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

Discovery of Voreloxin as a Dual-Selective Stabilizer for c-Myc/Bcl-2 G-Quadruplexes in Leukemia

Overexpression of c-Myc is a key factor in the development of leukemia and other malignancies, highlighting the urgent need for novel drugs to inhibit c-Myc protein levels. DNA G-quadruplexes (G4) have emerged as potential regulatory targets for c-Myc expression. Previous studies identified trovafloxacin, a topoisomerase II inhibitor, as a novel c-Myc G4 stabilizer. In this study, virtual screening based on structural similarity led to the identification of nine derivatives of trovafloxacin, among which voreloxin exhibited potent cytotoxicity in multiple myeloma cells and showed promising therapeutic efficacy in leukemia cells. FRET assays demonstrated that voreloxin specifically stabilized the G4 structures of c-Myc and Bcl-2, with minimal effects on the G4 structures of other oncogenes. Moreover, voreloxin significantly reduced the expression levels of c-Myc and Bcl-2 in THP-1 and MOLM-13 cells. Molecular docking, molecular dynamics (MD) simulations, and MM/GBSA calculations further confirmed the stable binding of voreloxin to both c-Myc and Bcl-2 G4s, primarily driven by π-π stacking and hydrogen bonding interactions. These findings provide valuable insights for the development of G4-targeting drugs for cancer therapy.

Association Between Vitamin Intake and Colorectal Cancer: Evidence from NHANES Data

PURPOSE

This study aims to investigate the associations between vitamins and colorectal cancer (CRC) based on a national sample of US adults.

METHODS

A total of 6200 samples were collected from the National Health and Nutrition Examination Survey to explore the relationship between vitamins (specifically, A, C, and D) and CRC. Logistic regression models were employed to assess the associations between dietary vitamin intake and CRC.

RESULTS

Our findings indicate a negative association between vitamin C intake and CRC. However, the associations of vitamin A and vitamin D with CRC were not statistically significant. For vitamin C, compared to the first tertile, the odds ratios (ORs) and 95% confidence intervals (CIs) were 0.91 (0.76-0.97) for the second tertile and 0.81 (0.64-0.95) for the third tertile (P < 0.01). Conversely, for vitamin A, compared to the first tertile, the odds ratios (ORs) and 95% confidence intervals (CIs) were 1.02 (0.82-1.22) for the second tertile and 1.04 (0.75-1.25) for the third tertile (P < 0.01). For vitamin D, compared to the first tertile, the odds ratios (ORs) and 95% confidence intervals (CIs) were 0.96 (0.84-1.06) for the second tertile and 1.01 (0.83-1.15) for the third tertile (P < 0.01). Additionally, the negative association between vitamin C and CRC was more pronounced among females (0.76, 0.67-0.92), individuals aged 60 and above (0.75, 0.69-0.95), and those with a BMI > 30 (0.78, 0.67-0.93).

CONCLUSION

Our findings suggest that higher vitamin C intake is associated with a reduced prevalence of CRC. However, further large-scale prospective cohort studies are warranted to validate our results.

Network pharmacology in combination with bibliometrics analysis on the mechanism of compound Kushen injection in the treatment of radiation pneumonia and lung cancer

Radiation pneumonia is a common adverse reaction during radiotherapy in lung cancer patients, which negatively impacts the quality of life and survival of patients. Recent studies have shown that compound Kushen injection (CKI), a traditional Chinese medicine (TCM), has great anti-inflammatory and anticancer potential, but the mechanism is still unclear. We used CiteSpace, the R package "bibliometrix," and VOSviewers to perform a bibliometrics analysis of 162 articles included from the Web of Science core collection. A network pharmacology-based approach was used to screen effective compounds, screen and predict target genes, analyze biological functions and pathways, and construct regulatory networks and protein interaction networks. Molecular docking experiments were used to identify the affinity of key compounds and core target. The literature metrology analysis revealed that over 90% of the CKI-related studies were conducted by Chinese scholars and institutions, with a predominant focus on tumors, while research on radiation pneumonia remained limited. Our investigation identified 60 active ingredients of CKI, 292 genes associated with radiation pneumonia, 533 genes linked to lung cancer, and 37 common targets of CKI in the treatment of both radiation pneumonia and lung cancer. These core potential targets were found to be significantly associated with the OS of lung cancer patients, and the key compounds exhibited a good docking affinity with these targets. Additionally, GO and KEGG enrichment analysis highlighted that the bioinformatics annotation of these common genes mainly involved ubiquitin protein ligase binding, cytokine receptor binding, and the PI3K/Akt signaling pathway. Our study revealed that the main active components of CKI, primarily quercetin, luteolin, and naringin, might act on major core targets, including AKT1, PTGS2, and PPARG, and further regulated key signaling pathways such as the PI3K/Akt pathway, thereby playing a crucial role in the treatment of radiation pneumonia and lung cancer. Moreover, this study had a certain promotional effect on further clinical application and provided a theoretical basis for subsequent experimental research.

Burden of biliary tract carcinoma in China (1990-2021): Findings from the 2021 Global Burden of Disease Study

Biliary tract carcinoma (BTC) is a group of malignant tumors that originate in the digestive system and occurs with a high incidence in China. Few consistent and comparable assessments of BTC disease burden have been conducted at national or subnational levels, and little is known about the demographic, temporal, and geographic patterns of epidemiological characteristics and disease burden of BTC in China. The incidence, mortality, disability-adjusted life-years (DALYs), years of life lost (YLLs) due to premature death and years lived with disability (YLDs) of BTC were comprehensively examined by age, sex, and calendar year in the Chinese population, using the methodological framework and analytical strategies used for the 2021 Global Burden of Disease study. All-age incidence increased from 17,077 to 51,720 between 1990 and 2021, and the age-standardized incidence rate rose by 13.62%; all-age deaths increased from 17,251 to 37,833, but the age-standardized mortality rate fell by nearly one-fifth. The DALYs rose by 89.57% while the age-standardized DALY rate fell by 23.24%. Variations of the tendencies in BTC burden were found between sexes and age groups. Data for each provincial region indicate that coastal eastern provincial regions have higher incidence and YLD levels, whereas northern provincial regions have higher mortality, DALY, and YLL levels. The proportions of DALYs attributable to high body mass index (BMI) illustrate the growing attribution obesity has made, and high BMI usually puts more burden on northern provincial regions. These results provide evidence to support precise, targeted, and customed public health strategies aimed at enhancing biliary tract health among the Chinese population.

Work Participation of Hematological Cancer Survivors After Hematopoietic Cell Transplantation: A Scoping Review

PURPOSE

Hematopoietic cell transplantation (HCT) is a common treatment for people diagnosed with hematological cancers. However, it can cause side effects that may affect work participation. This scoping review aims to provide an overview of the factors that influence the work participation of hematological cancer survivors who have undergone HCT.

METHODS

We conducted a scoping review following the Joanna Briggs Institute guidelines and developed our search strategy in collaboration with a scientific librarian and searched nine databases (CINAHL, MEDLINE, EMBASE, Cochrane, PubMed, PsycINFO, Web of Science, Scopus, ProQuest Dissertations, & Theses Global) for primary studies in French or English until February 2024. Two reviewers extracted the data and analyzed it thematically. We synthesized and presented the findings using a narrative description approach.

RESULTS

We identified 940 publications, of which 36 met the eligibility criteria. Our findings underscore the significance of considering individuals over 50, those undergoing allogeneic HCT, women, and those with lower incomes. We noted disparities in evaluating or describing work participation.

CONCLUSION

It is crucial for researchers and healthcare professionals in hematological care to be aware of the intersecting factors that influence work participation. There are still significant gaps in how workplace dynamics, legislation, and healthcare systems affect the return to work process.

Circulating MicroRNAs as Biomarkers for the Early Diagnosis of Lung Cancer and Its Differentiation from Tuberculosis

BACKGROUND

The differential diagnosis of tuberculosis (TB) and lung cancer (LC) is often challenging due to similar clinicopathological presentations when bacterial shedding is negative, which can lead to delays in treatment. In this study, we tested the potential of plasma-circulating microRNAs (miRNAs) for the early and differential diagnosis of TB and LC.

METHODS

We conducted a two-phase study: profiling 188 miRNAs in pooled plasma samples and validating 14 selected miRNAs in individual plasma samples from 68 LC patients, 38 pulmonary TB patients, and 41 healthy controls.

RESULTS

Twelve miRNAs were significantly elevated in LC patients compared to controls and TB patients, while two miRNAs were significantly elevated in TB patients compared to controls. ROC analysis demonstrated that miR-130b-3p, miR-1-3p, miR-423-5p, and miR-200a-3p had good discriminatory ability to distinguish LC patients (including those with stage I tumours) from healthy individuals and miR-130b-3p, miR-423-5p, miR-15b-5p, and miR-18b-5p effectively distinguished LC patients (including those with stage I tumours) from TB patients. Additionally, miR-18b-5p showed good discriminatory ability between SCLC and NSCLC patients.

CONCLUSIONS

Circulating miRNAs hold strong potential for the early detection of LC and for distinguishing LC from TB.

Lactylation-related gene signature accurately predicts prognosis and immunotherapy response in gastric cancer

Background

Gastric cancer (GC) is a malignant tumor associated with significant rates of morbidity and mortality. Hence, developing efficient predictive models and directing clinical interventions in GC is crucial. Lactylation of proteins is detected in gastric cancer tumors and is linked to the advancement of gastric cancer.

Methods

The The Cancer Genome Atlas (TCGA) was utilized to analyze the gene expression levels associated with lactylation. A genetic pattern linked to lactylation was created using Univariate Cox regression and least absolute shrinkage and selection operator (LASSO) regression. The predictive ability of the model was evaluated and confirmed in the Gene Expression Omnibus (GEO) cohort, where patients were divided into two risk groups based on their scores. The study examined the relationship between gene expression and the presence of immune cells in the context of immunotherapy treatment. In vitro cytotoxicity assays, ELISA and PD-1 and PD-L1interaction assays were used to assess the expression of PD-L1 while knocking down SLC16A7.

Results

29 predictive lactylation-related genes with differential expression were discovered. A signature consisting of three genes was developed and confirmed. Patients who had higher risk scores experienced worse clinical results. The group with lower risk showed increased Tumor Immune Dysfunction and Exclusion (TIDE) score and greater responsiveness to immunotherapy. The tumor tissues secrete more lactate acid than normal tissues and express more PD-L1 than normal tissues, that is, lactate acid promotes the immune evasion of tumor cells. In GC, the lactylation-related signature showed strong predictive accuracy. Utilizing both anti-lactylation and anti-PD-L1 may prove to be an effective approach for treating GC in clinical settings. We further proved that one of the lactate metabolism related genes, SCL16A7 could promote the expression of PD-L1 in GC cells.

Conclusion

The risk model not only provides a basis for better prognosis in GC patients, but also is a potential prognostic indicator to distinguish the molecular and immune characteristics, and the response from Immune checkpoint inhibitors (ICI) therapy and chemotherapy in GC.

Epstein-Barr Virus and gastric carcinoma pathogenesis with emphasis on underlying epigenetic mechanisms

Gastric cancer (GC) remains one of the top causes of cancer-related mortality around the world. The pathogenesis of GC is attributed to lifestyle, family history, genetic mutations, epigenetic alterations, as well as infectious agents such as Epstein-Barr Virus (EBV). EBV, a ubiquitous human gamma herpes virus, with latent asymptomatic infection in more than 95% of the world's population, is able to infect through the oral epithelium. EBV is described as the first virus found in human neoplastic, when it was detected in Burkitt lymphoma tumor biopsy. Nowadays this virus is considered to be involved in various human malignancies such as GC. Despite comprehensive efforts and immense studies, the main underlying mechanism is not well described as there are crucial contradictions regarding the presence of this virus and the prognosis of the disease. Immunological alterations, genetic mutations, and epigenetic modifications are among the most important criteria presented in EBV- associated gastric cancer (EBVaGC), leading to its consideration as a separate subtype with unique clinical, histological, biochemical, and genetic characteristics. The current study aimed to review the association between EBV and GC with an emphasis on the role of epigenetic modifications in the suppression or progression of carcinogenesis. To put all findings in a nutshell, several genes and chromatin mutations, promoter hypermethylation and subsequent silencing of related genes, and histone modifications and aberrant micro RNAs (miRNAs) expression were considered as the major altered mechanisms in the pathogenesis of EBVaGC, most of which able to be suggested as therapeutic targets. However, the current knowledge appeared to be imperfect, hence further studies are encouraged.

Prognostic value of lymphocyte to monocyte ratio in patients with esophageal cancer: a systematic review and meta-analysis

Objectives

To report the largest systematic review and meta-analysis to evaluate prognostic value of lymphocyte to monocyte ratio (LMR) in patients with esophageal cancer.

Methods

We conducted a systematic literature retrieval via PubMed, Embase, Web of Science, and Cochrane until December, 2023 for studies which evaluated the prognostic value of LMR in patients with esophageal cancer. Outcomes measured were overall survival (OS), disease-free survival (DFS), relapse-free survival (RFS), and progression-free survival (PFS).

Results

11 studies including 3,377 patients with esophageal cancer were included for meta-analysis. Meta-analysis demonstrated that OS (HR: 1.65; 95% CI: 1.19, 2.31; P = 0.003) and DFS (HR: 1.48; 95% CI: 1.09, 2.01; P = 0.01) were significantly shorter in the low LMR group compared with the high LMR group. In addition, meta-analysis revealed a similar PFS (HR: 1.58; 95% CI: 1.00, 2.51; P = 0.05) and RFS (HR: 1.17; 95% CI: 0.93, 1.46; P = 0.18) in the two groups. Subgroup analysis found that the predictive value of LMR for OS remained significant in resectable and unresectable esophageal cancers, and in studies with follow-up ≥24 months and < 24 months. Subgroup analysis based on treatment methods found that the prognostic value of LMR was significant for both patients who received PD-1/PD-L1 inhibitors and those who did not receive PD-1/PD-L1 inhibitors. However, subgroup analysis based on LMR threshold found that the significance remained in studies with LMR threshold<3.5 (HR: 2.09; 95% CI: 1.13, 3.87; P = 0.02) but disappeared in studies with LMR threshold ≥ 3.5 (HR: 1.39; 95% CI: 0.93, 2.07; P = 0.11).

Conclusions

Low LMR is associated with poor prognosis in patients with esophageal cancer. Due to the simple availability and low cost of routine blood tests in clinical practice, LMR can be widely used to assess prognosis and construct risk prediction models for patients with esophageal cancer.

Systematic review registration

PROSPERO, identifier CRD42024509796.

Inequality in breast cancer: Global statistics from 2022 to 2050

This study evaluates the global inequalities of breast cancer incidence and mortality from 2022 to 2050 with the latest GLOBOCAN estimates. It focuses on disparities across continents, age groups and Human Development Index (HDI) levels. In 2022, Africa shows the highest positive slope values of age-standardized rates (world) of mortality vs. incidence, both for those under 40 (0.346) and those 40 and older (0.335). These values contrast with those for Asia (0.085, 0.208), Europe (0.002, -0.014), Latin America and the Caribbean (0.17, 0.303), Northern America (-0.078, -0.188), and Oceania (0.166, -0.001). In both age groups, lower HDI levels are correlated with higher slope values and vice versa. Projections to 2050 indicate significant increases in the burden of breast cancer, with persistent yet varied disparities and differences. This highlights the need for differentiated strategies in breast cancer prevention, early-stage diagnosis, and treatment.

Cancer-specific utility: clinical validation of the EORTC QLU-C10D in patients with glioblastoma

INTRODUCTION

Many health economic evaluations rely on the validity of the utility measurement for health-related quality of life (HRQoL). While generic utility measures perform well in HRQoL assessments of many diseases and patient populations, appropriateness for cancer-specific disease burdens needs attention and condition-specific measures could be a viable option. This study assessed the clinical validity of the cancer-specific EORTC QLU-C10D, a utility scoring algorithm for the EORTC QLQ-C30, in patients with glioblastoma. We expect the EORTC QLU-C10D to be sensitive and responsive in glioblastoma patients. Furthermore, we compared its statistical efficiency with the generic utility measure EQ-5D-3L.

METHODS

We used data from a multi-center randomized controlled trial (NCT00689221) with patients from 146 study sites in 25 countries. Both, the QLQ-C30 and the EQ-5D-3L, had been administered at seven assessment points together. Utilities of both measures were calculated for four country value set (Australia, Canada, UK, USA). Ceiling effects, agreement (Bland-Altman plots (BA), intra-class correlation (ICC)), were calculated to analyze construct validity. Sensitivity to known-groups (performance status; global health) and responsiveness to changes (progressive vs. non-progressive; stable vs. improved or deteriorated HRQoL) were investigated for clinical validity. Relative Efficiency (RE) was calculated to compare statistical efficiency of both utility measures.

RESULTS

435 patients were included at baseline and six subsequent time points (median timeframe 497 days). QLU-C10D country value set showed negligible ceiling effects (< 6.7%) and high agreement with EQ-5D-3L (ICC > 0.750). BA indicated that differences between both utility measures increased with deteriorating health states. While the QLU-C10D was more sensitive to global health groups (RE > 1.2), the EQ-5D-3L was more sensitive to performance status groups (RE < 0.7) than the other utility measure. Statistical efficiency to detect differences between change groups and within HRQoL deterioration group (RE > 1.4) favored QLU-C10D in 18 of 24 (75%) and 20 of 24 (83%) comparisons with the EQ-5D-3L respectively. Responsiveness to overall HRQoL change (RE > 3.4) also favored the QLU-C10D.

CONCLUSION

Our results indicate that the QLU-C10D is a valid utility measure to assess HRQoL in patients with glioblastoma. This facilitates the investigation of HRQoL profiles and utilities in this patient population by administering a single questionnaire, the EORTC QLQ-C30. Efficiency analyses point to higher statistical power of the QLU-C10D compared to the EQ-5D-3L.

Interpretable machine learning model for digital lung cancer prescreening in Chinese populations with missing data

We developed an interpretable model, BOUND (Bayesian netwOrk for large-scale lUng caNcer Digital prescreening), using a comprehensive EHR dataset from the China to improve lung cancer detection rates. BOUND employs Bayesian network uncertainty inference, allowing it to predict lung cancer risk even with missing data and identify high-risk factors. Developed using data from 905,194 individuals, BOUND achieved an AUC of 0.866 in internal validation, with time- and geography-based external validations yielding AUCs of 0.848 and 0.841, respectively. In datasets with 10%-70% missing data, AUC ranged from 0.827 - 0.746. The model demonstrates strong calibration, clinical utility, and robust performance in both balanced and imbalanced datasets. A risk scorecard was also created, improving detection rates up to 6.8 times, available free online ( https://drzhang1.aiself.net/ ). BOUND enables non-radiative, cost-effective lung cancer prescreening, excels with missing data, and addresses treatment inequities in resource-limited primary healthcare settings.

Long-term relative survival of patients with gastric cancer from a large-scale cohort: a period-analysis

BACKGROUND

Gastric cancer poses a significant global health challenge. We aim to use period analysis to assess the changes in gastric cancer treatment at our center over the past 15 years. This study reflects the current state of gastric cancer treatment at our center and provides valuable data to support clinical advancements.

METHOD

We used period analysis to evaluate the survival status of 3915 patients with gastric cancer at Nanfang Hospital, Southern Medical University, over a 15-year period spaning from 2008 to 2022. The 5-year relative survival rates were analyzed.

RESULT

Our findings indicate that the 5-year relative survival rate at our center from 2018 to 2022 is 71.4%. From 2018 to 2022, the 5-year relative survival rates for patients aged < 40, 40-54, 55-69, and ≥ 70 reached 67.5%, 73.5%, 72.0%, and 67.1%, respectively. For stage IV patients, the 5-year relative survival rate reached 29% in 2018-2022. For stage I-III patients, the 5-year relative survival rate reached 89.7% in 2018-2022. The five-year relative survival rate for patients who underwent laparoscopic surgery at our center rose from 50.3% in 2008-2012 to 71.4% in 2018-2022. Overall, there has been a notable increase in the 5-year relative survival rates, regardless of age, gender, region, or tumor stage.

CONCLUSION

Period analysis over the past 15 years shows significant improvement in the 5-year survival rate for gastric cancer at our center. This progress is due to standardized surgical techniques, perioperative management, and immunotherapy, providing robust data for evaluating the efficacy of recent treatments.

The Access to Oncology Medicines Coalition: Enhanced in-Country Coordination for Sustainable Access

The disparity in access to essential cancer medicines between less and more affluent countries is a major source of inequities in access to cancer care. In May 2022, the Union for International Cancer Control (UICC) launched a new initiative, the Access to Oncology Medicines Coalition (ATOM Coalition), bringing together over 40 organisations from the private and civil society sectors to cooperate and combine resources to address key barriers of access to cancer medicines in low- and lower-middle income countries. While the ATOM Coalition is engaged in global efforts to make cancer medicines more accessible, the initiative also includes a country-level support programme to enhance coordinated locally-led action and accelerate access. This is supported by a transparent governance and organisational structure as well as a working framework with governments and other key stakeholders to assess the current capacity and develop tailored responses that can lift and/or relax some of the identified barriers through joint collaborations with ATOM Coalition partners.

Current status and hotspots in breast cancer patient self-management research: A bibliometric and visual analysis via CiteSpace

BACKGROUND

Breast cancer remains a leading cause of cancer-related mortality worldwide. Patient self-management plays a pivotal role in enhancing outcomes and quality of life for individuals affected by this disease. This study employed bibliometric and visual analysis techniques utilizing CiteSpace to elucidate the current status and research hotspots in breast cancer patient self-management from January 1, 2005, to August 31, 2023.

METHODS

A comprehensive search was conducted in the Web of Science Core Collection (WoSCC). The retrieved literature was subjected to visualization and analysis using CiteSpace, focusing on publication timeline, article count, geographical distribution, institutional affiliations, journal sources, reference co-citation networks, and keyword analysis.

RESULTS

The analysis encompassed 1413 English-language documents. The United States emerged as the most prolific contributor, while the University of Toronto demonstrated the highest institutional output. The two-map overlay revealed prominent citation paths, indicating strong interconnections between publications in "Medicine, Medicine, Clinical" and "Health, Nursing, Medicine," as well as "Psychology, Education, Health" and "Health, Nursing, Medicine." The most frequently co-cited reference was "Self-Management: Enabling and Empowering Patients Living with Cancer as a Chronic Illness." High-frequency keywords identified included quality of life, chronic disease, self-management, patient education, randomized controlled trials, education, and intervention. These keywords formed 11 distinct clusters related to intervention content, methodologies, outcome indicators, and emerging research trends. Keyword burst analysis predicted future research hotspots focusing on patient needs, psychological distress, Internet technology, and mobile applications.

CONCLUSIONS

Research in breast cancer self-management is experiencing significant growth. Enhanced collaboration between countries, regions, and institutions is imperative. Further investigation is warranted, particularly in the domains of "quality of life," "patient education," and "mobile health." These findings provide valuable insights to guide future research directions in this critical field.

The Circular RNA Circ_0043947 Promoted Gastric Cancer Progression by Sponging miR-384 to Regulate CREB1 Expression

Background/Aims

: The occurrence and development of circular RNAs in gastric cancer (GC) has attracted increasing attention. This study focused on investigating the biological role and molecular mechanism of circ_0043947 in GC.

Methods

: The expression levels of circ_0043947, miR-384 and CAMP response element binding protein (CREB1) were determined by quantitative real-time polymerase chain reaction or Western blotting. Cell proliferation, migration, and invasion, the cell cycle and apoptosis were determined using a cell counting kit-8 assay, 5-ethynyl-2'-deoxyuridine assay, colony formation assay, wound healing assay, transwell assay, and flow cytometry assay. The interaction between miR-384 and circ_0043947 or CREB1 was verified by dual-luciferase reporter assay and RNA pull-down assay. The in vivo assay was conducted using a xenograft mouse model.

Results

: Circ_0043947 and CREB1 expression levels were significantly upregulated, whereas miR-384 expression levels were downregulated in GC tissues and cells. Functionally, knockdown of circ_0043947 inhibited cell proliferation, migration and invasion and induced G0/G1 phase arrest and apoptosis in vitro. Circ_0043947 could upregulate CREB1 expression by directly sponging miR-384. Rescue experiments showed that a miR-384 inhibitor significantly reversed the inhibitory effect of si-circ_0043947 on GC progression, and CREB1 overexpression significantly reversed the inhibitory effect of miR-384 mimics on the progression of GC cells. Furthermore, silencing of circ_0043947 inhibited tumor growth in vivo.

Conclusions

: Circ_0043947 acted as an oncogenic factor in GC to mediate GC cell proliferation, migration, and invasion, the cell cycle and apoptosis by regulating the miR-384/CREB1 axis. Circ_0043947 may be a potential target for GC diagnosis and therapy.

Physicians' perspectives on cancer-related fatigue management and their suggestions for improvements in medical training: a cross-sectional survey study in Germany

PURPOSE

Contrary to guidelines, many cancer patients are not screened for cancer-related fatigue (CRF) and do not receive information or adequate treatment. As physicians play a key role in cancer therapy, their knowledge of this common sequela and perspectives on its management are of major interest.

METHODS

For an online survey, physicians working in oncology in Germany were systematically drawn from registers and invited by using institutional newsletters or colleagues. Descriptive analyses, logistic regression analysis of physicians' knowledge, and Mann‒Whitney U tests were performed.

RESULTS

Two-thirds of the 148 surveyed physicians felt (rather) well informed about CRF and capable of counseling patients. Only 32% of the sample were aware of CRF-specific guidelines. Despite of this, participants rated the scientific evidence for recommending physical activity, exercise programs, and psychotherapeutic interventions in accordance with guidelines as being mostly (very) strong. However, despite 82.4% of the physicians being (rather) aware of its evidence, only 56.1% often to almost always recommended psychotherapeutic interventions. CRF was rarely covered in medical studies and medical specialist training. The completion of advanced training for palliative care increased the likelihood of knowing guidelines (OR = 2.6, 95% CI [1.1-6.0], p < 0.05). Suggestions for improving training included the mandatory coverage of CRF in medical training or its consideration in interprofessional supportive care workshops.

CONCLUSION

Although awareness and recommendation rates were adequate for some interventions in CRF treatment (such as physical activity), there were lower recommendation rates for others, including psychotherapy. Studies are required assessing for the reasons of this knowledge-to-practice gap. Moreover, training is needed among physicians in order to enhance knowledge of CRF guidelines.

TRIAL REGISTRATION

Clinicaltrials.gov , identifier: NCT04921644. Registered in June 2021.

Single-cell RNA sequencing reveals the landscape of the cellular ecosystem of primary hepatocellular carcinoma

Hepatocellular carcinoma (HCC) cells, along with multiple nonmalignant stromal cells, such as fibroblasts, endothelial cells and immune cells, comprise an intricate cellular ecosystem, undergo dynamic phenotypic changes and present complicated cellular interactions, thus synergistically facilitating HCC initiation and progression and leading to treatment resistance. Clarifying the heterogeneity, cell plasticity and complexity of the cellular ecosystem of HCC will be highly beneficial for understanding HCC development and identifying novel therapeutic targets. Single-cell RNA sequencing (scRNA-seq) refers to profiling the transcriptome at single-cell resolution, and the development of scRNA-seq technology and analysis algorithms has greatly promoted the analysis of cell composition, cell subpopulation heterogeneity, development trajectory and cell-to-cell interactions in cell populations. In this review, we systematically summarized and discussed scRNA-seq in treatment-naive primary HCC and revealed the global cell composition of HCC; the widespread molecular heterogeneity of HCC cells; the molecular subtypes of fibroblasts; the cell composition, functional states and development trajectory of immune cells; and the frequent interactions between different cell types to systematically draw the landscape of the cellular ecosystem of primary HCC.

The Cancer Incidence Pattern in Isfahan Province: An Industrial Region in the Central Part of Iran

Background: We aimed to study age-standardized incidence rates (ASRs) of different cancer sites in Isfahan province, an industrialized city in the central part of Iran. Method: We obtained cancer incidence data from 2014 to 2018 in the Isfahan population-based cancer registry (PBCR). We studied quality indicators of PBCR and the validity of residential places for cancer patients. ASRs per 100,000 of common cancers were reported overall and at subprovincial levels. Results: Overall, 42,994 new cancer cases were registered in Isfahan PBCR in 2014-2018, and 51.4% were male. A high percentage of microscopic verification (MV%) (78.1%) and a low percentage of death certificate-only (DCO%) cases (7%) indicate the acceptable validity and completeness of this registry. The ASRs per 100,000 for all cancers combined were 173.7 in men and 171.1 in women. The most common cancers were prostate (ASR = 26.1), bladder (ASR = 19.9), and colorectum (ASR = 19.6) cancers in men and breast (ASR = 49.9), thyroid (ASR = 11.5), and colorectal (ASR = 15.6) cancers in women. Compared to the national reports in Iran, Isfahan province had a higher ASR of leukemia (13.6 in men and 8.9 in women), non-Hodgkin lymphoma (14 in men and 9 in women), and bladder (19.9 in men and 3.4 in women) cancer. The ASR of childhood cancers was 182.7. Notably, the most frequent cancer was leukemia (ASR = 73.4). We observed a wide geographic heterogeneity of cancer incidence in different counties for some cancers like breast, prostate, leukemia, and colorectal cancers. Conclusion: High incidence rates of hematological malignancies and bladder cancers in Isfahan province suggest further research to study the association between occupational and environmental exposures due to industrial pollution.

The BrEasT cancer afTER-CARE (BETTER-CARE) programme to improve breast cancer follow-up: design and feasibility study results of a cluster-randomised complex intervention trial

BACKGROUND

The risk of breast cancer patients for long-term side effects of therapy such as neurotoxicity and cardiotoxicity as well as late effects regarding comorbidities varies from individual to individual. Personalised follow-up care concepts that are tailored to individual needs and the risk of recurrences, side effects and late effects are lacking in routine care in Germany.

METHODS

We describe the methodology of BETTER-CARE, a parallel-arm cluster-randomised controlled trial conducted at 15 intervention and 15 control centres, aiming to recruit 1140 patients, and the results of the pilot phase. The needs- and risk-adapted complex intervention, based on existing development frameworks, includes a multidisciplinary network and digital platforms for symptom and need documentation and just-in-time adaptive interventions. The control group comprises usual care according to clinical guidelines. The primary outcome is health-related quality of life (EORTC QLQ-C30 global health), and secondary outcomes include treatment adherence.

RESULTS

The 2-month pilot phase comprising 16 patients in one intervention and one control pilot centre demonstrated the feasibility of the BETTER-CARE approach.

DISCUSSION

BETTER-CARE is a feasible intervention and study concept, investigating individualised needs- and risk-adapted breast cancer follow-up care in Germany. If successful, the approach could be implemented in German routine care.

TRIAL REGISTRATION

German Clinical Trial Register DRKS00028840. Registered on April 2022.

Development of a novel disulfidptosis-correlated m6A/m1A/m5C/m7G gene signature to predict prognosis and therapeutic response for lung adenocarcinoma patients by integrated machine-learning

BACKGROUND

Lung adenocarcinoma (LUAD) represents a significant global health burden, necessitating advanced prognostic tools for improved patient management. RNA modifications (m6A, m1A, m5C, m7G), and disulfidptosis, a novel cell death mechanism, have emerged as promising biomarkers and therapeutic targets in cancer.

METHODS

We systematically compiled disulfidptosis-correlated genes and RNA modification-related genes from existing literature. A novel disulfidptosis-correlated m6A/m1A/m5C/m7G riskscore was computed using integrated machine-learning algorithms. Transcriptomic data from TCGA and GEO databases were downloaded analyzed. Single-cell RNA-sequencing data from the TISCH database was processed using the Seurat package. Genes' protein-protein interaction network was constructed using the String database. Functional phenotype analysis was performed using GSVA, ClusterProfiler, and IOBR packages. Consensus clustering divided patients into two distinct groups. Drug sensitivity predictions were obtained from the GDSC1 database and predicted using the Oncopredict package.

RESULTS

The disulfidptosis-correlated m6A/m1A/m5C/m7G risk score effectively stratified LUAD patients into prognostically distinct groups, demonstrating superior predictive accuracy compared to conventional clinical parameters. Patients in different risk groups exhibited significant molecular and clinical differences. Subsequent analyses identified two molecular subtypes associated with RNA modification and disulfidptosis, revealing differences in immune infiltration and prognosis. Functional enrichment analyses highlighted pathways involving RNA modification and disulfidptosis, underscoring their roles in LUAD pathogenesis. Single-cell analysis revealed distinct features between high- and low-risk status cells.

CONCLUSION

This study introduces a novel disulfidptosis-correlated m6A/m1A/m5C/m7G risk score as a robust prognostic tool for LUAD, integrating insights from RNA modifications and cell death mechanisms. The risk score enhances prognostic stratification and identifies potential targets for personalized therapeutic strategies in LUAD. This comprehensive approach emphasizes the critical roles of RNA modifications and disulfidptosis in LUAD biology, paving the way for future research and clinical applications aimed at improving patient outcomes.

Combined healthy lifestyle factors and psychosocial outcomes among cancer survivors: a systematic review and meta-analysis

PURPOSE

This systematic review aims to summarize the associations between combined healthy lifestyles and psychosocial outcomes (health-related quality of life (HRQOL), depression, anxiety, psychological distress (PD), and posttraumatic stress disorder (PTSD)) among cancer survivors.

METHODS

PubMed, Web of Science, Cochrane Library, and EMBASE were searched for observational and interventional studies examining healthy lifestyle scores (HLS, calculated by a combination of at least three lifestyles) and psychosocial outcomes among cancer survivors from inception to April 2024. A minimum of two studies with the same study design were pooled using random effects models.

RESULTS

Twenty-one studies (44,812 survivors) were included. Of all studies, 16 of which were included in meta-analysis. The pooling of cross-sectional evidence shows significant association between HLS and overall, physical, and psychosocial HRQOL. Significance was only observed for overall and physical HRQOL but not for psychosocial HRQOL in cohort studies. The estimations and 95% confidence interval (CI) with 1-point increase in HLS were 1.47 (0.83-2.12) and 1.42 (0.19-2.65) for overall and physical HRQOL, respectively. The evidence from interventional studies also indicated that interventions on multiple lifestyles have positive effects on the physical but not psychosocial HRQOL. Despite the limited number of studies, significant associations were found between HLS and depression, anxiety, PD, and PTSD.

CONCLUSIONS

Although evidence is limited, we found that the combination of multiple healthier lifestyles is associated with better psychosocial outcomes in cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

This review underscores the potential for adhering to multiple healthy lifestyles to improve psychosocial outcomes and enhance HRQOL for cancer survivors.

Traditional Chinese medicine in treating upper digestive tract cancers

Upper digestive tract cancers, such as oral cavity, laryngeal, esophageal, and gastric cancers, account for 10% of cancer cases and 14.5% of cancer-related deaths worldwide. Conventional treatments often provide limited survival benefits and are frequently associated with adverse effects and drug resistance. Chinese herbal drugs (CHDs) are widely used in the Far East for managing these cancers. In this narrative review, we summarize current clinical studies (published up to June 2024) on the use of 138 CHDs in the treatment of cancers and precancerous lesions of the upper digestive tract. For cancer treatment, 126 CHDs were tested, all in combination with conventional therapies. Each CHD increased the clinical efficacy and/or reduced the adverse effects of conventional therapies. The five-year survival rate is a critical metric for evaluating the clinical benefits of cancer treatments. Four of the CHDs were reported to increase five-year survival rates of patients receiving conventional therapies. The four CHDs are Sishen Jiedu Decoction, Pingxiao Tablet, Fuzheng Guben Granule, and Buyang Huanwu Tang. For managing precancerous lesions, 12 CHDs were tested: six used alone and six in combination with conventional therapies. Zengshengping is one of the CHDs used alone and is the only one that has been proven to prevent the development of esophageal cancer with convincing evidence. This review provides information about the clinical benefits of CHDs and offers a reference for their rational application in treating upper digestive tract cancers. The reviewed studies have limitations: most trials had small sample sizes and were not multi-center; only one study investigated the mechanisms of action of the studied CHD; and the active components of CHDs were not explored. To promote international recognition of CHDs, rigorously designed studies on clinical outcomes, mechanisms of action, and active components are warranted. Moreover, the studied CHDs should be standardized.

Feasibility and stage at diagnosis for children with cancer: a pilot study on population-based data in a middle-income country using the Toronto childhood cancer stage guidelines

Background

The aim was to conduct a pilot study in a middle-income country testing the use of the Toronto Childhood Cancer Staging System by Population-Based Cancer Registry (PBCR).

Methods

This study involved first the translation of the Australian pediatric cancer staging manual for 16 types of pediatric tumours. Four PBCRs from different regions of Brazil were selected for a pilot study. The study period was from 2005 to 2014, and data were collected from notification sources, including hospitals, pathological laboratories and routine medical records, and staging was done retrospectively.

Results

We identified 1,560 pediatric cancer cases diagnosed between 2005 and 2014. Notably, 94.7% met Tier 1 criteria, and 91.9% met Tier 2 criteria. The PBCR from Curitiba (south region) demonstrated higher staging feasibility (99.3% Tier 1; 96.7% Tier 2) than from Aracaju (northeast) (87.5% Tier 1; 81.3% Tier 2). Most cases had localised or regional disease (77.7%), while 14.3% were metastatic, and 8.0% could not be staged. Osteosarcoma had the highest metastasis rate (50.0%).

Conclusion

Our study demonstrates the feasibility of collecting pediatric cancer stage data from population-based registries in resource-limited settings, advancing our understanding of pediatric cancer outcomes in Brazil.

FKBP4 promotes glycolysis and hepatocellular carcinoma progression via p53/HK2 axis

FKBP4, a member of the FK506-binding protein (FKBP) family, is a promising target for a variety of disorders, including cancer. However, its underlying molecular mechanism and potential function in hepatocellular carcinoma (HCC) are largely elusive. Therefore, we aimed to investigate the expression status, functional implications and underlying mechanisms of FKBP4 in HCC. Our bioinformatics analysis of TCGA LIHC datasets, ICGC LIRI-JP datasets and GEO datasets results showed FKBP4 was upregulated in HCC tissues. We also confirmed the elevated FKBP4 in clinical HCC samples. Additionally, quantitative RT-PCR results revealed FKBP4 was highly expressed in all five tested HCC cell lines. We also observed a correlation between elevated FKBP4 expression and poor prognosis in HCC patients. Loss of FKBP4 can inhibit the proliferation and migration in HCC cells. Furthermore, we found that silencing FKBP4 suppressed glucose uptake, lactic acid production and 18F-FDG uptake compared with the control group. Mechanistically, our funding indicated that FKBP4 participates in glycolysis through p53 mediated HK2 signaling pathway, specially, FKBP4 knockdown promotes the expression and stability of p53 protein rather than affecting the transcription level. Finally, rescue experiments revealed that simultaneous knockdown of both FKBP4 and p53 partially reversed the inhibitory effects on HK2 protein levels and 18F-FDG uptake. Our study elucidates a novel role of FKBP4 in promoting HCC development and glycolysis by modulating the p53/HK2 signaling pathway. Given the critical role of aerobic glycolysis in the progression of HCC, targeting FKBP4 may offer a new therapeutic strategy for treating this malignancy.

Global Disparities of Cancer and Its Projected Burden in 2050

Importance

Cancer prevention and care efforts have been challenged by the COVID-19 pandemic and armed conflicts, resulting in a decline in the global Human Development Index (HDI), particularly in low- and middle-income countries. These challenges and subsequent shifts in health care priorities underscore the need to continuously monitor cancer outcome disparities and statistics globally to ensure delivery of equitable and optimal cancer prevention and care in uncertain times.

Objective

To measure the global burden of 36 cancers in 2022 by sex, age, and geographic location and to project future trends by 2050.

Design, Setting, and Participants

This cross-sectional study used population-based data from 2022 in 185 countries and territories were obtained from the Global Cancer Observatory database. Data extraction and analysis were carried out in April 2024.

Main Outcomes and Measures

Counts, rates, prevalence, mortality to incidence ratios (MIRs), and demography-based projections were used to characterize current and future cancer burden.

Results

This population-based study included 36 cancer types from 185 countries and territories. By 2050, 35.3 million cancer cases worldwide are expected, a 76.6% increase from the 2022 estimate of 20 million. Similarly, 18.5 million cancer deaths are projected by 2050, an 89.7% increase from the 2022 estimate of 9.7 million. Cancer cases and deaths are projected to nearly triple in low-HDI countries by 2050, compared to a moderate increase in very high-HDI countries (142.1% vs 41.7% for cancer cases and 146.1% vs 56.8% for cancer deaths). Males had a higher incidence and greater number of deaths in 2022 than females, with this disparity projected to widen by up to 16.0% in 2050. In 2022, the MIR for all cancers was 46.6%, with higher MIRs observed for pancreatic cancer (89.4%), among males (51.7%), among those aged 75 years or older (64.3%), in low-HDI countries (69.9%), and in the African region (67.2%).

Conclusions and Relevance

In this cross-sectional study based on data from 2022, cancer disparities were evident across HDI, geographic regions, age, and sex, with further widening projected by 2050. These findings suggest that strengthening access to and quality of health care, including universal health insurance coverage, is key to providing evidence-based cancer prevention, diagnostics, and care.

The Current State of Robot-Assisted Minimally Invasive Esophagectomy (RAMIE): Outcomes from the Upper GI International Robotic Association (UGIRA) Esophageal Registry

BACKGROUND

Robot-assisted minimally invasive esophagectomy (RAMIE) is increasingly adopted in centers worldwide, with ongoing refinements to enhance results. This study aims to assess the current state of RAMIE worldwide and to identify potential areas for improvement.

METHODS

This descriptive study analyzed prospective data from esophageal cancer patients who underwent transthoracic RAMIE in Upper GI International Robotic Association (UGIRA) centers. Main endpoints included textbook outcome rate, surgical techniques, and perioperative outcomes. Analyses were performed separately for intrathoracic (Ivor-Lewis) and cervical anastomosis (McKeown), divided into three time cohorts (2016-2018, 2019-2020, 2021-2023). A sensitivity analysis was conducted with cases after the learning curve (> 70 cases).

RESULTS

Across 28 UGIRA centers, 2012 Ivor-Lewis and 1180 McKeown procedures were performed. Over the time cohorts, textbook outcome rates were 39%, 48%, and 49% for Ivor-Lewis, and 49%, 63%, and 61% for McKeown procedures, respectively. Fully robotic procedures accounted for 66%, 51%, and 60% of Ivor-Lewis procedures, and 53%, 81%, and 66% of McKeown procedures. Lymph node yield showed 27, 30, and 30 nodes in Ivor-Lewis procedures, and 26, 26, and 34 nodes in McKeown procedures. Furthermore, high mediastinal lymphadenectomy was performed in 65%, 43%, and 37%, and 70%, 48%, and 64% of Ivor-Lewis and McKeown procedures, respectively. Anastomotic leakage rates were 22%, 22%, and 16% in Ivor-Lewis cases, and 14%, 12%, and 11% in McKeown cases. Hospital stay was 13, 14, and 13 days for Ivor-Lewis procedures, and 12, 9, and 11 days for McKeown procedures. In Ivor-Lewis and McKeown, respectively, the sensitivity analysis revealed textbook outcome rates of 43%, 54%, and 51%, and 47%, 64%, and 64%; anastomotic leakage rates of 28%, 18%, and 15%, and 13%, 11%, and 10%; and hospital stay of 11, 12, and 12 days, and 10, 9, and 9 days.

CONCLUSIONS

This study demonstrates favorable outcomes over time in achieving textbook outcome after RAMIE. Areas for improvement include a reduction of anastomotic leakage and shortening of hospital stay.

Enhancing prostate cancer segmentation on multiparametric magnetic resonance imaging with background information and gland masks

BACKGROUND

The landscape of prostate cancer (PCa) segmentation within multiparametric magnetic resonance imaging (MP-MRI) was fragmented, with a noticeable lack of consensus on incorporating background details, culminating in inconsistent segmentation outputs. Given the complex and heterogeneous nature of PCa, conventional imaging segmentation algorithms frequently fell short, prompting the need for specialized research and refinement.

PURPOSE

This study sought to dissect and compare various segmentation methods, emphasizing the role of background information and gland masks in achieving superior PCa segmentation. The goal was to systematically refine segmentation networks to ascertain the most efficacious approach.

METHODS

A cohort of 232 patients (ages 61-73 years old, prostate-specific antigen: 3.4-45.6 ng/mL), who had undergone MP-MRI followed by prostate biopsies, was analyzed. An advanced segmentation model, namely Attention-Unet, which combines U-Net with attention gates, was employed for training and validation. The model was further enhanced through a multiscale module and a composite loss function, culminating in the development of Matt-Unet. Performance metrics included Dice Similarity Coefficient (DSC) and accuracy (ACC).

RESULTS

The Matt-Unet model, which integrated background information and gland masks, outperformed the baseline U-Net model using raw images, yielding significant gains (DSC: 0.7215 vs. 0.6592; ACC: 0.8899 vs. 0.8601, p < 0.001).

CONCLUSION

A targeted and practical PCa segmentation method was designed, which could significantly improve PCa segmentation on MP-MRI by combining background information and gland masks. The Matt-Unet model showcased promising capabilities for effectively delineating PCa, enhancing the precision of MP-MRI analysis.

Lung cancer survival trends and prognostic factors: A 26-year population-based study in Girona Province, Spain

BACKGROUND

Lung cancer (LC) is Europe's primary cause of cancer-related mortality largely due to its historically low survival rates. The aim of this study was to analyze 26-year survival trends in the province of Girona, Spain, and to identify key prognostic factors.

METHODS

Population-based study of LC cases collected between 1994 and 2019, with follow-up until December 31, 2021. Variables included date of diagnosis, sex, age, histology, and tumor stage (the latter since 2010). Diagnosis dates were categorized into three periods (1994-2002, 2003-2011, and 2012-2019). Multivariate flexible parametric models, incorporating age as a non-linear, time-varying covariate, were used to analyze net survival (NS) and trends. Annual absolute change in survival (AAC_S) was calculated using 3-year NS.

RESULTS

The analysis of 9,113 LC cases showed a NS improvement between the first and last period (7.1 months (95 %CI: 6.5;7.6) to 8.5 months (95 %CI: 7.9;9.1)). Squamous cell carcinoma (NSC-SCC) showed the greatest improvement with an AAC_S of 0.32 % (95 % CI: 0.21; 0.43), while survival for non-small cell lung cancer not otherwise specified declined (AAC_S of -0.19 % (95 %CI: -0.26; -0.12)). Prognostic analysis of the 3,642 cases (2010-2019) indicated a lower LC death risk for adenocarcinoma and NSC-SCC compared to LC not otherwise specified (HR 0.52 and 0.62, respectively). Increasing tumor stage correlated with higher LC mortality risk (1.8-, 4.0-, and 10.1-fold increase for stage II, III, and IV, respectively, compared to stage I).

CONCLUSIONS

LC survival has notably improved, particularly for NSC-SCC. Survival is influenced by sex, age, date of diagnosis, tumor histology and especially by stage, underscoring comprehensive data collection's importance.

Survival among patients cured from gastric adenocarcinoma compared to the background population

BACKGROUND

It is unknown if gastric adenocarcinoma survivors have longer, shorter, or similar survival compared to the background population. This knowledge could contribute to evidence-based monitoring strategies, healthcare recommendations, and information for patients and families.

METHODS

This population-based cohort study included all patients who underwent gastrectomy for gastric adenocarcinoma between 2006-2015 in Sweden and survived ≥ 5 years after surgery. They were followed up until death, postoperative year 10, or end of study period (31 December, 2020). Division of the observed by the expected survival yielded relative survival rates with 95% confidence intervals (CIs) using the life table method. The expected survival was derived from the entire Swedish population of the corresponding age, sex, and calendar year. Data came from medical records and nationwide registers.

RESULTS

The survival among all 767 gastric adenocarcinoma survivors was shorter than the expected. The reduction in relative survival increased for each follow-up year, from 97.3% (95% CI 95.4-99.1%) year 6 to 86.6% (95% CI 82.3-90.9%) year 10. The decline in relative survival was more pronounced among patients who had gastrectomy in earlier calendar years (82.9% [95% CI 77.4-88.4%] year 10 for years 2011-2015), shorter education (85.2% [95% CI 77.4-93.0%] year 10 for education ≤ 9 years), more comorbidities (78.0% [95% CI 63.9-92.0%] year 10 for Charlson comorbidity score ≥ 2), and no neoadjuvant therapy (83.2% [95% CI 77.4-89.0%] year 10).

CONCLUSION

Gastric adenocarcinoma survivors seem to have poorer survival than the corresponding background population, particularly in certain subgroups.

Association between textbook outcome and long-term survival among patients undergoing curative-intent resection of gastric cancer

BACKGROUND

A single metric does not sufficiently capture the multidimensional and complex perioperative nature of treatment for patients with gastric cancer. There is a newly developed composite indicator, called textbook outcome, that reflects the "ideal" surgical outcome. However, limited evidence exists for the long-term prognosis of textbook outcome in patients with gastric cancer. Thus, this study was aimed at assessing the association between textbook outcome and long-term oncologic prognosis after gastrectomy.

METHODS

In total, 2,658 consecutive patients who underwent gastrectomy between January 2004 and December 2017 were included. The primary endpoint was 5-year conditional survival (if the patient survived the first 30 days after surgery). Textbook outcome was defined as retrieved ≥15 lymph nodes, pR0 resection, complete-potentially curative resection during operation, hospitalization ≤21 days, no reinterventions, no severe postoperative complications, no hospital readmission ≤30 days after discharge, no unplanned intensive care unit treatment, and no 30-day postoperative mortality. Multivariable analysis was performed to evaluate the adjusted predictors of textbook outcome. A Cox regression analysis was used to analyze the relationship between achieving textbook outcome parameters and long-term oncologic prognosis.

RESULTS

A total of 1,770 (66.6%) of the 2,658 patients achieved all textbook outcome metrics in this study. The textbook outcome group displayed a greater 5-year conditional overall survival than the nontextbook outcome group (64.7% vs 40.2%, P < .001). The 5-year conditional disease-free survival of the patients with textbook outcomes was strongly superior to that of the patients without textbook outcomes (63.1% vs 37.6%, P < .001). Textbook outcome was independently associated with longer 5-year conditional overall survival and disease-free survival (hazard ratio 0.494 [0.439-0.557] and hazard ratio 0.487 [0.433-0.547], respectively).

CONCLUSIONS

Attaining textbook outcome is strongly related to an improved long-term oncologic prognosis for patients with gastric cancer, underscoring the need for continued efforts to enhance surgical care quality.

Role experiences of women with breast cancer as daughters: A qualitative meta-synthesis

Objective

To synthesize qualitative data on the role experiences of women with breast cancer as daughters, and thereby provide inspiration and reference for psychological and social interventions for these patients and their families.

Methods

Six English databases (PubMed, Web of Science, CINAHL, Embase, Cochrane Library, and Joanna Briggs Institute) and four Chinese databases (CNKI, Wanfang, VIP, and CBM) were searched from inception to June 2024 to retrieve qualitative or mixed-methods studies on the role experiences of women with breast cancer as daughters. The Joanna Briggs Institute Critical Appraisal Tool for qualitative research was used to evaluate study quality, and the results were integrated using a meta-aggregation approach.

Results

Eighteen studies were included in this meta-synthesis: 37 findings were extracted and aggregated into 10 categories and three synthesized findings. Synthesized findings focused on negative experiences in the role of daughter; positive experiences in the role of daughter; and support needs in the role of daughter. The confidence of all synthesized findings was moderate.

Conclusions

Emphasis should be placed on the role experiences of women with breast cancer as daughters, and targeted practical assistance and professional support should be provided to promote the stable development of the patient's relationship with their parents and enhance the coping ability of both patients and their families.

Systematic review registration

PROSPERO, CRD42023456567.

The Prognostic Value of Serum Soluble Programmed Death 1 (sPD-1) and Programmed Death Ligand 1 (sPD-L1) in Esophageal Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis About Cohort Studies

Background and Aims

There are still no useful biomarkers for the prognosis of esophageal squamous cell carcinoma (ESCC). In the prognosis of some kinds of cancer, soluble programmed death 1 (sPD-1) and programmed death ligand 1 (sPD-L1) have demonstrated statistical significance, but the prognostic value of serum sPD-L1 and sPD-1 remains unclear in ESCC.

Methods

Here, a meta-analysis was performed to estimate the prognostic value of sPD-L1 and sPD-1 in ESCC. To obtain eligible studies, we searched mainstream databases (PubMed, Cochrane, Embase, Web of Science, Wanfang Data, and CNKI), and the survival data including hazard ratios (HR) and its 95% confidence intervals (95% CI) from included literature were extracted.

Results

Six articles were included, including 645 patients with ESCC. The statistical result of this meta-analysis indicated that serum sPD-1 had no significant correlation with overall survival (OS) of patients with ESCC (p > 0.05). Patients with ESCC with high concentrations of serum sPD-L1 demonstrated a significantly poor prognosis (HR = 1.73, 95% CI: 1.42-2.11, p < 0.001).

Conclusion

Higher levels of serum sPD-L1 may predict poor OS in ESCC patients, which may be a promising and credible prognostic biomarker for esophageal cancer.

Liver Cancer Etiology: Old Issues and New Perspectives

PURPOSE OF REVIEW

This review aims to synthesize the old issues and current understandings of the etiology of liver cancer, focusing on the diverse causative factors influenced by geographical, socioeconomic, and lifestyle variations across different regions.

RECENT FINDINGS

We highlight significant geographic disparities in liver cancer risk factors. While hepatitis B and C viruses, aflatoxin exposure, and alcohol consumption remain globally established contributors; metabolic dysfunction-associated steatotic liver disease and metabolic syndromes are increasingly prominent in the West. Chronic HBV and aflatoxin continue to dominate as risk factors in Asia and Africa. Dietary factors, metabolic diseases like diabetes and obesity, genetic predispositions, environmental risk factors and lifestyle choices such as smoking and alcohol use play substantial roles in specific populations. Protective factors like coffee and tea consumption, along with aspirin use, vegetables and fruits have shown potential in reducing HCC risk, although findings vary by population and dietary habits. Liver cancer etiology is influenced by various factors that differ by region. Established risk factors include hepatitis B and C, aflatoxin, and alcohol. Emerging risks, such as metabolic dysfunction-associated steatotic liver disease, are more prevalent in Western countries, while aflatoxin and HBV remains significant in Asia and Africa. Diet, metabolic conditions like diabetes and obesity, genetic predispositions, and lifestyle choices also play crucial roles. Coffee, tea, aspirin, vegetables, and fruits may reduce HCC risk, but effectiveness varies. Future research should integrate epidemiology, genetics, and nutrition, with global cooperation and data sharing essential for effective cancer control strategies.

Cervical squamous cell carcinoma outcomes across continents: A retrospective study

OBJECTIVE

To assess the influence of geographies and race on the survival outcomes in patients diagnosed with cervical squamous cell carcinoma (CSCC) across three continents.

METHODS

This multicontinental retrospective study was conducted in 8 hospitals across Asia, Europe, and North America (NA). Clinicopathologic data of 595 patients with presumed early stages of CSCC, treated surgically, with curative intent was collected. Descriptive analysis and Cox regression models were produced.

RESULTS

A total of 595 patients, consisting of 445 (74.8 %) white, 75 (12.6 %) Blacks, and 75 (12.6 %) Asian patients were included. Geographical distribution comprised 69 % of patients from NA, 22 % from Europe, and 9 % from Asia. The median age at diagnosis was 46 years. The median overall survival (OS) and relapse-free survival (RFS) were 22.09 years and 21.19 years, respectively. Patient characteristics varied significantly across geographical regions, except for consensus tumor grade. Patients in Europe from middle-income countries with limited CC screening had a substantially higher risk of death than those in NA (HR, 1.79; 95 % CI, 1.13 to 2.79; p = 0.015). Patients from single center in Japan had higher risk of relapse than those from the four heterogeneous NA centers (sub-distribution hazard ratio, 2.19; 95 % CI, 1.22 to 3.95; p = 0.009), although OS did not differ significantly. Race remained statistically insignificant for survival outcomes across the three continents but seemed to influence survival outcomes in NA centers.

CONCLUSION

Our study highlights impact of geographies and races on CSCC survival outcomes, emphasizing the need of considering these factors when developing targeted interventions against CSCC.

CYP1B1 promotes PARPi-resistance via histone H1.4 interaction and increased chromatin accessibility in ovarian cancer

INTRODUCTION

Ovarian cancer is the most lethal gynecological cancer and presents significant therapeutic challenges. The discovery of synthetic lethality between PARP inhibitors (PARPi) and homologous recombination deficiency marked a new era in treating BRCA1/2-mutated tumors. However, PARPi resistance remains a major clinical challenge.

METHODS

RNA sequencing was used to identify genes altered by PARPi treatment and LC-MS was used to detect proteins interacting with CYP1B1. Resistance mechanisms were explored through ATAC-seq and gene expression manipulation. Additional techniques, including micrococcal nuclease digestion assays, DAPI staining, and fluorescence microscopy, were used to assess changes in nuclear morphology and chromatin accessibility.

RESULTS

The gradual exposure of Olaparib has developed a PARPi-resistant cell line, A2780-OlaR, which exhibits significant upregulation of CYP1B1 at both RNA and protein levels. Down-regulating CYP1B1 expression or using specific inhibitors decreased the cellular response to Olaparib. Linker histone H1.4 was identified as associated with CYP1B1. ATAC-seq showed differential chromatin accessibility between A2780-OlaR and parental cells, indicating that the downregulation of H1.4 was associated with increased chromatin accessibility and higher cell viability after Olaparib treatment.

CONCLUSION

Our findings reveal a novel role for CYP1B1 in driving PARPi resistance through distinct molecular mechanisms in A2780-OlaR. This study highlights the importance of chromatin accessibility in PARPi efficacy and suggests the CYP1B1/H1.4 axis as a promising therapeutic target for overcoming drug resistance in ovarian cancer, offering potentially therapeutic benefits.

Targeting SRSF10 might inhibit M2 macrophage polarization and potentiate anti-PD-1 therapy in hepatocellular carcinoma

BACKGROUND

The efficacy of immune checkpoint blockade therapy in patients with hepatocellular carcinoma (HCC) remains poor. Although serine- and arginine-rich splicing factor (SRSF) family members play crucial roles in tumors, their impact on tumor immunology remains unclear. This study aimed to elucidate the role of SRSF10 in HCC immunotherapy.

METHODS

To identify the key genes associated with immunotherapy resistance, we conducted single-nuclear RNA sequencing, multiplex immunofluorescence, and The Cancer Genome Atlas and Gene Expression Omnibus database analyses. We investigated the biological functions of SRSF10 in immune evasion using in vitro co-culture systems, flow cytometry, various tumor-bearing mouse models, and patient-derived organotypic tumor spheroids.

RESULTS

SRSF10 was upregulated in various tumors and associated with poor prognosis. Moreover, SRSF10 positively regulated lactate production, and SRSF10/glycolysis/ histone H3 lysine 18 lactylation (H3K18la) formed a positive feedback loop in tumor cells. Increased lactate levels promoted M2 macrophage polarization, thereby inhibiting CD8+ T cell activity. Mechanistically, SRSF10 interacted with the 3'-untranslated region of MYB, enhancing MYB RNA stability, and subsequently upregulating key glycolysis-related enzymes including glucose transporter 1 (GLUT1), hexokinase 1 (HK1), lactate dehydrogenase A (LDHA), resulting in elevated intracellular and extracellular lactate levels. Lactate accumulation induced histone lactylation, which further upregulated SRSF10 expression. Additionally, lactate produced by tumors induced lactylation of the histone H3K18la site upon transport into macrophages, thereby activating transcription and enhancing pro-tumor macrophage activity. M2 macrophages, in turn, inhibited the enrichment of CD8+ T cells and the proportion of interferon-γ+CD8+ T cells in the tumor microenvironment (TME), thus creating an immunosuppressive TME. Clinically, SRSF10 could serve as a biomarker for assessing immunotherapy resistance in various solid tumors. Pharmacological targeting of SRSF10 with a selective inhibitor 1C8 enhanced the efficacy of programmed cell death 1 (PD-1) monoclonal antibodies (mAbs) in both murine and human preclinical models.

CONCLUSIONS

The SRSF10/MYB/glycolysis/lactate axis is critical for triggering immune evasion and anti-PD-1 resistance. Inhibiting SRSF10 by 1C8 may overcome anti-PD-1 tolerance in HCC.

The Determinants of Inpatient Palliative Care Use in Patients With Pancreatic Cancer

INTRODUCTION

Symptom burden management is a major goal of pancreatic cancer care given that most patients are diagnosed late. Early palliative care is recommended in addition to concurrent active treatment; however, disparities exist. We sought to determine the factors associated with inpatient palliative treatment among pancreatic cancer patients and compare treatment outcomes in terms of mortality, discharge disposition and resource utilization.

METHODS

We conducted a retrospective study of 22,053 pancreatic cancers using the National Inpatient Sample (NIS) database (January - December 2020). Patient and hospital characteristics, mortality, discharge disposition, length of stay (LOS), hospital costs and charges were compared between pancreatic cancer patients based on palliative treatment. Multivariate regression was used to evaluate patient and hospital characteristics and outcomes associated with palliative treatment.

RESULTS

A total number of 3839 (17.4%) patients received palliative care. Patients who received palliative care were more likely to be older, Medicaid insured, and nonobese. Patients were less likely to receive palliative care if they are males, Medicare insured, had a lower Charlson comorbidity score, or treated in Urban nonteaching hospitals. Patients who received palliative care displayed higher odds of in-hospital mortality and prolonged LOS. The adjusted additional mean hospital cost and charges in patients who received palliative care were lower by $1459, and $4222 respectively.

CONCLUSIONS

Inpatient palliative treatment in pancreatic cancer patients is associated with an older age, a higher comorbidity burden, non-obesity, insurance status and urban teaching hospitals. Our study suggests that inpatient palliative treatment decreased hospital resource utilization without prolonging survival.

The effect of median household income on the prognosis of lung adenocarcinoma: A SEER analysis

Background

Lung cancer is the main cause of death related to malignant tumors. Since cause-specific mortality can guide clinical decision-making, this study employed the Fine-Gray model based on the Surveillance, Epidemiology, and End Results (SEER) database to identify significantly how socio-economic status influences initial treatment decisions and survival outcomes in patients with lung adenocarcinoma.

Objective

The aim of this study was to identify the predictors of lung adenocarcinoma.

Methods

The U.S. Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients diagnosed with lung adenocarcinoma between 2000 and 2018. Seventeen thousand four hundred forty-one patients with lung adenocarcinoma were subdivided in four socio-economic tertiles, based on median household income. Cox regression modeling explored the relationship between race, surgery, grading, and median household income on survival outcomes. The study also assessed patient demographic characteristics, age at diagnosis, and surgical interventions.

Results

Among 17 441 patients with primary lung adenocarcinoma, the age distribution was as follows: less than 45 years (n=202, 1.16%), between 45 and 54 years (n=1121, 6.43%), 55 and 64 years (n=4252, 24.38%), 65 and 74 years (n=6357, 36.45%), 75 and 84 years (n=4426, 25.38%), and more than 84 years (n=1083, 6.2%). The adjusted hazard ratio (aHR) with 95% CI for ages 65-74 years, 75-84 years, and older than or equal to 85 years were 0.25 (0.11,1.29), 0.40 (0.11,1.50), and 0.72 (0.11,2.05), respectively. Multifactorial Cox regression indicated that the aHR for tumor metastasis was 0.93 (0.03, 2.54), and for patients who did not undergo surgery, it was 1.46 (0.03, 4.31). Grade IV patients exhibited the lowest survival rate [0.66(0.11, 1.93)]. A notable correlation existed between median household income and survival, with distinctly lower survival rates observed in low-income groups.

Conclusion

Older patients, especially those who did not undergo surgery and had a higher tumor grade, had significantly reduced survival. Moreover, survival rates for black patients in lower-income brackets were worse than those for white patients in the same financial category.

Implications for practice

The quality of life of lung cancer patients is affected by low-income family.

Prognostic and immunological values of SKA3 for overall survival in lung adenocarcinoma and its RNA binding protein involved mechanisms

This article aimed to investigate the correlations among SKA3 expression and prognosis, clinical relevance, tumor immunity, and RNA-binding protein (RBP)-involved mechanisms for overall survival (OS) in lung adenocarcinoma (LUAD). To explore the SKA3 expression level in LUAD by analyzing the genomic data as well as related clinical characteristics from the database of TCGA. Nomogram and gene set enrichment analysis (GSEA) were applied, respectively, to evaluate the performance of SKA3 in LUAD. Correlations between SKA3 and immunity and RBP-involved mechanisms were also performed. SKA3 had a higher expression level in LUAD samples than in adjacent normal lung samples, with shorter survival times in the high-SKA3-expressed LUAD subgroup (P < 0.05). qRT-PCR results remained consistent (P < 0.05). Uni-/multivariate Cox analyses revealed that SKA3 could have independent prognostic ability for LUAD (both P < 0.05). The nomogram model constructed with clinical pathological parameters and SKA3 expression levels predicted OS rates for LUAD and GSEA revealed SKA3-related pathways. In aspects of tumor immunity, SKA3 was significantly involved with tumor neoantigen burden, tumor mutational burden, immune cell pathways, and immune checkpoint inhibitor (ICI) molecules (all P < 0.05). The CellMiner database also found significant correlations between SKA3 and the antitumor drug sensitivity of chemotherapy, fenretinide, and PX-316. Besides, a total of nine LncRNA/RBP/SKA3 networks were revealed in LUAD for their RBP-involved mechanisms. SKA3 could serve as a potential biomarker for OS prognosis and immunotherapy in LUAD. LncRNA/RBP/SKA3 networks were identified in LUAD for their RBP-involved mechanisms, paving the way for further experimental verifications.

Factors associated with physical activity in patients with upper gastrointestinal cancer during outpatient chemotherapy: A cross-sectional study

Objective

This study aimed to clarify the physical activity level of patients with upper gastrointestinal cancer during outpatient chemotherapy and the factors associated with decreased physical activity levels after drug administration.

Methods

In this cross-sectional study, activity intensity and steps were measured using an accelerometer in 39 patients with upper gastrointestinal cancer for 1 week before and after drug administration. Furthermore, the participants responded to a questionnaire on their lifestyles.

Results

No significant differences in steps and activity intensity were found before and after drug administration, and many participants had low activity levels. Logistic regression analysis showed that the Geriatric 8 scores and domestic roles were positively associated with higher activity levels after drug administration, whereas total bedtime showed a negative association. A predictive score for low activity was calculated from the three associated factors, and receiver operating characteristic analysis was conducted, resulting in an area under the curve of 0.90.

Conclusions

Physical activity may be low in patients with upper gastrointestinal cancer during outpatient chemotherapy. To maintain and promote physical activity, the results suggest the need to predict those who become less active after treatment and to support them by focusing on their domestic roles and total bedtime while considering their general condition. Our newly proposed predictive score can objectively identify patients with lower physical activity, regardless of the nurse's experience and ability, and improve patients' support during chemotherapy, even in the limited time available as outpatients.

Loss of resilience in Taiwan's pediatric care system after the COVID-19 pandemic

During the COVID-19 pandemic, Taiwan's pediatric healthcare system faced its most severe shortage of pediatric residents in history. This review investigates the causes, consequences, and potential solutions to this shortage. Between 2020 and 2023, the recruitment rate of pediatric residents dropped by 27.3%, increasing workloads for attending pediatricians and may worsening health outcomes for pediatric patients. Compared to South Korea and Japan, Taiwan has the highest neonatal mortality rates and lowest life expectancy at birth. Additionally, Taiwan's National Health Insurance (NHI) pays pediatricians in hospitals half of what it pays those in local clinics, hindering the attraction of pediatric hospitalists. To sustain the pediatric healthcare system, the government could consider directly compensating pediatricians at clinic rates and transitioning to a capitation payment system. Systemic recommendations include increasing health expenditure as a percentage of gross domestic production (GDP) and amending the NHI Act to eliminate the global budget payment system. Managing the resulting increase in financial responsibility could involve raising tax revenue as a percentage of GDP. Implementing these measures could strengthen the pediatric healthcare system and prevent a collapse of pediatric inpatient care.

Utilization of miRNAs as Biomarkers for the Diagnosis, Prognosis, and Metastasis in Gynecological Malignancies

Gynecological cancer is a term referring to malignancies that typically involve ovarian, cervical, uterine, vaginal, and vulvar cancer. Combined, these cancers represent major causes of morbidity and mortality in women with a heavy socioeconomic impact. MiRNAs are small non-coding RNAs that are intensively studied in the field of cancer and changes in them have been linked to a variety of processes involved in cancer that range from tumorigenesis to prognosis and metastatic potential. This review aims to summarize the existing literature that has linked miRNAs with each of the female malignancies as potential biomarkers in diagnosis (circulating miRNAs), in tumor histology and prognosis (as tissue biomarkers), and for local (lymph node) and distant metastatic disease.

The diagnosis value of dual-energy computed tomography (DECT) multi-parameter imaging in lung adenocarcinoma and squamous cell carcinoma

BACKGROUND

Lung cancer continues to pose a serious risk to human health. With a high mortality rate, non-small cell lung cancer (NSCLC) is the major type of lung cancer, making up to 85% of all cases of lung cancer. Lung adenocarcinoma (AC), and lung squamous cell carcinoma (SC) are the two primary types of NSCLC. Determining the pathological type of NSCLC is important in establishing the most effective treatment method. Dual-energy computed tomography (DECT) multi-parameter imaging is an imaging technology that provides accurate and reliable disease diagnosis, and its uses are utilized for the combined diagnostic efficacy of AC and SC. The purpose of this study was to investigate the diagnostic value of spectral parameters of DECT in efficacy to AC and SC, and their combined diagnostic efficacy was also analyzed.

METHODS

We conducted a retrospective analysis of clinical and imaging data for 36 patients diagnosed with SC and 35 patients with AC. These patients underwent preoperative DECT chest scans, encompassing both arterial and venous phases, at our hospital from December 2020 to April 2022. The tumor diameter, water concentration (WC), iodine concentration (IC), normalized iodine concentration (NIC), Z effective (Zeff), and slope of the curve (K) in lesions were evaluated during two scanning phases in the two separate pathological types of lung cancers. The differences in parameters between these two types of lung cancers were statistically analyzed. In addition, receiver operating characteristic (ROC) curves were performed for these parameters to distinguish between SC and AC.

RESULTS

In a univariate analysis involving 71 lung cancer patients, the results from Zeff, IC, NIC, and K from the AC's arterial and venous phase images were more elevated than those from the SC (P < 0.05). In contrast, the WC results were lower than those from SC (P < 0.05). The area under the ROC curve (AUC) for multi-parameter joint prediction typing was 0.831, with a corresponding sensitivity of 63.9% and specificity of 94.3%.

CONCLUSION

It is possible to distinguish between central SC and AC using the spectrum characteristics of DECT-enhanced scanning (Zeff, IC, NIC, K, WC, and tumor diameter). Diagnostic effectiveness can be greatly improved when multiple variables are included.

The prognostic value of radiogenomics using CT in patients with lung cancer: a systematic review

This systematic review aimed to evaluate the effectiveness of combining radiomic and genomic models in predicting the long-term prognosis of patients with lung cancer and to contribute to the further exploration of radiomics. This study retrieved comprehensive literature from multiple databases, including radiomics and genomics, to study the prognosis of lung cancer. The model construction consisted of the radiomic and genomic methods. A comprehensive bias assessment was conducted, including risk assessment and model performance indicators. Ten studies between 2016 and 2023 were analyzed. Studies were mostly retrospective. Patient cohorts varied in size and characteristics, with the number of patients ranging from 79 to 315. The construction of the model involves various radiomic and genotic datasets, and most models show promising prediction performance with the area under the receiver operating characteristic curve (AUC) values ranging from 0.64 to 0.94 and the concordance index (C-index) values from 0.28 to 0.80. The combination model typically outperforms the single method model, indicating higher prediction accuracy and the highest AUC was 0.99. Combining radiomics and genomics in the prognostic model of lung cancer may improve the predictive performance. However, further research on standardized data and larger cohorts is needed to validate and integrate these findings into clinical practice. CRITICAL RELEVANCE STATEMENT: The combination of radiomics and genomics in the prognostic model of lung cancer improved prediction accuracy in most included studies. KEY POINTS: The combination of radiomics and genomics can improve model performance in most studies. The results of establishing prognosis models by different methods are discussed. The combination of radiomics and genomics may be helpful to provide better treatment for patients.

Multicenter Prospective Study in HER2-Positive Early Breast Cancer for Detecting Minimal Residual Disease by Circulating Tumor DNA Analysis With Neoadjuvant Chemotherapy: HARMONY Study

Background

Biomarkers to predict the recurrence risk are required to optimize perioperative treatment. Adjuvant chemotherapy for patients with human epidermal growth factor 2-positive (HER2-positive) early breast cancer is decided by pathological responses of neoadjuvant chemotherapy (NAC). However, whether pathological responses are appropriate biomarkers is unclear. Currently, there are several studies using minimal residual disease (MRD) as a predictor of prognosis in solid tumors. However, there is no standard method for detecting MRD.

Objectives

This study aimed at prospectively evaluating the relationship between MRD detection and recurrence in Asian patients with HER2-positive early breast cancer.

Design

Prospective, observational, single-group, and exploratory. This study will include 60 patients from 2 institutions in Japan and the Philippines. The invasive disease-free survival (IDFS) rates of the MRD-positive and MRD-negative groups are compared in patients with HER2-positive early breast cancer who undergo surgery after receiving NAC.

Methods and analysis

Circulating tumor DNA (ctDNA) levels of patients will be evaluated 6 times: before NAC, after NAC, after surgery, and annually after surgery for 3 years. We will analyze the genetic profile of blood and tissue samples using the Todai OncoPanel (TOP) and the methylation level of DNA. The primary endpoint is IDFS. Secondary endpoints include overall survival (OS) and disease-free survival (DFS). Patient enrollment began in June 2022, and new participants are still being recruited.

Ethics

This study has been approved by the National Cancer Center Hospital Certified Review Board in March 2022 and has been approved by the Research Ethics Board of the participating center.

Discussion

Our findings will contribute to determining whether MRD detection using TOP is useful for predicting the recurrence of HER2-positive early breast cancer. If this is proven, MRD detected by TOP could be used in the future as a biomarker to assist in the de-/escalation of treatment strategies in the next interventional trial, thereby avoiding overtreatment in patients at low risk, and in the addition of intensive treatment modalities for those in patients at high risk.

Analysis of the treatment efficacy and prognostic factors of PD-1/PD-L1 inhibitors for advanced gastric or gastroesophageal junction cancer: a multicenter, retrospective clinical study

Introduction

Immune checkpoint inhibitors (ICIs) have transformed advanced gastric cancer treatment, yet patient responses vary, highlighting the need for effective biomarkers. Common markers, such as programmed cell death ligand-1 (PD-L1), microsatellite instability/mismatch repair (MSI/MMR), tumor mutational burden, tumor-infiltrating lymphocytes, and Epstein-Barr virus, face sampling challenges and high costs. This study seeks practical, minimally invasive biomarkers to enhance patient selection and improve outcomes.

Methods

This multicenter retrospective study analyzed 617 patients with advanced gastric or gastroesophageal junction cancer treated with programmed cell death protein-1 (PD-1)/PD-L1 inhibitors from January 2019 to March 2023. Clinical data and peripheral blood marker data were collected before and after treatment. The primary endpoints were overall survival (OS) and progression-free survival (PFS); the secondary endpoints included the objective response rate (ORR) and disease control rate (DCR). Least absolute shrinkage and selection operator (LASSO)-Cox and LASSO logistic regression analyses identified independent factors for OS, PFS, and ORR. Predictive nomograms were validated using receiver operating characteristic (ROC) curves, areas under the curve (AUCs), C-indices, and calibration curves, with clinical utility assessed via decision curve analysis (DCA), net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

Results

OS-related factors included treatment line, T stage, ascites, pretreatment indirect bilirubin (pre-IBIL), posttreatment CA125, CA199, CA724, and the PLR. PFS-related factors included treatment lines, T stage, metastatic sites, pre-IBIL, posttreatment globulin (GLOB), CA125, and CA199 changes. ORR-related factors included treatment line, T stage, N stage, liver metastasis, pretreatment red cell distribution width-to-platelet ratio (RPR), CA125, and CA724 changes. The nomograms showed strong predictive performance and clinical utility.

Conclusions

Early treatment, lower T stage, the absence of ascites, and lower pre-IBIL, post-CA125, CA199, CA724, and PLR correlate with better OS. Factors for improved PFS include early treatment, lower T stage, fewer metastatic sites, and lower pre-IBIL, post-GLOB, and post-CA125 levels. Nomogram models can help identify patients who may benefit from immunotherapy, providing valuable clinical guidance.