Effects of Social and Contextual Factors Including Marital Status and Children on the Use of Palliative Chemotherapy in Metastatic Colorectal Cancer

The efficacy and safety of glucocorticoid for perioperative patients with hepatectomy: a systematic review and meta-analysis

OBJECTIVE

Glucocorticoids have been used in patients undergoing perioperative hepatectomy, however their safety and efficacy remain controversial. This meta-analysis was conducted to investigate this issue and further provide reference for clinical practice.

METHODS

PubMed/MEDLINE, Embase, and Cochrane Library were searched for randomized controlled trials (RCTs) from database inception to December 2022. Literature screening and data extraction were performed independently by two reviewers. The methodological quality of the RCTs was assessed using the Jadad scale. RevMan 5.4 was used for the meta-analysis.

RESULTS

A total of 11 RCTs involving 905 patients were included. Compared with the control group, we found perioperative glucocorticoid administration significantly lowered overall complication rate [RR = 0.67; 95% CI (0.55, 0.83); P = 0.0003], infectious complication rate [RR = 0.41; 95% CI (0.21, 0.82); P = 0.01] and postoperative liver failure [RR = 0.63; 95% CI (0.41, 0.97); P = 0.03]. In addition, glucocorticoids appear to improve liver function (TBil) [MD = -0.36, 95% CI (-0.59, -0.14), P = 0.001] and reduce the release of certain inflammatory cytokines (IL-6) [MD = -48.52, 95% CI (-56.88, -40.16), P < 0.00001].

CONCLUSION

Based on the available evidence, glucocorticoids appear to be safe and effective in patients undergoing hepatectomy, but further research is needed.

Factors associated with chemotherapy benefit in breast cancer patients with midrange Oncotype DX breast recurrence scores

Chemotherapy for patients with hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, node-negative breast cancer, and with midrange Oncotype DX breast recurrence scores (RS) still needs to be further individualized. To improve the treatment decision making, we aimed to develop a method that provides a single score based on multiple factors associated with chemotherapy benefit. We analyzed Surveillance, Epidemiology, and End Results registry data from 31,731 patients with hormone receptor-positive, HER2-negative, node-negative breast cancer and midrange RS characterized by sociodemographic (age and marital status) and clinicopathologic (tumor size, histologic grade, progesterone receptor status, broad histological classification, lesion laterality, and lesion overlap) features and stratified by RS ranges. For the entire sample and for each characteristic, overall survival was compared between patients who underwent chemotherapy and those who did not (or status unknown) within each RS stratum. There was no any association between chemotherapy and survival for patients with RS = 11-15. However, for patients with RS = 16-25, a chemotherapy benefit was associated with tumor size, histologic grade, progesterone receptor status, histological type, and lesion laterality. In addition, overlapping lesion of breast and married at diagnosis might provide additional predictive information of chemotherapy benefit when RS = 21-25. A simple and effective algorithm was designed by combining these factors to output a novel and personalized chemotherapy benefit score to effectively identify patients with RS = 16-25 who would most likely benefit from chemotherapy, which might facilitate improved treatment by providing individualized recommendations.

Current State of Geospatial Methodologic Approaches in Canadian Population Oncology Research

Geospatial analyses are increasingly used in population oncology. We provide a first review of geospatial analysis in Canadian population oncology research, compare to international peers, and identify future directions. Geospatial-focused peer-reviewed publications from 1992-2020 were compiled using PubMed, MEDLINE, Web of Science, and Google Scholar. Abstracts were screened for data derived from a Canadian cancer registry and use of geographic information systems. Studies were classified by geospatial methodology, geospatial unit, location, cancer site, and study year. Common limitations were documented from article discussion sections. Our search identified 71 publications using data from all provincial and national cancer registries. Thirty-nine percent (N = 28) were published in the most recent 5-year period (2016-2020). Geospatial methodologies included exposure assessment (32.4%), identifying spatial associations (21.1%), proximity analysis (16.9%), cluster detection (15.5%), and descriptive mapping (14.1%). Common limitations included confounding, ecologic fallacy, not accounting for residential mobility, and small case/population sizes. Geospatial analyses are increasingly used in Canadian population oncology; however, efforts are concentrated among a few provinces and common cancer sites, and data are over a decade old. Limitations were similar to those documented internationally, and more work is needed to address them. Organized efforts are needed to identify common challenges, develop leading practices, and identify shared priorities.