae Son, Sang Nam Yoon, Jin Soo Ihm, Byung Mo Kang, Jong Wan Kim

Purpose: The COVID-19 pandemic has influenced various aspects of colorectal cancer (CRC) patient care, including diagnosis, treatment, and outcomes. This study assesses the pandemic's impact on CRC patients.

Methods: We performed a retrospective analysis of medical records for CRC patients who underwent surgery at five hospitals affiliated with Hallym University from January 2017 to December 2022. Patients were divided into two groups: the pre-COVID group (2017-2019) and the COVID group (2020-2022).

Results: Among 2038 patients, 987 (48.4%) were in the pre-COVID group, and 1051 (51.6%) were in the COVID group. The COVID group had more patients with two or more comorbidities (P < 0.001) and a higher incidence of rectal cancer (P = 0.010). While the rates of laparoscopic surgeries were similar, the COVID group had increased emergency surgeries (P = 0.005) and diversion procedures (P = 0.002). Additionally, the COVID group faced more overall complications (P < 0.001) and severe complications (Grade III-V, P = 0.004). There was a rise in lymphovascular invasion (P < 0.001) and T4 stage tumors (P < 0.001) within the COVID group. Despite these differences, both groups had similar 2-year overall survival rates (P = 0.409).

Conclusion: Although patients treated during the COVID period experienced more frequent stoma formation, complications, and adverse prognostic factors, there were no differences in short-term oncologic outcomes, which was likely due to the follow-up period being insufficient to detect differences in OS.

目的:COVID-19 大流行影响了结直肠癌 (CRC) 患者护理的各个方面,包括诊断、治疗和结果。本研究评估了大流行对 CRC 患者的影响:我们对 2017 年 1 月至 2022 年 12 月期间在韩国韩林大学五家附属医院接受手术治疗的 CRC 患者的病历进行了回顾性分析。患者分为两组:COVID 前组(2017-2019 年)和 COVID 组(2020-2022 年):在2038名患者中,987人(48.4%)属于COVID前组,1051人(51.6%)属于COVID组。COVID 组中有两种或两种以上合并症的患者更多(P < 0.001),直肠癌发病率更高(P = 0.010)。虽然腹腔镜手术率相似,但COVID组的急诊手术(P = 0.005)和转流手术(P = 0.002)有所增加。此外,COVID 组面临更多的总体并发症(P < 0.001)和严重并发症(III-V 级,P = 0.004)。COVID组的淋巴管侵犯(P < 0.001)和T4期肿瘤(P < 0.001)有所增加。尽管存在这些差异,但两组患者的两年总生存率相似(P = 0.409):结论:虽然在COVID期间接受治疗的患者造口形成、并发症和不良预后因素的发生率更高,但短期肿瘤治疗结果没有差异,这可能是由于随访时间不足以检测出OS的差异。
{"title":"Impact of COVID-19 Pandemic on the Clinical and Pathologic Characteristics of Colorectal Cancer: A Retrospective Multicenter Study in South Korea.","authors":"Jae Hyun Kang, Il Tae Son, Sang Nam Yoon, Jin Soo Ihm, Byung Mo Kang, Jong Wan Kim","doi":"10.2147/CMAR.S478056","DOIUrl":"10.2147/CMAR.S478056","url":null,"abstract":"<p><strong>Purpose: </strong>The COVID-19 pandemic has influenced various aspects of colorectal cancer (CRC) patient care, including diagnosis, treatment, and outcomes. This study assesses the pandemic's impact on CRC patients.</p><p><strong>Methods: </strong>We performed a retrospective analysis of medical records for CRC patients who underwent surgery at five hospitals affiliated with Hallym University from January 2017 to December 2022. Patients were divided into two groups: the pre-COVID group (2017-2019) and the COVID group (2020-2022).</p><p><strong>Results: </strong>Among 2038 patients, 987 (48.4%) were in the pre-COVID group, and 1051 (51.6%) were in the COVID group. The COVID group had more patients with two or more comorbidities (P < 0.001) and a higher incidence of rectal cancer (P = 0.010). While the rates of laparoscopic surgeries were similar, the COVID group had increased emergency surgeries (P = 0.005) and diversion procedures (P = 0.002). Additionally, the COVID group faced more overall complications (P < 0.001) and severe complications (Grade III-V, P = 0.004). There was a rise in lymphovascular invasion (P < 0.001) and T4 stage tumors (P < 0.001) within the COVID group. Despite these differences, both groups had similar 2-year overall survival rates (P = 0.409).</p><p><strong>Conclusion: </strong>Although patients treated during the COVID period experienced more frequent stoma formation, complications, and adverse prognostic factors, there were no differences in short-term oncologic outcomes, which was likely due to the follow-up period being insufficient to detect differences in OS.</p>","PeriodicalId":9479,"journal":{"name":"Cancer Management and Research","volume":"16 ","pages":"1131-1139"},"PeriodicalIF":2.5,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
The Opposite Role of Alternatively Spliced Isoforms of LINC00477 in Gastric Cancer [Retraction]. LINC00477 替代剪接异构体在胃癌中的相反作用 [撤回]。
IF 2.5 4区 医学 Q3 ONCOLOGY Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI: 10.2147/CMAR.S493688

[This retracts the article DOI: 10.2147/CMAR.S202430.].

[这篇文章撤消了 DOI: 10.2147/CMAR.S202430.]。
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引用次数: 0
Functional Variants of lncRNA LINC00673 and Gastric Cancer Susceptibility: a Case-Control Study in a Chinese Population [Retraction]. lncRNA LINC00673的功能变异与胃癌易感性:一项中国人群的病例对照研究 [撤回]。
IF 2.5 4区 医学 Q3 ONCOLOGY Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI: 10.2147/CMAR.S493685

[This retracts the article DOI: 10.2147/CMAR.S187011.].

[本文撤回了文章 DOI:10.2147/CMAR.S187011]。
{"title":"Functional Variants of lncRNA LINC00673 and Gastric Cancer Susceptibility: a Case-Control Study in a Chinese Population [Retraction].","authors":"","doi":"10.2147/CMAR.S493685","DOIUrl":"https://doi.org/10.2147/CMAR.S493685","url":null,"abstract":"<p><p>[This retracts the article DOI: 10.2147/CMAR.S187011.].</p>","PeriodicalId":9479,"journal":{"name":"Cancer Management and Research","volume":"16 ","pages":"1107-1108"},"PeriodicalIF":2.5,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11370750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Circular RNA Profiling Reveals That circRNA_104433 Regulates Cell Growth by Targeting miR-497-5p in Gastric Cancer [Retraction]. 环状 RNA 图谱揭示 circRNA_104433 通过靶向胃癌中的 miR-497-5p 调节细胞生长 [撤回]。
IF 2.5 4区 医学 Q3 ONCOLOGY Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI: 10.2147/CMAR.S493692

[This retracts the article DOI: 10.2147/CMAR.S219307.].

[本文撤回文章 DOI:10.2147/CMAR.S219307]。
{"title":"Circular RNA Profiling Reveals That circRNA_104433 Regulates Cell Growth by Targeting miR-497-5p in Gastric Cancer [Retraction].","authors":"","doi":"10.2147/CMAR.S493692","DOIUrl":"https://doi.org/10.2147/CMAR.S493692","url":null,"abstract":"<p><p>[This retracts the article DOI: 10.2147/CMAR.S219307.].</p>","PeriodicalId":9479,"journal":{"name":"Cancer Management and Research","volume":"16 ","pages":"1105-1106"},"PeriodicalIF":2.5,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11370765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Prognostic Role of Pre-Treatment Body Composition Parameters in Patients Undergoing First-Line Immunotherapy for Metastatic Renal Cell Carcinoma. 接受一线免疫疗法治疗转移性肾细胞癌患者治疗前身体成分参数的预后作用
IF 2.5 4区 医学 Q3 ONCOLOGY Pub Date : 2024-08-28 eCollection Date: 2024-01-01 DOI: 10.2147/CMAR.S476150
Sangmin Lee, Jae-Hun Kim, Wan Song, Hyun Hwan Sung, Hwang Gyun Jeon, Byong Chang Jeong, Seong Il Seo, Seong Soo Jeon, Se Hoon Park, Ji Hyun Lee, Jiwoong Yu, Minyong Kang

Purpose: We investigated the relationship between body mass index (BMI), radiological body composition, and survival outcomes in patients with metastatic renal cell carcinoma (mRCC) underwent first-line immune checkpoint inhibitor (ICI)-based therapy.

Methods: Analyzing data from 102 patients treated between November 2019 and March 2023, pre-treatment computed tomography (CT) scans assessed fat and muscle areas. BMI and body composition indices were examined, including skeletal muscle index, subcutaneous fat index (SFI), visceral fat index, and total fat index. Kaplan-Meier curves and Log rank tests compared progression-free survival (PFS) and overall survival (OS), while multivariable Cox proportional regression analysis was performed to identify the variables significantly associated with survival outcomes.

Results: 54 patients (52.9%) experienced disease progression, and 26 (25.5%) died during a median follow-up of 17.4 months. High SFI was significantly associated with improved OS (p = 0.018) but not PFS (p = 0.090). Multivariable analysis confirmed the positive impact of high SFI on OS (adjusted HR: 0.37, p = 0.029) and suggested a trend towards improved PFS (adjusted HR: 0.61, p = 0.088). Notably, in the ipilimumab + nivolumab subgroup, high SFI significantly correlated with both PFS and OS (p = 0.047 and p = 0.012, respectively).

Conclusion: High SFI predicts favorable OS in patients with mRCC receiving first-line ICI-based therapy, especially patients treated with ipilimumab + nivolumab displayed a significant association between high SFI and favorable PFS and OS.

目的:我们研究了接受一线免疫检查点抑制剂(ICI)治疗的转移性肾细胞癌(mRCC)患者的体重指数(BMI)、放射学身体成分和生存结果之间的关系:分析2019年11月至2023年3月期间接受治疗的102名患者的数据,治疗前计算机断层扫描(CT)评估脂肪和肌肉面积。检查了体重指数和身体成分指数,包括骨骼肌指数、皮下脂肪指数(SFI)、内脏脂肪指数和总脂肪指数。卡普兰-梅耶曲线和对数秩检验比较了无进展生存期(PFS)和总生存期(OS),同时进行了多变量考克斯比例回归分析,以确定与生存结果显著相关的变量:结果:在中位 17.4 个月的随访期间,54 名患者(52.9%)出现疾病进展,26 名患者(25.5%)死亡。高SFI与OS改善(p = 0.018)明显相关,但与PFS(p = 0.090)无关。多变量分析证实了高 SFI 对 OS 的积极影响(调整后 HR:0.37,p = 0.029),并表明 PFS 有改善的趋势(调整后 HR:0.61,p = 0.088)。值得注意的是,在ipilimumab + nivolumab亚组中,高SFI与PFS和OS均有显著相关性(分别为p = 0.047和p = 0.012):结论:高SFI可预测接受一线ICI治疗的mRCC患者的良好OS,尤其是接受伊匹单抗+nivolumab治疗的患者,高SFI与良好的PFS和OS之间存在显著关联。
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引用次数: 0
Influence of Financial Toxicity on the Quality of Life in Lung Cancer Patients Undergoing Immunotherapy: The Mediating Effect of Self-Perceived Burden. 经济毒性对接受免疫疗法的肺癌患者生活质量的影响:自我感觉负担的中介效应
IF 2.5 4区 医学 Q3 ONCOLOGY Pub Date : 2024-08-27 eCollection Date: 2024-01-01 DOI: 10.2147/CMAR.S470862
Zhao-Li Zhang, Zhen Xu, Shi-Kun Yang, Jin-Gui Huang, Feng-Mei Huang, Yu-Mei Shi

Purpose: The purpose of this study is to understand the level of quality of life (QOL) of lung cancer patients receiving immunotherapy and to clarify the potential mediating role of self-perceived burden (SPB) in the relationship between financial toxicity (FT) and QOL.

Patients and methods: A convenience sample of 342 lung cancer patients receiving immunotherapy was recruited from a cancer hospital from October 2022 to April 2023 for this cross-sectional study. The participants were requested to complete the following structured questionnaires: a sociodemographic and clinical questionnaire, the Functional Assessment of Cancer Therapy-Lung (FACT-L), the Self-Perceived Burden Scale (SPBS) and the COmprehensive Score for Financial Toxicity (COST). The data were subjected to Pearson correlation analysis and bootstrapping analysis in structural equation modelling.

Results: The total FACT-L score was 79.90±15.84 points in 322 lung cancer patients receiving immunotherapy. FT (β = 0.37, P < 0.01) and SPB (β = -0.27, P < 0.01) had a direct effect on QOL. In addition, SPB partly mediated the association between FT and QOL, and the standardized indirect effect was 0.19, accounting for 33.9% of the total effect.

Conclusion: The present study revealed that there is still much room for improvement in the QOL of lung cancer patients during immunotherapy. A greater financial burden resulted in a greater self-perceived burden and was thus associated with inferior QOL. It is imperative for oncology nurses to routinely assess QOL, FT or risk and SPB for lung cancer patients undergoing immunotherapy as well as to assist those patients in understanding the potential financial risk of each choice and help them take more active roles in their routine clinical care.

目的:本研究旨在了解接受免疫治疗的肺癌患者的生活质量(QOL)水平,并阐明自我感觉负担(SPB)在经济毒性(FT)与QOL之间的潜在中介作用:2022年10月至2023年4月期间,我们从一家肿瘤医院招募了342名接受免疫治疗的肺癌患者,作为这项横断面研究的方便样本。参与者需填写以下结构化问卷:社会人口学和临床问卷、肺癌治疗功能评估(FACT-L)、自我感觉负担量表(SPBS)和经济毒性综合评分(COST)。对数据进行了皮尔逊相关分析和结构方程模型的引导分析:322名接受免疫治疗的肺癌患者的FACT-L总分为(79.90±15.84)分。FT(β=0.37,P<0.01)和SPB(β=-0.27,P<0.01)对QOL有直接影响。此外,SPB在一定程度上介导了FT与QOL之间的关系,标准化间接效应为0.19,占总效应的33.9%:本研究显示,肺癌患者在免疫治疗期间的 QOL 仍有很大的改善空间。经济负担越重,自我感觉的负担越重,因此与QOL较差有关。肿瘤科护士有必要对接受免疫治疗的肺癌患者的QOL、FT或风险和SPB进行常规评估,并协助患者了解每种选择的潜在经济风险,帮助他们在日常临床护理中发挥更积极的作用。
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引用次数: 0
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