Sex and gender disparities in patients with advanced gastroesophageal adenocarcinoma: data from the AGAMENON-SEOM registry

Background

Recommendations for research articles include the use of the term sex when reporting biological factors and gender for identities or psychosocial or cultural factors. There is an increasing awareness of incorporating the effect of sex and gender on cancer outcomes. Thus, these types of analyses for advanced gastroesophageal adenocarcinoma are relevant.

Patients and methods

Patients with advanced gastroesophageal adenocarcinoma from the Spanish AGAMENON-SEOM registry treated with first-line combination chemotherapy were selected. Epidemiology, characteristics of the disease, treatment selection, and results were examined according to sex.

Results

This analysis included 3274 advanced gastroesophageal adenocarcinoma patients treated with combination chemotherapy between 2008 and 2021: 2313 (70.7%) men and 961 (29.3%) women. Tumors in females were more frequently HER2-negative (67.8% versus 60.8%; P < 0.0001), grade 3 (45.4% versus 36.8%; P < 0.001), diffuse (43.3% versus 26.5%; P < 0.0001), and signet ring cell histology (40.5 versus 23.9%; P < 0.0001). Peritoneal spread was more common in women (58.6% versus 38.9%; P < 0.0001), while liver burden was lower (58.9% versus 71.1%; P < 0.0001). There were no significant differences in treatment recommendation. Treatment doses, density, and duration were comparable between sexes. Women experienced more diarrhea (46% versus 37%; P < 0.0001), neutropenia (51% versus 43%; P < 0.0001), and anemia (62% versus 57%; P < 0.0001). After a median 59.6-month follow-up [95% confidence interval (CI) 54.5-70.8], there were no statistically significant differences between the sexes in progression-free survival [6.21 months (95% CI 5.8-6.5 months) versus 6.08 months (95% CI 5.8-6.3 months); log-rank test, χ² = 0.1, 1 df, P = 0.8] or in overall survival [10.6 months (95% CI 9.8-11.1 months) versus 10.9 months (95% CI 10.4-11.4 months); log-rank test: χ² = 0.6, 1 df, P = 0.5].

Conclusion

This sex analysis of patients with advanced gastroesophageal adenocarcinoma from the AGAMENON-SEOM registry receiving first-line polychemotherapy found no differences in survival. Although women had worse prognostic histopathology, metastatic disease pattern, and greater toxicity, treatment allocation and compliance were equivalent.

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Sex and gender are determinants of health inequalities and may affect treatments, tolerability, and therapeutic outcomes.

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According to sex, subtle biological and clinical differences exist in advanced gastroesophageal adenocarcinoma.

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Women with advanced gastroesophageal adenocarcinoma experience greater toxicity with therapeutic results comparable with men.

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Stratification and analysis by sex in studies of gastroesophageal adenocarcinoma should be considered.

Automated Cerebral Hemorrhage Detection Using RAPID

BACKGROUND AND PURPOSE

Intracranial hemorrhage (ICH) is an important event that is diagnosed on head NCCT. Increased NCCT utilization in busy hospitals may limit timely identification of ICH. RAPID ICH is an automated hybrid 2D-3D convolutional neural network application designed to detect ICH that may allow for expedited ICH diagnosis. We determined the accuracy of RAPID ICH for ICH detection and ICH volumetric quantification on NCCT.

MATERIALS AND METHODS

NCCT scans were evaluated for ICH by RAPID ICH. Consensus detection of ICH by 3 neuroradiology experts was used as the criterion standard for RAPID ICH comparison. ICH volume was also automatically determined by RAPID ICH in patients with intraparenchymal or intraventricular hemorrhage and compared with manually segmented ICH volumes by a single neuroradiology expert. ICH detection accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratios by RAPID ICH were determined.

RESULTS

We included 308 studies. RAPID ICH correctly identified 151/158 ICH cases and 143/150 ICH-negative cases, which resulted in high sensitivity (0.956, CI: 0.911-0.978), specificity (0.953, CI: 0.907-0.977), positive predictive value (0.956, CI: 0.911-0.978), and negative predictive value (0.953, CI: 0.907-0.977) for ICH detection. The positive likelihood ratio (20.479, CI 9.928-42.245) and negative likelihood ratio (0.046, CI 0.023-0.096) for ICH detection were similarly favorable. RAPID ICH volumetric quantification for intraparenchymal and intraventricular hemorrhages strongly correlated with expert manual segmentation (correlation coefficient r = 0.983); the median absolute error was 3 mL.

CONCLUSIONS

RAPID ICH is highly accurate in the detection of ICH and in the volumetric quantification of intraparenchymal and intraventricular hemorrhages.

Hispanic Dementia Family Caregiver's Knowledge, Experience, and Awareness of Self-Management: Foundations for Health Information Technology Interventions

PURPOSE

As a first step toward developing a web-based Family-Health Information Management System intervention, we explored Hispanic dementia family caregiver's knowledge, use, and awareness of self-management principles and skills to address health and health care needs for themselves and the person with dementia (PWD).

METHOD

Twenty caregivers and 11 caregiver counselors attended an English or Spanish language focus group ranging from 4 to 6 participants. We conducted a directed content analysis informed by Lorig and Holman's conceptualization of self-management.

RESULTS

A complement of six skills (i.e., problem solving, decision making, resource utilization, patient-provider partnership, action planning, and self-tailoring) to achieve one of three tasks (i.e., emotional, medical, and role management) can fully represent Hispanic dementia family caregivers' ability to self-manage health and health care needs. While not prominent in our study, caregivers and caregiver counselors pointed out existing and potential uses of personal consumer technology to schedule reminders and search for resources.

DISCUSSION

A broad conceptualization of self-management may be necessary to understand Hispanic dementia family caregiver's ability and needs to address emotional, medical, and role challenges of caregiving.

CONCLUSIONS

These findings and advances in the use of consumer health information technology support the development of self-management caregiver interventions.

Information, communication, and online tool needs of Hispanic family caregivers of individuals with Alzheimer's disease and related dementias

PURPOSE

To identify the information and communication needs of Hispanic family caregivers for individuals with Alzheimer's Disease and Related Dementias (ADRD) and the manner in which online tools may meet those needs.

METHODS

We conducted 11 participatory design sessions with 10 English- and 14 Spanish-speaking urban-dwelling Hispanic family caregivers and gathered data using a survey, collage assemblage, and audio and video recordings. Four investigators analyzed transcripts of audio recordings with a coding framework informed by several conceptual models.

RESULTS

Participants had an average age of 59.7 years, were mostly female (79.2%), and had cared for a family member with ADRD for an average of 6.5 years. All participants accessed the Internet at least once a week with 75% ≥ daily. Most used the Internet to look up health information. All participants reported caregiver attributes including awareness of the disease symptoms or behaviors. The majority reported information needs/tasks (91.7%), communication needs/tasks (87.5%), and need for online tools (79.2%).

CONCLUSION

Hispanic caregivers of individuals with ADRD reported key information and communication needs/tasks. Only Spanish-speaking participants reported Internet and technology use deficits suggesting the requirement for further technology support. Data show a need for online tools to meet the needs of caregivers.

Prognostic significance of tumor regression in lymph nodes after neoadjuvant therapy for rectal carcinoma

Neoadjuvant therapy (NAT) is mainly indicated for locally advanced rectal carcinoma. Many reports have shown that regression of the primary tumor is a prognostic factor. However, few reports to date have analyzed the potential prognostic significance of lymph node regression in rectal carcinoma. The aim of the present study is to describe the pattern of tumor regression in lymph nodes after NAT for rectal carcinoma and its potential prognostic significance. We have retrospectively reviewed 106 cases of rectal carcinoma treated at a single institution. We have retrieved data from the patients and reviewed the histopathological slides to evaluate tumor regression both of the primary tumor and of LN metastases. Prognosis has been defined both in terms of disease-free survival (DFS) and disease-specific survival (DSS). Of the patients, 16% showed complete response of the primary tumor, while 24% showed poor response, according to the CAP regression grading system. Absence of lymph node involvement after therapy was found in 80% of the patients (ypN0 cases), while 20% were ypN+. We reviewed 639 LN; 85 were involved by tumor, and 170 showed histological signs of tumor regression. The main pattern of tumor regression in lymph nodes was fibrosis (66.3%), followed by hystiocytosis (29.1%) and mucin pools (4.6%). We found histological signs of regression in 57% of ypN0 cases and 76% of ypN+ cases. We found a significant association between regression grade of the primary tumor and of lymph node metastases. For ypN0 patients with persistence of the primary tumor after NAT, the median DFS was significantly shorter in patients showing tumor regression in the LN. In a Cox multivariate survival model for DFS, this prognostic influence was independent of the regression grade of the primary tumor and also of the ypTNM stage. We found no significant association between any factor and DSS. The pattern of tumor regression in lymph nodes was not significantly associated with prognosis. Tumor regression in lymph nodes is an important prognostic factor in rectal carcinoma after NAT and should be specifically looked for and included in pathology reports.

[Cancer screening. Concepts, trends, and practices]

A National Cancer Surveillance Program has begun in Portugal in 1990. However, it is unevenly applied throughout the country and is almost unknown to clinicians other than general practitioners. As potentially life-saving procedures, cancer screening and early detection have an important impact not only among physicians but also among the general public, making it absolutely necessary an harmony of rationale, guidelines and practices. The author summarizes the points in discussion concerning cancer prevention procedures, the different published guidelines and some numbers on its practices. The aim is a contribution to an improvement in cancer screening in Portugal, achievable through awareness, promotion of evidence evaluation and the pursuit of consensus in strategies.