Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for the Global Burden of Disease Study

Global, regional, and national burden of neuroblastoma and peripheral nervous system tumours in individuals aged over 60 from 1990 to 2021: a trend analysis of global burden of disease study

PURPOSE

Elderly individuals diagnosed with neuroblastoma and peripheral nervous system tumours often have a poor prognosis. However, there is currently a lack of comprehensive analysis on these conditions in older adults. This study aims to determine the global epidemiological trends of neuroblastoma and peripheral nervous system tumours (in individuals aged 60 and above).

METHODS

We obtained cross-sectional data from the 2021 Global Burden of Disease, Injuries, and Risk Factors Study (GBD) ( https://vizhub.healthdata.org/gbd-results/ ). We assessed the burden of neuroblastoma and peripheral nervous system tumours in the elderly from 1990 to 2021 using indicators such as prevalence and incidence. These indicators were classified by global, national, and regional levels, further stratified by Socio-Demographic Index (SDI), age, and gender. The results are organized by SDI, age, and gender categories.

RESULTS

From 1990 to 2021, the global age-standardised prevalence and incidence rates of neuroblastoma and peripheral nervous system tumours among the elderly increased from 0.06 (95% UI 0.05, 0.08) and 0.12 (95% UI 0.09, 0.15) per 100,000 to 0.11 (95% UI 0.09, 0.13) and 0.22 (95% UI 0.17, 0.26) per 100,000, respectively. Age-standardised mortality and DALY rates also rose. Central Europe had the highest age-standardised prevalence and incidence rates in 2021, while Eastern Europe had the highest DALY rate. East Asia reported the highest number of total cases and experienced the fastest growth, with significant increases in prevalence, incidence, mortality, and DALY rates. Gender disparities were evident, with elderly men showing higher rates than women, and greater EAPC values indicating a higher increase in disease burden over time. The highest age-specific rates were found in the 90-94 age group, while the 70-74 age group had the highest DALY burden.

CONCLUSION

The continuous rise in the incidence of neuroblastoma and peripheral nervous system tumours among the elderly highlights a pressing the necessity for focused public health measures and improved treatment approaches. Addressing the regional, gender, and age-related disparities requires a comprehensive approach that integrates medical advancements, social support, and public health policies. Future research should explore potential risk factors and innovative therapies to mitigate this growing global health challenge.

Current research status and future directions of hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma

The rapid evolution of systemic therapies for hepatocellular carcinoma (HCC), one of the most common types of liver cancer, has attracted significant attention especially to hepatic arterial infusion chemotherapy (HAIC) as a highly promising treatment approach. This method, which delivers chemotherapy directly into the liver's arterial supply, is designed to maximize the concentration of anti-cancer drugs at the tumor site while minimizing systemic side effects. Despite the potential and the encouraging results observed in various studies, HAIC has not yet achieved widespread acceptance and utilization. Sorafenib is a widely used systemic therapy that targets multiple pathways involved in tumor growth and angiogenesis, while transarterial chemoembolization (TACE) is a locoregional therapy that combines arterial embolization with chemotherapy. These treatments have been the mainstay of HCC management, yet they have limitations that HAIC may potentially overcome. This article specifically comments on the network meta-analysis that examined the current research status of HAIC, highlighting its effectiveness and safety profile in comparison to established standard treatments such as Sorafenib and TACE. Through an extensive review of existing studies, the authors conclude that patients receiving HAIC often experience better survival rates and longer periods without disease progression compared to those receiving Sorafenib or TACE.

RNA splicing variants of the novel long non-coding RNA, CyKILR, possess divergent biological functions in non-small cell lung cancer

The CDKN2A gene, responsible for encoding the tumor suppressors p16(INK4A) and p14(ARF), is frequently inactivated in non-small cell lung cancer (NSCLC). Herein, an uncharacterized long non-coding RNA (lncRNA) (ENSG00000267053) on chromosome 19p13.12 was found to be overexpressed in NSCLC cells with an active, wild-type CDKN2A gene. This lncRNA, named cyclin-dependent kinase inhibitor 2A-regulated lncRNA (CyKILR), also correlated with an active WT STK11 gene, which encodes the tumor suppressor, liver kinase B1. CyKILR displayed two splice variants, CyKILRa (exon 3 included) and CyKILRb (exon 3 excluded), which are cooperatively regulated by CDKN2A and STK11 as knockdown of both tumor suppressor genes was required to induce a significant loss of exon 3 inclusion in mature CyKILR RNA. CyKILRa localized to the nucleus, and its downregulation using antisense RNA oligonucleotides enhanced cellular proliferation, migration, clonogenic survival, and tumor incidence. In contrast, CyKILRb localized to the cytoplasm, and its downregulation using small interfering RNA reduced cell proliferation, migration, clonogenic survival, and tumor incidence. Transcriptomics analyses revealed the enhancement of apoptotic pathways with concomitant suppression of key cell-cycle pathways by CyKILRa demonstrating its tumor-suppressive role. CyKILRb inhibited tumor suppressor miRNAs indicating an oncogenic nature. These findings elucidate the intricate roles of lncRNAs in cell signaling and tumorigenesis.

Analysis of Unused Organ Donors in the Netherlands: Older Donor Age Associated With Higher Risk of Non-Utilization

This study aims to provide objective evidence for the subjectively observed increase in non-utilized donors and to investigate whether they share common risk factors, hypothesizing that the aging of the donor population may be a possible explanation. All referred deceased donors in the Netherlands between 2018 and 2023 were analyzed. A utilized donor was defined as a referred donor that resulted in at least one transplanted organ. A non-utilized donor was defined as a donor from whom no organ was transplanted as a result of the cessation. In total, 2,235 donors were defined as referred; 1,618 donors were utilized and 617 were non-utilized. A significant increase in referred donors aged >66 years was observed, together with an increase of 51% in non-utilized donors. The most frequent reasons for not utilizing a donor were found to be an agonal phase > 2 hours in DCD donors (45%) and an unacceptable medical history at screening (22%). Multivariable logistic regression analysis showed that increasing donor age (age 66-75 years OR 1.81, 95% CI 1.09-3.00), DCD donors (OR 4.37 95% CI 3.24-5.89, p < 0.01), history of hypertension (OR 1.29 95% CI 1.01-1.66, p = 0.04) and/or diabetes (OR 2.48 95% CI 1.75-3.51, p < 0.01) were associated with non-utilization. Non-utilized donors are significantly older, are more often DCD donors and have more co-morbidities, confirming the hypothesis that these donors are the more marginal donors.

Assessing oral Health-Related quality of life in women undergoing chemotherapy for breast Cancer in Karachi Pakistan

INTRODUCTION

In Pakistan, women undergoing chemotherapy are usually unaware of the potential impact of the treatment on their oral health related quality of life. This study aims to assess the impact of chemotherapy on oral health related quality of life.

METHOD

A cross-sectional study was conducted among 160 breast cancer (BC) patients on chemotherapy coming to Aga Khan Hospital and Jinnah Postgraduate medical center. Data collection was performed using a validated questionnaire for sociodemographic variables, types and frequency of oral hygiene measures, oral mucositis (OM) and oral health related quality of life (OHRQoL) and oral examination was performed. Data was analyzed using simple linear regression method.

RESULTS

Among these females, 119 were married, with a mean age of 47.64 ± 10.89 years. OM was present in 88, 25 used miswak/dentonic, 33 did not receive care by dentists/nurses, 15 reported moderate to severe gingival inflammation, and 85 were at stage 3 BC. OHRQoL was significantly associated with OM, women's age, marital status, gingival status, and platelet count.

CONCLUSION

This multi-center cross-sectional study highlights poor OHRQoL among BC patients undergoing chemotherapy. These findings highlight the need for comprehensive oral health care for these patients to improve their quality of life and treatment outcomes. Word Count: 201.

The role and mechanism of CHMP4C in poor prognosis and drug sensitivity of lung adenocarcinoma

BACKGROUND

Chromatin modified protein 4C (CHMP4C) is a charged polyvesicular protein (CHMP) that is involved in the composition of the endosomal sorting complex (ESCRT-III) required for transport III and promotes the necessary separation of daughter cells. CHMP4C involved in a wide variety of tumor progress, such as prostate cancer, cervical cancer and lung squamous cell carcinoma. However, the value of CHMP4C in lung adenocarcinoma has not been explored.

METHODS

RNA-seq data and lung adenocarcinoma clinical information and corresponding pan-cancer were extracted from The Cancer Genome Atlas (TCGA) database to analyze CHMP4C expression and survival prognosis. The differential expression of CHMP4C was analyzed using the Human Protein Atlas (HPA) database. Clinical samples were collected to verify the differential expression of CHMP4C between lung adenocarcinoma and normal lung tissues via immunohistochemical (IHC) staining, qRT‒PCR and Western blotting. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses of CHMP4C-related genes were performed. The correlation between CHMP4C and chemosensitivity was analyzed in the TCGA database. Then, qRT‒PCR, western blotting, transwell assays, cell proliferation assays, colony formation assays, wound healing assays, and cell cycle analysis were used to verify the possible regulatory mechanism involved. Molecular docking was used to predict small molecule compounds with potential roles in the treatment of lung adenocarcinoma.

RESULTS

TIMER2.0 database analysis revealed that CHMP4C was differentially expressed in different tumors.Compared with that in healthy lung tissue, CHMP4C was significantly upregulated in lung adenocarcinoma tissue, and subsequent in vitro survival analysis revealed that CHMP4C expression has significant clinical prognostic value in lung adenocarcinoma. Enrichment analysis revealed that CHMP4C was mainly related to cell proliferation, cell migration, and the PI3K-Akt signaling pathway, etc. Overexpression of CHMP4C was associated with sensitivity to chemotherapy. Knocking down CHMP4C can significantly inhibit the proliferation, migration and invasion of lung adenocarcinoma cells and prolong the G0/G1 phase of the cell cycle. Molecular docking predicts 10 key drugs that may be used for the treatment of lung adenocarcinoma.

CONCLUSIONS

CHMP4C is highly expressed in a variety of tumors. We demonstrated that CHMP4C expression may be associated with the occurrence, development, prognosis and chemotherapy sensitivity in patients with lung adenocarcinoma. These findings may open up new research directions and development opportunities for the treatment of lung adenocarcinoma.

CD45RO-Positive Memory T-Cell Density in the Tumoral Core and Invasive Margin Predict Long-Term Survival in Esophageal Squamous Cell Carcinoma

BACKGROUND

The association between tumor-infiltrating lymphocytes and tumor immunity has long been recognized. Among T-cell types, CD45RO-positive memory T cells (CD45RO+) are reported to correlate with survival in several cancer types, but clinical evidence is lacking in esophageal squamous cell carcinoma (ESCC).

METHODS

In surgical specimens from 162 preoperatively untreated patients, immunohistochemistry for CD45RO was performed to evaluate the density of CD45RO+ in the tumor core (CT) and invasive margin (IM) using an auto-count method. Patients were classified into high- versus low-CD45RO+ groups based on CD45RO+ density in CT and IM separately and combined. The relationship between CD45RO+ density and clinicopathological factors, including prognosis, was evaluated.

RESULTS

Average CD45RO+ density was 133/mm2 in CT and 372/mm2 in IM. No significant differences in clinicopathological factors according to high- versus low-CD45RO+ scores were identified. Using CT scores, the CD45RO+-high group had a better 5-year overall survival (OS) rate (77.2% vs. 54.7% CD45RO+-low, P = 0.0433), but OS rates did not differ statistically between the two groups by IM scores (75.7% vs. 50.3%, P = 0.0576). Using immunohistochemical scores for CT+IM, the survival difference was significant, with a 5-year OS rate of 73.7% for the CD45RO+-high group versus 46.3% for the CD45RO+-low group (P = 0.0141). Multivariate analysis identified CD45RO+ CT+IM density as an independent prognostic variable in OS (hazard ratio 2.27, 95% confidence interval 1.43-3.62, P = 0.0006).

CONCLUSIONS

Density of CD45RO+ expression in the CT and IM might be a predictor of long-term survival in ESCC.

The Impact of TP53-Induced Glycolysis and Apoptosis Regulator on Prognosis in Hepatocellular Carcinoma: Association with Tumor Microenvironment and Ferroptosis

Introduction

TP53-induced glycolysis and apoptosis regulator (TIGAR) is a p53 target protein that has critical roles in glycolysis and redox balance. The reports about the effect of TIGAR on prognosis and its biological role in hepatocellular carcinoma (HCC) are limited.

Methods

A total of 386 patients with HCC who had undergone hepatic resection were enrolled. Immunohistochemical staining for TIGAR was performed. Additionally, the regulation of malignant activity and ferroptosis by TIGAR was investigated in vitro.

Results

Patients were divided into TIGAR-positive (n = 80, 20.7%) and -negative (n = 306, 79.3%) groups. TIGAR positivity was significantly correlated with lower albumin, higher α-fetoprotein/ des-gamma-carboxyprothrombin, larger tumor size/number of tumors, and greater proportions of BCLC staging C/single nodular type/poor differentiation/microscopic vascular invasion/microscopic intrahepatic metastasis. In multivariate analysis, TIGAR positivity was an independent prognostic factor (p < 0.0001). In addition, TIGAR positivity was significantly associated with a smaller number of cluster of differentiation (CD) 8-positive T cells (p = 0.0450), larger number of CD68-positive macrophages (p = 0.0058), larger number of programmed death-ligand 1-positive cases (p = 0.0002), and larger number of vessels that encapsulate tumor cluster-positive cases (p = 0.0004). In vitro, TIGAR knockdown decreased cell motility and induced ferroptosis. TIGAR knockdown inhibited the phosphorylation of adenosine monophosphate-activated protein kinase and acetyl-CoA carboxylase. Ferroptosis induced by TIGAR knockdown was inhibited by liproxstatin and baicalein treatment. The combination of TIGAR knockdown and lenvatinib further induced ferroptosis.

Conclusion

High expression of TIGAR impacted the clinical outcome of HCC patients and TIGAR was associated not only with tumor microenvironment but also with resistance to ferroptosis.

Association between serum uric acid and the risk of breast cancer: A meta-analysis of observational studies

BackgroundThe relationship between serum uric acid and breast cancer remains uncertain. This meta-analysis aimed to elucidate the dose-response association between elevated serum uric acid levels and breast cancer risk.MethodsWe systematically searched PubMed, Embase, and Web of Science for observational studies evaluating serum uric acid and breast cancer risk in adult women. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model.ResultsTen studies were included. High serum uric acid was associated with an increased breast cancer risk (RR: 1.34; 95% CI: 1.03-1.73; P = 0.03; I2 = 78%). Meta-regression analysis revealed that the cutoff for high serum uric acid positively correlated with breast cancer risk (coefficient = 0.24; P < 0.001), explaining heterogeneity (residual I2 = 0%). Subgroup analysis demonstrated a high serum uric acid was significantly related to an increased breast cancer risk in studies with a cutoff value ≥ 5.4 mg/dL (RR: 1.95; P < 0.001), but not in those with a cutoff value < 5.4 mg/dL (RR: 0.97; P = 0.44). The dose-response meta-analysis revealed a U-shaped association between serum uric acid levels and the risk of breast cancer (P for nonlinearity = 0.013). The risk of breast cancer fell until around 4.5 mg/dL of serum uric acid, and increased afterward.ConclusionSerum uric acid may be nonlinearly associated with the risk of breast cancer (U-shaped). The risk of breast cancer increases with serum uric acid above 4.5 mg/dL, and a higher association between serum uric acid and the increased risk of breast cancer could be observed in studies with cutoff of serum uric acid  > 5.4 mg/dL.

Overview of skin cancer types and prevalence rates across continents

Skin cancer is one of the most prevalent cancers in the world, and its incidence and mortality rates are increasing continuously, mostly in regions with white-skinned inhabitants. The types of skin cancer vary in their origin and clinical appearances and also differ in their extensiveness. The continents of the world have different scenarios of skin cancer prevalence. This review aims to explore the different types of skin cancer, their clinical features, and their worldwide prevalence based on the literature. Literature from different electronic databases, including Google Scholar, ResearchGate, PubMed, Scopus, Web of Science, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Elsevier, and Springer, were collected through a literature search using specific keywords such as "skin cancer", "skin cancer types", "melanoma", "non-melanoma", "skin cancer continental prevalence" or similar keywords. The search included English publications from 2000 to 2024. Melanoma skin cancer (MSC) ranks 17th in global prevalence, with the highest incidence and deaths occurring in Europe, However, Australia and New Zealand record the highest incidence and mortality rates. Asia has a lower incidence rate of melanoma, but a higher mortality rate. Superficial spreading melanoma (SSM) is the most common type of MSC. Non-melanoma skin cancers (NMSCs) have the highest incidence in North America, with the highest number of deaths occurring in Asia, Australia and New Zealand have the highest incidence rates for basal cell carcinoma (BCC). BCC is the most commonly diagnosed skin cancer worldwide and the most prevalent form of NMSCs; however, squamous cell carcinoma is the most aggressive form of NMSCs, causing more deaths. NMSCs are the most prevalent cancers worldwide, causing most skin cancer-related deaths. The prevalence of skin cancer rising globally, with several continents experiencing higher incidence and mortality rates. The types and subtypes of skin cancer are becoming more common among clinically diagnosed cancers. This review comprehensively describes skin cancer types and their prevalence worldwide. However, the actual prevalence of skin cancer in these countries should be investigated. Further research on the prevalence of skin cancer across different continents is required to develop more effective cancer management strategies and control the spread of the disease.

Grading the evidence for physical activity and any outcome in cancer survivors: An Umbrella review of 740 meta-analytic associations

BACKGROUND

To contribute to the refinement of future physical activity (PA) guidelines, which have remained mostly generic until now, we performed an umbrella review of meta-analyses for PA in cancer survivors.

METHODS

Medline and Scopus databases were searched in January 2024 for systematic reviews and meta-analyses on the association/effect of any type of PA in every cancer type and for any studied outcome. Statistically significant meta-analyses were categorized into four evidence groups (strong, highly suggestive, suggestive, weak) using pre-established grading criteria.

RESULTS

A total of 102 publications reporting 740 meta-analytic associations were identified, including breast (n = 427), prostate (n = 104), hematological (n = 58), colorectal (n = 79) and lung (n = 54) cancer survivors. Overall, 401 (54 %) associations were nominally statistically significant, of which 16 were categorised as strong, 10 as highly suggestive, and 93 as suggestive evidence. In breast cancer, there was strong or highly suggestive evidence that post-diagnosis PA is associated with lower all-cause mortality, recurrence, cancer-related fatigue, depression, and higher mental health, body strength, aerobic capacity, and weight loss. In prostate cancer, strong evidence was identified for the positive association of PA with cardiovascular fitness, quality of life and fatigue amelioration. In colorectal cancer, strong and highly suggestive evidence supported the association of PA with lower all-cause mortality. In lung cancer, strong evidence supported the association of preoperative combination of breathing exercise and PA with reduced length of hospital stay.

CONCLUSION

This grading of the entirety of the available evidence can facilitate robust introduction of targeted exercise prescription in oncology care as standard practice.

Multicenter Real-World Study: 432 Patients with Apalutamide in Metastatic Hormone-Sensitive Prostate Cancer

Background: The management of metastatic hormone-sensitive prostate cancer (mHSPC) has evolved significantly in recent years due to the introduction of androgen receptor-targeted agents (ARTAs). When used alongside androgen deprivation therapy (ADT), these treatments have shown improved oncological results and enhanced survival rates for patients with this condition. Objectives: The objective of this study was to describe the decline in prostate-specific antigen (PSA), the oncological outcomes, and the toxicity profile of mHSPC patients treated with apalutamide. Materials and Methods: Clinical data obtained from seven national hospitals were utilized between March 2021 and July 2024. PSA responses were collected at 3, 6, 12, 18, and 24 months, along with adverse effects reported by patients, dose reductions, or drug discontinuations. The association between PSA decline and progression-free survival (PFS) was evaluated with respect to metastasis volume, location, and timing of diagnosis. Results: A total of 432 patients were included, of whom 40% were de novo cases, and the greater part were classified as M1b. After one year, a reduction of more than 90% in PSA levels was observed in 88.2% of cases, with undetectable levels (≤0.2 ng/mL) achieved in 81.7% of them. The drug was discontinued in 76 patients (15.6%), with adverse effects reported in 7.8% (grade 3) and 1.9% (grade 4). Regarding PSA levels <0.02 ng/mL, promising results were observed, with ultralow PSA (UL2) achieved in 43% of cases at 6 months. Conclusions: This study revealed strong oncological outcomes, with rapid and profound PSA declines and drug safety consistent with emerging evidence. The distinctive finding of this study underscores the importance of a rapid and profound response (UL PSA) as a predictor of better oncological outcomes.

Palliative biliodigestive bypass for unresectable pancreatic malignancy at Kilimanjaro Christian medical centre: a retrospective cross-sectional study

BACKGROUND

Pancreatic cancer is a common and deadly cancer, ranking as the 14th most common cancer worldwide and the 7th leading cause of cancer-related deaths. Advanced pancreatic malignancy frequently presents with biliary and gastric outlet obstruction and palliative open interventions are often required, especially in low-income countries where endoscopic surgical bypass methods are often unavailable. This study aimed to describe the demographic and clinical characteristics of patients undergoing biliodigestive bypass for pancreatic malignancy.

METHODS

This was a hospital-based retrospective observational study at the tertiary hospital in northern Tanzania. We included 53 patients who underwent double or triple bypass surgery for pancreatic malignancy between January 2019 to December 2022 at Kilimanjaro Christian Medical Centre (KCMC), Tanzania. Data was collected from medical records, analyzing demographics, comorbidities, pre-surgery and surgery details, and post-surgery outcomes. Descriptive statistics were used to summarize continuous variables as mean with standard deviation and categorical variables as percentages.

RESULTS

53 patients were analyzed, with a mean age of 63.2 years and a male to female ratio of 1.03:1. Jaundice was the most common presentation (77.4%). Of the patients, 74.5% had comorbidities, and the majority (81.1%) were uninsured. 50.9% of patients had a length of hospital stay shorter than 5 days, and 88.3% resumed normal oral intake. Palliation failure was observed in 22.6% of patients. The median survival time for the entire cohort of patients was 65 days. Patients with palliation failure had a significantly shorter mean survival time than those without complications (14.17 vs. 90 days, p = 0.001).

CONCLUSION

Bypass surgery remains a treatment of choice for palliating symptoms in patients with advanced pancreatic cancer. This study highlights the importance of prompt diagnosis of pancreatic tumors, especially in low-income countries, to achieve better outcomes.

Diagnostic accuracy of methylated SEPT9 for primary liver cancer: a systematic review and meta-analysis

Background

Primary live cancer (PLC), including hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). This meta-analysis was conducted to evaluate the diagnostic efficacy of blood methylated septin 9 gene (mSEPT9) for PLC and to analyze its performance across various subgroups.

Methods

We conducted a comprehensive search across PubMed, the Cochrane Library, Embase, and China National Knowledge Infrastructure (CNKI), covering research up to May 10, 2024. The pooled sensitivity, specificity, diagnostic odds ratios, and area under the summary receiver operating characteristic (AUC) were calculated for the diagnostic performance of mSEPT9 for PLC. The quality of the studies was assessed using the QUADAS-2 tool, and the meta-analysis was performed using Stata16.0 software.

Results

Ten articles with 2,182 participants were included in the meta-analysis. The pooled sensitivity of mSEPT9 for detecting primary liver cancer was 0.51 (95% confidence interval [CI]: 0.37-0.65), and the pooled specificity was 0.93 (95% CI: 0.78-0.98). The pooled diagnostic odds ratio was 13 (95% CI: -58), and the area under the Summary Receiver Operator Characteristic Curve was 0.75 (95% CI: 0.71-0.79). Subgroup analyses showed that ICC, case-control studies, qPCR and Asian populations had higher specificities (0.99 [95% CI: 0.97-1.00], 0.93 [95% CI: 0.91-0.95], 0.90 [95% CI: 0.88-0.92] and 0.94 [95% CI: 0.92-0.96], respectively) and diagnostic odds ratios (62.04 [95% CI: 6.53-589.53], 17.62 [95% CI: 4.03-76.99], 13.03 [95% CI: 2.01-84.63] and 14.19 [95% CI: 2.42-83.11], respectively) compared to hepatocellular carcinoma, cohort Study, and Euramerican populations.

Conclusions

This study confirmed that mSEPT9 in blood has high specificity and moderate sensitivity for detecting primary liver cancer. The diagnostic performance of mSEPT9 varied across different subgroups, limiting its use as an independent screening tool and necessitating its use in conjunction with other methods for confirmatory diagnostics.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42024549669.

Exploring the Therapeutic Potential of Artemisia and Salvia Genera in Cancer, Diabetes, and Cardiovascular Diseases: A Short Review of Clinical Evidence

Metabolic syndrome, a cluster of metabolic disorders comprising dyslipidemia, insulin resistance, elevated blood pressure, and abdominal obesity, is a silent epidemic that may lead to outcomes such as cardiovascular disease, diabetes, and cancer. Due to the increase in the prevalence of these pathologies, the search for better treatments and more efficient drugs is imperative. Species of Artemisia and Salvia genera are excellent examples of noteworthy sources of bioactive products with health applications, their therapeutic properties being well known both in popular medicine and in the scientific community. There are reports of plant extracts or compounds from species belonging to either of these genera, which were able to combat cancer, diabetes, and cardiovascular pathologies. For instance, dihydroartemisinin (analog of artemisin extracted from Artemisia annua L.) can reduce tumor markers p53 and Ki-67 expression levels, leading to a reduction in tumor proliferation. Salvia officinalis L. has antihyperglycemic and lipid profile-improving effects since it decreases total cholesterol, glycosylated hemoglobin, fasting glucose, low-density lipoprotein cholesterol, and triglyceride levels while increasing high-density lipoprotein cholesterol levels. Clinical trials using mixtures (dried powdered plants or extracts) of known medicinal plants are recurrent in published works, in contrast with the scarce clinical trial studies with isolated compounds. Salvia miltiorrhiza Bunge. was by far the most targeted plant in the clinical trials analyzed here. Regarding clinical trials concerning Artemisia, there are more studies aiming to see its effect on diabetes, but the studies about cancer are more advanced. This review aims to give a critical summary of the most interesting and promising results from clinical trials. The abundance of studies with limited statistically significant clinical evidence hinders progress in clinical therapy. This situation demands far greater rigor from the scientific community, researchers, regulatory agencies, editors, and reviewers in conducting and publishing clinical studies.

A Clinical Trial to Determine the Impact of Tumor Size, Histological Subtype, and Vitamin D Status on the Therapeutic Response of Basal Cell Carcinoma to Photodynamic Therapy

Photodynamic therapy (PDT) with topical aminolevulinic acid (ALA) can be effective for select basal cell carcinoma (BCC) lesions. However, the histological depth and subtype of tumors that respond to PDT remain uncertain. Here, we report a clinical trial of high-dose oral Vitamin D (VD), used as a PDT neoadjuvant for BCC. In this multi-institutional, intra-patient, randomized trial, 35 patients (9 with Gorlin Syndrome) received three PDT sessions (20% ALA; 417 nm blue light) preceded by oral VD, placebo, or no pretreatment. Tumors (122 BC) were monitored using 3D photography and computer-assisted volumetric analysis. Values for absolute volume (3DAbsVol) and average height (3DAvHt) were calculated and used to quantify tumor response kinetics. From histological sections, 3DAvHt was found to correlate with actual tumor depth, although 3DAvHt is only ~10-20% of the latter. Importantly, 3DAvHt measurements revealed a distinct depth threshold that predicts PDT responsiveness. Of 122 tumors analyzed, 70% cleared after PDT; remaining tumors were micronodular or other aggressive histologic subtypes. To evaluate VD's effects upon treatment response kinetics after PDT, only 40% of original lesions were available for analysis. By stratifying remaining tumors by 3DAvHt, we found 65% of thin tumors to be VD-responsive, whereas only 28% of thick tumors responded to VD. Overall, PDT was effective for the majority of BCC lesions in our study. Tumors most likely to respond can be predicted histologically and by noninvasive 3D morphometry. For PDT-appropriate BCC lesions, neoadjuvant oral Vitamin D represents a safe and beneficial way to accelerate tumor resolution.

C-reactive protein is a prognostic biomarker in pancreatic ductal adenocarcinoma patients

AIM

The 5-year survival rate of pancreatic ductal adenocarcinoma (PDAC) is approximately 11% and has only improved marginally over the last three decades. For operable PDAC, resection and adjuvant FOLFIRINOX chemotherapy is standard of care. There is growing interest in perioperative regimens to improve outcomes. The non-randomized Phase II study "Gemcitabine and Abraxane for resectable Pancreatic cancer" (GAP) demonstrated the feasibility of perioperative gemcitabine/abraxane. Long-term survival in PDAC requires an effective immune response; hence, we undertook this translational study of the GAP trial cohort to identify immune-oncology biomarkers for clinical use.

METHODS

We combined Nanostring nCounter technology with immunohistochemistry to investigate the correlation between gene expression and overall patient survival. Findings were investigated in samples from the International Cancer Genome Consortium (ICGC, n = 88) and the Australian Pancreatic Genome Initiative (APGI, n = 227).

RESULTS

We confirmed that human equilibrative nucleoside transporter 1 (hENT1) expression was not a prognostic marker in PDAC but patients with high levels of hENT1 were more likely to live longer than 24 months post-surgery. Additionally, CD274 (PD-L1) and two novel biomarkers of survival, cathepsin W (CTSW) and C-reactive protein (CRP), were identified in the GAP cohort (n = 19). CRP expression was confirmed in data from the ICGC. Although PD-L1 and CTSW proteins were not significant across all three cohorts, results show that low CRP mRNA and protein expression are associated with longer overall survival in all three patient groups.

CONCLUSION

PDAC patients with long survival have higher hENT1 expression levels. Furthermore, CRP expression is a biomarker of poor prognosis following perioperative chemotherapy and resection in PDAC patients and thus may be useful for identifying patients who could benefit from more aggressive adjuvant strategies.

Bladder Cancer Mortality Trend in Montenegro: 1990-2021

Background

Bladder cancer accounts for more than 200,000 deaths annually on a global level, with an age-standardized mortality rate of 2.9 per 100,000 individuals. Despite declining global rates, it remains a substantial public health burden. We aimed to analyze the mortality trend of bladder cancer in Montenegro and identify the measures taken to combat this tumor.

Methods

Bladder cancer mortality data in Montenegro from 1990 to 2021 were collected. Mortality rates were age-standardized to the World Standard Population. The joinpoint, linear and Poisson regressions were used to assess bladder cancer mortality trend.

Results

There was a consistent increase in mortality rates due to bladder cancer, with statistical significance for both the overall population and specifically for males, with an average annual percent change (AAPC) of 1.5% (95% CI: 1.5 (0.5-2.9)) and 1.6% (AAPC (95% CI): 1.6 (0.4-3.3)) respectively. Additionally, there was a notable annual increase in the number of bladder cancer cases: average annual increase was 3.4% for the overall population, 3.5% in male and 2.9% in female, with statistical parameters (AAPC (95% CI), P-value) for join point regression: 3.4 (2.4-4.8), <0.001; 3.5 (2.3-5.1), 0.003; and 2.9 (1.2-5.1), 0.004, respectively. The majority of bladder cancer deaths occurred in the age groups of 65-74 (35.8%), 75-84 (33.6%), and 55-64 (16.8%).

Conclusion

The ongoing increase in bladder cancer mortality in Montenegro, particularly among men and elderly should encourage policymakers to take action to reverse this unfavorable trend.

Burden of respiratory tract cancers in China and its provinces, 1990-2021: a systematic analysis of the Global Burden of Disease Study 2021

Background

Respiratory tract cancers emerged as a public health challenge with the highest incidence and mortality among all cancer types in China, despite many national policies in place, such as early cancer screening. It is of outmost importance to monitor the burden of respiratory tract cancers across China and its provinces for refining health strategies.

Methods

Based on Global Burden of Disease (GBD) estimates, the present study investigated the age-sex specific pattern alterations of incidence, prevalence, mortality, and disability adjusted life years (DALYs) of respiratory tract cancers in China from 1990 to 2021, as well as its Estimated Annual Percentage Change (EAPC), Age-Standardized Incidence Rate (ASIR), and Age-Standardized Mortality Rate (ASMR).

Findings

Between 1990 and 2021, China experienced an escalation in burdens of respiratory tract cancers, with the new cases surging from 274,752 (95% Uncertainty Interval (UI): 234,741-315,112) to 934,704 (750,040-1,136,938), marking an increase of 240.20% (156.05-342.29). Their attributed deaths similarly increased from 278,235 (238,518-322,013) to 814,121 (652,231-994,858). In 2021, the eastern and northeastern regions reported the highest incidence and mortality rates, particularly Shandong, with the highest new cases at 77,225 (58,842-101,352), while Tibet, Qinghai, and Macau observed the lowest. Regarding laryngeal cancer, Guangdong reported the highest incidence at 3466 (2230-4934), with Hainan exhibiting the highest ASIR at 3.46 (2.10-5.11) per 100,000 person-years and ASMR at 2.11 (1.37-3.09) per 100,000 person-years. Over the same timeframe, the EAPC for the ASIR of tracheal, bronchus, and lung cancer was 0.88 (0.63-1.14), and for ASMR, it was 0.29 (0.05-0.62), signifying an upward trend. Conversely, laryngeal cancer exhibited a stable ASIR with an EAPC of 0.04 (-0.22 to 0.30) and a declining ASMR with an EAPC of -1.69 (-1.80 to 1.59). Tracheal, bronchus, and lung cancer burdens exhibited notable sex differences, with their ASIR being 62.63 (46.50-79.90) per 100,000 person-years in males and 28.16 (22.22-34.90) per 100,000 person-years in females. For laryngeal cancer, the ASIR was 3.12 (2.34-4.04) per 100,000 person-years for males and 0.58 (0.35-0.79) per 100,000 person-years for females. Smoking and air pollution emerged as the predominant risk factors contributed to tracheal, bronchus, and lung cancer, accounting for 61.58% (30.00-82.95) and 25.98% (16.94-35.00) of deaths, respectively. In contrast, smoking contributed more to laryngeal cancer-caused deaths (76.70% [65.55-85.15]), followed by alcohol use (14.52% [7.70-20.99]).

Interpretation

The burden of respiratory tract cancers in China has increased over the past three decades, and without intervention, the associated health losses could escalate further. This burden predominantly affected the eastern provinces, particularly impacting older males. Our findings advocate for the formulation of targeted prevention, screening, and intervention strategies based on regional and sex disparities.

Funding

Bill & Melinda Gates Foundation.

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.

Quality assurance in lung cancer screening

The effectiveness of screening programmes is critically dependent on the accuracy of the screening test. Where this relies on clinical expertise, there is an imperative to assure that the level of expertise meets expected standards. In cancer screening involving images, the focus is on the reader. Auditing of results is fraught with difficulty because of the time taken to accumulate enough data with confirmed outcomes to identify underperformance before any harm is done. Late recognition can lead to the need for reanalysis and recall of screening participants with loss of confidence in the programme. External quality assurance (EQA) is a method that enables clinical expertise to be tested rapidly by using test datasets with confirmed clinical outcome. In the UK, the breast cancer screening programme has had EQA in place for over 30 years. This article describes the development of the first EQA process in lung cancer screening, using the experience gained from running the breast cancer EQA, and the proposed future developments.

Effectiveness of mHealth-based psychosocial interventions for breast cancer patients and their caregivers: A systematic review and meta-analysis

BACKGROUND

Breast cancer causes significant distress in patient-caregiver dyads. While psychosocial and/or mHealth-based interventions have shown efficacy in improving their psychosocial well-being, no reviews have synthesised the effectiveness of such interventions delivered specifically to the breast cancer patient-caregiver dyad.

OBJECTIVE

To synthesise available evidence examining the effectiveness of mHealth-based psychosocial interventions among breast cancer patient-caregiver dyads in improving their psychosocial well-being (primary outcomes: dyadic adjustment, depression and anxiety; secondary outcomes: stress, symptom distress, social well-being and relationship quality), compared to active or non-active controls.

DESIGN

A systematic review and meta-analysis.

METHODS

Randomised controlled trials and quasi-experimental studies were comprehensively searched from seven electronic databases (PubMed, CENTRAL, CINAHL, Embase, PsycINFO, Scopus, Web of Science), ongoing trial registries (ClinicalTrials.gov, WHO ICTRP) and grey literature (ProQuest Dissertations and Theses Global) from inception of databases till 23 December 2022. Studies involving breast cancer patient-caregiver dyads participating in mHealth-based psychosocial interventions, compared to active or non-active controls, were included. Exclusion criteria were terminally ill patients and/or participants with psychiatric disorders or cognitive impairment and interventions collecting symptomatic data, promoting breast cancer screening or involving only physical activities. Screening, data extraction and quality appraisal of studies were conducted independently by two reviewers. Cochrane Risk of Bias Tool version 1 and JBI Critical Appraisal Checklist were used to appraise the randomised controlled trials and quasi-experimental studies, respectively. Meta-analyses using Review Manager 5.4.1 synthesised the effects of outcomes of interest. Sensitivity and subgroup analyses were conducted. The GRADE approach appraised the overall evidence quality.

RESULTS

Twelve trials involving 1204 breast cancer patient-caregiver dyads were included. Meta-analyses found statistically significant increase in caregiver anxiety (standardised mean difference (SMD) = 0.43, 95% confidence interval (CI) [0.09, 0.77], Z = 2.47, p = 0.01), involving 479 caregivers in 5 studies, and stress (SMD = 0.25, 95% CI [0.05, 0.45], Z = 2.44, p = 0.01), involving 387 caregivers in 4 studies post-intervention, favouring control groups. The intervention effects on the remaining outcomes were statistically insignificant. Beneficial effects of such interventions remain uncertain. The overall quality of evidence was very low for all primary outcomes.

CONCLUSIONS

Results of the effectiveness of mHealth-based psychosocial interventions on the psychosocial well-being of breast cancer patient-caregiver dyads are inconclusive. The high heterogeneity shown in the meta-analyses and very-low overall quality of evidence imply the need for cautious interpretation of findings. Higher-quality studies are needed to assess the effects of psychosocial interventions on dyadic outcomes and determine optimal intervention regimes.

Ischemic Heart Disease in the Cancer Population: Trends, Outcomes, Epidemiology, and Challenges in Diagnosis and Treatment

Patients with cancer are at increased risk of ischemic heart disease (IHD). The increased risk of IHD in these patients is due to the interaction of shared risk factors, cancer type and stage, and immuno/chemotherapy and radiotherapy regimens. Management of IHD in cancer patients is challenging, due to atypical presentation, increased thrombotic and bleeding risk, and worse outcomes compared to patients without cancer. In this review, we will discuss the trends, outcomes, epidemiology and challenges in the diagnosis and treatment of IHD among cancer patients.

Breast Cancer Prevention Practices and Knowledge in Italian and Chinese Women in Italy: Clinical Checkups, Free NHS Screening Adherence, and Breast Self-Examination (BSE)

Breast cancer remains a significant global concern, underscoring the critical need for early detection and prevention strategies. Primary and secondary preventive measures, such as routine screenings and behaviors like breast self-examination (BSE), play a crucial role in facilitating early diagnosis. While the National Health System (NHS) in Italy offers free regular screenings for women aged 50-69, there is a lack of clarity regarding the participation of both Italian and Chinese women residing in Italy in these screening programs. This study aims to bridge this knowledge gap by thoroughly assessing the involvement in regular clinical check-ups and the types of screening employed, the adherence to free screenings offered by the NHS, and the practice of BSE among women aged 50-69 of these two groups. Furthermore, it investigates their knowledge and perceptions regarding breast cancer and BSE. Results reveal disparities in breast cancer control practice between Italian and Chinese women in Italy: the former demonstrates higher adherence to clinical checkups (53% vs. 3%, p < 0.001), while both groups show low participation in free NHS screenings (70% vs. 4%, p < 0.001). Additionally, Chinese women reported significantly lower frequency of mammography (96% vs. 33%, p < 0.001) and ultrasound (69% vs. 16%, p < 0.001). The frequency of BSE also differed substantially, with 47% of Chinese women never performing BSE compared to 12% of Italian women (p < 0.001). This comprehensive exploration provides valuable insights, attitudes, and knowledge into the disparities and potential areas for improvement in breast cancer prevention, thus contributing to the overall well-being of these communities. The findings highlight the necessity for educational initiatives aimed at improving awareness and participation in screenings, particularly among the Chinese population. These initiatives could have profound implications for patient education by equipping women with the knowledge and skills necessary to engage in proactive health behaviors.

Integrating multiomics analysis and machine learning to refine the molecular subtyping and prognostic analysis of stomach adenocarcinoma

Stomach adenocarcinoma (STAD) is a common malignancy with high heterogeneity and a lack of highly precise treatment options. We downloaded the multiomics data of STAD patients in The Cancer Genome Atlas (TCGA)-STAD cohort, which included mRNA, microRNA, long non-coding RNA, somatic mutation, and DNA methylation data, from the sxdyc website. We synthesized the multiomics data of patients with STAD using 10 clustering methods, construct a consensus machine learning-driven signature (CMLS)-related prognostic models by combining 10 machine learning methods, and evaluated the prognosis models using the C-index. The prognostic relationship between CMLS and STAD was assessed using Kaplan-Meier curves, and the independent prognostic value of CMLS was determined by univariate and multivariate regression analyses. we also evaluated the immune characteristics, immunotherapy response, and drug sensitivity of different CMLS groups. The results of the multiomics analysis classified STAD into three subtypes, with CS1 resulting in the best survival outcome. In total, 10 hub genes (CES3, AHCYL2, APOD, EFEMP1, CYP1B1, ASPN, CPE, CLIP3, MAP1B, and DKK1) were screened and constructed the CMLS was significantly correlated with prognosis in patients with STAD and was an independent prognostic factor for patients with STAD. Using the CMLS risk score, all patients were divided into a high CMLS group and a low CMLS group. Patients in the low-CMLS group had better survival, more enriched immune cells, and higher tumor mutation load scores, suggesting better immunotherapy responsiveness and a possible "hot tumor" phenotype. Patients in the high-CMLS group had a significantly poorer prognosis and were less sensitive to immunotherapy but were likely to benefit more from chemotherapy and targeted therapy. In this study, 10 clustering methods and 10 machine learning methods were combined to analyze the multiomics of STAD, classify STAD into three subtypes, and constructed CMLS-related prognostic model features, which are important for accurate management and effective treatment of STAD.

Utilizing TP53 hotspot mutations as effective predictors of gemcitabine treatment outcome in non-small-cell lung cancer

TP53 mutations are recognized to correlate with a worse prognosis in individuals with non-small cell lung cancer (NSCLC). There exists an immediate necessity to pinpoint selective treatment for patients carrying TP53 mutations. Potential drugs were identified by comparing drug sensitivity differences, represented by the half-maximal inhibitory concentration (IC50), between TP53 mutant and wild-type NSCLC cell lines using database analysis. In addition, clinical data from NSCLC patients were collected to evaluate both their TP53 status and their response to gemcitabine, thereby facilitating further validation. Subsequently, NSCLC cell lines with different TP53 status (A549 and H1299) were subjected to gemcitabine treatment to investigate the association between TP53 mutations and gemcitabine response. According to the dataset, NSCLC cell lines carrying TP53 mutations displayed heightened sensitivity to gemcitabine. From a clinical standpoint, patients exhibiting TP53 hotspot mutations demonstrated prolonged overall survival upon gemcitabine treatment. In vitro, overexpressing various hotspot TP53 mutations significantly sensitized H1299 cells to gemcitabine. Moreover, the knockdown of TP53 in A549 cells notably augmented sensitivity to gemcitabine treatment, as evidenced by cell viability and reproductive cell death assays. Conversely, the overexpression of wild-type TP53 in H1299 cells led to an increased resistance against gemcitabine. Gemcitabine is a treatment option for patients with non-small cell lung cancer (NSCLC) who carry TP53 hotspot mutations. This potential effectiveness might arise from its ability to disrupt DNA damage repair processes, leading to G2/M phase cell cycle arrest or an augmentation of mitotic abnormalities, eventually cause cell death. As a result, when planning treatment strategies for NSCLC patients possessing TP53 hotspot mutations, gemcitabine should be considered to incorporate into the indication.

Evaluation of Grading Estrogen Receptors in Breast Cancer Using Fully Automated Rapid Immunohistochemistry Based on Alternating-Current Electric Field Technology

BACKGROUND

Immunohistochemistry (IHC) is crucial for determining cancer treatments. We previously developed a rapid IHC method and have now developed a fully automated rapid IHC stainer (R-Auto). This study aimed to evaluate the clinical reliability of the R-Auto protocol for staining estrogen receptors (ERs) in breast cancer specimens and evaluate the staining performance.

METHODS

Between January 2015 and June 2020, 188 surgical specimens collected from breast cancer patients treated at our hospital were evaluated via ER staining using R-Auto, conventional manual IHC, and a commercial autostainer. The specimens were scored using Allred scores, after which the staining results were compared between R-Auto and conventional IHC or the commercial autostainer. Weighted kappa coefficients and AC1 statistics were used to assess the agreement between the methods.

RESULTS

The AC1 statistic for comparison between R-Auto and conventional IHC was 0.9490 (0.9139-0.9841), with a 95.7% agreement rate, and that for comparison between R-Auto and the commercial autostainer was 0.9095 (0.8620-0.9570), with a 92.6% agreement. There was, thus, substantial agreement between R-Auto and both conventional IHC and the commercial autostainer. However, R-Auto shortened the time required for IHC from 209 min with conventional IHC to 121 min.

CONCLUSIONS

R-Auto enables a good staining performance in a shorter time with less effort.

Cervical cancer screening by cotesting method for Vietnamese women 25-55 years old: a cost-effectiveness analysis

BACKGROUND

Cervical cancer (CC) is preventable through regular screening and vaccination against human papillomavirus (HPV). However, CC remains a significant public health issue in low-income and middle-income countries (LMICs) like Vietnam, where financial constraints hinder the widespread implementation of HPV vaccination and screening programmes. Currently, Vietnam lacks both a national CC screening intervention and an HPV vaccination programme for women and girls. To date, cost-effectiveness studies evaluating CC screening methods in Vietnam remain limited.

OBJECTIVES

To evaluate the cost-effectiveness of two CC screening strategies for Vietnamese women aged 25-55 years: (1) cotesting combining cytology and HPV testing conducted three times at 5 year intervals (intervention) and (2) cytology-based screening conducted five times at 2 year intervals (comparator). The objective is to provide evidence to inform policy and clinical practice in Vietnam.

DESIGN

Cost-effectiveness analysis using a Markov model with 1 year cycles to simulate the natural progression of CC.

SETTING

The Vietnamese healthcare system, modelled from the provider's perspective, with parameters adapted to the local context through expert consultations.

PARTICIPANTS

A simulated cohort of Vietnamese women aged 25-55 years.

INTERVENTIONS

The intervention involved cotesting (cytology and HPV testing) three times at 5 year intervals. The comparator was cytology-based screening conducted five times at 2 year intervals.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measure was quality-adjusted life years (QALYs). Costs and cost-effectiveness ratios were assessed using Vietnam's gross domestic product (GDP) per capita as the cost-effectiveness threshold (1-3 times GDP per capita). Sensitivity analyses (one-way deterministic and probabilistic) were conducted to account for uncertainties.

RESULTS

The cotesting strategy was less effective and more costly than cytology-based screening across all age groups. Cotesting resulted in higher costs and fewer QALYs than the comparator. Probabilistic sensitivity analyses confirmed that cotesting was not cost-effective under current conditions in Vietnam.

CONCLUSIONS

Cytology-based screening conducted five times at 2 year intervals is a more cost-effective option for CC screening in Vietnamese women aged 25-55 years. The cotesting strategy cannot be recommended due to its higher cost and lower effectiveness.

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.

Global, regional and national burden of pancreatic cancer and its attributable risk factors from 2019 to 2021, with projection to 2044

Background

To estimate the global burden of pancreatic cancer in 2019 and 2021 including incidence, mortality, and disability-adjusted-life-years (DALYs).

Methods

Data on pancreatic cancer incidence, mortality and DALYs were downloaded from the Global Health Data Exchange. The 95% uncertainty intervals (UIs) were reported for annual numbers and rates (per 100,000 populations).

Results

In 2021, there were 508,532 (95% UI: 462,09 to 547,208) incident cases of pancreatic cancer globally, of which 273,617 (250,808 to 299,347; 53.8%) were in males. The age-standardized incidence rate was 6.0 (5.5 to 6.5) per 100,000 people in 2019 and decreased to 5.9 (5.4 to 6.4) per 100,000 people in 2021. There was a 3.9% increase in the number of deaths from pancreatic cancer from 486,869 (446,272 to 517,185) in 2019 to 505,752 (461,224 to 543,899) in 2021. There was a 3.5% increase in DALYs due to pancreatic cancer, increasing from 10.9 million (10.1 to 11.7) in 2019 to 11.3 million (10.5 to 12.2) in 2021. In 2021, the highest age-standardized death rates were observed in Greenland and Monaco, and the highest age-standardized DALY rates were observed in Greenland and Uruguay. The numbers of incident cases and deaths peaked at the ages of 70 to 74 years. The pancreatic cancer burden increased as the socio-demographic index increased. To 2044, the number of incident cases and deaths will be more than 875 thousand and 879 thousand, respectively.

Conclusion

The disease burden of pancreatic cancer remains high, especially in high-income regions. More cancer prevention measures are needed in the future to reduce the burden of pancreatic cancer.

Gene-Environment Interaction: Small Deletions (DELs) and Transcriptomic Profiles in Non-Melanoma Skin Cancer (NMSC) and Potential Implications for Therapy

Arsenic (As) is a risk factor for non-melanoma skin cancer (NMSC). From a six-year follow-up study on 7000 adults exposed to As, we reported the associations of single-nucleotide variation in tumor tissue and gene expression. Here, we identify the associations of small deletions (DELs) and transcriptomic profiles in NMSC. Comparing the (a) NMSC tissue (n = 32) and corresponding blood samples from each patient, and (b) an independent set of non-lesional, healthy skin (n = 16) and paired blood, we identified NMSC-associated DELs. Differential expressions of certain gene pathways (TGF-β signaling pathway, IL-17 pathway, PD-L1 pathway, etc.) showed significant interactions with these somatic DELs and As exposure. In low-As-exposure cases, the DELs in APC were associated with the up-regulation of inflamed T-Cell-associated genes by a fold change (FC) of 8.9 (95% CI 4.5-17.6), compared to 5.7 (95% CI 2.9-10.8) without APC DELs; in high-As-exposure cases, the APC DELs were associated with an FC of 5.8 (95% CI 3.5-9.8) compared to 1.2 (95% CI -1.3 to 1.8) without APC DELs. We report, for the first time, the significant associations of somatic DELs (many in STR regions) in NMSC tissue and As exposure with many dysregulated gene pathways. These findings may help in selecting groups of patients for potential targeted therapy like PD-L1 inhibitors, IL-17 inhibitors, and TGF-β inhibitors in the future.

CD33-CD123 IF-THEN Gating Reduces Toxicity while Enhancing the Specificity and Memory Phenotype of AML-Targeting CAR-T Cells

SIGNIFICANCE

Our study demonstrates the use of "IF-THEN" SynNotch-gated CAR-T cells targeting CD33 and CD123 in AML reduces off-tumor toxicity. This strategy enhances T-cell phenotype, improves expansion, preserves HSPCs, and mitigates cytokine release syndrome-addressing critical limitations of existing AML CAR-T therapies.

Evaluating the impact of enhanced recovery after surgery protocols following oesophagectomy: a systematic review and meta-analysis of randomised clinical trials

Enhanced Recovery After Surgery (ERAS) protocols are evidence-based care improvement pathways which are perceived to expedite patient recovery following surgery. Their utility in the setting of oesophagectomy remains unclear. The aim of this study was to perform a systematic review and meta-analysis of randomised clinical trials (RCTs) to evaluate the impact of ERAS protocols on recovery following oesophagectomy compared to standard care. A systematic review was performed in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. Meta-analysis was performed using Review Manager (Version 5.4). Six RCTs including 850 patients were included in this meta-analysis. Overall complication rate (Odds Ratio (OR): 0.35, Confidence Interval (CI): 0.21, 0.59, P < 0.0001), pulmonary complications (OR: 0.40, CI: 0.24, 0.67, P = 0.0005), post-operative length of stay (LOS) (OR -1.88, CI -2.05, -1.70, P < 0.00001) and time to post-operative flatus (OR: -5.20, CI: -9.46, -0.95, P = 0.02) favoured the ERAS group. There was no difference noted for anastomotic leak (OR: 0.55, CI: 0.24, 1.28, P = 0.17), cardiac complications (OR: 0.86, CI: 0.30, 2.46, P = 0.78), gastrointestinal complications (OR: 0.51, CI: 0.23, 1.17, P = 0.11), wound complications (OR: 0.85, CI: 0.28, 2.58, P = 0.78), mortality (OR: 1.37, CI: 0.26, 7.4, P = 0.71), and 30-day re-admission rate (OR: 1.29, CI: 0.30, 5.47, P = 0.73) between ERAS and standard care groups. ERAS implementation improved post-operative complications, LOS, and time to flatus following oesphagectomy. These results support the robust adoption of ERAS in patients indicated to undergo oesphagectomy.

Application of MRI image segmentation algorithm for brain tumors based on improved YOLO

Objective

To assist in the rapid clinical identification of brain tumor types while achieving segmentation detection, this study investigates the feasibility of applying the deep learning YOLOv5s algorithm model to the segmentation of brain tumor magnetic resonance images and optimizes and upgrades it on this basis.

Methods

The research institute utilized two public datasets of meningioma and glioma magnetic resonance imaging from Kaggle. Dataset 1 contains a total of 3,223 images, and Dataset 2 contains 216 images. From Dataset 1, we randomly selected 3,000 images and used the Labelimg tool to annotate the cancerous regions within the images. These images were then divided into training and validation sets in a 7:3 ratio. The remaining 223 images, along with Dataset 2, were ultimately used as the internal test set and external test set, respectively, to evaluate the model's segmentation effect. A series of optimizations were made to the original YOLOv5 algorithm, introducing the Atrous Spatial Pyramid Pooling (ASPP), Convolutional Block Attention Module (CBAM), Coordinate Attention (CA) for structural improvement, resulting in several optimized versions, namely YOLOv5s-ASPP, YOLOv5s-CBAM, YOLOv5s-CA, YOLOv5s-ASPP-CBAM, and YOLOv5s-ASPP-CA. The training and validation sets were input into the original YOLOv5s model, five optimized models, and the YOLOv8s model for 100 rounds of iterative training. The best weight file of the model with the best evaluation index in the six trained models was used for the final test of the test set.

Results

After iterative training, the seven models can segment and recognize brain tumor magnetic resonance images. Their precision rates on the validation set are 92.5, 93.5, 91.2, 91.8, 89.6, 90.8, and 93.1%, respectively. The corresponding recall rates are 84, 85.3, 85.4, 84.7, 87.3, 85.4, and 91.9%. The best weight file of the model with the best evaluation index among the six trained models was tested on the test set, and the improved model significantly enhanced the image segmentation ability compared to the original model.

Conclusion

Compared with the original YOLOv5s model, among the five improved models, the improved YOLOv5s-ASPP model significantly enhanced the segmentation ability of brain tumor magnetic resonance images, which is helpful in assisting clinical diagnosis and treatment planning.

Epidemiology of breast cancer in Chinese women from 1990 to 2021: a systematic analysis and comparison with the global burden

BACKGROUND

Breast cancer is a major global public health concern and a major cause of cancer-related mortality. In 2020, 8.3% of the total breast cancer deaths worldwide were reported from China, which highlighted the need to understand the epidemiological trends of breast cancer within the country. Therefore, this study aimed to analyse the trends in the breast cancer burden in China from 1990 to 2021 and compare them with global trends to provide insights for future prevention and control strategies.

METHODS

Data were sourced from the Global Burden of Disease database 2021, which includes comprehensive information on the disease burden across 204 countries from 1990 to 2021. We analysed six key indicators: the mortality, prevalence, incidence, disability-adjusted life years, years lived with disability, and years of life lost. Age-standardized rates were analysed using the global age structure as a reference. Joinpoint regression was employed to assess the annual percentage change and average annual percentage change.

RESULTS

In 2021, 3.75 million prevalent breast cancer cases, with 385,837 new breast cancer cases and 88,106 deaths due to breast cancer, were reported from China. The crude rates of the prevalence, incidence, mortality, disability-adjusted life years, years lived with disability, and years of life lost significantly increased in 2021 compared with 1990. The age-standardized rates per 100,000 women were 355.72 for prevalence (+ 103.22% from 1990), 37.00 for incidence (107.40%), 8.24 for mortality (-8.24%), 281.54 for disability-adjusted life years (-6.68%), 25.86 for years lived with disability (110.24%), and 255.69 for years of life lost (-11.62%). The burden of breast cancer has notably increased among the women above 40 years of age, peaking between the ages of 50 and 59 years, and the proportion of cases in women under 40 years has decreased.

CONCLUSIONS

The age-standardized rate of the mortality, disability-adjusted life years, and years of life lost of breast cancer decreased slightly in China; however, the age-standardized rate of the incidence, prevalence, and years lived with disability exhibited an upward trend between 1990 and 2021, thereby highlighting the need to improve treatment outcomes and formulate better policies for the prevention and control of breast cancer in China.

Development and validation of nomogram for predicting the cancer-specific survival among patients aged 80 and above with early-stage non-small cell lung cancer

BACKGROUND

The use of nomograms in predicting the prognosis of early-stage non-small cell lung cancer (NSCLC), particularly in elderly patients, is not widespread. A validated prognostic model specifically for NSCLC patients over 80 years old holds promising potential for clinical application in forecasting patient outcomes.

METHODS

The prognostic value of various factors for NSCLC patients aged 80 and above was evaluated using data from the Surveillance, Epidemiology, and End Results (SEER) database (2010-2017). Kaplan-Meier (KM) curves, Cox proportional hazards regression models, and nomogram were utilized to evaluate the impact of each factor on cancer-specific survival (CSS).

RESULTS

A cohort comprising 7045 individuals was selected for inclusion in the analysis. Through rigorous statistical analysis, 10 independent prognostic factors were identified and incorporated into the nomogram. The nomogram's receiver operating characteristic (ROC) curve area under the curve (AUC) was higher than that of the AJCC 7th edition TNM staging system's predicted CSS (0.744 versus 0.602), establishing the superior prognostic value of the nomogram.

CONCLUSIONS

We have successfully created a highly accurate and discriminative nomogram that enables oncologists to predict the survival outcome of each individual patient with I/II NSCLC who is 80 years or older.

The Effect of Rabdosia rubescens on Radiotherapy-Induced Oral Mucositis in Nasopharyngeal Carcinoma Patients: A Phase II Clinical Study

PURPOSE

Radiotherapy-induced oral mucositis is the most common side effect in nasopharyngeal carcinoma (NPC) patients. We aimed to evaluate the efficacy and safety of Rabdosia rubescens drop pills in NPC patients with radiation-induced oral mucositis (RTOM).

METHODS

The study involved 40 NPC patients who were given Rabdosia rubescens drop pills thrice daily from the start of radiation therapy. The study monitored the incidence and severity of oral mucositis and oral pain. The main outcomes measured were the occurrence rate of oral mucositis, grade 3 oral mucositis, oral pain assessment, and changes in immunological function, body weight, BMI, NRS2002, and albumin levels.

RESULTS

In the study, 38 patients completed the treatment. The incidence rates of Grade 0 to 3 oral mucositis were 5.26%, 21.05%, 47.37%, and 26.32% respectively. Pain levels were mild (42.11%), moderate (13.16%), and severe (13.16%). The onset of Grade 1, 2, and 3 oral mucositis occurred at 18, 24, and 30 days respectively. Grade 3 oral mucositis was associated with body weight, BMI, NRS2002 score, and albumin levels. Post-treatment, there was a decrease in CD4+/CD8+, CD3+, and CD4+ immune cells, but an increase in CD8+ cells. Mild to moderate gastrointestinal adverse events were observed in 13.2% of patients.

CONCLUSION

Rabdosia rubescens drop pills administration can reduce the incidence and severity of radiotherapy induced oral mucositis. Our finding suggested a positive impact of Rabdosia rubescens drops pills upon administration to NPC patients.

Global, regional, and national burden of ovarian cancer among young women during 1990-2019

BACKGROUND

Ovarian cancer, the most devastating tumor in women globally, significantly impacts young women, compromising their daily lives and overall well-being. Ovarian cancer represents a significant public health concern due to its extensive physical and psychological consequences.

MATERIAL AND METHODS

Data from the Global Burden of Disease were used to assess the global, regional, and national burden of ovarian cancer in young women aged 20-39 from 1990 to 2019. This analysis focused on trends measured by the estimated annual percentage change and explored the socioeconomic impacts via the socio-demographic index (SDI).

RESULTS

During 1990-2019, the incidence and prevalence of ovarian cancer among young women increased globally, with annual rates of 0.74% and 0.89%, respectively. The mortality rate and disability-adjusted life years also rose annually by 0.20% and 0.23%, respectively. A significant burden shift was observed toward regions with lower SDI, with high fasting plasma glucose, BMI, and asbestos exposure identified as prominent risk factors, particularly in lower SDI regions.

CONCLUSION

Our findings underscore ovarian cancer in young women as an escalating global health challenge, with the burden increasingly shifting toward lower socioeconomic areas. This underscores the necessity for targeted prevention and control strategies for ovarian cancer, focusing on reducing the identified risk factors and ensuring equitable health resource distribution.

Development and validation of the surmising model for volumetric breast density using X-ray exposure conditions in digital mammography

The use of breast density as a biomarker for breast cancer treatment has not been well established owing to the difficulty in measuring time-series changes in breast density. In this study, we developed a surmising model for breast density using prior mammograms through a multiple regression analysis, enabling a time series analysis of breast density. We acquired 1320 mediolateral oblique view mammograms to construct the surmising model using multiple regression analysis. The dependent variable was the breast density of the mammary gland region segmented by certified radiological technologists, and independent variables included the compressed breast thickness (CBT), exposure current times exposure second (mAs), tube voltage (kV), and patients' age. The coefficient of determination of the surmising model was 0.868. After applying the model, the correlation coefficients of the three groups based on the CBT (thin group, 18-36 mm; standard group, 38-46 mm; and thick group, 48-78 mm) were 0.913, 0.945, and 0.867, respectively, suggesting that the thick breast group had a significantly low correlation coefficient (p = 0.00231). In conclusion, breast density can be accurately surmised using the CBT, mAs, tube voltage, and patients' age, even in the absence of a mammogram image.

USP31 Activates the Wnt/β-catenin Signaling Pathway and Promotes Gastric Cancer Cell Proliferation, Invasion and Migration

BACKGROUND

Gastric cancer (GC) has a poor prognosis because it is highly aggressive, yet there are currently few effective therapies available. Although protein ubiquitination has been shown to play a complex role in the development of gastric cancer, to date, no efficient ubiquitinating enzymes have been identified as treatment targets for GC.

METHODS

The TCGA database was used for bioinformatic investigation of ubiquitin-specific protease 31 (USP31) expression in GC, and experimental techniques, including Western blotting, qRT-PCR, and immunohistochemistry, were used to confirm the findings. We also analyzed the relationship between USP31 expression and clinical prognosis in patients with GC. We further investigated the effects of USP31 on the proliferation, invasion, migration, and glycolysis of GC cells in vitro and in vivo by using colony formation, CCK-8 assays, Transwell chamber assays, cell scratch assays, and cell-derived xenograft. Furthermore, we examined the molecular processes by which USP31 influences the biological development of GC.

RESULTS

Patients with high USP31 expression have a poor prognosis because USP31 is abundantly expressed in GC. Therefore, USP31 reduces the level of ubiquitination of the Wnt/β-catenin pathway by binding to β-catenin, thereby activating glycolysis, which ultimately promotes GC proliferation and aggressive metastasis.

CONCLUSION

USP31 inhibits ubiquitination of β-catenin by binding to it, stimulates the Wnt/β-- catenin pathway, activates glycolysis, and accelerates the biology of GCs, which are all demonstrated in this work.

Burdens of Tracheal, Bronchus, and Lung Cancer From 1990 to 2021 in China Compared to the Global Projection of 2036: Findings From the 2021 Global Burden of Disease Study

BACKGROUND

Tracheal, bronchial, and lung cancers (TBL cancers) pose a significant global health challenge, with rising incidence and mortality rates, particularly in China. Studies from the Global Burden of Disease (GBD), 2021, can guide screening and prevention strategies for TBL cancer. This study aims to provide a comprehensive analysis of the burden of TBL cancers in China compared to global data.

METHODS

We conducted an analysis of incidence, prevalence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021. We also performed Joinpoint regression analysis and Bayesian age-period-cohort (BAPC) modeling to project future trends.

RESULTS

From 1990 to 2021, there was a substantial increase in TBL cancer indicators for all sexes in China, with the most significant rise observed in females. The female population showed alarming increases in age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR). While global efforts have managed to stabilize these rates, China's figures remain high, suggesting the impact of persistent risk factors such as smoking and air pollution, coupled with an aging population. Furthermore, we utilized the projection model in China to estimate that these indicators of TBL cancers in females will likely follow continuous and rapid upward trends, while the burden of TBL cancers among males is expected to have a steady trend.

CONCLUSION

Although global efforts have been effective in reducing the burden of TBL cancers over the past three decades, there still remains strong regional and gender heterogeneity. TBL cancers need more screening strategies and medical attention in China and in the female population.

Early, integrated palliative care for people with chronic respiratory disease: lessons learnt from lung cancer

Lung cancer and chronic non-malignant respiratory disease cause pervasive, multifactorial suffering for patients and informal carers alike. Palliative care aims to reduce suffering and improve quality of life for patients and their families. An established evidence base exists that has demonstrated the essential role of specialist palliative care for people with lung cancer. Emerging evidence supports similar benefits among people with chronic respiratory disease. Many lessons can be learnt from lung cancer care, particularly as the model of care delivery has transformed over recent decades due to major advances in the diagnostic pathway and the development of new treatments. This narrative review aims to summarize the evidence for specialist palliative care in lung cancer and chronic respiratory disease, by highlighting seven key lessons from lung cancer care that can inform the development of proactive, integrated models of palliative care among those with chronic respiratory disease. These seven lessons emphasize (1) managing challenging symptoms; (2) the efficacy of specialist palliative care; (3) the importance of providing specialist palliative care integrated with disease-directed care according to patients' needs not prognosis; (4) the need for new models of collaborative palliative care, (5) which are culturally appropriate and (6) able to evolve with changes in disease-directed care. Finally, we discuss (7) some of the critical research gaps that persist and reduce implementation in practice.

Mesenchymal Stem Cells in Cancer Therapy

The mesenchymal stem/stromal cells (MSCs) are multipotent cells that were initially discovered in the bone marrow in the late 1960s but have so far been discovered in almost all tissues of the body. The multipotent property of MSCs enables them to differentiate into various cell types and lineages, such as adipocytes, chondrocytes, and osteocytes. The immunomodulation capacity and tumor-targeting features of MSCs made their use crucial for cell-based therapies in cancer treatment, yet limited advancement could be observed in translational medicine prospects due to the need for more information regarding the controversial roles of MSCs in crosstalk tumors. In this review, we discuss the therapeutic potential of MSCs, the controversial roles played by MSCs in cancer progression, and the anticancer therapeutic strategies that are in association with MSCs. Finally, the clinical trials designed for the direct use of MSCs for cancer therapy or for their use in decreasing the side effects of other cancer therapies are also mentioned in this review to evaluate the current status of MSC-based cancer therapies.

Predicting Lung Cancer in Korean Never-Smokers With Polygenic Risk Scores

In the last few decades, genome-wide association studies (GWAS) with more than 10,000 subjects have identified several loci associated with lung cancer and these loci have been used to develop novel risk prediction tools for cancer. The present study aimed to establish a lung cancer prediction model for Korean never-smokers using polygenic risk scores (PRSs); PRSs were calculated using a pruning-thresholding-based approach based on 11 genome-wide significant single nucleotide polymorphisms (SNPs). Overall, the odds ratios tended to increase as PRSs were larger, with the odds ratio of the top 5% PRSs being 1.71 (95% confidence interval: 1.31-2.23) using the 40%-60% percentile group as the reference, and the area under the curve (AUC) of the prediction model being of 0.76 (95% confidence interval: 0.747-0.774). The receiver operating characteristic (ROC) curves of the prediction model with and without PRSs as covariates were compared using DeLong's test, and a significant difference was observed. Our results suggest that PRSs can be valuable tools for predicting the risk of lung cancer.

Exploration of Body Image in Postoperative Patients With Oral Cancer: An Exploratory Sequential Mixed Methods Study

BACKGROUND

Postoperative patients with oral cancer are deeply distressed about their body image. However, their true inner feelings and the factors influencing body image remain unclear.

AIMS

This study aims to investigate the experience of body image disturbance in patients 3 months after oral cancer surgery and analyze the influencing factors.

METHODS

This study process was divided into three steps: (1) semi-structured interviews, based on the Society Ecosystems Theory, of patients with body image disorders 3 months after oral cancer surgery, followed by theme summaries; (2) appropriate selection of scales according to the qualitative results; and (3) a cross-sectional survey to explore the factors and pathways affecting the body image of the patients.

RESULTS

Qualitative research summarized nine themes from the individual, family/employment, and societal/institutional levels, with the individual level being most commonly mentioned. Further investigation into the individual factors influencing the body image of the patients revealed that self-esteem and social alienation have a chain mediating effect on the relationship between speech handicap and body image.

CONCLUSIONS

The body image of postoperative patients with oral cancer is influenced by personal, family, and societal aspects. These study results lay the groundwork for formulating interventions to alleviate body image concerns.

Global trends and risk factors in gastric cancer: a comprehensive analysis of the Global Burden of Disease Study 2021 and multi-omics data

Background: Gastric cancer (GC) remains a significant global health challenge. This study aimed to comprehensively analyze GC epidemiology and risk factors to inform prevention and intervention strategies. Methods: We analyzed the Global Burden of Disease Study 2021 data, conducted 16 different machine learning (ML) models of NHANES data, performed Mendelian randomization (MR) studies on disease phenotypes, dietary preferences, microbiome, blood-based markers, and integrated differential gene expression and expression quantitative trait loci (eQTL) data from multiple cohorts to identify factors associated with GC risk. Results: Global age-standardized disability-adjusted life year rates (ASDR) for GC declined from 886.24 to 358.42 per 100,000 population between 1990 and 2030, with significant regional disparities. Despite this decline, total disability-adjusted life years show a concerning upward trend from 2015, rising from approximately 22.9 million to a projected 24.3 million by 2030. The slope index of inequality shifted from 87 in 1990 to -184 in 2021, indicating a reversal in GC burden distribution, with higher ASDR now associated with lower socio-demographic index countries. The ML models analysis identified higher levels of clinical characteristics such as phosphorus, calcium, eosinophils percent, and triglycerides, as well as lower levels of iron and monocyte percent, may be associated with an increased risk of GC. MR analyses revealed causal associations between GC risk and disease phenotypes such as Helicobacter pylori infection, chronic gastritis, obesity, depression, and dietary preferences such as dairy and processed meats. Gut microbiome analysis showed associations with microbiome such as Phascolarctobacterium and Ruminococcaceae species. Blood-based markers analysis identified protective and risk effects for cortisol, glutamate, nicotinamide, Natural Killer %lymphocyte, CD4-CD8- T cell Absolute Count, Phosphatidylcholine (16:0_18:1), and Interleukin-1-alpha. Integrated genomic analysis identified 10 genes significantly associated with GC risk, with strong evidence for colocalization in genes such as CCR6 and PILRB. Conclusions: This systematic analysis reveals complex global trends in GC burden and identifies novel clinical, disease phenotypes, dietary preferences, microbial, blood-based, and genetic risk factors. These findings provide potential targets for improved risk stratification, prevention, and intervention strategies to reduce the global burden of GC.

The immunohistochemical expression of c-MET and RON in lung adenocarcinoma with clinicopathologic correlation

BACKGROUND

Mesenchymal epidermal transition (MET) and receptor originating from nantes (RON) are transmembrane tyrosine kinase receptors. Both are members of a proto-oncogene family and thus play a role in the pathogenesis of various cancers and acquired resistance to kinase inhibitors in lung cancer.

AIMS

The aim of this study was to investigate the immunohistochemical expression of c-MET and RON in lung adenocarcinoma and its clinicopathologic correlation.

SETTINGS AND DESIGN

Retrospective study.

MATERIALS AND METHODS

The immunohistochemical c-MET and RON expression in specimens obtained from lung adenocarcinoma ( n = 175) and associated clinicopathologic parameters were evaluated.

STATISTICAL ANALYSIS USED

The correlation between c-MET and RON expression was analyzed by Chi-square test. A Cox proportional hazards model and Kaplan-Meier curve analysis were used to evaluate the risk factors and prognosis.

RESULTS

High expression of the c-MET protein showed a strong correlation with that of RON ( P = 0.013, kappa = 0.183). Five-year survival and recurrence-free 5-year survival were not associated with high expression of c-MET or RON. High c-MET expression was significantly associated with age older than 60 years ( P = 0.000), tumor differentiation ( P = 0.009), lymphovascular invasion ( P = 0.016), and pleural invasion ( P = 0.005). High RON expression was associated with a solid growth pattern ( P = 0.001) and pleural invasion ( P = 0.002).

CONCLUSIONS

The results point to the potential of immunohistochemical expression of c-MET and RON as useful prognostic markers of unfavorable histopathologic features in lung adenocarcinoma.

Hematopoietic cell transplantation for older acute myeloid leukemia patients in first complete remission: results of a randomized phase III study

Given the selection of elderly patients with AML in first complete remission (CR1) the advantage of consolidation with allogeneic hematopoietic cell transplantation (HCT) over chemotherapy is still unclear. Newly diagnosed AML patients in CR1 aged 60-75 years were registered and a donor search initiated. After one consolidation cycle, patients with a matched donor were randomized to HCT with fludarabine/low-dose total body irradiation and cyclosporine/mycophenolate mofetil immunosuppression or conventional non-HCT. Primary outcome was restricted mean leukemia-free survival (RM-LFS) up to 5 years. Between 2010 and 2017, 245 patients (median age 67 years) were registered at CR1. After one consolidation, 26.9% of patients failed inclusion criteria. Of the 179 (73%) patients still on study, 75.4% had an HLA identical donor. Ten ineligible patients were excluded, and 125 randomized to HCT (N=83) or non-HCT (N=42). The primary outcome RM-LFS up to 5 years was 24.5 months (95% confidence interval [CI]: 18.9-30.1) in the HCT and 15.6 months (95% CI: 10.4-20.8) in the non-HCT arm (P=0.022) due to a decrease in cumulative relapse incidence from 91.1% (95% CI: 80.7-100.0) after non-HCT to 37.8% (95% CI: 27.2-48.4) after HCT (P<0.0001). The secondary endpoints RM-OS up to 5 years was 27.8 months (95% CI:22.3-33.2) in the HCT as compared to 28.6 months (95% CI: 22.2-35.0) in the non-HCT arm; non-relapse mortality at 5 years was 33.4% (95% CI: 23.0-43.9) with HCT and 0% without. In older patients with AML in CR1 5-year RM-LFS is better with HCT than with non-HCT consolidation treatment. The long-term RM-LFS benefit did not translate into a better RM-OS during the study period.