Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries

Trends in incidence and survival of the four most common cancers by stage at diagnosis in Cyprus: A population-based study from 2004 to 2017

BACKGROUND

Breast, colorectal, lung and prostate cancers are the most frequent malignancies in Cyprus. This study estimated the incidence rate and 5-year net survival (NS) trends for these cancers, by sex, age, and tumor stage at diagnosis.

METHODS

We analyzed data from the Cyprus Cancer Registry for adults diagnosed between 2004 and 2017, with follow-up until 2019. Tumor stage was classified into localized, regional, distant and unknown categories. We estimated the annual percentage change (APC) in incidence rates using Joinpoint regression. NS was estimated using flexible parametric models, adjusting for sex, age, stage and period of diagnosis. Multiple imputation was used to address unknown cancer stage.

RESULTS

During 2004-2017, the incidence significantly increased for breast and lung cancer (APC: 1.1 % and 2.6 %, respectively), mainly among the elderly (70 +). A decreasing trend was identified for prostate cancer only among individuals aged 80 +. No temporal variations were identified for colorectal cancer incidence. A positive time trend was identified for localized breast cancer between 2006 and 2017 (APC: 2.8 %). Conversely, a significant increase was noted at more advanced stages for lung (APCdistant: 4.1 %) and prostate (APCregional: 7.6 %) cancers. NS improved for all cancers, ranging between 80 % and 90 % for regional and all stages of breast cancer, localized colorectal cancer, and all stages of prostate cancer, surpassing 95 % for localized breast cancer, localized and regional prostate cancer.

CONCLUSION

The study observed increased (breast and lung) or stable (colorectal and prostate) cancer incidence and substantial improvements in 5-years NS trends for all cancer types, despite differences by sex and stage. Efforts should be intensified to reduce incidence by addressing cancer risk factors, and to improve survival by implementing and increasing the uptake of screening programs.

An Overview of Real-World Data Infrastructure for Cancer Research

AIMS

There is increasing interest in the opportunities offered by Real World Data (RWD) to provide evidence where clinical trial data does not exist, but access to appropriate data sources is frequently cited as a barrier to RWD research. This paper discusses current RWD resources and how they can be accessed for cancer research.

MATERIALS AND METHODS

There has been significant progress on facilitating RWD access in the last few years across a range of scales, from local hospital research databases, through regional care records and national repositories, to the impact of federated learning approaches on internationally collaborative studies. We use a series of case studies, principally from the UK, to illustrate how RWD can be accessed for research and healthcare improvement at each of these scales.

RESULTS

For each example we discuss infrastructure and governance requirements with the aim of encouraging further work in this space that will help to fill evidence gaps in oncology.

CONCLUSION

There are challenges, but real-world data research across a range of scales is already a reality. Taking advantage of the current generation of data sources requires researchers to carefully define their research question and the scale at which it would be best addressed.

A prospective study comparing highly qualified Molecular Tumor Boards with AI-powered software as a medical device

BACKGROUND

The implementation of cancer precision medicine in Japan is deeply intertwined with insurance reimbursement policies and requires case-by-case reviews by Molecular Tumor Boards (MTBs), which impose considerable operational burdens on healthcare facilities. The extensive preparation and review times required by MTBs hinder their ability to efficiently assess comprehensive genomic profiling (CGP) test results. Despite attempts to optimize MTB operations, significant challenges remain. This study aims to evaluate the effectiveness of QA Commons, an artificial intelligence-driven system designed to improve treatment planning using CGP analysis. QA Commons utilizes a comprehensive knowledge base of drugs, regulatory approvals, and clinical trials linked to genetic biomarkers, thereby enabling the delivery of consistent and standardized treatment recommendations. Initial assessments revealed that the QA Commons' recommendations closely matched the ideal treatment recommendations (consensus annotations), outperforming the average results of MTBs at Cancer Genomic Medicine Core Hospitals.

METHODS

A clinical performance evaluation study will be conducted by comparing the QA Commons' treatment recommendations with those of the Academia Assembly, which includes medical professionals from the Cancer Genomic Medicine Core and Hub Hospitals. One hundred cases selected from the "Registry of the Academia Assembly," based on defined inclusion and exclusion criteria, will be analyzed to assess the concordance of recommendations.

CONCLUSION

The expected outcomes suggest that QA Commons could reduce the workload of MTB members, standardize the quality of MTB discussions, and provide consistent outcomes in repeated patient consultations. In addition, the global expansion of QA Commons could promote worldwide adoption of Japan's pioneering precision oncology system.

Cancer situation in China: an analysis based on the global epidemiological data released in 2024

BACKGROUND

Cancer remains a major cause of mortality and a significant economic burden in China. Exploring the disparities in cancer patterns and control strategies between China and developed countries may offer valuable insights for policy formulation and enhance cancer management efforts. This study examined the incidence, mortality, and disability-adjusted life year (DALY) burden of cancer in China, and compared these metrics with those observed in the United States (US) and the United Kingdom (UK).

METHODS

Data on cancer incidence, mortality, and DALYs for China, the US, and the UK were sourced from the GLOBOCAN 2022 online database and the Global Burden of Disease 2021 study (GBD 2021). We utilized Joinpoint regression models to analyze trends in cancer incidence and mortality across these countries, calculating annual percent changes (APCs) and determining the optimal joinpoints.

RESULTS

In 2022, China recorded around 4,824,703 new cancer cases and 2,574,176 cancer-related deaths, contributing to 71,037,170 DALYs. China exhibited a lower cancer incidence rate compared to the US and the UK. Although cancer-related mortality in China is slightly lower than that in the UK, it is significantly higher than that in the US. Additionally, China experienced significantly higher DALY rates compared to both the US and UK. The cancer landscape in China was also undergoing significant changes, with a rapid rise in the incidence and burden of lung, colorectal, breast, cervical, and prostate cancers. Meanwhile, the incidence and burden of stomach cancer continued to decline. Although the incidence of liver and esophageal cancers was decreasing, the burden of liver cancer was increasing, while the burden of esophageal cancer remained largely unchanged.

CONCLUSIONS

The cancer profile of China is shifting from that of a developing country to one more typical of a developed country. The ongoing population aging and the rise in unhealthy lifestyles are expected to further escalate the cancer burden in China. Consequently, it is crucial for Chinese authorities to revise the national cancer control program, drawing on successful strategies from developed countries, while also accounting for the regional diversity in cancer types across China.

Health and disability status among middle-aged and older adult cancer survivors: a case-control study

PURPOSE

The objective of this study is to evaluate whether the presence of a cancer history constitutes a risk for encountering unfavourable health outcomes and functional limitations. Moreover, the study also aims to identify specific attributes of cancer survivors that are associated with an increased risk of experiencing poor health and disability.

METHODS

This study has utilized data from Longitudinal Ageing Study in India (LASI) conducted in 2017-18. The analytical sample size for this study was 65,562 older individuals of age 45 years and above. We have focused on individuals diagnosed with cancer, i.e., cancer survivors, and compared their health outcomes to those of a similar group (without a cancer history) with similar socioeconomic and demographic features. Descriptive statistics and logistic regression models were used to assess the adjusted effect of explanatory variables on cancer survivors.

RESULTS

The result shows that the overall number of cancer survivors is 673 per 100.000 older adults and is higher in Urban areas (874 per 100.000) than in rural areas (535 per 100.000). 43.7% of the survivors reported poor self-rated health, and around 34.0% of cancer survivors reported depression, while this prevalence was much lower among older adults without a cancer history. Individuals who were diagnosed with cancer a long time ago have a significantly lower likelihood of experiencing poor SRH, depression, and diminished life satisfaction in comparison to those diagnosed more recently.

CONCLUSION

The study highlights the importance of factors such as time since diagnosis and the number of cancer sites in influencing health outcomes among survivors. Additionally, socioeconomic factors, such as wealth and access to health insurance, appear to play a role in the health status of cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Healthcare policies should recognize the long-term impact of cancer and prioritize the provision of long-term survivorship care. This may involve establishing survivorship clinics or dedicated healthcare centres that provide specialized care for cancer survivors, addressing their unique needs throughout the survivorship continuum.

Systematic review on the effectiveness of mobile health applications on mental health of breast cancer survivors

PURPOSE

Breast cancer survivors are more likely to report psychological distress and unmet need for support compared to healthy controls. Psychological mobile health interventions might be used in follow-up care of breast cancer patients to improve their mental health.

METHODS

We searched MEDLINE, PsychINFO, Cochrane and PROSPERO for articles on controlled trials examining the effectiveness of psychological mobile health interventions compared to routine care regarding mental health outcomes of adult breast cancer survivors. This review followed the PRISMA statement and was registered on PROSPERO (CRD42022312972). Two researchers independently reviewed publications, extracted data and assessed risk of bias.

RESULTS

After screening 204 abstracts published from 2005 to February 2023, eleven randomised trials involving 2249 patients with a mean age between 43.9 and 56.2 years met the inclusion criteria. All interventions used components of cognitive behavioural therapy. Most studies applied self-guided interventions. Five studies reported percentages of patients never started (range = 3-15%) or discontinued the intervention earlier (range = 3-36%). No long-term effect > 3 months post intervention was reported. Three of seven studies reported a significant short-term intervention effect for distress. Only one study each showed an effect for depression (1/5), anxiety (1/5), fear of recurrence (1/4) and self-efficacy (1/3) compared to a control group.

CONCLUSIONS

A wide variance of interventions was used. Future studies should follow guidelines in developing and reporting their mobile interventions and conduct long-term follow-up to achieve reliable and comparable results.

IMPLICATIONS FOR CANCER SURVIVORS

No clear effect of psychological mobile health interventions on patients' mental health could be shown.

REGISTRATION

PROSPERO ID 312972.

Colorectal cancer survivors' adjustment to permanent colostomy in Switzerland: A qualitative analysis

Colostomized colorectal cancer survivors present physical, psychological, and social difficulties after treatment, which complicate their return to normal life. Nevertheless, we lack insight into their lived transition experience after treatment in Switzerland. We led nine semi-structured interviews with participants who had a colostomy for a mean of 16.4 years. The participants' mean age was 73.1 years. Through an inductive thematic analysis, we highlighted several adaptation difficulties. Their body image was poor, and they behaved differently than before the surgery. For fear of being rejected, they concealed their colostomy. However, they felt isolated and often wished for more support. They may be in a vicious circle where their difficulties are maintained. We advocate that supporting survivors psychologically beyond the end of their treatment is essential to facilitate adjustment and overcome cancer.

Potential of photodynamic therapy using polycationic photosensitizers in the treatment of lung cancer patients with SARS-CoV-2 infection and bacterial complications: Our recent experience

The problem of treating cancer patients with lung cancer has become more difficult due to the SARS-CoV-2 viral infection and concomitant bacterial lesions. The analysis shows that the photodynamic effect of long-wavelength polycationic photosensitizers suppresses the tumor process (including the destruction of cancer stem cells), SARS-CoV-2 coronavirus infection, Gram-positive and Gram-negative bacteria, including those that can cause pneumonia. Therefore, the photodynamic approach using such photosensitizers is promising for the development of an effective treatment method for patients with lung cancer, including those with SARS-CoV-2 infection and bacterial complications.

Global patterns of leukemia by subtype, age, and sex in 185 countries in 2022

In 2022, leukemia ranked as the second most common hematological malignancy after non-Hodgkin lymphoma worldwide. However, updated global estimates of leukemia incidence by subtype are unavailable. We estimated leukemia incidences for different leukemia subtypes by country, world region, and human developmental index using data from the Cancer Incidence in Five Continents databases combined with the GLOBOCAN 2022 estimates of leukemia in 185 countries. We estimated sex-specific age-standardized rates (ASRs) per 100 000 for children (0-19 years) and adults (20+ years). In adults, the most common leukemia worldwide was AML (males: 38%, ASR = 3·1; females: 43%, ASR = 2·4), followed by CLL (males: 28%, ASR = 2·2; females: 24%, ASR = 1·3). In very high HDI countries, the ASR of CLL was higher than the ASR of AML among males (5·2 versus 4·3, respectively) and similar among females (2·9 and 3·0, respectively). In children, the most common leukemia was ALL (boys: 70%, ASR = 2·4; girls: 68%, ASR = 1·8) followed by AML (boys: 22%, ASR = 0·76; girls: 25%, ASR = 0·65). ALL proportions varied across world sub-regions from 57 to 78% among boys, and from 49 to 80% among girls. Our findings suggest clear geographical patterns of leukemia subtypes in adults and children. Further research into underlying causes that explain these variations is needed to support cancer control strategies for prevention and plan national healthcare needs.

External validation of twelve existing survival prediction models for patients with spinal metastases

BACKGROUND CONTEXT

Survival prediction models for patients with spinal metastases may inform patients and clinicians in shared decision-making.

PURPOSE

To externally validate all existing survival prediction models for patients with spinal metastases.

DESIGN

Prospective cohort study using retrospective data.

PATIENT SAMPLE

953 patients.

OUTCOME MEASURES

Survival in months, area under the curve (AUC), and calibration intercept and slope.

METHOD

This study included patients with spinal metastases referred to a single tertiary referral center between 2016 and 2021. Twelve models for predicting 3, 6, and 12-month survival were externally validated Bollen, Mizumoto, Modified Bauer, New England Spinal Metastasis Score, Original Bauer, Oswestry Spinal Risk Index (OSRI), PathFx, Revised Katagiri, Revised Tokuhashi, Skeletal Oncology Research Group Machine Learning Algorithm (SORG-MLA), Tomita, and Van der Linden. Discrimination was assessed using (AUC) and calibration using the intercept and slope. Calibration was considered appropriate if calibration measures were close to their ideal values with narrow confidence intervals.

RESULTS

In total, 953 patients were included. Survival was 76.4% at 3 months (728/953), 62.2% at 6 months (593/953), and 50.3% at 12 months (479/953). Revised Katagiri yielded AUCs of 0.79 (95% CI, 0.76-0.82) to 0.81 (95% CI, 0.79-0.84), Bollen yielded AUCs of 0.76 (95% CI, 0.73-0.80) to 0.77 (95% CI, 0.75-0.80), and OSRI yielded AUCs of 0.75 (95% CI, 0.72-0.78) to 0.77 (95% CI, 0.74-0.79). The other 9 prediction models yielded AUCs ranging from 0.59 (95% CI, 0.55-0.63) to 0.76 (95% CI, 0.74-0.79). None of the twelve models yielded appropriate calibration.

CONCLUSIONS

Twelve survival prediction models for patients with spinal metastases yielded poor to fair discrimination and poor calibration. Survival prediction models may inform decision-making in patients with spinal metastases, provided that recalibration using recent patient data is performed.

Temporal changes in regional variations in cancer survival rates in Osaka, Japan (1997-2015)

The variation in survival rates among patients with cancer based on residential areas has become a significant concern globally. Japan's Basic Plan to Promote Cancer Control Programs (BPPCCP), implemented in 2007, aimed to reduce this variation by designating cancer care hospitals in each cancer medical area (CMA) where patients resided. From the Osaka Cancer Registry data, we extracted 407,489 patients aged 15-74 years with cancer who received treatment in Osaka Prefecture between 1997 and 2015 and analyzed regional variations in survival rates for each patient's residential CMA before and after the implementation of the BPPCCP. By standardizing the distribution of the patients' background factors (sex, age, stage, and socioeconomic status) to the distribution of the whole prefecture, 5-year relative survival rates for each CMA were calculated, and regional variations were assessed. Before BPPCCP, survival variation reached 2.00 percentage points (p-values < 0.05); post-BPPCCP, it decreased to 0.98 percentage points and was no longer significant. In conclusion, the introduction of the BPPCCP in 2007 may have reduced regional variation in the survival rate of patients with cancer in Osaka Prefecture. Measures such as the BPPCCP could potentially equalize the cancer care delivery system.

Radioresistance in rectal cancer: can nanoparticles turn the tide?

Rectal cancer accounts for over 35% of the worldwide colorectal cancer burden representing a distinctive subset of cancers from those arising in the colon. Colorectal cancers exhibit a continuum of traits that differ with their location in the large intestine. Due to anatomical and molecular differences, rectal cancer is treated differently from colon cancer, with neoadjuvant chemoradiotherapy playing a pivotal role in the control of the locally advanced disease. However, radioresistance remains a major obstacle often correlated with poor prognosis. Multifunctional nanomedicines offer a promising approach to improve radiotherapy response rates, as well as to increase the intratumoral concentration of chemotherapeutic agents, such as 5-Fluorouracil. Here, we revise the main molecular differences between rectal and colon tumors, exploring the complex orchestration beyond rectal cancer radioresistance and the most promising nanomedicines reported in the literature to improve neoadjuvant therapy response rates.

Global, regional, and national burden of children and adolescents with acute lymphoblastic leukemia from 1990 to 2021: a systematic analysis for the global burden of disease study 2021

Background

Acute lymphoblastic leukemia (ALL) is a common cancer in children and adolescents, severely affecting their survival and health. With the discovery of new drugs and improved treatment options, the survival rate of ALL in children and adolescents has improved significantly.

Methods

We used the GBD (global burden of disease) database to collect patients aged 0-19 years (0-5 years, 5-9 years, 10-14 years, 15-19 years) diagnosed with ALL between 1990 and 2021. Disease status and change were analyzed by learning about the prevalence, death, incidence, DALYs (disability-adjusted life years), percentage change, and the estimated annual percentage change (EAPC).

Results

In 2021, there were 53,485 new cases of childhood and adolescent ALL, 23,991 deaths, and an estimated 1960,922 DALYs. Incidence, deaths and DALYs have declined globally, with only a rise in low-SDI regions. In 2021, middle-SDI regions have the highest cases of prevalence, incidence, deaths, and DALYs, accounting for approximately one-third of the global total. High-SDI regions have the lowest deaths and DALYs. East Asia has the highest prevalence and incidence. Australasia has the lowest death and DALYs. From 1990 to 2021, children and adolescent ALL deaths and DALYs show a declining trend in about 72.5% of countries, with only Sub-Saharan Africa showing an increase. The prevalence of ALL in children and adolescents is higher in males, with the highest cases in patients under 5 years of age.

Conclusion

Our study highlights the trend of decreasing deaths and DALYs of ALL in children and adolescents. However, there is a need to improve healthcare prevention and timely standardized treatment in developing countries and less developed regions.

Monotropein represses the proliferation and angiogenesis via the AKT/NF-κB pathway in lung cancer

Monotropein (Mon) is an iridoid glycosides extracted from Morinda officinalis F.C. How. (Rubiaceae) that shows anticancer effects on colorectal cancer. This study aimed to investigate the therapeutic effect of Mon on lung cancer. The viability, apoptosis, invasion, and tube formation of A549 and H1299 were determined by CCK8 assay, flow cytometry, transwell assay, and tube formation assay. NF-κB expression in the nucleus was detected by immunofluorescent staining. In vivo assay, BALB/c nude mice were divided into a sham group and a 2 mg/kg Mon group. For the Mon group, mice were orally administered with 2 mg/kg Mon. The duration of the animal study was 35 days, and the tumor formation and angiogenesis were investigated. Compared with the control (Mon 0 μM) group, Mon dramatically repressed the viability, invasion, tube formation, proliferation marker Ki67, N-cadherin, and VEGFA expressions in A549 cells (Mon of 25, 50, and 100 µM) and H1299 cells (Mon of 50 and 100 µM). Mon dramatically promoted cell apoptosis, cleaved caspase 3, and E-cadherin expressions. Besides, Mon remarkably downregulated p-AKT and p-NF-κB protein expressions. Moreover, AKT agonist SC79 reversed the anticancer effects of 100 µM Mon on A549 cells. Furthermore, Mon markedly suppressed tumor growth, decreased N-cadherin, VEGFA, p-AKT, and p-NF-κB expressions, increased apoptosis and E-cadherin expression, and SC79 reversed the inhibition effects of Mon in vivo. Thus, Mon is a potential antitumor natural drug, and more signaling pathways involved in Mon-modulated lung cancer progression are worth testing for further investigation.

The association of travel distance and other patient characteristics with breast cancer stage at diagnosis and treatment completion at a rural Rwandan cancer facility

BACKGROUND

Butaro Cancer Center of Excellence (BCCOE) was founded to serve Rwanda's rural low-income population, providing subsidized cancer diagnosis and treatment with transport stipends for the lowest-income patients. We examined whether travel distance to BCCOE was associated with advanced-stage diagnoses and treatment completion.

METHODS

We conducted a retrospective cohort study using medical record data from BCCOE patients with pathologically-confirmed breast cancer from 2012-2016. Women with no prior surgery were included in the stage analysis; those with non-metastatic disease were included in the treatment analysis. We calculated travel distances using spatial analytic software and used multivariable logistic regression to examine the association of distance and other patient characteristics with late-stage diagnoses and treatment completion within one year of diagnosis.

RESULTS

The analytic cohort for stage included 426 patients; 75.1% had late-stage (stage 3 or 4) disease. In univariable analyses, patients residing in BCCOE's surrounding district had a lower proportion of late-stage diagnoses compared to those residing outside the district (57.9% v 76.8%, p = 0.02). In adjusted analyses, odds of late-stage diagnosis were 2.46 (95% CI:1.21-5.12) times higher among those in distance quartile 4 (> 135.8 km) versus 1 (< 55.7 km); the effect of distance was less strong in sensitivity analyses excluding patients from BCCOE's surrounding district. Patients from sectors with > 50% poverty had 2.33 times higher odds of late-stage diagnoses (95% CI:1.07-5.26) relative to those with poverty < 30%. In the treatment completion cohort (n = 348), 49.1% of patients completed surgery and chemotherapy within a year. In adjusted analyses, travel distance and poverty were not linearly associated with treatment completion.

CONCLUSIONS

At Rwanda's first public cancer facility, sector-level poverty and longer travel distances were associated with late-stage breast cancer diagnoses, but less clearly associated with treatment completion, perhaps partly due to travel stipends provided to the lowest-income individuals undergoing treatment. Our findings support further investigation into wider use of travel stipends to facilitate early diagnosis and treatment completion.

Identifying Primary Sites of Spinal Metastases: Expert-Derived Features vs. ResNet50 Model Using Nonenhanced MRI

BACKGROUND

The spinal column is a frequent site for metastases, affecting over 30% of solid tumor patients. Identifying the primary tumor is essential for guiding clinical decisions but often requires resource-intensive diagnostics.

PURPOSE

To develop and validate artificial intelligence (AI) models using noncontrast MRI to identify primary sites of spinal metastases, aiming to enhance diagnostic efficiency.

STUDY TYPE

Retrospective.

POPULATION

A total of 514 patients with pathologically confirmed spinal metastases (mean age, 59.3 ± 11.2 years; 294 males) were included, split into a development set (360) and a test set (154).

FIELD STRENGTH/SEQUENCE

Noncontrast sagittal MRI sequences (T1-weighted, T2-weighted, and fat-suppressed T2) were acquired using 1.5 T and 3 T scanners.

ASSESSMENT

Two models were evaluated for identifying primary sites of spinal metastases: the expert-derived features (EDF) model using radiologist-identified imaging features and a ResNet50-based deep learning (DL) model trained on noncontrast MRI. Performance was assessed using accuracy, precision, recall, F1 score, and the area under the receiver operating characteristic curve (ROC-AUC) for top-1, top-2, and top-3 indicators.

STATISTICAL TESTS

Statistical analyses included Shapiro-Wilk, t tests, Mann-Whitney U test, and chi-squared tests. ROC-AUCs were compared via DeLong tests, with 95% confidence intervals from 1000 bootstrap replications and significance at P < 0.05.

RESULTS

The EDF model outperformed the DL model in top-3 accuracy (0.88 vs. 0.69) and AUC (0.80 vs. 0.71). Subgroup analysis showed superior EDF performance for common sites like lung and kidney (e.g., kidney F1: 0.94 vs. 0.76), while the DL model had higher recall for rare sites like thyroid (0.80 vs. 0.20). SHapley Additive exPlanations (SHAP) analysis identified sex (SHAP: -0.57 to 0.68), age (-0.48 to 0.98), T1WI signal intensity (-0.29 to 0.72), and pathological fractures (-0.76 to 0.25) as key features.

DATA CONCLUSION

AI techniques using noncontrast MRI improve diagnostic efficiency for spinal metastases. The EDF model outperformed the DL model, showing greater clinical potential.

PLAIN LANGUAGE SUMMARY

Spinal metastases, or cancer spreading to the spine, are common in patients with advanced cancer, often requiring extensive tests to determine the original tumor site. Our study explored whether artificial intelligence could make this process faster and more accurate using noncontrast MRI scans. We tested two methods: one based on radiologists' expertise in identifying imaging features and another using a deep learning model trained to analyze MRI images. The expert-based method was more reliable, correctly identifying the tumor site in 88% of cases when considering the top three likely diagnoses. This approach may help doctors reduce diagnostic time and improve patient care.

LEVEL OF EVIDENCE

3 TECHNICAL EFFICACY: Stage 2.

Global, regional, and national burden of esophageal cancer using the 2019 global burden of disease study

Esophageal cancer, with its aggressive nature and high mortality, poses diverse epidemiological challenges worldwide. Over the past three decades, esophageal cancer has exhibited a substantial global burden, marked by a significant increase in absolute numbers, contrasting with a decline in age-standardized metrics. Prevalence nearly doubled, reaching 0.961 million in 2019, while the age-standardized rate (ASR) decreased to 11.6 per 100,000 cases. New incidence cases surged by 67.07%, yet the age-standardized incidence rate reduced to 6.5 per 100,000 cases. Deaths increased to 0.498 million, with a decline in age-standardized mortality to 6.1 per 100,000 cases. Disability-Adjusted Life Years (DALYs) rose to 11.67 million, but the ASR decreased to 139.8 per 100,000 cases. Gender-specific analysis revealed consistently higher rates in males, with increasing gaps over time. Correlations with SDI indicated a negative association, and frontier analysis underscored the impact of socio-economic progress on disease control. Projections suggest a continued rise in prevalence, incidence, deaths, and DALYs, with gender-specific variations. The research underscores the importance of continued efforts in public health and medical research to adapt to and manage the changing landscape of esophageal cancer globally.

Development, Characterization, and Evaluation of Chi-Tn mAb-Functionalized DOTAP-PLGA Hybrid Nanoparticles Loaded with Docetaxel for Lung Cancer Therapy

Background/Objectives: The focus of this study was to prepare and characterize docetaxel (DCX)-loaded lipid/polymer hybrid nanoparticles (LPHNps) functionalized with the monoclonal antibody (mAb) Chi-Tn for a potential active targeting approach in lung cancer treatment. Methods: We synthesized DOTAP-PLGA hybrid nanoparticles loaded with DCX and functionalized them with Chi-Tn mAb through a biotin-avidin approach. The physicochemical characterization involved dynamic light scattering, transmission electron microscopy, Raman spectroscopy, and atomic force microscopy. The in vitro and in vivo evaluations encompassed uptake studies, cell viability tests, and the assessment of tumor growth control in a lung cancer model. Results: The nanoparticles featured a hydrophobic PLGA core with 99.9% DCX encapsulation efficiency, surrounded by a DOTAP lipid shell ensuring colloidal stability with a high positive surface charge. The incorporation of PEGylated lipids on their surface helps evade the immune system and facilitate Chi-Tn mAb attachment. The resulting nanoparticles exhibit a spherical shape with monodisperse particle sizes averaging 250 nm, and demonstrate sustained drug release. In vitro uptake studies and viability assays conducted in A549 cancer cells show that the Chi-Tn mAb enhances nanoparticle internalization and significantly reduces cell viability. In vivo studies demonstrate a notable reduction in tumor volume and an increased survival rate in the A549 tumor xenograft mice model when DCX was encapsulated in nanoparticles and targeted with Chi-Tn mAb in comparison to the free drug. Conclusions: Therefore, Chi-Tn-functionalized LPHNps hold promise as carriers for actively targeting DCX to Tn-expressing carcinomas.

The association between Chlamydia pneumoniae infection and prognosis in lung cancer patients: a prospective study

BACKGROUND

The prognostic value of Chlamydia pneumoniae (Cpn) infection in postoperative lung cancer patients remains unclear. This study aimed to evaluate the association between Cpn infection and survival in lung cancer patients.

METHODS

This study included 309 newly diagnosed primary lung cancer patients from three hospitals in Fuzhou, China. Chlamydia pneumoniae IgG and IgA antibodies were detected using a micro-immunofluorescence kit and a unified questionnaire was used to collect demographic and clinical information. Follow-up was conducted every six months until August 25, 2022, or death. Patients were followed up for a median duration of 74 months. Overall survival was compared between Cpn IgA and IgG positive/negative patients. Statistical analysis included the χ2 test, Kaplan-Meier method, Log-rank test, and Cox proportional hazards regression model.

RESULTS

Cpn IgA infection status was found to be associated with lymph node metastasis in lung cancer patients. The overall survival of patients with Cpn IgA(++) was shorter compared to negative and positive patients(with IgA(-) group as the control group, P < 0.001, HR = 5.441, 95%CI: 2.341-12.645). Serum IgA positivity indicated chronic infection and was associated with poor prognosis. Multivariate analysis confirmed that Cpn IgA(++) infection was an independent risk prognostic factor for operable lung cancer patients (with IgA(-) group as the control group, HR = 3.39, 95%CI: 1.41-8.17).

CONCLUSION

This study suggests that Cpn infection is an independent prognostic factor in lung cancer patients. Further research is needed to understand the underlying mechanisms and explore the potential of Cpn as a biomarker or therapeutic target for lung cancer.

The diagnostic value of vascular architecture in solid solitary pulmonary nodules quantified by dynamic contrast enhanced MRI

Background

Alterations in the vascular microenvironment of cancer have gradually gained widespread attention in oncology research, and early qualitative diagnosis using noninvasive examination techniques is crucial in clinical practice. This study aimed to explore the value of quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the assessment of vascular architecture of solid solitary pulmonary nodules (SSPNs).

Methods

DCE-MRI scan images of a total of 79 patients with SSPNs from November 2021 to December 2023 were prospectively analyzed. Quantitative permeability parameters Ktrans, Kep, and Ve values of the lesions were measured, labeled immunohistochemically with CD31 microvessel density (CD31-MVD), smooth muscle actin microvessel density (SMA-MVD), and vascular endothelial growth factor (VEGF), and quantitative values of vascular architectural parameters were obtained using the image analysis software Image-J. The diagnostic efficacy of quantitative permeability parameters for the diagnosis of malignant SSPNs was analyzed by receiver operating characteristic (ROC) curves using surgical pathology findings as the gold standard for the diagnosis of malignant SSPNs. Spearman's correlation analysis was used to evaluate the relationship between quantitative permeability parameters and vascular construct parameters.

Results

The study included 51 female patients (64.6%) with a mean age of 50.5±11.5 years. Only 21 patients (26.6%) had a smoking history, and 30 patients (38.0%) had a normal weight. Statistically significant differences were found between benign and malignant SSPNs subgroups in Ktrans and Ve values in quantitative permeability parameters, and in SMA-MVD and microvascular perfusion index (MPI) in vascular conformation parameters (P<0.05). Ktrans and Ve values showed high diagnostic value for malignant SSPNs [area under the curve (AUC), 0.813 and 0.759]. Ktrans, Kep, and Ve were significantly positively correlated with CD31-MVD, with r-values of 0.857, 0.830, and 0.798 (P<0.05); they were also significantly positively correlated with VEGF, with r-values of 0.851, 0.859, and 0.764 (P<0.05); and Ktrans and Kep were significantly negatively correlated with MPI, with r-values were -0.779 and -0.864 (P<0.05).

Conclusions

The quantitative permeability parameters of DCE-MRI correlate with some of the vascular architectural parameters, and magnetic resonance image-based quantification of pulmonary nodal vascular architecture provides a noninvasive method for the differential diagnosis of SSPNs.

What are the problems and suggestions related to cancer health education in Sichuan, China? A qualitative study of community health workers (CHWs)

BACKGROUND

Health education conducted by community health workers (CHWs) is an evidence-based strategy for promoting cancer prevention, cancer screening, and adherence to medical guidance from doctors. However, CHWs are confronted with some problems related to cancer health education in China. This study aimed to clarify CHWs' awareness of problems in cancer health education in China and the solutions that they were considering to improve the quality and efficiency of cancer health education.

METHODS

A qualitative descriptive design with purposive sampling was applied in eight primary health care sectors in Guangyuan and Chengdu in Sichuan, China. Face-to-face, in-depth, semistructured interviews were conducted, and a total of 60 CHWs were interviewed. The interviews were transcribed verbatim and imported into Nvivo12.0. Thematic analysis using the constant comparative method was used to analyze the data.

RESULTS

Uncooperative inhabitants, poor organization, low-frequency provision, and inadequate training for CHWs were problems related to cancer health education provided by CHWs in China. CHWs proposed some suggestions to improve the accessibility and acceptability of cancer health education, including combining online and offline education, health education after screening, cancer plus others, health education in the workplace, and volunteer recruitment.

CONCLUSIONS

Both the problems and suggestions described in this study may provide evidence for cancer health education and policy-making related to cancer prevention and control in China.

Is first-line treatment with polatuzumab vedotin-rituximab-cyclophosphamide, doxorubicin and prednisone (pola-R-CHP) for previously untreated diffuse large B-cell lymphoma cost-effective in China? A cost-effectiveness analysis using a Markov model

OBJECTIVE

To evaluate the cost-effectiveness of polatuzumab vedotin-rituximab-cyclophosphamide, doxorubicin and prednisone (pola-R-CHP) in CD20-positive patients with previously untreated diffuse large B-cell lymphoma (DLBCL) in China.

DESIGN

A Markov model was constructed to analyse the cost-effectiveness of two strategies in CD20-positive patients with previously untreated DLBCL over a lifetime horizon: (1) pola-R-CHP and (2) rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP). The clinical outcomes were obtained from the POLARIX(NCT03274492), SCHOLAR-1, ZUMA-7(NCT03391466) and TRANSFORM(NCT03575351) trials. Costs were derived from the Chinese official websites and published literature, and utility values were obtained from the published literature. The willingness-to-pay (WTP) threshold was set at triple the 2023 Chinese per capita gross domestic product of US$38 042.49/quality-adjusted life year (QALY). Uncertainty was addressed using sensitivity analyses. The scenario analyses were also conducted.

SETTING

Chinese healthcare system perspective.

PARTICIPANTS

A hypothetical cohort of adult patients presenting with CD20-positive, patients with previously untreated DLBCL.

INTERVENTIONS

Pola-R-CHP versus R-CHOP.

MAIN OUTCOME MEASURES

The main outcomes of the study were QALYs, incremental cost-effectiveness ratio (ICER) and incremental net-health benefit (INHB).

RESULTS

In China, the ICER and INHB of pola-R-CHP compared with R-CHOP were US$77 036.33/QALY and -1.11 QALYs, respectively. The ICER was above the WTP threshold. Outcomes were most responsive to the price of pola. Probabilistic sensitivity analyses indicated that pola-R-CHP had a low probability of being cost-effective under the current WTP threshold. The scenario analyses demonstrated that when the price of pola fell by more than 32.5% to less than US$33.19/mg, the economic probability of pola-R-CHP was greater than 50% in previously untreated CD20-positive patients with DLBCL in China.

CONCLUSIONS

Pola-R-CHP is not cost-effective in the first-line treatment for previously untreated CD20-positive DLBCL in China. A value-based price for the cost of pola is less than US$33.19/mg.

Clinical and mechanistic insights into biomedical application of Se-enriched probiotics and biogenic selenium nanoparticles

Selenium is an essential element with various industrial and medical applications, hence the current considerable attention towards the genesis and utilization of SeNPs. SeNPs and other nanoparticles could be achieved via physical and chemical methods, but these methods would not only require expensive equipment and specific reagents but are also not always environment friendly. Biogenesis of SeNPs could therefore be considered as a less troublesome alternative, which opens an excellent window to the selenium and nanoparticles' world. bSeNPs have proved to exert higher bioavailability, lower toxicity, and broader utility as compared to their non-bio counterparts. Many researchers have reported promising features of bSeNP such as anti-oxidant and anti-inflammatory, in vitro and in vivo. Considering this, bSeNPs have been tried as effective agents for health disorders, especially as constituents of probiotics. This article briefly reviews selenium, selenium nanoparticles, Se-enriched probiotics, and bSeNPs' usage in an array of health disorders. Obviously, there are very many articles on bSeNPs, but we wanted to summarize studies on prominent bSeNPs features published in the twenty-first century. This review is hoped to give an outlook to researchers for their future investigations, ultimately serving better care of health disorders.

Investigation of the trends and associated factors of ovarian cancer in Indonesia: A systematic analysis of the Global Burden of Disease study 1990-2021

INTRODUCTION

Ovarian cancer is one of the most lethal gynecological cancers. Despite diagnosis and treatment advances, survival rates have not increased over the past 32 years. This study estimated and reported the global burden of ovarian cancer during the past 32 years to inform preventative and control strategies.

METHODS

We examined ovarian cancer incidence, mortality, and disability-adjusted life years (DALYs) using age-standardized rates from the Global Burden of Disease, Injuries, and Risk Factors Study 2021. high body mass index and occupational asbestos exposure were linked with death and DALYs. Data are presented as averages with 95% uncertainty intervals (UIs).

RESULTS

Indonesia had 13 250 (8 574-21 565) ovarian cancer cases in 2021, with 5 296 (3 520-8958) deaths and 186 917 (121 866-309 820) DALYs. The burden increased by 233.53% for new cases, 221.95% for mortalities, and 206.65% for DALYs. The age-standardized rate also increased from 1990 to 2021. Ovarian cancer burden increased with age but declined in the 50+ year age group. According to the sociodemographic index, the gross domestic product per capita and number of obstetricians and oncologic gynecologists in provinces showed different trends.

CONCLUSIONS

Indonesian ovarian cancer rates are rising despite gynecologic oncologists in 24 of 34 provinces. These findings will help policymakers and healthcare providers identify ovarian cancer prevention and control gaps.

Next-generation sequencing-based evaluation of the actionable landscape of genomic alterations in solid tumors: the "MOZART" prospective observational study

BACKGROUND

The identification of the most appropriate targeted therapies for advanced cancers is challenging. We performed a molecular profiling of metastatic solid tumors utilizing a comprehensive next-generation sequencing (NGS) assay to determine genomic alterations' type, frequency, actionability, and potential correlations with PD-L1 expression.

METHODS

A total of 304 adult patients with heavily pretreated metastatic cancers treated between January 2019 and March 2021 were recruited. The CLIA-/UKAS-accredit Oncofocus assay targeting 505 genes was used on newly obtained or archived biopsies. Chi-square, Kruskal-Wallis, and Wilcoxon rank-sum tests were used where appropriate. Results were significant for P < .05.

RESULTS

A total of 237 tumors (78%) harbored potentially actionable genomic alterations. Tumors were positive for PD-L1 in 68.9% of cases. The median number of mutant genes/tumor was 2.0 (IQR: 1.0-3.0). Only 34.5% were actionable ESCAT Tier I-II with different prevalence according to cancer type. The DNA damage repair (14%), the PI3K/AKT/mTOR (14%), and the RAS/RAF/MAPK (12%) pathways were the most frequently altered. No association was found among PD-L1, ESCAT, age, sex, and tumor mutational status. Overall, 62 patients underwent targeted treatment, with 37.1% obtaining objective responses. The same molecular-driven treatment for different cancer types could be associated with opposite clinical outcomes.

CONCLUSIONS

We highlight the clinical value of molecular profiling in metastatic solid tumors using comprehensive NGS-based panels to improve treatment algorithms in situations of uncertainty and facilitate clinical trial recruitment. However, interpreting genomic alterations in a tumor type-specific manner is critical.

Breast cancer survival analysis in the Republic of Mauritius by age, stage at diagnosis and molecular subtype: A retrospective cohort study

Breast cancer is by far the leading cancer both in terms of incidence and mortality in the Republic of Mauritius, a Small Island Developing State (SIDS). However, few studies assessed its survival by age, stage at diagnosis and molecular subtype. We identified 1399 breast cancer cases newly diagnosed between 2017 and 2020 at the Central Health Laboratory, Victoria Hospital. Cancers were categorized into five molecular subtypes: (1) luminal A, (2) luminal B Her2 negative, (3) luminal B Her2 positive, (4) Her2 enriched and (5) Triple negative. The net 1 and 3-year survival were estimated for different age groups, staging at time of diagnosis and molecular subtype. We also estimated the excess hazards using a multivariate Cox proportional hazards model. While early stage at diagnosis (stage 1 [44.4%] and stage 2 [20.1%]) were most common compared to late presentation (Stage 3 [25.4%] and stage 4 [10.1%]), luminal B Her2 negative (36.7%) was the most frequent molecular subtype. The net 1- and 3-year breast cancer survival rates were 93.9% (92.3-95.4) and 83.4% (80.4-86.4), respectively. Breast cancer three-year survival rates were poorest among the youngest patients (<50 years), 77.1% (70.7-83.5), those diagnosed with stage 4 (28.5% [17.1-39.9]) and cancer with a triple negative molecular subtype (71.3% [63.3-79.3]). Emphasis on a national breast cancer screening programme, down staging breast cancer at diagnosis and systematic molecular subtyping of all breast tissues could be pivotal in improving breast cancer survival outcomes in the Republic of Mauritius.

Integrative multi-omics analysis for identifying novel therapeutic targets and predicting immunotherapy efficacy in lung adenocarcinoma

Aim: Lung adenocarcinoma (LUAD), the most prevalent subtype of non-small cell lung cancer (NSCLC), presents significant clinical challenges due to its high mortality and limited therapeutic options. The molecular heterogeneity and the development of therapeutic resistance further complicate treatment, underscoring the need for a more comprehensive understanding of its cellular and molecular characteristics. This study sought to delineate novel cellular subpopulations and molecular subtypes of LUAD, identify critical biomarkers, and explore potential therapeutic targets to enhance treatment efficacy and patient prognosis. Methods: An integrative multi-omics approach was employed to incorporate single-cell RNA sequencing (scRNA-seq), bulk transcriptomic analysis, and genome-wide association study (GWAS) data from multiple LUAD patient cohorts. Advanced computational approaches, including Bayesian deconvolution and machine learning algorithms, were used to comprehensively characterize the tumor microenvironment, classify LUAD subtypes, and develop a robust prognostic model. Results: Our analysis identified eleven distinct cellular subpopulations within LUAD, with epithelial cells predominating and exhibiting high mutation frequencies in Tumor Protein 53 (TP53) and Titin (TTN) genes. Two molecular subtypes of LUAD [consensus subtype (CS)1 and CS2] were identified, each showing distinct immune landscapes and clinical outcomes. The CS2 subtype, characterized by increased immune cell infiltration, demonstrated a more favorable prognosis and higher sensitivity to immunotherapy. Furthermore, a multi-omics-driven machine learning signature (MOMLS) identified ribonucleotide reductase M1 (RRM1) as a critical biomarker associated with chemotherapy response. Based on this model, several potential therapeutic agents targeting different subtypes were proposed. Conclusion: This study presents a comprehensive multi-omics framework for understanding the molecular complexity of LUAD, providing insights into cellular heterogeneity, molecular subtypes, and potential therapeutic targets. Differential sensitivity to immunotherapy among various cellular subpopulations was identified, paving the way for future immunotherapy-focused research.

Making the Case for an International Childhood Cancer Data Partnership

Childhood cancers are a heterogeneous group of rare diseases, accounting for less than 2% of all cancers diagnosed worldwide. Most countries, therefore, do not have enough cases to provide robust information on epidemiology, treatment, and late effects, especially for rarer types of cancer. Thus, only through a concerted effort to share data internationally will we be able to answer research questions that could not otherwise be answered. With this goal in mind, the U.S. National Cancer Institute and the French National Cancer Institute co-sponsored the Paris Conference for an International Childhood Cancer Data Partnership in November 2023. This meeting convened more than 200 participants from 17 countries to address complex challenges in pediatric cancer research and data sharing. This Commentary delves into some key topics discussed during the Paris Conference and describes pilots that will help move this international effort forward. Main topics presented include: 1) the wide variation in interpreting the European Union's General Data Protection Regulation among Member States; 2) obstacles with transferring personal health data outside of the European Union; 3) standardization and harmonization, including common data models; and 4) novel approaches to data sharing such as federated querying and federated learning. We finally provide a brief description of three ongoing pilot projects. The International Childhood Cancer Data Partnership is the first step in developing a process to better support pediatric cancer research internationally through combining data from multiple countries.

Effect of eHealth Interventions on Body Image of Patients With Cancer: Systematic Review

BACKGROUND

Body image issues are prevalent among individuals diagnosed with cancer, leading to detrimental effects on their physical and psychological recovery. eHealth has emerged as a promising approach for enhancing the body image of patients with cancer.

OBJECTIVE

The purpose of this study was to evaluate the effectiveness of eHealth interventions on body image and other health outcomes (quality of life, physical symptoms, and emotional distress) among patients with cancer. In addition, the acceptability, engagement, and challenges of eHealth interventions were also assessed.

METHODS

A total of 11 databases were searched, encompassing PubMed; Embase; Web of Science; MEDLINE (via Ovid); Scopus; the Cochrane Library; CINAHL (via EBSCO); OpenGrey; and 3 prominent Chinese repositories: China National Knowledge Infrastructure, China Wanfang Database, and China VIP Database. The search dates were from the inception of the database to September 25, 2024. The inclusion criteria for this study encompassed research that used randomized controlled trials (RCTs) and quasi-experiments (QEs) to examine the effectiveness of eHealth interventions for patients with cancer. The methodological quality of RCTs and QEs was evaluated using the Cochrane risk of bias tool and the Joanna Briggs Institute Critical Evaluation Checklist, respectively. The review adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was registered with PROSPERO.

RESULTS

There were 3548 studies reviewed, and 7 studies were selected. Three studies were RCTs and 4 were QEs, involving a total of 512 patients. Evidence of efficacy for eHealth interventions targeting body image and other health outcomes (physical symptoms and emotional distress) was mixed. Nevertheless, our findings indicate that there was no notable enhancement in quality of life resulting from eHealth interventions. A total of 5/7 (71%) studies reported the acceptability of eHealth interventions among patients with cancer, and patients perceived eHealth interventions as acceptable. However, the difficulty of operating the software, determination of the most effective course of treatment, and time constraints emerged as the primary challenges associated with electronic interventions.

CONCLUSIONS

The implementation of eHealth interventions has the potential to enhance body image, physical symptoms, and emotional distress in patients with cancer. Researchers should undertake more rigorous experiments in the future to elucidate the effectiveness of eHealth and address pertinent concerns.

Quality of Life and Associated Factors Among Family/Caregivers of Pediatric Patients Treated for Cancer at Tikur Anbessa Specialized Hospital: Institution-Based Cross-Sectional Study

BACKGROUND

Pediatric cancer significantly affects the quality of life (QOL) of patients and their families/caregivers particularly in low-income countries where there is scarcity of resources. Thus, the purpose of this study was to evaluate the QOL and associated factors among family/caregivers of pediatric patients treated for cancer at Tikur Anbassa Specialized Hospital (TASH), Addis Ababa, Ethiopia.

METHOD

An institution-based cross-sectional study design was used to collect information from family/caregivers who were present in the pediatric oncology unit at TASH from January 2, 2023 to May 30, 2023. The validated Amharic version of the caregiver oncology quality of life questionnaire (CarGOQOL) was used to collect the data. A random sampling technique was applied to select the study participants. The descriptive and regression analysis were conducted using statistical software SPSS version 27.0.

RESULTS

A total of 350 family/caregivers answered the questionnaire. The overall response rate was 82.7%, and about 55% of the respondents were women. Among the participants, under-35 age made up the majority (60.9%). About 81% of family/caregivers were parents, and 77.7% of family/caregivers were married. More than half of the participants have at least a secondary level education. In addition, about two-thirds of the participants (63%) live in rural areas. Furthermore, more than half of the participants generate less than $17.86 per month. Nearly fifty percent of family/caregivers of pediatric cancer patients had poor QOL. The finding showed that widowed family/caregivers (AOR:5.59, 95%CI: 1.12, 27.79, P-value: 0.03) had poor QOL as compared to married, and those with a monthly income of between $17.87- $89.29 were less likely to have poor QOL compared to those with an income below <$17.87 (P-value: 0.01).

CONCLUSION

In the current study, poor QOL was high among family/caregivers of pediatric cancer patients. Being widowed and lowest income were significantly associated with the QOL of the caregivers of pediatric patients with cancer.

Outcomes of endoscopic submucosal dissection versus esophagectomy for poorly differentiated superficial esophageal squamous cell carcinoma: A 10-year cohort study

BACKGROUNDS

The efficacy of endoscopic submucosal dissection (ESD) to treat poorly differentiated superficial esophageal squamous cell carcinoma (SESCC) is unclear.

AIMS

To exploring the efficacy and prognosis of ESD treatment poorly differentiated SESCC compared with esophagectomy.

METHODS

A retrospective cohort study was conducted, the data of poorly differentiated SESCC patients who received ESD or esophagectomy from Jan 2011 to Jan 2021 were analyzed. Overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS), and procedure-related variables were compared between ESD and esophagectomy group.

RESULTS

95 patients underwent ESD, while 86 underwent esophagectomy. No significant differences were found between the two groups in OS (P = 0.587), DSS (P = 0.172), and RFS (P = 0.111). Oncologic outcomes were also similar between the two groups in propensity score-matched analysis. For T1a ESCC, the rates of R0 resection, LVI or nodal metastasis and additional therapy were similar between ESD and esophagectomy groups. But for T1b ESCC, the rates of positive resection margin and additional therapy were significantly higher in ESD group than those in esophagectomy group.

CONCLUSIONS

ESD is a minimally invasive procedure that has comparable oncologic outcomes with esophagectomy for treatment poorly differentiated T1a ESCC. However, ESD is not suitable for poorly differentiated T1b ESCC, additional surgery or radiochemotherapy should be required.

Identification of subgroups of self-reported outcomes among breast cancer patients undergoing surgery and chemotherapy: A cross-sectional study

Objectives

To identify the subgroups of self-reported outcomes and associated factors among breast cancer patients undergoing surgery and chemotherapy.

Methods

A cross-sectional study was conducted between January and November 2021. We recruited patients from two tertiary hospitals in Shanghai, China, using convenience sampling during their hospitalization. Patients were assessed using a questionnaire that included sociodemographic and clinical characteristics, the Patient Reported Outcomes Measurement Information System profile-29 (PROMIS-29), and the PROMIS-cognitive function short form 4a. Latent class analysis was performed to examine possible classes regarding self-reported outcomes. Multiple logistic regression analysis was used to determine the associated factors. Analysis of variance (ANOVA) was conducted for symptoms across the different classes.

Results

A total of 640 patients participated in this study. The findings revealed three subgroups in terms of self-reported outcomes among breast cancer patients undergoing surgery and chemotherapy: low physical-social-cognitive function, high physical-low cognitive function, and high physical-social-cognitive function. Multivariable logistic regression analysis showed that age (≥ 60 years old), menopause, the third chemotherapy cycle, undergoing simple mastectomy and breast reconstruction, duration of disease 3-12 months, stage III/IV cancer, and severe pain were associated factors of the functional decline groups. Besides, significant differences in depression and sleep disorders were observed among the three groups.

Conclusions

Breast cancer patients receiving surgery and chemotherapy can be divided into three subgroups. Aging, menopause, chemotherapy cycle, surgery type, duration and stage of disease, and severe pain affected the functional decline groups. Consequently, healthcare professionals should make tailored interventions to address the specific functional rehabilitation and symptom relief needs.

Infiltration of innate and adoptive lymphoid cells in 4T1 and MC4-L2 breast cancer models

Objectives

Innate lymphoid cells (ILCs) are tissue-resident lymphocytes that have vital roles in activating further immune responses. However, due to their tumor-induced diversity, we decided to examine ILCs, T cells, and the associated cytokines in mouse models of breast cancer.

Materials and Methods

4T1 and MC4-L2 cells were used to induce triple-negative and hormone-receptor-positive breast cancer, respectively. Tumor tissue was resected at early and late stages of tumor growth and used for further analysis. Total RNA was extracted and used in Real-Time PCR to analyze the expression of IFN-γ, IL-4, IL-10, IL-13, and IL-22. Tumor tissue was digested and used in a flow cytometric assay. H&E staining was used to examine the pathology of tumor progression.

Results

Both tumor models showed a notable increase in T-cell frequency at the early stage of tumor growth. However, as the tumors progressed, the frequency of T cells significantly decreased, while the ILC component exhibited a significant increase in tumor progression. Gene analysis indicated a significant increase in the inflammatory to anti-inflammatory cytokine ratio during tumor progression in the tumor model. In contrast, this ratio was considerably reduced in advanced MC4-L2 tumors. Both tumor models showed the development of invasive breast carcinoma and lung metastasis in advanced tumors.

Conclusion

Our study highlighted the expansion of ILCs during tumor progression in two distinct breast cancer models with different immunogenicity. These findings suggest that ILCs may actively modulate the tumor microenvironment during the advanced stage of tumor growth.

New Oral Selective Estrogen Receptor Degraders Redefine Management of Estrogen Receptor-Positive Breast Cancer

Oral selective estrogen receptor degraders (SERDs) are pure estrogen receptor antagonists that have the potential to overcome common resistance mechanisms to endocrine therapy in estrogen receptor-positive breast cancer. There are currently five oral SERDs in published and ongoing clinical trials-elacestrant, camizestrant, giredestrant, imlunestrant, and amcenestrant-with more in development. They offer a reasonably well-tolerated oral therapy option with low discontinuation rates in studies. This review summarizes the currently available literature on this new class of drugs.

Global view of haematolymphoid tumor classifications and their application in low- and middle-income countries

The accurate diagnosis of haematolymphoid malignancies is crucial for effective cancer care, but major obstacles to diagnosis exist in low- and middle-income countries (LMICs). This article explores the global applicability of current haematolymphoid classification systems, which are predominantly derived from data generated in high-income countries (HICs). Although disproportionately burdened with poor cancer outcomes, LMICs are generally faced with limited diagnostic resources, suboptimal access to therapeutics, and inadequate healthcare infrastructure. The article highlights the challenges faced by LMICs, including inconsistent access to high-quality pathology services, limited availability of advanced diagnostic techniques, and a lack of population-based cancer registry data. It also discusses the progress made in narrowing the gap between LMICs and HICs, such as the introduction of resource-adapted classifications, improved guidance on essential diagnostic tools, and strengthening of in-country professional pathology networks. Innovative diagnostic approaches, including gene expression profiling and machine learning, represent potential solutions for improving the diagnostic accuracy in LMICs, but addressable gaps remain. Recommendations are suggested for sustainable investments in diagnostic infrastructure, capacity-building, and population-based cancer registries to enhance the global applicability of haematolymphoid classification systems and improve outcomes for patients in LMICs.

[(Surviving) life with cancer: the importance of sport and physical activity]

As the survival prognosis of cancer patients continues to improve, the improvement in quality of life during and after cancer treatment is becoming increasingly important 1. Exercise therapy has a positive effect on so-called "patient-reported outcomes" 2. The combination of endurance training and individualized strength training plays a particularly important role here. There is therefore a need for consistent and comprehensive implementation of quality-assured exercise therapy in everyday clinical practice.

Optical sensor for fast and accurate lung cancer detection with tissue autofluorescence and diffuse reflectance spectroscopy

BACKGROUND

Cancer is a severe threat to human health, and surgery is a major method of cancer treatment. This study aimed to develop an optical sensor for fast cancer tissue.

METHODS

The tissue autofluorescence spectrum and diffuse reflectance spectrum were obtained by using a laboratory-developed optical sensor system. A total of 151 lung tissue samples were used in this ex vivo study.

RESULTS

Experimental results demonstrate that tissue autofluorescence spectroscopy with a 365-nm excitation has better performance than diffuse reflectance spectroscopy, and 63 of 64 test samples (98.4% accuracy) were correctly classified with tissue autofluorescence spectroscopy and our developed data analysis method.

CONCLUSIONS

Our promising ex vivo study results show that the developed optical sensor system has great promise for future clinical translation for intraoperative lung cancer detection and other applications.

A Novel Effective Models for Identifying BRCA Patients and Optimizing Clinical Treatments

OBJECTIVE

This study aimed to develop an effective model that identifies high-risk breast cancer (BRCA) patients and optimizes clinical treatments.

METHODS

This study includes five public datasets, TCGA-BRCA as the training dataset and other cohorts as the validation datasets. Machine learning algorithms for finding key tumor-associated immune gene pairs (TAIGPs). These TAIGPs were used to construct tumor-associated immune gene pair index (TAIGPI) by multivariate analysis and further validated on the validation datasets. In addition, the differences in clinical prognosis, biological characteristics, and treatment benefits between high and low TAIGPI groups were further analyzed.

RESULTS

The TAIGPI was established by 36 TAIGPs. Better clinical outcomes in the low TAIGPI patients, with consistent results, were also obtained in the validation datasets. The study showed that patients in the low TAIGPI group had a high infiltration of immune cells and low proliferative activity of tumor cells. In contrast, patients in the high TAIGPI group exhibited low infiltration of immune cells and high proliferative activity of tumor cells. In addition, patients in the low TAIGPI group are more likely to benefit from chemotherapy, adjuvant chemotherapy, or immunotherapy.

CONCLUSIONS

The TAIGPI can be an effective predictive strategy for the clinical prognosis of breast cancer patients, providing new insights into personalized treatment options for breast cancer patients.

NEK2 affects the ferroptosis sensitivity of gastric cancer cells by regulating the expression of HMOX1 through Keap1/Nrf2

NEK2 is a serine/threonine protein kinase that is involved in regulating the progression of various tumors. Our previous studies have found that NEK2 is highly expressed in gastric cancer and suggests that patients have a worse prognosis. However, its role and mechanism in gastric cancer are only poorly studied. In this study, we established a model of ferroptosis induced by RSL3 or Erastin in AGS cells in vitro, and konckdown NEK2, HOMX1, Nrf2 by siRNA. The assay kit was used to analyzed cell viability, MDA levels, GSH and GSSG content, and FeRhoNox™-1 fluorescent probe, BODIPY™ 581/591 C11 lipid oxidation probe, CM-H2DCFDA fluorescent probe were used to detected intracellular Fe2+, lipid peroxidation, and ROS levels, respectively. Calcein-AM/PI staining was used to detect the ratio of live and dead cells, qRT-PCR and Western blot were used to identify the mRNA and protein levels of genes in cells, immunofluorescence staining was used to analyze the localization of Nrf2 in cells, RNA-seq was used to analyze changes in mRNA expression profile, and combined with the FerrDb database, ferroptosis-related molecules were screened to elucidate the impact of NEK2 on the sensitivity of gastric cancer cells to ferroptosis. We found that inhibition of NEK2 could enhance the sensitivity of gastric cancer cells to RSL3 and Erastin-induced ferroptosis, which was reflected in the combination of inhibition of NEK2 and ferroptosis induction compared with ferroptosis induction alone: cell viability and GSH level were further decreased, while the proportion of dead cells, Fe2+ level, ROS level, lipid oxidation level, MDA level, GSSG level and GSSG/GSH ratio were further increased. Mechanism studies have found that inhibiting NEK2 could promote the expression of HMOX1, a gene related to ferroptosis, and enhance the sensitivity of gastric cancer cells to ferroptosis by increasing HMOX1. Further mechanism studies have found that inhibiting NEK2 could promote the ubiquitination and proteasome degradation of Keap1, increase the level of Nrf2 in the nucleus, and thus promote the expression of HMOX1. This study confirmed that NEK2 can regulate HMOX1 expression through Keap1/Nrf2 signal, and then affect the sensitivity of gastric cancer cells to ferroptosis, enriching the role and mechanism of NEK2 in gastric cancer.

Global Leadership Initiative in Sarcopenia (GLIS)-defined sarcopenia increases the mortality of esophageal cancer patients after esophagectomy: A Chinese real-world cohort study

OBJECTIVES

To assess the impact of the definition of the Global Leadership Initiative in Sarcopenia (GLIS) on mortality in esophageal cancer (EC) patients, postesophagectomy, within a Chinese cohort and to validate the effectiveness of a new GLIS framework in oncology.

METHODS

We performed an observational real-world cohort study in a single center at Daping Hospital of the Army Medical University in China, spanning from December 2014 to July 2022. We used the combined definition of muscle mass and muscle strength in a new GLIS framework for the diagnosis of sarcopenia. Potential covariates were identified through univariate and multivariate analyses. The association between GLIS-defined sarcopenia and mortality was estimated using Kaplan-Meier curves and Cox models. We also conducted stratified analyses to assess the stability of multivariable Cox models.

RESULTS

A total of 520 EC patients were included in the study, with a median follow-up of 48.7 months. A total of 229 EC patients (44.0%) were identified with GLIS-defined sarcopenia. Patients with GLIS-defined sarcopenia had significantly worse overall survival in Kaplan-Meier curves (log-rank P = 0.015). Age; sex; tumor, node, metastasis stage; blood glucose; bleeding volume in operation; and operating time were introduced as covariates in a fully adjusted Cox model. Multivariable-adjusted Cox models revealed that GLIS-defined sarcopenia was an independent prognostic factor for EC patients postesophagectomy (hazard ratio, 1.87, 95% confidence interval, 1.28-2.74, P = 0.001). Stratified analyses confirmed the stability of the relationship between GLIS-defined sarcopenia and mortality in EC patients.

CONCLUSIONS

GLIS-defined sarcopenia is prevalent among Chinese EC patients and is linked to increased mortality risk postesophagectomy. This finding offers compelling evidence and serves as a valuable reference for the establishment of an operational definition of GLIS sarcopenia.

The application of immunotherapy combined with taxanes in second‑line treatment of advanced HER2 negative gastric cancer

Human epidermal growth factor receptor-2 (HER2) negative advanced gastric cancer (GC) has a high global incidence and mortality rate with limited options for second-line treatment. Monotherapy is not effective and the combination of chemotherapy and immunotherapy has not yet been included in the guidelines. The present study aimed to explore a new treatment approach by conducting a single-center, retrospective, observational real-world study. A total of 21 patients with advanced HER2-negative GC, who had progressed after receiving standard first-line regimens [tegafur, gimeracil and oteracil potassium capsules (S-1) or capecitabine plus oxaliplatin], were selected. The application of programmed cell death-1 (PD-1) inhibitor combined with taxanes was selected as the second-line treatment. The primary outcomes measured were progression-free survival (PFS), pathological complete response, objective response rate (ORR), disease control rate (DCR) and adverse reactions in the present patient cohort. The median (m)PFS in the overall population was 7.1 months, with a 95% confidence interval (CI) of 6.0-8.2 months and the median overall survival (mOS) was 11.3 months, with a 95% CI of 4.5-18.2 months. The ORR was 9.5% and the DCR was 90.5%. Univariate and multivariate analyses indicated that Ki67 <70% and tumor marker-positive status [one or two increases among carcinoembryogenic antigen (CEA), cancer antigen (CA) 199 and CA125] were independent prognostic factors for PFS and overall survival (OS) in second-line treatment. Significant statistical differences were noted in PFS (mPFS=5.3 months, 95% CI: 3.1-7.5 months vs. mPFS=9.1 months, 95% CI: 6.2-12.0 months; P=0.002) and OS (mOS=8.8 months, 95% CI: 7.0-10.7 months vs. mOS=17.2 months, 95% CI: 16.0-18.5 months; P=0.013) between the Ki67-high group (Ki67 ≥70%) and the Ki67-low group (Ki67 <70%). Significant statistical differences were noted in OS between tumor marker-negative status (CEA, CA199 and CA125 within normal range) and tumor marker-positive status (one or two increases among CEA, CA199 and CA125; mOS=17.2 months, 95% CI: 16.0-18.4 months vs. mOS=8.8 months, 95% CI: 5.3-12.4 months; P=0.018); however, no significant differences were noted in PFS between these two groups. The present study retrospectively analyzed the new second-line approach of PD-1 inhibitor combined with taxanes for HER2 negative GC which effectively improved patient PFS and OS compared with single-agent chemotherapy. The expression levels of Ki67 and the tumor marker-negative status possess potential clinical value in monitoring prognosis and guiding future individualized use of chemotherapy combined with immunotherapy.

Spatial Cancer-Immune Phenotypes Predict Shorter Recurrence-Free Survival in the No Specific Molecular Profile Molecular Subtype of Endometrial Carcinoma

Compartmentation of the immune response into 3 main spatial cancer-immune phenotypes (SCIs) - inflamed, excluded, and desert - has been proposed as the main predictor of response to immune checkpoint inhibitors in solid tumors. The objective of the study was to define and characterize the SCI in a consecutive series of 213 endometrial carcinomas (ECs) by correlating it with molecular subtypes, clinicopathologic features, and prognosis. Immunohistochemistry (IHC) and next-generation sequencing were used to assign surrogate molecular EC subtypes: POLE mutant (POLE), mismatch repair deficient (MMRd), TP53 mutant (p53abn), and no specific molecular profile (NSMP). Immune cell markers (CD20, CD3, CD8, CD68, PD-L1) were assessed by IHC on whole sections and quantified by digital image analysis to define the 3 SCIs. ECs were stratified into 4 molecular subtypes: 17 (8.0%) POLE, 68 (31.9%) MMRd, 42 (19.7%) p53abn, and 86 (40.4%) NSMP. SCI determination showed 105 (49.3%) inflamed, 62 (29.1%) desert, and 46 (25.6%) excluded tumors. The inflamed phenotype was more prevalent in MMRd (64.7%) and POLE (76.5%) subtypes compared with NSMP (45.3%) and p53abn (21.4%). SCI revealed a strong correlation with disease-free survival in NSMP tumors: inflamed 96.2%, desert 83.2%, and excluded 40.5%. The SCI prognostic impact was also maintained in NSMP cases treated with adjuvant therapy resulting in a significant difference in recurrence between the inflamed and excluded phenotypes. To simplify SCI determination, a subset of immune cell markers was selected as appropriate to define the 3 SCI patterns: high intraepithelial CD8 for the inflamed phenotype; CD68, CD20, and PD-L1 to discriminate between desert and excluded tumors. The integration of SCI into molecular classification could be a promising opportunity to improve the prognostic risk stratification of patients and may guide the therapeutic approach, particularly in the NSMP subtype. Thus, the different patterns of immune response are a new prognostic parameter in the NSMP subtype.

Prophylactic salpingectomy as a preventative strategy for ovarian cancer in the general population: a systematic review and meta-analysis

OBJECTIVE

The impact of prophylactic salpingectomy on the prevention of epithelial ovarian cancer (EOC) remains unclear, particularly in Asian populations where data is lacking. In this systematic review and meta-analysis study, we sought to assess whether prophylactic salpingectomy could reduce the incidence of ovarian cancer in the general population of multiple ethnicities.

METHODS

A systematic review and meta-analysis were conducted using PubMed/MEDLINE, EMBASE, the Cochrane Library, and Web of Science to assess the effectiveness of salpingectomy, bilateral salpingectomy (BS), and unilateral salpingectomy (US) in reducing the risk of EOC and evaluating postoperative outcomes.

RESULTS

The final analyses included 6 eligible trials (5,747,056 patients), including 1 cohort study and 5 case-control studies. The analyses of these studies demonstrated that women who underwent salpingectomy had a significantly reduced risk of EOC compared to those who did not receive salpingectomy (odds ratio [OR]=0.63; 95% confidence interval [CI]=0.45-0.89; p=0.007). Five studies (5,746,469 patients) indicated a significant reduction in EOC risk among patients who underwent BS (OR=0.48; 95% CI=0.33-0.69; p<0.001). On the other hand, in the analysis of 4 studies (5,745,887 patients) that examined US, the association with EOC risk was not significant despite the protective trend (OR=0.82; 95% CI=0.64-1.06; p=0.12).

CONCLUSION

Our results indicate BS is an effective strategy for reducing the risk of sporadic EOC, but the results did not lead to the same conclusion for patients who underwent US. When a candidate or patient is undergoing a hysterectomy or has other benign diseases, prophylactic BS may be a safe surgical procedure that carries future benefits in terms of EOC risk.

Staging at Diagnosis and Survival of Hematologic Neoplasms in Children and Adolescents in Mato Grosso, Brazil: A Population-based Study

OBJECTIVE

To apply the Toronto Childhood Cancer Staging Guidelines (TG) and Estimate the Observed Survival Probabilities for Pediatric Patients with Leukemia and Lymphoma.

METHODS

Staging at diagnosis was conducted according to tier 2 of the TG. The study cohort included patients aged 0 -19 years from the Population-Based Cancer Registry (PBCR) of Mato Grosso, diagnosed with leukemia and lymphoma between 2008 and 2017, with follow-up until December 31, 2022. Observed 60-month survivals were calculated using the Kaplan-Meier method.

RESULTS

Staging was assigned in 67.3% of cases (n=239), while in 32.7% (n=116), staging could not be applied due to incomplete data. Among the cases of acute lymphoblastic leukemia (ALL), 70.7% (n=133) were staged as CNS1, with an observed survival probability of 75.0%. For acute myeloid leukemia (AML), 42.2% (n=21) were staged as CNS-, with an estimated survival of 60.0%. Most Hodgkin lymphoma (HL) cases were staged as IIA/B (37.7%, n=23) and IIIA/B (21.3%, n=13), with survival probabilities of 91.3% and 91.7%, respectively. Among non-Hodgkin lymphoma (NHL) cases, 32.1% (n=18) were staged as stage III, with a survival probability of 70.6%.

CONCLUSION

The application of TG in the PBCR in Mato Grosso proved feasible, allowing for comparability of survival estimates across different stages. However, collecting tier 2 staging information will be a challenge for the PBCR due to incomplete information in medical records.

Changing trends in lung cancer disease burden between China and Australia from 1990 to 2019 and its predictions

PURPOSE

Lung cancer (LC) is a leading cause of death and presents a substantial societal burden. This article compares its disease burden and risk factors between China and Australia to support health policymakers for LC prevention and treatment.

MATERIALS AND METHODS

The data from the 2019 Global Burden of Disease Study were used to analyze disease temporal trends using Joinpoint regression model. The Bayesian age-period-cohort model was used for prediction. The population-attributable fraction (PAF) was used to analyze LC risk factors.

RESULTS

In 2019, the age-standardized rates (ASR) of incidence and of mortality of LC in China were 41.71/100 000 and 38.70/100 000, while Australia's rates were 30.45/100 000 and 23.46/100 000. It showed an increasing trend in China but a decreasing trend in Australia. By 2030, the ASR of incidence and mortality are predicted to be 47.21/100 000 and 41.54/100 000 in China, while Australia's rates will reach 30.09/100 000 and 23.3/100 000, respectively. Smoking is the most common risk factor for LC, followed by particulate matter and occupational carcinogenesis. The PAF of smoking dropped in Australia (from 68.38% to 53.75% in females; 77.41% to 58.47% in males) but increased in China (from 19.56% to 26.58% in females; 80.45% to 82.03% in males) from 1990 to 2019.

CONCLUSIONS

The disease burden of LC in China is rising, whereas in Australia, it is declining. China still faces a heavy LC burden. Risk factor analysis supported for further improving the compliance and enforcement of polices on tobacco control and environmental management to reduce this disease burden.

A potential target of GXYLT2 affecting the prognosis of gastric cancer by enhancing the EMT process: A clinical retrospective study

The present study aimed to investigate glucoside xylosyltransferase 2 (GXYLT2) as a potential prognostic marker for gastric cancer (GC). The expression levels of GXYLT2, Notch1, E-cadherin and vimentin in GC and adjacent tissues were detected by Elivision™️ Plus immunohistochemistry. The relationship between GXYLT2, Notch1, E-cadherin and vimentin, and clinicopathological parameters was also analyzed. Univariate and multivariate Cox regression analyses were conducted to evaluate the effect of GXYLT2 on survival. The results revealed that GC tissues exhibited a marked increase in GXYLT2, Notch1 and vimentin, and a marked reduction in E-cadherin. The expression of GXYLT2 was related to the differentiation degree of GC and the pathological tumor-node-metastasis (pTNM) stage; the expression of Notch1 was related to the vascular and nerve infiltration of GC; and E-cadherin and vimentin expression were related to patient age, tumor size, tumor differentiation degree, depth of infiltration, lymph node metastasis and pTNM stage. Positive associations existed between GXYLT2 and Notch1 expression, GXYLT2 and vimentin expression, and Notch1 and vimentin expression. Furthermore, the Kaplan-Meier analysis showed that survival and prognosis were associated with factors such as GXYLT2 protein levels, pTNM stage, tumor dimensions, depth of infiltration and lymph node metastasis. Through Cox regression analysis, GXYLT2 was identified as an independent predictor for GC. In conclusion, GXYLT2 may be related to the pathogenesis of GC, and its abnormal expression could be associated with epithelial-mesenchymal transition. Consequently, GXYLT2 may be considered a promising prognostic marker in the context of GC.

Genetic profile in primary tumor tissue of advanced lung adenocarcinoma patients with adrenal metastasis

The aim of this study was to examine the genomic characteristics and explore the molecular mechanisms underlying adrenal metastases in lung adenocarcinoma. 57 patients diagnosed with lung adenocarcinoma (LUAD) and adrenal metastases (AM) were enrolled, alongside 33 controls diagnosed with non-adrenal metastases (non-AM) at the time of diagnosis. The primary lung cancer tissue sample were analyzed using next-generation sequencing. The molecular and clinical features were correlated with clinical outcomes. TP53, EGFR and KRAS were the most frequently mutated gene in both groups. EGFR mutations, especially rare variants (G724A, L747P, Q701 L, G719C, V769 L and S768I), exhibited significant enrichment in the non-AM group (P<0.001). An elevated age-related signature in the group of patients with AM, whereas the non-AM group exhibited a higher BRCA signature. Potential prognostic biomarkers such as KEAP1, LRP1B, NOTCH1 and RET mutations were detected in the non-AM group, while ALK mutations in the AM group correlated with shorter overall survival (P<0.001). KRAS mutations in the early synchronous adrenal metastases group were also associated with shorter OS (P<0.001). The analysis of 425 tumor genes in 29 patients with adrenal metastases showed significant enrichment in pathways associated with invasion and metastasis, including TNF signaling pathway and TGF-β signaling pathway. Patients without EGFR mutations in LUAD need to be more concerned about adrenal metastases. Meanwhile, patients with adrenal metastases harboring ALK or KRAS mutations have a poor prognosis and require more aggressive treatment. The TNF and TGF-β pathways might be associated with adrenal metastasis.

Worldwide patterns and trends in ovarian cancer incidence by histological subtype: a population-based analysis from 1988 to 2017

BACKGROUND

Ovarian cancer (OC) is a heterogeneous malignancy with multiple histological subtypes, showing global variability in incidence. Temporal changes in diagnostic criteria and risk factors might influence the incidence and distribution of OC and its subtypes.

METHODS

This study analyzed incidence patterns (2013-2017) and trends (1988-1992 to 2013-2017) of OC and its subtypes across 65 and 40 countries, respectively. Data were extracted from the Cancer Incidence in Five Continents (CI5 Ⅻ) and CI5plus databases (accessed in June 2024). Annual percent changes were computed to describe trends in age-standardized rates (ASRs) of OC and its subtypes. Proportions of ASR for each subtype relative to the ASR of OC for individual countries were calculated.

FINDINGS

The incidence of OC displayed marked disparities across regions and Human Development Index (HDI), with the highest ASRs in Eastern and Central Europe and very high HDI regions, and the lowest in Africa, Asia, and medium HDI regions. Despite stable trend in ASRs of OC globally, notable declines were observed in Europe, America, and Oceania, in contrast to increases in Asian countries like Japan and South Korea. Globally, serous carcinomas remained the most prevalent subtype. European countries exhibited a higher proportion of serous carcinomas, while Asian countries had a higher proportion of endometrioid and clear cell carcinomas. Although trends in subtypes also remained stable, ASRs increased over time for serous carcinomas and germ cell tumor in most countries, while mucinous carcinomas and adenocarcinoma NOS showed a decline.

INTERPRETATION

Variations in global patterns and trends in OC incidence and its subtypes might be influenced by genetic and reproductive factors. Consequently, region-specific prevention strategies and ongoing surveillance are essential to mitigate the burden of OC.

FUNDING

The National Key Research and Development Program of China (No.2022YFC2704205), the Natural Science Foundation of China (No.82073647, 82373674, and 82103914), Outstanding Scientific Fund of Shengjing Hospital, 345 Talent Project of Shengjing Hospital of China Medical University, the Max Planck - University of Helsinki Center from the Jane and Aatos Erkko Foundation (No.210046), the Max Planck Society (No.5714240218), the University of Helsinki (No.77204227), and the European Union (ERC Synergy, BIOSFER, 101071773).

Care Models for Cancer Survivors

The population of cancer survivors is on the rise due to an increase in cancer incidence and a decline in cancer mortality. This growing survivor population creates a number of challenges. Although there have been improvements in care planning for cancer survivors, our healthcare system still lacks the delivery of coordinated care between primary care physicians and specialists. Understanding the needs of cancer survivors can help improve the current care models. In this review we describe existing survivorship care models. We also describe emerging models using some programs at the Cleveland Clinic to highlight various potential approaches.

Fecal methylated syndecan-2 (SDC2) testing for early screening of colorectal cancerous and precancerous lesions: A real-world retrospective study in China

Background

Colorectal cancer (CRC) is a major public health concern and the second leading cause of cancer-related deaths worldwide. However, challenges remain in deploying effective screening strategies for early-stage CRC. This study aimed to evaluate the effectiveness of a fecal-based syndecan-2 (SDC2) methylation test for the detection of colorectal lesions and CRC.

Methods

We retrospectively collected data on participants who underwent fecal SDC2 methylation testing from January 1, 2019, to May 30, 2023. Patients with positive results were recommended to undergo colonoscopy. Performance indicators associated with certain clinical characteristics, including positive rate (PR), positive predictive value (PPV), and colonoscopy compliance rate (CCR), were subjected to statistical analysis.

Results

We analyzed data from 113,209 participants, of whom 11,841 (10.4% PR) had positive fecal SDC2 methylation test results. A total of 4315 participants with positive results adhered to the colonoscopy recommendations, and the CCR was 36.4%. Finally, 3169 colorectal lesions were detected, including 1134 polyps, 875 non-advanced adenomas (NAAs), 770 advanced adenomas (AAs), and 390 CRCs, with PPV values of 26.3% (1134/4315), 20.3% (875/4315), 17.8% (770/4315), and 9.0% (390/4315), respectively. Notably, the PPV for CRC increased significantly with age (χ 2 = 164.40, P < 0.0001). In addition, as the cycle threshold (CT) values increased, the PPVs of AAs and CRCs generally decreased, whereas those of NAAs and polyps significantly increased. Moreover, the clinical patient group had the highest incidence of late-stage CRC (stage II and higher), whereas asymptomatic populations from the staff physical examination group and rural town-based screening programs had the highest number of stage 0 and I CRCs detected (P = 0.0107).

Conclusions

This study indicates that fecal SDC2 methylation testing combined with colonoscopy may be an effective screening method for colorectal lesions and CRC.