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Ko TM, Laraia KN, Alexander HR, Ecker BL, Grandhi MS, Kennedy TJ, In H, Langan RC, Pitt HA, Stroup AM, Eskander MF. Low neighborhood socioeconomic status is associated with poor outcomes in young adults with colorectal cancer. Surgery 2024; 176:626-632. [PMID: 38972769 DOI: 10.1016/j.surg.2024.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/22/2024] [Accepted: 05/19/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND The incidence of early-onset colorectal cancer has increased markedly over the past decade. Although established for older adults, there are limited data on socioeconomic and racial disparities in screening, treatment, and outcomes in this distinct group. METHODS Adults with primary colorectal cancer diagnosed at age <50 were identified from the Surveillance, Epidemiology, and End Results database. The exposure of interest was neighborhood socioeconomic status based on the Yost Index, a census-tract level composite score of neighborhood economic health. Univariate analysis was performed with χ2 analyses. Logistic regression models were created to evaluate the association of neighborhood socioeconomic status (Yost Index quintile) with metastasis at presentation and surgical intervention. Kaplan-Meier and Cox proportional hazards models were created. RESULTS In total, 45,660 early-onset colorectal cancer patients were identified; 16.8% (7,679) were in the lowest quintile of neighborhood socioeconomic status. Patients with the lowest neighborhood socioeconomic status were 1.13 times (95% confidence interval 1.06-1.21) more likely to present with metastases and had lower survival (hazard ratio 1.45, 95% confidence interval 1.37-1.53) compared to those with the highest neighborhood socioeconomic status. Non-Hispanic Black patients were more likely to present with metastatic disease (odds ratio 1.11, 95% confidence interval 1.05-1.19), less likely to undergo surgery for localized or regional disease (odds ratio 0.48, 95% confidence interval 0.43-0.53), and had lower survival (hazard ratio 1.21, 95% confidence interval 1.15-1.27) than non-Hispanic White patients. CONCLUSION Socioeconomic and racial disparities in early-onset colorectal cancer span diagnosis, treatment, and survival. As the disease burden of early-age onset colorectal cancer increases, interventions to boost early diagnosis and access to surgery are necessary to improve survival among minorities and patients with low neighborhood socioeconomic status.
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Affiliation(s)
- Tomohiro M Ko
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
| | - Kayla N Laraia
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
| | - H Richard Alexander
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Brett L Ecker
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Miral S Grandhi
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Timothy J Kennedy
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Haejin In
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Russell C Langan
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Henry A Pitt
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Antoinette M Stroup
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, NJ; Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Mariam F Eskander
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
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Ferrari D, Violante T, Day CN, McKenna NP, Mathis KL, Dozois EJ, Larson DW. Unveiling the Hidden Consequences: Initial Impact of COVID-19 on Colorectal Cancer Operation. J Am Coll Surg 2024; 239:85-97. [PMID: 38525960 DOI: 10.1097/xcs.0000000000001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND The COVID-19 pandemic has severely affected healthcare systems globally, resulting in significant delays and challenges in various medical treatments, particularly in cancer care. This study aims to investigate the repercussions of the pandemic on surgical interventions for colorectal cancer (CRC) in the US, using data from the National Cancer Database. STUDY DESIGN We conducted a retrospective analysis of the National Cancer Database, encompassing adult patients who underwent surgical procedures for colon and rectal cancer in 2019 (pre-COVID) and 2020 (COVID). We examined various demographic and clinical variables, including patient characteristics, tumor staging, surgical approaches, and socioeconomic factors. RESULTS The analysis included 105,517 patients, revealing a 17.3% reduction in surgical cases during the initial year of the pandemic. Patients who underwent surgery in 2020 displayed more advanced clinical and pathological tumor stages compared to those treated in 2019. After diagnosis, no delay was reported in the treatment. Patients operated during the pandemic, Black patients, uninsured, and Medicaid beneficiaries had worse stage colon and rectal cancer, and individuals with lower incomes bore the burden of advanced colon cancer. CONCLUSIONS The impact of the COVID-19 pandemic on CRC surgery transcends a mere decline in case numbers, resulting in a higher prevalence of patients with advanced disease. This study underscores the exacerbated disparities in cancer care, particularly affecting vulnerable populations. The COVID-19 pandemic has left a significant and enduring imprint on CRC surgery, intensifying the challenges faced by patients and healthcare systems. Comprehensive studies are imperative to comprehend the long-term consequences of delayed screenings, diagnoses, and treatments as healthcare planning for the future must consider the unintended repercussions of pandemic-related disruptions.
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Affiliation(s)
- Davide Ferrari
- From the Divisions of Colon and Rectal Surgery (Ferrari, Violante, McKenna, Mathis, Dozois, Larson), Mayo Clinic, Rochester, MN
- General Surgery Residency Program, University of Milan, Milan, Italy (Ferrari)
| | - Tommaso Violante
- From the Divisions of Colon and Rectal Surgery (Ferrari, Violante, McKenna, Mathis, Dozois, Larson), Mayo Clinic, Rochester, MN
- School of General Surgery, Alma Mater Studiorum Università di Bologna, Bologna, Italy (Violante)
| | | | - Nicholas P McKenna
- From the Divisions of Colon and Rectal Surgery (Ferrari, Violante, McKenna, Mathis, Dozois, Larson), Mayo Clinic, Rochester, MN
| | - Kellie L Mathis
- From the Divisions of Colon and Rectal Surgery (Ferrari, Violante, McKenna, Mathis, Dozois, Larson), Mayo Clinic, Rochester, MN
| | - Eric J Dozois
- From the Divisions of Colon and Rectal Surgery (Ferrari, Violante, McKenna, Mathis, Dozois, Larson), Mayo Clinic, Rochester, MN
| | - David W Larson
- From the Divisions of Colon and Rectal Surgery (Ferrari, Violante, McKenna, Mathis, Dozois, Larson), Mayo Clinic, Rochester, MN
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Vazquez S, Berke C, Lu VM, Wu EM, Silva MA, Das A, Soldozy S, Dominguez JF, Wang S. Pediatric Patients with Intracranial Arteriovenous Malformations: Trends in Emergency Room Presentation. World Neurosurg 2024; 188:e297-e304. [PMID: 38796143 DOI: 10.1016/j.wneu.2024.05.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Pediatric intracranial arteriovenous malformation (AVM) patients are commonly admitted to the emergency room (ER). Increasing patient utilization of the ER has been associated with healthcare disparities and a trend of decreased efficiency. The aim of this study was to evaluate the trends of pediatric AVM ER admissions over recent years and identify factors associated with health care resource utilization and outcomes. METHODS The 2016-2019 National Inpatient Sample was queried for patients under the age of 18 admitted with AVM. Cases of admission through the ER were identified. Demographic and severity factors associated with ER admission were explored using comparative and regression statistics. RESULTS Of 3875 pediatric patients with AVM admitted between 2016 and 2019, 1280 (33.0%) were admitted via the ER. Patients admitted via the ER were more likely to be in the lowest median income category (P < 0.001), on Medicaid insurance (P = 0.008), or in the South (P < 0.001) than patients admitted otherwise. There was increased severity and increased rates of intracranial hemorrhage (ICH) in patients admitted via the ER (P < 0.001). Finally, there were increasing trends in ER admissions and ICH throughout the years. CONCLUSIONS ER admission of pediatric AVM patients with ICH is increasing and is associated with a distinct socioeconomic profile and increased healthcare resource utilization. These findings may reflect decreased access to more advanced diagnostic modalities, primary care, and other important resources. Identifying populations with barriers to care is likely an important component of policy aimed at decreasing the risk of severe disease presentation.
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Affiliation(s)
- Sima Vazquez
- School of Medicine, New York Medical College, Valhalla, New York, USA.
| | - Chandler Berke
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Victor M Lu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eva M Wu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael A Silva
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ankita Das
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Sauson Soldozy
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Shelly Wang
- Department of Neurosurgery, Nicklaus Children's Hospital, Miami, Florida, USA
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Rouhafzay A, Yousefi J. Geographical Disparities in Colorectal Cancer in Canada: A Review. Curr Oncol Rep 2024:10.1007/s11912-024-01574-x. [PMID: 39073526 DOI: 10.1007/s11912-024-01574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE OF REVIEW Colorectal cancer (CRC) is a prominent contributor to cancer-related mortality in Canada. This review paper sheds light on the research conducted in Canada to scrutinize the influence of economicfactors. The review seeks to uncover notable disparities in Colorectal cancer incidence and mortality rate across diverse Canadian populations, including Indigenous communities, rural dwellers, and individuals with lower socioeconomic status (SES). RECENT FINDINGS Recent investigations reveal significant disparities in CRC incidence, mortality, and treatment outcomes among various demographic groups in Canada. Indigenous peoples, rural populations, and those with lower SES are particularly vulnerable to these disparities. Access to screening and specialized cancer care is notably limited for these marginalized populations, exacerbating existing health inequities. Furthermore, emerging evidence underscores the potential influence of dietary factors on CRC risk, highlighting the importance of tailored prevention and treatment strategies. The findings underscore the urgent need for targeted interventions aimed at enhancing access to CRC screening and specialized cancer care for disadvantaged populations in Canada. By addressing these disparities, more individuals can undergo timely screening and receive early-stage diagnoses, thereby improving prognosis and ultimately saving lives. However, to effectively bridge these gaps, further research is imperative to elucidate the underlying mechanisms driving these disparities and to identify and implement effective interventions.
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Affiliation(s)
- Asal Rouhafzay
- Shannon School of Business, Cape Breton University, Sydney, NS, Canada
| | - Jamileh Yousefi
- Shannon School of Business, Cape Breton University, Sydney, NS, Canada.
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada.
- Nova Scotia Health Authority, Halifax, NS, Canada.
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Sterpetti AV, Gabriele R, Iannone I, Dimarzo L, Borrelli V. National organized screening programs for breast, colorectal, and cervical cancer reduce socioeconomic disparities, but it is not enough. Cancer 2024; 130:2395-2397. [PMID: 38642368 DOI: 10.1002/cncr.35335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2024]
Affiliation(s)
| | | | | | - Luca Dimarzo
- Department of Surgery, Sapienza University of Rome, Rome, Italy
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Bourgeois A, Horrill T, Mollison A, Stringer E, Lambert LK, Stajduhar K. Barriers to cancer treatment for people experiencing socioeconomic disadvantage in high-income countries: a scoping review. BMC Health Serv Res 2024; 24:670. [PMID: 38807237 PMCID: PMC11134650 DOI: 10.1186/s12913-024-11129-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 05/21/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Despite advances in cancer research and treatment, the burden of cancer is not evenly distributed. People experiencing socioeconomic disadvantage have higher rates of cancer, later stage at diagnoses, and are dying of cancers that are preventable and screen-detectable. However, less is known about barriers to accessing cancer treatment. METHODS We conducted a scoping review of studies examining barriers to accessing cancer treatment for populations experiencing socioeconomic disadvantage in high-income countries, searched across four biomedical databases. Studies published in English between 2008 and 2021 in high-income countries, as defined by the World Bank, and reporting on barriers to cancer treatment were included. RESULTS A total of 20 studies were identified. Most (n = 16) reported data from the United States, and the remaining included publications were from Canada (n = 1), Ireland (n = 1), United Kingdom (n = 1), and a scoping review (n = 1). The majority of studies (n = 9) focused on barriers to breast cancer treatment. The most common barriers included: inadequate insurance and financial constraints (n = 16); unstable housing (n = 5); geographical distribution of services and transportation challenges (n = 4); limited resources for social care needs (n = 7); communication challenges (n = 9); system disintegration (n = 5); implicit bias (n = 4); advanced diagnosis and comorbidities (n = 8); psychosocial dimensions and contexts (n = 6); and limited social support networks (n = 3). The compounding effect of multiple barriers exacerbated poor access to cancer treatment, with relevance across many social locations. CONCLUSION This review highlights barriers to cancer treatment across multiple levels, and underscores the importance of identifying patients at risk for socioeconomic disadvantage to improve access to treatment and cancer outcomes. Findings provide an understanding of barriers that can inform future, equity-oriented policy, practice, and service innovation.
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Affiliation(s)
- Amber Bourgeois
- Institute for Aging & Lifelong Health, University of Victoria, PO Box 1700, Victoria, BC, V8V 2Y2, Canada.
- BC Cancer, Nursing and Allied Health Research and Knowledge Translation, 686 West Broadway, Vancouver, BC, V5Z 1G1, Canada.
| | - Tara Horrill
- College of Nursing, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada
| | - Ashley Mollison
- Institute for Aging & Lifelong Health, University of Victoria, PO Box 1700, Victoria, BC, V8V 2Y2, Canada
| | - Eleah Stringer
- BC Cancer, Nursing and Allied Health Research and Knowledge Translation, 686 West Broadway, Vancouver, BC, V5Z 1G1, Canada
| | - Leah K Lambert
- BC Cancer, Nursing and Allied Health Research and Knowledge Translation, 686 West Broadway, Vancouver, BC, V5Z 1G1, Canada
- School of Nursing, University of British Columbia, 2211 Wesbrook Mall T201, Vancouver, BC, V6T 2B5, Canada
| | - Kelli Stajduhar
- Institute for Aging & Lifelong Health, University of Victoria, PO Box 1700, Victoria, BC, V8V 2Y2, Canada
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Horrill TC, Bourgeois A, Kleijberg M, Linton J, Leahy K, Stajduhar KI. Services, models of care, and interventions to improve access to cancer treatment for adults who are socially disadvantaged: A scoping review protocol. PLoS One 2024; 19:e0296658. [PMID: 38408051 PMCID: PMC10896524 DOI: 10.1371/journal.pone.0296658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 12/05/2023] [Indexed: 02/28/2024] Open
Abstract
Timely access to guideline-recommended cancer treatment is known to be an indicator of the quality and accessibility of a cancer care system. Yet people who are socially disadvantaged experience inequities in access to cancer treatment that have significant impacts on cancer outcomes and quality of life. Among people experiencing the intersecting impacts of poor access to the social determinants of health and personal identities typically marginalized from society ('social disadvantage'), there are significant barriers to accessing cancer, many of which compound one another, making cancer treatment extremely difficult to access. Although some research has focused on barriers to accessing cancer treatment among people who are socially disadvantaged, it is not entirely clear what, if anything, is being done to mitigate these barriers and improve access to care. Increasingly, there is a need to design cancer treatment services and models of care that are flexible, tailored to meet the needs of patients, and innovative in reaching out to socially disadvantaged groups. In this paper, we report the protocol for a planned scoping review which aims to answer the following question: What services, models of care, or interventions have been developed to improve access to or receipt of cancer treatment for adults who are socially disadvantaged? Based on the methodological framework of Arksey and O'Malley, this scoping review is planned in six iterative stages. A comprehensive search strategy will be developed by an academic librarian. OVID Medline, EMBASE, CINAHL (using EBSCOhost) and Scopus will be searched for peer-reviewed published literature; advanced searches in Google will be done to identify relevant online grey literature reports. Descriptive and thematic analysis methods will be used to analyze extracted data. Findings will provide a better understanding of the range and nature of strategies developed to mitigate barriers to accessing cancer treatment.
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Affiliation(s)
- Tara C. Horrill
- College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amber Bourgeois
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | | | - Janice Linton
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kate Leahy
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Kelli I. Stajduhar
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
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Ruan Y, Heer E, Warkentin MT, Jarada TN, O'Sullivan DE, Hao D, Ezeife D, Cheung W, Brenner DR. The association between neighborhood-level income and cancer stage at diagnosis and survival in Alberta. Cancer 2024; 130:563-575. [PMID: 37994148 DOI: 10.1002/cncr.35098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Socioeconomic status (SES) is associated with a range of health outcomes, including cancer diagnosis and survival. However, the evidence for this association is inconsistent between countries with and without single-payer health care systems. In this study, the relationships between neighborhood-level income, cancer stage at diagnosis, and cancer-specific mortality in Alberta, Canada, were evaluated. METHODS The Alberta Cancer Registry was used to identify all primary cancer diagnoses between 2010 and 2020. Average neighborhood income was determined by linking the Canadian census to postal codes and was categorized into quintiles on the basis of income distribution in Alberta. Multivariable multinomial logistic regression was used to model the association between income quintile and stage at diagnosis, and the Fine-Gray proportional subdistribution hazards model was used to estimate the association between SES and cancer-specific mortality. RESULTS Out of the 143,818 patients with cancer included in the study, those in lower income quintiles were significantly more likely to be diagnosed at stage III (odds ratio [OR], 1.07; 95% CI [confidence interval], 1.06-1.09) or IV (OR, 1.12; 95% CI, 1.11-1.14) after adjusting for age and sex. Lower income quintiles also had significantly worse cancer-specific survival for breast, colorectal, liver, lung, non-Hodgkin lymphoma, oral cavity, pancreas, and prostate cancers. CONCLUSIONS Disparities were observed in cancer outcomes across neighborhood-level income groups in Alberta, which demonstrates that health inequities by SES exist in countries with single-payer health care systems. Further research is needed to better understand the underlying causes and to develop strategies to mitigate these disparities.
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Affiliation(s)
- Yibing Ruan
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, Alberta, Canada
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Emily Heer
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew T Warkentin
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tamer N Jarada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dylan E O'Sullivan
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Desiree Hao
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Doreen Ezeife
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Winson Cheung
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Darren R Brenner
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, Alberta, Canada
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Chiu LS, Huang KZ, Xu X, Heeren T, Haque R, Schroy PS. Initial Stage of Disease Similar for White and Black Patients With Early-Onset Colorectal Cancer at a Safety-Net Hospital. J Clin Gastroenterol 2024; 58:162-168. [PMID: 36806090 DOI: 10.1097/mcg.0000000000001840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/16/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Non-Hispanic Black (NHB) patients with early-onset colorectal cancer (EOCRC) are more likely to present with advanced-stage disease than their Non-Hispanic White (NHW) counterparts. To further elucidate whether differences in tumor biology or disparities in access to care may be responsible, we examined the association between race/ethnicity and initial stage of disease, time to diagnosis, and tumor characteristics among NHW and NHB patients with EOCRC cared for in a safety-net health care setting. METHODS We performed a retrospective cohort study of NHW and NHB patients diagnosed with primary EOCRC who received care at Boston Medical Center between January 2000 and May 2020. We compared demographics, risk factors, presenting signs/symptoms, time to diagnosis, health care utilization, and tumor characteristics (stage, grade, location, and mutational status). RESULTS We identified 103 patients (mean age 41.5±7.2 y, 53.4% men), including 40 NHWs and 63 NHBs, with EOCRC. NHB and NHW patients were similar with respect to demographics, presenting signs/symptoms, and risk factor distribution. There were also no significant differences between NHWs and NHBs with respect to the advanced stage of disease at presentation (45.0% vs. 42.9%, P =0.83), the median time to diagnosis [152 d (IQR, 40 to 341) vs. 160 d (IQR, 61 to 312), P =0.79] or tumor characteristics, except for a predilection for proximal disease among NHBs (30.2% vs. 15.0%). CONCLUSIONS NHB patients were no more likely than NHW patients to present with advanced-stage disease, aggressive tumor histology, or experience delays in diagnosis within a safety-net health care system.
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Affiliation(s)
- Laura S Chiu
- Department of Medicine, Section of Gastroenterology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Kevin Z Huang
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Xixi Xu
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Rubiya Haque
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul S Schroy
- Department of Medicine, Section of Gastroenterology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
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Boopathy LK, Roy A, Gopal T, Kandy RRK, Arumugam MK. Potential molecular mechanisms of myrtenal against colon cancer: A systematic review. J Biochem Mol Toxicol 2024; 38:e23525. [PMID: 37665681 DOI: 10.1002/jbt.23525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/12/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023]
Abstract
Colon cancer is a serious health problem across the globe with various dietary lifestyle modifications. It arises as an inflammation mediated crypts in the colon epithelial cells and undergoes uncontrolled cell division and proliferation. Bacterial enzymes contribute to a major outbreak in colon cancer development upon the release of toxic metabolites from the gut microflora. Pathogen associated molecular patterns and damage associated molecular patterns triggers the NLPR3 inflammasome pathways that releases pro-inflammatory cytokines to induce cancer of the colon. Contributing to this, specific chemokines and receptor complexes attribute to cellular proliferation and metastasis. Bacterial enzymes synergistically attack the colon mucosa and degenerate the cellular integrity causing lysosomal discharge. These factors further instigate the Tol like receptors (TLRs) and Nod like receptors (NLRs) to promote angiogenesis and supply nutrients for the cancer cells. Myrtenal, a monoterpene, is gaining more importance in recent times and it is being widely utilized against many diseases such as cancers, neurodegenerative diseases and diabetes. Based on the research data's, the reviews focus on the anticancer property of myrtenal by emphasizing its therapeutic properties which downregulate the inflammasome pathways and other signalling pathways. Combination therapy is gaining more importance as they can target every variant in the cellular stress condition. Clinical studies with compounds like myrtenal of the monoterpenes family is provided with positive results which might open an effective anticancer drug therapy. This review highlights myrtenal and its biological potency as a cost effective drug for prevention and treatment of colon cancer.
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Affiliation(s)
- Lokesh Kumar Boopathy
- Centre for Laboratory Animal Technology and Research, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu, India
| | - Anitha Roy
- Department of Pharmacology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
| | - Thiyagarajan Gopal
- Centre for Laboratory Animal Technology and Research, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu, India
| | - Rakhee Rathnam Kalari Kandy
- Department of Biochemistry and Molecular Biology, Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland, USA
| | - Madan Kumar Arumugam
- Cancer Biology Lab, Centre for Molecular and Nanomedical Sciences, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu, India
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Lo A, Le B, Colin-Escobar J, Ruiz A, Creps J, Kampalath R, Lee S. Disparities in Diagnostic Imaging for Initial Local Staging for Rectal Cancer. J Am Coll Radiol 2024; 21:154-164. [PMID: 37634795 DOI: 10.1016/j.jacr.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 06/30/2023] [Accepted: 07/08/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE To assess the presence, quality, and timeliness of initial staging imaging for rectal cancer patients, and to evaluate demographic factors associated with disparities. METHODS We conducted a chart review of consecutive rectal adenocarcinoma cancer registry cases from a single institution for the period from 2015 to 2020. We recorded whether initial staging MRI or endoscopic ultrasound (EUS) was performed, and whether it was performed in or outside the institution. MRI quality was assessed based on compliance to the Society of Abdominal Radiology rectal cancer disease-focused panel protocol recommendations. The times between diagnosis and imaging were calculated. Patients' age, race, ethnicity, sex, body mass index, address, and primary payer were acquired from the electronic medical record. Descriptive analysis, odds ratios, and Student's t tests were used for analysis. RESULTS Of 346 patients, 39% were female, and the average age was 59 years. A total of 93 patients (26.8%) had no initial staging MRI or endoscopic ultrasound. Of the 142 MRIs evaluated for image quality, 100 patient exams (72.4%) met the criteria for adequate quality. The mean time interval from diagnosis to imaging was 30.9 days. A lower likelihood of receiving initial local staging was associated with being of Hispanic ethnicity (P < .01), having Medicaid or no insurance (P < .01), and residing in a low-income census block (P < .01). Higher quality of imaging was associated with residence in a census block with high median income (P < 0.01), more recent diagnosis (P < .01), and MRI performed at the institution presented (P < .01). CONCLUSIONS Although radiologic workup variability was found across all demographics, sociodemographic factors have an effect on local initial imaging of rectal cancer, emphasizing the need to improve image acquisition for underserved patients and improve quality standardization at low-volume centers.
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Affiliation(s)
- Angelina Lo
- Department of Radiology, University of California, Irvine, School of Medicine, Orange, California
| | - Brittany Le
- Department of Radiology, University of California, Irvine, School of Medicine, Orange, California
| | - Jessica Colin-Escobar
- Department of Radiology, University of California, Irvine, School of Medicine, Orange, California
| | - Andres Ruiz
- Department of Radiology, University of California, Irvine, School of Medicine, Orange, California
| | - James Creps
- Department of Radiology, University of California, Irvine, School of Medicine, Orange, California
| | - Rony Kampalath
- Society of Abdominal Radiology Colorectal and Anal Cancer Disease Focused-Panel, Educational Subcommittee Lead, Department of Radiology, University of California, Irvine, School of Medicine, Orange, California
| | - Sonia Lee
- Radiology Lead of the Inflammatory Bowel Disease Multidisciplinary Conference, and a Member of the Society of Abdominal Radiology Treated Hepatocellular Carcinoma Disease Focused Panel, Department of Radiology, University of California, Irvine, School of Medicine, Orange, California.
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12
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Reif de Paula T, Keller DS. A national evaluation of adjuvant chemotherapy in pT4N0M0 colon cancer from the National Cancer Database. J Natl Cancer Inst 2023; 115:1616-1625. [PMID: 37584736 DOI: 10.1093/jnci/djad164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/24/2023] [Accepted: 08/13/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND T stage is a prognostic biomarker for overall survival in colon cancer and pathologic T4 disease is a high-risk characteristic. Adjuvant chemotherapy is recommended to improve overall survival in pT4N0M0, but compliance with guidelines is unknown. We aimed to evaluate adjuvant chemotherapy use and impact on overall survival in pT4N0M0 colon cancer. METHODS The National Cancer Database was reviewed for pT4N0M0 colon adenocarcinomas undergoing curative surgical resection (2010-2017). Cases were stratified into no adjuvant chemotherapy and adjuvant chemotherapy cohorts. Moderated multiple regression assessed factors associated with no AC. Kaplan-Meier and Cox regression assessed overall survival in propensity-score matched cohorts. The main outcome measures were adjuvant chemotherapy use, factors associated with adjuvant chemotherapy, and impact on overall survival. RESULTS Of 11 847 cases, 62.4% (n = 7391) received no adjuvant chemotherapy. With private insurance, comorbidities or income do not affect adjuvant chemotherapy use. Medicare cases with a Charlson-Deyo comorbidity index of 0 (odds ratio [OR] = 0.861, 95% confidence interval [CI] = 0.760 to 0.975; P = .019) and Medicare payors with high income (OR = 0.813, 95% CI = 0.690 to 0.959; P = .014) were associated with adjuvant chemotherapy. Medicaid Charlson-Deyo comorbidity index 0 (OR = 1.374, 95% CI = 1.125 to 1.679; P = .002) and uninsured Charlson-Deyo comorbidity index 0 (OR = 1.351, 95% CI = 1.120 to 1.629; P = .002) were associated with no adjuvant chemotherapy. Adjuvant chemotherapy was associated with improved 5-year overall survival (71.7% vs 56.4%; P < .001; adjusted hazard ratio = 0.543, 95% CI = 0.499 to 0.590; P < .001). CONCLUSION Although adjuvant chemotherapy is associated with improved overall survival, compliance is low. There is a complex relationship between payor, income, comorbidity, and adjuvant chemotherapy receipt. Medicare patients with no comorbidities or higher income have better adjuvant chemotherapy use. With private insurance, adjuvant chemotherapy compliance is not affected by comorbidities or income, whereas Medicaid and uninsured patients with no comorbidities have poor compliance. Future work could target these disparities for equitable care.
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Affiliation(s)
- Thais Reif de Paula
- Lankenau Institute for Medical Research, Lankenau Medical Center, Wynnewood, PA, USA
| | - Deborah S Keller
- Lankenau Institute for Medical Research, Lankenau Medical Center, Wynnewood, PA, USA
- Department of Surgery, Lankenau Medical Center, Marks Colorectal Surgical Associates, Wynnewood, PA, USA
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13
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Zhu B, Hu FH, Jia YJ, Zhao DY, Zhang WQ, Tang W, Hu SQ, Ge MW, Du W, Shen WQ, Chen HL. Socioeconomic status on survival outcomes in patients with colorectal cancer: a cross-sectional study. J Cancer Res Clin Oncol 2023; 149:15641-15655. [PMID: 37658279 DOI: 10.1007/s00432-023-05344-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/24/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is widely acknowledged as a prevalent malignancy and the second most common cause of cancer-related mortality worldwide. The aim of this study was to examine the independent impact of Median Household Income (MHI) on prognosis and survival outcomes in patients with CRC. METHODS Data from 17 cancer registries of the United States Surveillance, Epidemiology, and End Results program, with follow-up extended until November 2022 was analyzed. A Cox proportional hazards regression analysis was conducted to evaluate the influence of different levels of MHI on survival outcomes among patients with CRC. A total of 761,697 CRC patient records were retrieved from the SEER database. RESULTS The Cox regression analysis results indicated that patients with higher MHI exhibited improved overall survival outcomes when compared to those with lower MHI (MMHI: P < 0.001; HMHI: P < 0.001). Regardless of the specific tumor location, gender, stage of CRC, or treatment method, higher MHI is consistently linked to improved survival outcomes. However, this association was not found to be statistically significant among American Indian/Alaska Native (MMHI: P = 0.017; HMHI: P = 0.081), Asian or Pacific Islander (MMHI: P = 0.223; HMHI: P = 0.002) and unmarried or domestic partner patients (MMHI: P = 0.311; HMHI: P = 0.011). CONCLUSION These results emphasize the importance of considering socioeconomic factors, such as income level, in understanding and addressing disparities in survival outcomes of CRC patients.
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Affiliation(s)
- Bin Zhu
- Department of Hepatobiliary Surgery, Nantong First People's Hospital, The Second Affiliated Hospital of Nantong University, No. 666 Shengli Road, Nantong, People's Republic of China
| | - Fei-Hong Hu
- Medical School of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Yi-Jie Jia
- Medical School of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Dan-Yan Zhao
- Medical School of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Wan-Qing Zhang
- Medical School of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Wen Tang
- Medical School of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Shi-Qi Hu
- Medical School of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Meng-Wei Ge
- Medical School of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Wei Du
- Medical School of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Wang-Qin Shen
- Medical School of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, Jiangsu, 226001, People's Republic of China.
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14
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Meng X, An Z, Xu Y, Du J, Tan L, Yu H, Yu L. Living experiences of people with advance cancer with low socioeconomic status: A systematic review of qualitative evidence. Palliat Med 2022; 37:444-459. [PMID: 36411513 DOI: 10.1177/02692163221137106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The number of patients with advanced cancer is rapidly increasing, and the subgroup of this population with low socioeconomic status has suffered more disease burden than others. However, there is no recent qualitative synthesis of primary research studies into advanced cancer patients with low socioeconomic status. OBJECTIVE To synthesise qualitative research findings into advanced cancer patients' experiences with low socioeconomic status, and then to help provide targeted and effective strategies to improve their quality of life. DESIGN A systematic review and meta-synthesis of qualitative evidence (PROSPERO: CRD42021250423). DATA SOURCES PubMed, Web of Science Core Collection (ISI Web of Science), Cochrane Library, Embase, OVID LWW, CINAHL Complete (EBSCO), PsycINFO (EBSCO) and MEDLINE (ISI Web of Science), China National Knowledge Infrastructure (CNKI), WangFang, and Vip databases were systematically searched from their original dates to July 2022. Qualitative data were appraised using the Joanna Briggs Institute (JBI) qualitative assessment. FINDINGS The findings were synthesised into the following three analytical themes: (1) multi-dimensional disease distresses; (2) barriers in coping with disease distresses; and (3) strategies for dealing with disease distresses. CONCLUSIONS Patients with advanced cancer with low socioeconomic status experienced complicated and interactional distresses, unique life barriers, and a wide range of adaptation strategies. These findings will provide a comprehensive perspective to promote individual-centred health care systems and services to help these vulnerable people deal with the challenges of disease and improve their quality of life.
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Affiliation(s)
- Xianmei Meng
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Zifen An
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Yuying Xu
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Jiayi Du
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Lanhui Tan
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Huidan Yu
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Liping Yu
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
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15
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Liu Y, Xu HF, Zhang X, Yu YQ, Zhao YQ, Zhang SK, Qiao YL. Disease knowledge, medical experience, health-related quality of life and health-care costs among patients with advanced colorectal cancer in China: protocol for a nationwide multicentre survey. BMJ Open 2022; 12:e054403. [PMID: 35264348 PMCID: PMC8915290 DOI: 10.1136/bmjopen-2021-054403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the most common cancers in China. Most patients have developed advanced stage at diagnosis, leading to a low 5-year survival rate. To optimise prevention strategies, we planned a survey to evaluate the disease knowledge, medical experience and health-related quality of life (HRQOL) before and after the treatment of CRC, and healthcare costs among patients with advanced CRC in China. METHODS AND ANALYSIS This is a nationwide, hospital-based, multicentre survey. Nineteen hospitals in seven cities were selected by multistage stratified sampling. Mainland China is divided into seven regions according to the traditional administrative district definition; two cities of each region were selected through simple random sampling, and then one tertiary cancer hospital and one general hospital were selected for each city. More than 4445 patients with CRC in the selected hospitals with stage III or IV will be enrolled in this study. The trained interviewers will collect information through patients' self-report and/or medical records, including demographics and medical history; knowledge about CRC high-risk factors, screening procedure and treatment methods; medical experience on CRC screening, diagnosis and treatment; HRQOL before and after CRC treatment; and costs of CRC. All data will be input by two independent staff and verified using Epidata V.3.1 software. Data validation plan will be made to guide data checking. All statistical analyses will be conducted using SAS V.9.4 and SPSS V.24.0 software. ETHICS AND DISSEMINATION The study was approved by the ethics committees of Henan Cancer Hospital, the leading participant hospital. Findings of this study will be disseminated through peer-reviewed open-access journals and presented as posters and/or oral sections in national and international conferences. Results will also be popularised to the public via media or the internet.
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Affiliation(s)
- Yin Liu
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, China
| | - Hui-Fang Xu
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, China
| | - Xi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yan-Qin Yu
- The Clinical epidemiology of research center, Department of Dermatological, The First Affiliated Hospital of Baotou Medical College, Baotou City, China
| | - Yu-Qian Zhao
- Center for Cancer Prevention Research, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shao-Kai Zhang
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, China
| | - You-Lin Qiao
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, China
- Center for Global Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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16
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Sun C, Ma S, Chen Y, Kim NH, Kailas S, Wang Y, Gu W, Chen Y, Tuason JPW, Bhan C, Manem N, Huang Y, Cheng C, Zhou Z, Zhou Q, Zhu Y. Diagnostic Value, Prognostic Value, and Immune Infiltration of LOX Family Members in Liver Cancer: Bioinformatic Analysis. Front Oncol 2022; 12:843880. [PMID: 35311155 PMCID: PMC8931681 DOI: 10.3389/fonc.2022.843880] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/08/2022] [Indexed: 12/13/2022] Open
Abstract
Background Liver cancer (LC) is well known for its prevalence as well as its poor prognosis. The aberrant expression of lysyl oxidase (LOX) family is associated with liver cancer, but their function and prognostic value in LC remain largely unclear. This study aimed to explore the function and prognostic value of LOX family in LC through bioinformatics analysis and meta-analysis. Results The expression levels of all LOX family members were significantly increased in LC. Area under the receiver operating characteristic curve (AUC) of LOXL2 was 0.946 with positive predictive value (PPV) of 0.994. LOX and LOXL3 were correlated with worse prognosis. Meta-analysis also validated effect of LOX on prognosis. Nomogram of these two genes and other predictors was also plotted. There was insufficient data from original studies to conduct meta-analysis on LOXL3. The functions of LOX family members in LC were mostly involved in extracellular and functions and structures. The expressions of LOX family members strongly correlated with various immune infiltrating cells and immunomodulators in LC. Conclusions For LC patients, LOXL2 may be a potential diagnostic biomarker, while LOX and LOXL3 have potential prognostic and therapeutic values. Positive correlation between LOX family and infiltration of various immune cells and immunomodulators suggests the need for exploration of their roles in the tumor microenvironment and for potential immunotherapeutic to target LOX family proteins.
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Affiliation(s)
- Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, Chicago, IL, United States
| | - Shaodi Ma
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Yue Chen
- Department of Clinical Medicine, School of the First Clinical Medicine, Anhui Medical University, Hefei, China
| | - Na Hyun Kim
- AMITA Health Saint Joseph Hospital Chicago, Chicago, IL, United States
| | - Sujatha Kailas
- Gastroenterology, AMITA Health Saint Joseph Hospital Chicago, Chicago, IL, United States
| | - Yichen Wang
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, MA, United States
| | - Wenchao Gu
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yisheng Chen
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | | | - Chandur Bhan
- AMITA Health Saint Joseph Hospital Chicago, Chicago, IL, United States
| | - Nikitha Manem
- AMITA Health Saint Joseph Hospital Chicago, Chicago, IL, United States
| | - Yuting Huang
- University of Maryland Medical Center Midtown Campus, Baltimore, MD, United States
| | - Ce Cheng
- College of Medicine, The University of Arizona, Tucson, AZ, United States
- Banner-University Medical Center South, Tucson, AZ, United States
| | - Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Qin Zhou
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Yanzhe Zhu
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Yanzhe Zhu,
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