Development and validation of age-specific risk prediction models for primary ovarian insufficiency in long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study and St Jude Lifetime Cohort

The Impact of Radiotherapy on the Uterus and Its Implications for Pregnancy

Radiotherapy is an effective treatment for various cancers, but it can cause significant side effects on various organ systems, including the reproductive organs, which is a major concern for women of reproductive age. A well-known long-term effect of oncological treatment is premature ovarian insufficiency. Another critical but sometimes overlooked organ at risk in female cancer survivors is the uterus. This review focuses on the impact of radiotherapy on uterine physiology, highlighting key issues such as the development of fibrosis and loss of elasticity, vascular damage, and hormonal disruption, all of which can compromise uterine function. These changes can negatively impact fertility and pregnancy outcomes, such as miscarriage, preterm birth, and low birth weight. Limited evidence is also available suggesting that radiotherapy may affect endometrial receptivity and contribute to abnormal placentation. We conclude by discussing strategies aimed at mitigating the damage caused by radiotherapy, such as fertility-preserving treatments and hormonal interventions. A thorough understanding of these effects is essential for healthcare providers to offer informed support to women who wish to maintain their fertility and have children following cancer treatment.

The association between Glycated Hemoglobin to High Density Lipoprotein Cholesterol Ratio and risk of cardiovascular diseases caused death among adult cancer survivors: evidence from NHANES 1999-2018

BACKGROUND

The population of cancer survivors is growing markedly, facing an elevated risk of overall mortality as well as death from cardiovascular diseases (CVDs). Uncovering biomarkers that associated with CVDs among cancer survivors appears to be vital.

METHODS

We collected data from NHANES (1999-2018), focusing on cancer survivors with comprehensive Glycated Hemoglobin (GH), High Density Lipoprotein Cholesterol (HDL-C), CVDs history and survival follow-up information. We first executed test for Proportional Hazards assumptions among the variables, paving the way for constructing the COX proportional hazards model. By stratifying participants by age, we explored the association between GH/HDL-C levels and the CVDs-caused mortality risk across various age segments. Restricted cubic spline (RCS) curves were employed to detect any potential non-linear associations. When non-linear associations were identified, we proceeded with segmented analyses based on reference values to better understand the association between GH/HDL-C and the risk of CVDs-related mortality among cancer survivors. To further affirm the robustness of our findings, subgroup and sensitivity analyses were conducted.

RESULTS

A total of 3,244 eligible participants were included in this study. The GH/HDL-C levels in cancer survivors died from CVDs were markedly higher than those who survived the follow-up period. According to the results from the Proportional Hazards assumptions test, the endpoint for CVDs mortality was established at 168 months, and the subjects were classified into three age groups: <60 years, between 60 and 74 years, and ≥ 75 years. For the young cohort (< 60 years), there was no significant association between GH/HDL-C levels and CVDs mortality. However, in the 60 ~ 74 age group, a linear association was noted, with higher GH/HDL-C levels indicating a greater CVDs-related mortality risk. For cancer survivors aged 75 and older, the association appeared nonlinear, resembling a U-shaped curve, where high GH/HDL-C levels were associated with higher mortality risk above the certain reference point (4.25mmol/L^-1), while lower levels were associated with reduced risk or no significant impact.

CONCLUSION

The study highlighted that in cancer survivors, the GH/HDL-C is significantly associated with the risk of CVDs mortality. Those between 60 and 74 years old showed a straightforward increase in CVD death risk with higher GH/HDL-C levels. In individuals aged 75 and older, the association was more complex, exhibiting a non-linear U-shaped trend.

Genetic and epigenetic bases of long-term adverse effects of childhood cancer therapy

Over the past decade, genome-scale molecular profiling of large childhood cancer survivorship cohorts has led to unprecedented advances in our understanding of the genetic and epigenetic bases of therapy-related adverse health outcomes in this vulnerable population. To facilitate the integration of knowledge generated from these studies into formulating next-generation precision care for survivors of childhood cancer, we summarize key findings of genetic and epigenetic association studies of long-term therapy-related adverse effects including subsequent neoplasms and cardiomyopathies among others. We also discuss therapy-related genotoxicities including clonal haematopoiesis and DNA methylation, which may underlie accelerated molecular ageing. Finally, we highlight enhanced risk prediction models for survivors of childhood cancer that incorporate both genetic factors and treatment exposures, aiming to achieve enhanced accuracy in predicting risks for this population. These new insights will hopefully inspire future studies that harness both expanding omics resources and evolving data science methodology to accelerate the translation of precision medicine for survivors of childhood cancer.

Cellular Senescence Genes as Cutting-Edge Signatures for Abdominal Aortic Aneurysm Diagnosis: Potential for Innovative Therapeutic Interventions

Abdominal aortic aneurysm (AAA) is the most prevalent dilated arterial aneurysm that poses a significant threat to older adults, but the molecular mechanisms linking senescence to AAA progression remain poorly understood. This study aims to identify cellular senescence-related genes (SRGs) implicated in AAA development and assess their potential as therapeutic targets. Four hundred and twenty-nine differentially expressed genes (DEGs) were identified from the GSE57691 training set, and 867 SRGs were obtained. Through the intersection of DEGs with SRGs, 19 differentially expressed senescence-related genes (DESRGs) were uncovered. Functional enrichment analysis was performed to explore their biological roles in AAA. To identify hub genes, we applied machine learning algorithms, including LASSO, SVM-RFE and random forest. These hub genes were then validated in two independent datasets. In the initial validation cohort, significant differences in the expression levels of BTG2, ETS1, ID1 and ITPR3 were observed between the AAA and control groups. Receiver operating characteristic (ROC) analysis demonstrated a robust diagnostic performance. Further validation across different AAA stages (small, large and ruptured AAA) identified ETS1 and ITPR3 as potential diagnostic genes. Subsequently, the diagnostic relevance of ETS1 and ITPR3 was further validated in human serum samples and mouse models of AAA. In addition, single-cell RNA sequencing suggests that senescent endothelial cells play a pivotal role in AAA progression, we further confirmed the correlation between ETS1 and ITPR3 and senescent endothelial cells by WB, IF and RT-qPCR. In conclusion, our study reveals the pivotal role of cellular senescence in AAA progression and identifies ETS1 and ITPR3 as promising diagnostic biomarkers.

Clinical dilemmas in ovarian tissue cryopreservation

Ovarian tissue cryopreservation (OTC) is increasingly offered globally as a fertility preservation strategy for both postpubertal women and prepubertal girls, with subsequent reimplantation of cryopreserved ovarian cortex resulting in a rapidly growing number of live births. There remains very limited evidence of efficacy from tissue stored when the patient was prepubertal or from conditions affecting the ovary directly, e.g., Turner syndrome. Although OTC is becoming a more established practice, several clinical dilemmas remain from a practical and ethical standpoint. This review discusses the challenges regarding optimal patient selection for the procedure, the use of OTC in patients with a poor prognosis, the potential of reimplantation of tissue contaminated with malignant cells, and the role of OTC in those with an intrinsic ovarian disorder.

Research progress on sexual functioning and associated factors in childhood cancer survivors: a scoping review

Background

Childhood Cancer Survivors (CCSs) are more likely to report sexual dysfunction than people without cancer history. Sexual functioning encompasses more than just sexual dysfunction. The scarcity of information regarding the status and influencing factors of sexual functioning in CCSs, hampers to devise suitable screening or interventions. This review aims to summarize research progress on sexual functioning and associated factors among CCSs.

Methods

This review protocol is registered in PROSPERO(CRD42023427939) and performed according to PRISMA guidelines. From inception to November 15, 2023, a comprehensive search was conducted in PubMed, EMBASE, CINAHL, Web of Science, SCOPUS, PsycINFO, CNKI Database, Wanfang of Chinese Database, SinoMed Database and Cochrane Library on sexual functioning and childhood cancer survivors. Inclusion criteria were English or Chinese studies focusing on sexual functioning and related factors of cancer survivors, who diagnosed with cancer before 18 years old, and were adult and disease-free when participating in the study. Studies were excluded if the focus was on adult cancer patients or without age information.

Findings

395 records were retrieved, and 22 studies were finally included in this review. Results suggest that CCSs experience a substantial burden of sexual issues, including delayed psychosexual development, low satisfaction, and high prevalence of dysfunction. Underlying factors related to sexual functioning of CCSs were identified, including demographic, cancer treatment-related, psychological, and physiological factors. The historical change in research on sexual functioning was summarized.

Interpretation

Research on sexual functioning among CCSs is limited. The extent to which cancer and related treatments affect sexual functioning remains largely unknown. The relationships between various factors and mechanisms underlying sexual functioning need to be confirmed by more rigorous studies to enable effective interventions to be developed.

Funding

None.

A 14-year-old girl with premature ovarian insufficiency but with a positive pregnancy test

OBJECTIVES

Childhood cancer survivors are at risk for premature ovarian insufficiency, especially after treatment with alkylating agents. The objective of this report is to highlight a case in which this phenomenon caused a false-positive pregnancy test.

CASE PRESENTATION

A workup was performed in a 14-year-old girl with a positive pregnancy test. She was diagnosed with stage IV neuroblastoma of the left adrenal gland at the age of 4 years. She received extensive treatment, including alkylating agents, and had been diagnosed with premature ovarian insufficiency. An LH/hCG suppression test was performed using high dose 17 bèta-estradiol: hCG levels normalized.

CONCLUSIONS

The pregnancy test was false-positive due to production of low amounts of hCG by the pituitary gland as a result of high LH concentrations following premature ovarian insufficiency. It may be helpful to perform the LH/hCG suppression test to prove pituitary origin of the hCG overproduction.