Plasma cell-free DNA as a sensitive biomarker for multi-cancer detection and immunotherapy outcomes prediction

BACKGROUND

Cell-free DNA (cfDNA) has shown promise in detecting various cancers, but the diagnostic performance of cfDNA end motifs for multiple cancer types requires verification. This study aimed to assess the utility of cfDNA end motifs for multi-cancer detection.

METHODS

This study included 206 participants: 106 individuals with cancer, representing 20 cancer types, and 100 healthy individuals. The participants were divided into training and testing cohorts. All plasma cfDNA samples were profiled by whole-genome sequencing. A random forest model was constructed using cfDNA 4 bp-end-motif profiles to predict cancer in the training cohort, and its performance was evaluated in the testing cohort. Additionally, a separate random forest model was developed to predict immunotherapy responses.

RESULTS

In the training cohort, the model based on 4 bp-end-motif profiles achieved an AUC of 0.962 (95% CI 0.936-0.987). The AUC in the testing cohort was 0.983 (95% CI 0.960-1.000). The model also maintained excellent predictive ability in different tumor sub-cohorts, including lung cancer (AUC 0.918, 95% CI 0.862-0.974), gastrointestinal cancer (AUC 0.966, 95% CI 0.938-0.993), and other cancer cohort (AUC 0.859, 95% CI 0.776-0.942). Moreover, the model utilizing 4 bp-end-motif profiles exhibited sensitivity in identifying responders to immunotherapy (AUC 0.784, 95% CI 0.609-0.960).

CONCLUSION

The model based on 4 bp-end-motif profiles demonstrates superior sensitivity in multi-cancer detection. Detection of 4 bp-end-motif profiles may serve as potential predictive biomarkers for cancer immunotherapy.

Double versus Single Primary Malignant Neoplasm of Breast and Colorectal Cancer: A Case-Control Study

PURPOSE

Breast cancer (BC) and colorectal cancer (CRC) are common in female. This study compared survival time between women affected with both cancers with ones with single BC or single CRC.

METHOD

Medical records of subjects with both BC & CRC (June 1, 2010, to June 30, 2021) were reviewed. Age-matched subjects who had BC or CRC alone were used as control. Survival analysis using Kaplan-Meier method was performed.

RESULT

There were 63 double cancers [40 BC first (DBC): 23 CRC first (DCRC), mean age±SD 60.5±9.9 and 60.9±12.2 years] and 76 subjects in single cancer group [53 SBC: 23 SCRC, mean age 57.4±11.3 and 61.1±12.5 years]. The 5-year survival rate of the double cancer group was 74.6% and the single cancer group was 63.2%. D-group had slightly longer survival time than S-group (116.5±4.0 vs. 101.3±5.5, p=0.055). In D-group, the occurrence of addition of other primary cancers were more common (p=0.015). The second cancer occurred 61.7±45.3 months later in DBC group, and 39.1±26.6 months later in DCRC group (p=0.016). SCRC had shorter survival time vs. DCRC group (p=0.031). SBC and DBC had no different in mean survival time.

CONCLUSION

BC and CRC could occur as a part of multiple primary cancers. Detection of more than one cancer did not lead to decrease survival if the second cancer was early detected and treated. The occurrence of the second cancer might be beyond 5 years after the diagnosis of the first cancer. Thus, longer surveillance may be warranted. Awareness and provision of early screening should be offered to individuals diagnosed with either primary cancer. Detection of more than one cancer did not lead to shorter survival.

Impact of previous extra-pulmonary malignancies on surgical outcomes of sequential primary non-small cell lung cancer

Reduced cancer deaths have led to an increase in the number of cancer survivors and the risk of the second primary tumor. This study explored the surgical outcomes of patients with non-small cell lung cancer as the second primary tumor and the impact of previous extra-pulmonary malignancies. Patients' data were obtained from Surveillance, Epidemiology and End Results database. The patients were divided into lung surgery and non-surgery groups. Propensity-score matching was used to balance potential confounders. Kaplan-Meier curves were generated to test the overall survival and lung-cancer-specific survival. Cox regression analysis was performed to calculate death risk. In total 3054 lung surgery and 1094 non-surgery patients with stage I-II non-small cell lung cancer as the second primary tumor were included. The surgery group showed longer overall survival (68 vs. 22 months) and lung cancer-specific survival (not reached vs. 37 months) than those of non-surgery groups (both P < 0.001). Patients with previous hormone-dependent malignancies had similar survival rates (overall survival: 22 vs. 20 months, P = 0.666; lung cancer-specific survival: 38 vs. 37 months, P = 0.292) as those with non-hormone dependent malignancies in the non-surgery group. Significantly longer overall survival (90 vs. 60 months, P = 0.001) was observed in patients with hormone-dependent malignancies in the surgery group; however, there was no difference in lung cancer-specific survival (P = 0.225). Competing risk analysis showed that for patients undergoing lung surgery, there was higher previous malignancy-induced mortality in patients with non-hormone dependent malignancies than in patients with hormone-dependent malignancies. However, there was no difference in lung cancer-induced mortality between the two groups. Patients who underwent lobectomy showed longer survival than those who underwent pneumonectomy and other resection types (89, 27.5 and 65 months, P < 0.001). In summary, lung surgery is beneficial for patients with stage I-II non-small cell lung cancer as the second primary tumor after hormone-dependent malignancy resection.

Risks of second non-breast primaries following breast cancer in women: a systematic review and meta-analysis

BACKGROUND

Second primary cancer incidence is rising among breast cancer survivors. We examined the risks of non-breast second primaries, in combination and at specific cancer sites, through a systematic review and meta-analysis.

METHODS

We conducted a systematic search of PubMed, Embase, and Web of Science, seeking studies published by March 2022. We included studies that reported standardized incidence ratios (SIRs), with associated standard errors, assessing the combined risk of second non-breast primaries following breast cancer. We performed meta-analyses of combined second primary risks, stratifying by age, follow-up duration, and geographic region. We also assessed second primary risks at several specific sites, stratifying by age. The inverse variance method with DerSimonian-Laird estimators was used in all meta-analyses, assuming a random-effects model. Associated biases and study quality were evaluated using the Newcastle-Ottawa scale.

RESULTS

One prospective and twenty-seven retrospective cohort studies were identified. SIRs for second non-breast primaries combined ranged from 0.84 to 1.84. The summary SIR estimate was 1.24 (95% CI 1.14-1.36, I2: 99%). This varied by age: the estimate was 1.59 (95% CI 1.36-1.85) when breast cancer was diagnosed before age 50, which was significantly higher than in women first diagnosed at 50 or over (SIR: 1.13, 95% CI 1.01-1.36, p for difference: < 0.001). SPC risks were also significantly higher when based on Asian, rather than European, registries (Asia-SIR: 1.47, 95% CI 1.29-1.67. Europe-SIR: 1.16, 95% CI 1.04-1.28). There were significantly increased risks of second thyroid (SIR: 1.89, 95% CI 1.49-2.38), corpus uteri (SIR: 1.84, 95% CI 1.53-2.23), ovary (SIR: 1.53, 95% CI 1.35-1.73), kidney (SIR: 1.43, 95% CI 1.17-1.73), oesophagus (SIR: 1.39, 95% CI 1.26-1.55), skin (melanoma) (SIR: 1.34, 95% CI 1.18-1.52), blood (leukaemia) (SIR: 1.30, 95% CI 1.17-1.45), lung (SIR: 1.25, 95% CI 1.03-1.51), stomach (SIR: 1.23, 95% CI 1.12-1.36) and bladder (SIR: 1.15, 95% CI 1.05-1.26) primaries.

CONCLUSIONS

Breast cancer survivors are at significantly increased risk of second primaries at many sites. Risks are higher for those diagnosed with breast cancer before age 50 and in Asian breast cancer survivors compared to European breast cancer survivors. This study is limited by a lack of data on potentially confounding variables. The conclusions may inform clinical management decisions following breast cancer, although specific clinical recommendations lie outside the scope of this review.

Long-Term patterns of cancer incidence among patients with and without type 2 diabetes in the United Kingdom

AIMS

Studies using contemporary cohorts are needed to assess the association between type 2 diabetes and cancer.

METHODS

Using the United Kingdom Clinical Practice Research Datalink, we matched patients with type 2 diabetes between 1988 and 2019 to patients without type 2 diabetes. Poisson regression models were fit to estimate incidence rate ratios (IRRs) with 95% confidence intervals (CIs) for cancer. In secondary analyses, we determined whether the strength of the association varied with calendar time and whether patients with type 2 diabetes had a higher incidence of being diagnosed with multiple cancers during the follow-up period.

RESULTS

890,214 patients with type 2 diabetes were matched to an equal number of patients without type 2 diabetes. Patients with type 2 diabetes had a higher cancer incidence than patients without type 2 diabetes (IRR 1.19, 95% CI 1.18-1.21). The IRR was higher 2010 onwards (IRR: 1.25, 95% CI: 1.23-1.28) compared with the association in previous years. Overall, patients with type 2 diabetes had a 5% higher incidence of being diagnosed with multiple cancers (IRR: 1.05, 95% CI: 1.04-1.07).

CONCLUSIONS

The results of this large population-based study indicate that type 2 diabetes is associated with an increased risk of several cancers.

Triple cancer of gallbladder, common bile duct and papilla of Vater: Report of a case and review of literature

INTRODUCTION AND IMPORTANCE

Synchronous malignancies of gallbladder and biliary tree are together rare entity whose pathogenesis is yet unknown. We report the case of a triple synchronous cancer of 3 distinct location: gallbladder, common bile duct (CBD) and papilla of Vater.

CASE PRESENTATION

An 84-years-old woman, was admitted to our Hospital with clinics features of obstructive jaundice. Dilatation of the biliary tree and CBD without evidence of gallstones was seen at US. CT scan confirmed distal CBD obstruction. An endo-US showed a nodule of the head of pancreas infiltrating the lower CBD. Finally, hepatic-MRI displayed a gallbladder malignancy with invasion of CBD. Preoperative staging showed 3 diagnostic suspicions: carcinoma of CBD on CT, pancreatic carcinoma on endo-US and malignancy of gallbladder on MRI. A cephalic duodenopancreatectomy and radical gallbladder resection was performed. Final pathology revealed 3 distinct location of moderately differentiated adenocarcinomas: Gallbladder, CBD and Vater's papilla. Microscopic examination didn't detect any direct continuity between the 3 tumors. Metastases were identified in the pancreaticoduodenal, peri-hepatic and peri-gastric lymph nodes.

CLINICAL DISCUSSION

Literature displayed 22 cases of synchronous malignancies of gallbladder and CBD and 1 case of triple cancer with associated Vater's papilla carcinoma. In most of these cases, an association with an anomalous pancreatic-bile duct junction was reported. Although the real incidence remain unknown, it was reported to occur in 5-10% of CBD cancers.

CONCLUSION

Suspicion of such combination of cancer should be remembered, especially when preoperative investigations don't allow a precise localization of tumor in the biliary tree.

Oral squamous cell carcinoma of the tongue dorsum with multiple cancer-associated mutations in the TP53 gene

OBJECTIVES

Squamous cell carcinoma (SCC) of the tongue is one of the most common oral cancers, tongue dorsum being a site of low incidence of primary SCC. We report a rare case of SCC of the tongue dorsum in a 69-year-old man having a history of multiple cancers, including esophageal cancer, gastric cancer, and renal cell carcinoma. We discuss the findings in relation to past reports.

MATERIALS AND METHODS

TP53 was PCR amplified using the genomic DNA extracted from peripheral blood mononuclear cells and formalin-fixed, paraffin-embedded tissue sections from the tumor site of the patient, and was sequenced.

RESULTS

Physical examination revealed an elastic hard mass on the tongue dorsum, with a size of 22 × 15 mm. There were no palpable enlarged lymph nodes in the cervical and submandibular region. An incisional biopsy was performed. The diagnosis was well-differentiated SCC of tongue, T2N0M0, Stage II, and was treated through surgery. Surgical specimen of the deep ulcer area showed increased expression of p16 protein with no expression of p53 protein. He had a heterozygous gene polymorphism (c.215C > G: p.Pro72Arg) and a germline mutation (c.838A > T: p.Arg280*) of the TP53. However, there has been no recurrence or metastasis of the tongue carcinoma through the follow-up for 3 years.

CONCLUSION

Germline TP53 mutation and codon 72 polymorphism are risk factors for uncontrolled cell proliferation, possibly leading to the patient's clinical phenotype. Therefore, strict follow-up is required when treating those who are at a higher risk of cancer due to a TP53 mutation.

Molecular subtype switching in early-stage gastric cancers with multiple occurrences

BACKGROUND

Multiple gastric cancers at the same time (synchronous) or recurrence after 1 year (metachronous) are frequently encountered. Since their genetic profiles were not well elucidated, we molecularly subtyped the genetic events of synchronous and metachronous early-stage gastric cancers.

METHODS

We studied mismatch repair (MMR) genes in 84 tumors from 31 patients (15 synchronous and 16 metachronous) by immunohistochemistry. We performed microsatellite instability analysis and targeted sequencing of 58 significantly mutated genes (SMGs) in 35 tumors from thirteen patients. Genomic data from TCGA were used for comparisons with advanced-stage cancers.

RESULTS

Among the 31 patients, at least one deficient-MMR (dMMR) tumor was observed in eight (26%). Of eight patients, seven showed a mixture of proficient-MMR (pMMR) and dMMR tumors. The one case with only dMMR had six recurrent tumors within 2 years. To further subtype, we sequenced 58 SMGs in 35 samples (25 pMMR and 10 dMMR) from thirteen patients. In 35 samples, 163 mutations were identified, but none matched in almost cases, strongly indicating different clonal origins, whether synchronous or metachronous occurrences. Of the 25 pMMR cases, 1 belonged to Epstein-Barr virus (EBV), 24 belonged to chromosomal instability (CIN) subtypes. Of the thirteen cases, repetitive CIN, a mixture of CIN and MSI, a mixture of CIN and EBV, and repetitive MSI were observed in nine (70%), two (15%), one (8%) and one (8%), respectively.

CONCLUSIONS

Despite multiple tumors occurring in the same patient simultaneously or several years apart, clonal origin was totally different. 'Switching' or 'mixing' of dMMR and pMMR, EBV or CIN occurred, which had clinical relevance with regard to immunotherapy.

A case of oral multiple primary cancer including Spindle Cell Carcinoma

Spindle Cell Carcinoma (SPCC) is a relatively rare tumour that is classified as a subtype of squamous cell carcinoma (SCC). Histologically, SPCC is composed of a SCC region and epithelium-derived spindle cells with mesenchymal differentiation. We encountered an interesting case of multiple cancer including SPCC. A histopathologically atypical papillary lesion was found 13 years before our initial examination. Multiple verrucous leukoplakia later developed in the oral mucosa, for which an oral vitamin A derivative (a retinoid) was intermittently administered. Multiple cancer including SPCC subsequently developed in the lower gingiva. We investigated the case histologically and immunohistologically based on the concept of field cancerization.

Hyperplastic polyposis associated with two asynchronous colon cancers

We report a patient with hyperplastic polyposis who had two asynchronous colon cancers, a combined adenoma-hyperplastic polyp, a serrated adenoma, and tubular adenomas. Hyperplastic polyposis is thought to be a precancerous lesion; and adenocarcinoma arises from hyperplastic polyposis through the hyperplastic polyp-adenoma-carcinoma sequence. Most polyps in patients with hyperplastic polyposis present as bland-looking hyperplastic polyps, which are regarded as non-neoplastic lesions; however, the risk of malignancy should not be underestimated. In patients with multiple hyperplastic polyps, hyperplastic polyposis should be identified and followed up carefully in order to detect malignant transformation in the early stage.