The impact of socioeconomic status on stage specific prostate cancer survival and mortality before and after introduction of PSA test in Finland

Disparities in Overall Survival Rates for Cancers across Income Levels in the Republic of Korea

BACKGROUND

The overall survival rates among cancer patients have been improving. However, the increase in survival is not uniform across socioeconomic status. Thus, we investigated income disparities in the 5-year survival rate (5YSR) in cancer patients and the temporal trends.

METHODS

This study used a national cancer cohort from 2002 to 2018 that was established by linking the Korea Central Cancer Registry and the National Health Insurance Service (NHIS) claim database to calculate the cancer survival rate by income level in the Republic of Korea. Survival data were available from 2002 onward, and the analysis was based on the actuarial method. We compared the survival of the earliest available 5-year period of 2002-2006 and the latest available 5-year period of 2014-2018, observing until 31 December 2021. Income level was classified into six categories: Medical Aid beneficiaries and five NHIS subtypes according to insurance premium. The slope index of inequality (SII) and relative index of inequality were used to measure absolute and relative differences in 5YSR by income, respectively.

RESULTS

The 5YSR between the 2002-2006 and 2014-2018 periods for all cancers improved. A significant improvement in 5-year survival rates (5YSR) over the study period was observed in lung, liver, and stomach cancer. The SII of survival rates for lung (17.5, 95% confidence interval (CI) 7.0-28.1), liver (15.1, 95% CI 10.9-19.2), stomach (13.9, 95% CI 3.2-24.7), colorectal (11.4, 95% CI 0.9-22.0), and prostate (10.7, 95% CI 2.5-18.8) cancer was significantly higher, implying higher survival rates as income levels increased. The SII for lung, liver, and stomach cancer increased, while that of thyroid, breast, cervical, prostate, and colorectal cancer decreased over the study period.

CONCLUSIONS

Although substantial improvement in the 5YSR was observed across cancer types and income levels from 2002 to 2018, this increase was not uniformly distributed across income levels. Our study revealed persistent income disparities in the survival of cancer patients, particularly for lung and liver cancer.

Establishment of a prognostic risk model for prostate cancer based on Gleason grading and cuprotosis related genes

INTRODUCTION

Prostate cancer (PCa) is common in aging males, diagnosed via the Gleason grading system. The study explores the unexamined prognostic value of cuprotosis, a distinct cell death type, alongside Gleason grades in PCa.

METHODS

We explored Cuprotosis-related genes (CRGs) in prostate cancer (PCa), using NMF on TCGA-PRAD data for patient classification and WGCNA to link genes with Gleason scores and prognosis. A risk model was crafted via LASSO Cox regression. STX3 knockdown in PC-3 cells, analyzed for effects on cell behaviors and tumor growth in mice, highlighted its potential therapeutic impact.

RESULTS

We identified five genes crucial for a prognostic risk model, with higher risk scores indicating worse prognosis. Survival analysis and ROC curves confirmed the model's predictive accuracy in TCGA-PRAD and GSE70769 datasets. STX3 was a key adverse prognostic factor, with its knockdown significantly reducing mRNA and protein levels, impairing PC-3 cell functions. In vivo, STX3 knockdown in PC-3 cells led to significantly smaller tumors in nude mice, underscoring its potential therapeutic value.

CONCLUSION

Our prognostic model, using five genes linked to Gleason scores, effectively predicts prostate cancer outcomes, offering a novel treatment strategy angle.

Survival in patients diagnosed with melanoma in situ compared to the general population. A Swedish population-based matched cohort study

Background

The incidence of melanoma in situ (MIS) is increasing even more rapidly than the incidence of cutaneous malignant melanoma (CMM). No previous studies have in detail investigated the survival in individuals diagnosed with MIS compared to the general population.

Methods

This population-based study included individuals with MIS diagnosed in Sweden between 2001 and 2010 and randomly selected MIS-free comparators matched on age, sex and county of residence. Exclusion criterion was a previous CMM. Data on socioeconomic status (SES) including educational level, income and marital status, comorbidity and cause of death were obtained from population-based registers. Overall survival (OS) was estimated by the Kaplan-Meier method. The mortality risk adjusted for SES and comorbidity was assessed by multivariable Cox regression analyses.

Findings

The survival analyses included 7963 cases and 39,662 comparators. Median age at MIS diagnosis were 63 (IQR 50-75) and 67 (IQR 57-76) years in women and men respectively. Median follow-up time was 120 months (IQR 102-152 months). In individuals with MIS, the ten-year OS was 77% (95% CI 0.76-0.78) compared to 72% (95% CI 0.72-0.73) in comparators. The MIS patients had a higher SES and lower comorbidity burden than the comparators. In a fully adjusted multivariable analysis, including 7772 cases and 38,103 comparators, the mortality was significantly lower in women with MIS (HR 0.88, 95% CI 0.82-0.94) compared to the background population. The corresponding estimate in men was HR 0.94 (95% CI 0.88-1.0). The risk of melanoma-related deaths during the study period was ten-fold higher in MIS patients.

Interpretation

Despite being at increased risk of developing CMM, MIS patients had a better OS compared to their matched comparators from the background population, findings which could not fully be explained by differences in SES and comorbidity. Our results are reassuring and should be communicated to patients who have been diagnosed with MIS.

Funding

Stiftelsen Onkologiska Klinikens i Uppsala Forskningsfond, Mats and Stefan Paulsson Trust, Medicon Village, Lund and Uppsala University Hospital (ALF).

How education level affects postoperative rehabilitation and follow-up: a single-center experience

BACKGROUND

Radical prostatectomy remains the fundamental treatment for prostate cancer, and improving patients' compliance with postoperative follow-ups is essential for improving patients' quality of life. This study investigates the effect of education levels on patients' recovery and follow-up after radical prostatectomy.

METHODS

Data from 1,112 patients undergoing radical prostatectomy between 2011 and 2020 were collected using medical records, and "pc-follow" systems were used to collect patients' baseline information, education level, pathological information, number of outpatient visits, the time interval between each visit, and PSA test data.

RESULTS

Regarding postoperative outpatient data, there was no difference in the number of outpatient visits among the different education level groups in Shanghai (P = 0.063). A significant difference was found in the interval between outpatient visits among the groups (P < 0.001). Furthermore, significant differences were detected in the number and duration of outpatient clinic visits among the education level groups in all patients (P = 0.016, P = 0.0027). By contrast, no significant difference was found in the recovery time of urinary continence between all patients and those in Shanghai, grouped according to education level (P = 0.082, P = 0.68). For all patients and patients in the Shanghai area, the number of PSA follow-ups increased gradually with an increasing level of education (P < 0.001, P = 0.0029).

CONCLUSIONS

Education level affected the number of postoperative clinic visits, compliance, and the number of PSA tests. However, no significant effect on the recovery of urinary continence was found. Further, clinicians must increase their focus on patients with low education levels to achieve equitable access to health services for all patients.

An analysis of time trends in breast and prostate cancer mortality rates in Lithuania, 1986-2020

Background

Breast cancer (BC) and prostate cancer (PC) mortality rates in Lithuania remain comparatively high despite the ongoing BC and PC screening programmes established in 2006. The aim of this study was to investigate time trends in BC and PC mortality rates in Lithuania evaluating the effects of age, calendar period of death, and birth-cohort over a 35-year time span.

Methods

We obtained death certification data for BC in women and PC in men for Lithuania during the period 1986–2020 from the World Health Organisation database. Age-standardised mortality rates were analysed using Joinpoint regression. Age-period-cohort models were used to assess the independent age, period and cohort effects on the observed mortality trends.

Results

Joinpoint regression analysis indicated that BC mortality increased by 1.6% annually until 1996, and decreased by − 1.2% annually thereafter. The age-period-cohort analysis suggests that temporal trends in BC mortality rates could be attributed mainly to cohort effects. The cohort effect curvature showed the risk of BC death increased in women born prior to 1921, remained stable in cohorts born around 1921–1951 then decreased; however, trend reversed in more recent generations. The period effect curvature displayed a continuous decrease in BC mortality since 1991–1995. For PC mortality, after a sharp increase by 3.0%, rates declined from 2007 by − 1.7% annually. The period effect was predominant in PC mortality, the curvature displaying a sharp increase until 2001–2005, then decrease.

Conclusions

Modestly declining recent trends in BC and PC mortality are consistent with the introduction of widespread mammography and PSA testing, respectively, lagging up to 10 years. The study did not show that screening programme introduction played a key role in BC mortality trends in Lithuania. Screening may have contributed to favourable recent changes in PC mortality rates in Lithuania, however the effect was moderate and limited to age groups < 65 years. Further improvements in early detection methods followed by timely appropriate treatment are essential for decreasing mortality from BC and PC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14207-4.

Prognostic values of the core components of the mammalian circadian clock in prostate cancer

Background

Prostate cancer (PC) is one of the most common malignancies in males. Extensive and complex connections between circadian rhythm and cancer were found. Nonetheless, in PC, the potential role of the core components of the mammalian circadian clock (CCMCCs) in prognosis prediction has not been fully clarified.

Methods

We firstly collected 605 patients with PC from The Cancer Genome Atlas (TCGA) and the Gene Expression Omnibus (GEO) databases. Survival analysis was carried out for each CCMCC. Then, we investigated the prognostic ability of CCMCCs by Cox regression analysis. Independent prognostic signatures were extracted for the establishment of the circadian clock-based risk score model. We explored the predictive performance of the risk score model in the TCGA training cohort and the independent GEO dataset. Finally, the relationships between risk score and clinicopathological parameters, biological processes, and signaling pathways were evaluated.

Results

The expression levels of CCMCCs were widely correlated with age, tumor status, lymph node status, disease-free survival (DFS), progression-free survival (PFS), and overall survival (OS). Nine circadian clock genes, including CSNK1D, BTRC, CLOCK, CSNK1E, FBXL3, PRKAA2, DBP, NR1D2, and RORB, were identified as vital prognostic factors in PC and were used to construct the circadian clock-based risk score model. For DFS, the area under the 3-year or 5-year receiver operating characteristic curves ranged from 0.728 to 0.821, suggesting better predictive performance. When compared with T3-4N1 stage, PC patients at T2N0 stage might be benefited more from the circadian clock-based risk score model. Furthermore, a high circadian clock-based risk score indicated shorter DFS (p < 0.0001), early progression (p < 0.0001), and higher 5-year death rate (p = 0.007) in PC. The risk score was related to tumor status (p < 0.001), lymph node status (p < 0.001), and ribosome-related biogenesis and pathways.

Conclusions

The vital roles of circadian clock genes in clinical outcomes were fully depicted. The circadian clock-based risk score model could reflect and predict the prognosis of patients with PC.

Variation in cancer survival between hospital districts and within them in Finland

BACKGROUND

Monitoring regional variation in population-based cancer survival is useful for assessing equity in national health-care system. This study quantifies variation in survival between municipalities and hospital districts responsible for primary care and for specialised care, respectively, in Finland.

MATERIAL AND METHODS

Five-year relative survival of 11 cancers and close to 700,000 patients was estimated by municipality in Finland over 1962-2016 using hierarchical Bayesian modelling. Variation (i) between hospital districts, (ii) between municipalities within hospital districts, and (iii) between all municipalities (total variation) were quantified by the standard deviation of 5-year relative survival standardised by the average survival level.

RESULTS

In 2007-2016, the largest variation in 5-year relative survival between all municipalities was in stomach, prostate, kidney and liver cancer and skin melanoma. In male skin melanoma, prostate, and kidney cancer and in male and female pancreatic cancer, there was substantial and statistically significant variation between hospital districts, too. Variation within hospital districts was on average 67% (95% posterior interval [58%,76%]) out of the total variation and had decreased by 18% [2%, 33%] from 1997-2006.

CONCLUSION

The decrease in variation within hospital districts suggests that equity in diagnostics and primary care has improved in Finland. However, the variation between hospital districts in skin melanoma, prostate and kidney cancer reflects differences in early diagnostics. In pancreatic cancer, substantial variation between hospital districts may relate to regional differences in the accessibility and the quality of cancer treatments.

Development of an autophagy-related gene expression signature for prognosis prediction in prostate cancer patients

Background

Prostate cancer (PCa) is one of the most prevalent cancers that occur in men worldwide. Autophagy-related genes (ARGs) may play an essential role in multiple biological processes of prostate cancer. However, ARGs expression signature has rarely been used to investigate the association between autophagy and prognosis in PCa. This study aimed to identify and assess prognostic ARGs signature to predict overall survival (OS) and disease-free survival (DFS) in PCa patients.

Methods

First, a total of 234 autophagy-related genes were obtained from The Human Autophagy Database. Then, differentially expressed ARGs were identified in prostate cancer patients based on The Cancer Genome Atlas (TCGA) database. The univariate and multivariate Cox regression analysis was performed to screen hub prognostic ARGs for overall survival and disease-free survival, and the prognostic model was constructed. Finally, the correlation between the prognostic model and clinicopathological parameters was further analyzed, including age, T status, N status, and Gleason score.

Results

The OS-related prognostic model was constructed based on the five ARGs (FAM215A, FDD, MYC, RHEB, and ATG16L1) and significantly stratified prostate cancer patients into high- and low-risk groups in terms of OS (HR = 6.391, 95% CI = 1.581– 25.840, P < 0.001). The area under the receiver operating characteristic curve (AUC) of the prediction model was 0.84. The OS-related prediction model values were higher in T3-4 than in T1-2 (P = 0.008), and higher in Gleason score  > 7 than  ≤ 7 (P = 0.015). In addition, the DFS-related prognostic model was constructed based on the 22 ARGs (ULK2, NLRC4, MAPK1, ATG4D, MAPK3, ATG2A, ATG9B, FOXO1, PTEN, HDAC6, PRKN, HSPB8, P4HB, MAP2K7, MTOR, RHEB, TSC1, BIRC5, RGS19, RAB24, PTK6, and NRG2), with AUC of 0.85 (HR = 7.407, 95% CI = 4.850–11.320, P < 0.001), which were firmly related to T status (P < 0.001), N status (P = 0.001), and Gleason score (P < 0.001).

Conclusions

Our ARGs based prediction models are a reliable prognostic and predictive tool for overall survival and disease-free survival in prostate cancer patients.

Disadvantageous Socioeconomic Position at Specific Life Periods May Contribute to Prostate Cancer Risk and Aggressiveness

Background: Previous studies on socioeconomic position (SEP) and risk of prostate cancer (PCa) have produced contradictory results. Most measured SEP only once during the individuals' life span. The aim of the study was to identify life course models that describe best the relationship between SEP measured during childhood/adolescence, early- and late-adulthood, and risk of PCa overall as well as according to tumor aggressiveness at diagnosis. Methods: We used data from a population-based case-control study of PCa conducted in the predominantly French-speaking population in Montreal, Canada. Cases (n = 1,930) with new, histologically-confirmed PCa were ascertained across hospitals deserving the French-speaking population in 2005-2009. Controls (n = 1,991), selected from Quebec's list of French-speaking electors, were frequency-matched to cases (±5 years). In-person interviews collected information on socio-demographic and lifestyle characteristics, and a complete occupational history. Measures of SEP during childhood/adolescence included parents' ownership of a car and father's longest occupation, while the subject's first and longest occupations were used to indicate early- and late-adulthood SEP, respectively. We used the Bayesian relevant life course exposure model to investigate the relationship between lifelong SEP and PCa risk. Results: Cumulative exposure to disadvantageous SEP was associated with about a 50% increase in odds of developing PCa. Late-adulthood SEP was identified as a sensitive period for aggressive PCa. Childhood/adolescence SEP based on parents' ownership of a car was associated with non-aggressive PCa. Associations were independent from PCa screening. Conclusion: Disadvantageous SEP over the life course was associated with higher PCa incidence, with consistent evidence of sensitive time periods for cancer aggressiveness. The mechanisms through which disadvantageous SEP relates to PCa risk need to be further elucidated.