Prediagnostic BMI trajectories in relation to pancreatic cancer risk in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

Impacts of BRCA mutations and clinical factors on niraparib efficacy in patients with platinum-sensitive recurrent ovarian cancer: a retrospective study

OBJECTIVE

To investigate the impacts of breast cancer gene (BRCA) mutations, clinical factors such as body mass index (BMI), carbohydrate antigen 125 (CA125), human epididymis protein 4 (HE4), International Federation of Gynecology and Obstetrics (FIGO) staging and platinum sensitivity, and pathological characteristics on progression-free survival (PFS) in platinum-sensitive recurrent ovarian cancer (PSROC) patients treated with niraparib, and to identify independent prognostic factors for treatment outcomes.

METHODS

A total of 312 patients with ovarian cancer undergoing treatment between Jan. 2020 and Jan. 2022 were selected for the retrospective study. Patients were eligible if they were ≥ 18 years old and diagnosed with epithelial ovarian cancer, fallopian tube cancer, or primary peritoneal cancer. In addition, they received platinum-sensitive treatment (PFS ≥ 6 months) and niraparib as a maintenance therapy. Univariate and multivariate Cox proportional hazards regression models were used to evaluate the influence of clinical and pathological variables on PFS. Time-dependent receiver operating characteristic (ROC) curve analysis was performed to assess the predictive power of significant factors.

RESULTS

Univariate Cox regression analysis identified significant associations between patients' PFS and BRCA mutation status, BMI, CA125 levels, FIGO staging, platinum sensitivity, and niraparib usage and timing. Patients with BRCA mutations, BMI ≥ 24 kg/m2, CA125 level ≤ 500 U/mL, FIGO stage II, or platinum sensitivity demonstrated a significantly longer PFS. Multivariate Cox regression analysis confirmed BRCA mutations (hazard ratio (HR) = 1.754, P = 0.049), BMI ≥ 24 kg/m2 (HR = 2.317, P = 0.015), CA125 level ≤ 500 U/mL (HR = 2.517, P = 0.005), FIGO stage III/IV (HR = 0.159, P < 0.001; HR = 2.558, P = 0.011), and platinum sensitivity (HR = 2.599, P = 0.043) as independent predictors for PFS. Time-dependent ROC analysis demonstrated that platinum sensitivity and FIGO staging were the most influential prognostic factors to predict the 1-year and 3-year PFS. In addition, it was found that niraparib-associated adverse events occurred in 62.84% of the enrolled patients, primary of which were mild to moderate hematological and gastrointestinal toxicities.

CONCLUSION

BRCA mutations, CA125 levels, FIGO staging, BMI, and platinum sensitivity are critical factors influencing the efficacy of niraparib in PSROC patients. These findings have provided valuable insights into the individualized application of niraparib and the optimization of treatment strategies for PSROC patients.

Association of overweight/obesity and digestive system cancers: A meta-analysis and trial sequential analysis of prospective cohort studies

BACKGROUND

Previous researches have reported correlations between overweight/obesity and common digestive system cancers (DSCs), including gastric, liver, esophageal, colorectal, and pancreatic cancers. However, the inconsistency in defining overweight/obesity and the risk of recall bias from case-control and retrospective cohort studies may influence existing results. Therefore, we aimed to validate the relationship between overweight/obesity and common DSCs by combining prospective cohort studies based on the World Health Organization (WHO) criteria for defining overweight/obesity.

METHODS

A comprehensive literature search was conducted across PubMed, Embase, Web of Science, and Cochrane databases, covering all publications up to February 7, 2024. The inclusion criteria focused on prospective cohort studies that examined the link between overweight/obesity and risks of DSCs. R software 4.1.3 and STATA 12 were utilised to calculate the relative risk (RR), with 95% confidence interval (CI) and prediction interval (PI). TSA v0.9.5.10 Beta software was used for trial sequential analysis (TSA).

RESULTS

The meta-analysis encompassed 39 articles. The overall analysis showed that compared with normal weight, overweight/obesity increased the risks of liver cancer (overweight: RR [95% CI] =  1.237 [1.112-1.377]; 95% PI: 0.888-1.725; obesity: RR [95% CI] =  1.642 [1.466-1.839]; 95% PI: 1.143-2.358) and colorectal cancer (overweight: RR [95% CI] =  1.124 [1.056-1.197]; 95% PI: 0.931-1.357; obesity: RR [95% CI] =  1.366 [1.242-1.503]; 95% PI: 0.959-1.945) in the total population. Subgroup analysis revealed that overweight (RR [95% CI] =  1.237 [1.165-1.314]; 95% PI: 1.154-1.327) and obesity (RR [95% CI] =  1.306 [1.152-1.480]; 95% PI: 1.108-1.539) were associated with an increased risk of pancreatic cancer only in women, and overweight also increased the gastric cancer risk of women (RR [95% CI] =  1.041 [1.013-1.070], 95% PI: 0.806-1.230). No significant association of overweight/obesity and esophageal cancer was observed in both male and female.

CONCLUSION

Our study suggested that overweight/obesity elevated the risks of liver and colorectal cancer in both men and women. No significant association was found between overweight/obesity and the risk of developing esophageal cancer. Clinicians are advised to consider weight control as an effective measure for preventing pancreatic, liver, and colorectal cancers.

Overcoming underestimation of the association of excess weight with pancreatic cancer due to prediagnostic weight loss: Umbrella review of systematic reviews, meta-analyses, and pooled-analyses

Elevated body mass index (BMI) is linked to increased pancreatic cancer (PC) risk. Cancer-associated weight loss can occur years before the malignancy is diagnosed. This might have led to underestimation of the BMI-PC association. However, it is unknown if and to what extent this issue has been considered in previous epidemiological studies. We searched two databases through February 19, 2024 for systematic reviews, meta-analyses, and pooled analyses examining the BMI-PC association. We extracted information on study design with a special focus on the article's examination of prediagnostic weight loss as a potential source of bias, as well as how included cohort studies addressed this concern. Thirteen review articles, meta-analyses, and pooled analyses were identified. Only five (four pooled analyses, one systematic review) considered prediagnostic weight loss in their analyses. Twenty-four of 32 identified cohort studies reported having excluded initial years of follow-up. However, only 13 studies reported results after such exclusions, and effect estimates generally increased with longer periods of exclusion. We conclude that the association of overweight and obesity with PC risk is likely larger than suggested by published epidemiological evidence. Future studies should pay careful attention to avoid or minimize potential bias resulting from prediagnostic weight loss.

The correlation between KRAS and TP53 gene mutations and early growth of pulmonary nodules

PURPOSE

The purpose of this study is to investigate whether gene mutations can lead to the growth of malignant pulmonary nodules.

METHODS

Retrospective analysis was conducted on patients with pulmonary nodules at Hebei Provincial People's Hospital, collecting basic clinical information such as gender, age, BMI, and hematological indicators. According to the inclusion and exclusion criteria, 85 patients with malignant pulmonary nodules were selected for screening, and gene mutation testing was performed on all patient tissues to explore the relationship between gene mutations and the growth of malignant pulmonary nodules.

RESULTS

There is a correlation between KRAS and TP53 gene mutations and the growth of pulmonary nodules (P < 0.05), while there is a correlation between KRAS and TP53 gene mutations and the growth of pulmonary nodules in the subgroup of invasive malignant pulmonary nodules (P < 0.05).

CONCLUSION

Mutations in the TP53 gene can lead to the growth of malignant pulmonary nodules and are correlated with the degree of invasion of malignant pulmonary nodules.

Associations between Two Dietary Quality Scores and Pancreatic Cancer Risk in a US National Prospective Cohort Study

OBJECTIVE

Most previous studies investigated the associations between intake of individual nutrients and risk of disease, which failed to consider the potential interactions and correlations between various nutrients contained in food. Although dietary quality scores provide a comprehensive evaluation of the entire diet, it remains elusive whether they are associated with the risk of pancreatic cancer.

METHODS

Dietary intake data collected with the Dietary Questionnaire (DQX) and Diet History Questionnaire (DHQ) were used to calculate HEI-2015 and DQI-R scores for participants in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. A high score indicates an increased intake of adequacy components and a decreased intake of moderation components. This study included 252 cases of pancreatic cancer documented from 58,477 persons during a median follow-up of 12.2 years in the DQX cohort and 372 cases of pancreatic cancer ascertained from 101,721 persons during a median follow-up of 8.9 years in the DHQ cohort. Cox proportional hazards regression analysis was performed to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the associations between the two dietary quality scores and pancreatic cancer risk.

RESULTS

After adjustment for confounders, HEI-2015 and DQI-R scores were not significantly associated with pancreatic cancer risk. However, a significantly lower risk was observed for overweight persons with a higher HEI-2015 score in the DQX cohort (HR [95% CI] comparing the highest with lowest tertile: 0.52 [0.32, 0.85], p for trend = 0.009) and those with higher scores of some individual components.

CONCLUSION

Collectively, overall dietary quality is not associated with an altered risk of pancreatic cancer in this US population.