Cumulative Incidence Research Articles

Second primary malignancy (SPM) in patients (pts) with multiple myeloma (MM) receiving chimeric antigen receptor T-cell (CAR T) therapy or other systemic anticancer therapy (SACT): A comparative study using a real-world database.

7519 Background: Cases of SPM have been reported following CAR T therapy, but comparative studies are scarce. We compared the risk of SPM following CAR T therapy vs other SACT in pts with MM. Methods: Pts aged ≥18 years with MM who initiated CAR T therapy or other SACT, except stem cell transplant, in second-line or beyond were identified from Komodo Health claims data (3/26/2021–1/31/2024). Incident SPM was identified by ≥1 diagnostic code through death, disenrollment, or data cutoff (4/30/2024), whichever was earliest. Cumulative incidence of SPM following CAR T therapy or other SACT was estimated through 24 months, weighted by baseline factors including prior MM treatments; p-values were calculated for differences in the area under the curves through 24 months. Results: Pts who received CAR T therapy (n=436) or other SACT (n=18,603) were followed for a median of 11.8 months (IQR 5.7–22.8). Compared to pts who received other SACT, pts who received CAR T therapy had nominally higher risk (cumulative incidence [95% CI]) of any SPM (p = 0.05; 24.1% [18.4%, 29.8%] vs. 18.1% [13.5%, 22.8%] at 24 months), driven by significantly higher heme SPM risk (p=0.01; 8.7% [6.1%, 11.4%] vs. 5.6% [3.0%, 8.8%] at 6 months, 12.1% [8.7%, 15.3%] vs. 7.2% [4.3%, 10.4%] at 12 months, and 17.9% [12.8%, 23.5%] vs. 8.7% [5.4%, 11.7%] at 24 months; respectively), including higher risks of myelodysplastic syndrome and leukemias. The risk of solid SPM was nominally lower following CAR T vs other SACT (p=0.28; 9.1% [6.2–12.3] vs 13.9% [9.6–18.4] at 24 months). In the sensitivity analysis requiring ≥2 diagnostic codes to identify an SPM, the absolute risk was reduced and the difference in heme SPM risk was attenuated (p=0.39; Table). Notably, pts were more likely to receive bone marrow examination following CAR T therapy vs other SACT (47% vs 10% at 0–3 months, respectively). Conclusions: Pts with MM appeared to have a higher risk of heme SPM through 24 months following CAR T therapy compared with other SACT. However, the difference was attenuated in a sensitivity analysis that required ≥2 diagnostic codes, assumed to represent a confirmed diagnosis. Potential detection bias may exist, suggested by a higher rate of bone marrow examination following CAR T therapy. Longer term studies are needed to further evaluate this association. Cumulative incidence (%) and 95% CI of SPM at 24 months. SPM Analysis CAR T therapy Other SACT p-value Any Main 24.1 (18.4–29.8) 18.1 (13.5–22.8) 0.05 Sensitivity 11.5 (8.1–15.1) 9.5 (6.3–13.2) 0.10 Heme Main 17.9 (12.8–23.5) 8.7 (5.4–11.7) 0.01 Sensitivity 5.5 (3.4–7.6) 4.7 (2.3–7.6) 0.39 Solid Main 9.1 (6.2–12.3) 13.9 (9.6–18.4) 0.28 Sensitivity 6.4 (3.8–9.7) 5.1 (3.0–8.4) 0.14 Sensitivity analysis requires 2+ diagnostic codes to identify an SPM.

Cancer incidence among indigenous adults in Brazil: A 19-year analysis of hospital cancer registry data (2000–2018).

e13830 Background: Cancer disparities persist among Indigenous populations due to socio-demographic, cultural, and environmental factors. In Brazil, limited healthcare access contributes to late diagnoses and worse outcomes. While cancer trends have been extensively studied in the general population, evidence on Indigenous adults remains scarce. This study evaluates temporal trends in cancer incidence among Indigenous adults in Brazil from 2000 to 2018, using data from the Brazilian Hospital-based Cancer Registry (HbCR), and compares findings with estimates from the Brazilian Demographic Census. Methods: A retrospective cohort study was conducted using HbCR (SIS-RHC) data. The cohort included Indigenous individuals aged ≥18 years, diagnosed with malignant neoplasms (ICD-10), and treated within the Brazilian Unified Health System (SUS). Temporal trends in cancer incidence were assessed using the Mann-Kendall test, with bivariate analyses evaluating associations between variables. Cumulative incidence rates (CIR) were calculated based on the Brazilian Demographic Census of 2000 and 2010. Results: Among 3,701 Indigenous individuals (mean age: 56.91 years, SD: 16.22), 58.61% were female, 51.44% had elementary education, and 32.14% resided in the Northeast. Family history of cancer was reported by 35.22%; 62.19% did not consume alcohol, and 53% were non-smokers. Multiple primary tumors were absent in 96.93% of cases. The most common cancers were cervical (19.02%) and breast (11.51%), followed by non-melanoma skin (10.81%) and prostate (8.46%) cancer. Most cases were localized (stages I–II, 35.38%), while 33.71% were regional (stage III) and 30.92% metastatic (stage IV). Diagnoses at localized and regional stages (I–III) increased significantly (p < 0.001). Significant differences were observed across sexes and age groups (p < 0.001). Annual cancer case counts rose significantly from 2000 to 2018 (S = 113; p < 0.001), with 337 cases (8.84%) reported from 2000–2004, 982 (26.53%) from 2005–2009, 849 (22.94%) from 2010–2014, and 1,238 (33.45%) from 2015–2018. Overall, cases increased by 378.59% during the study period. The CIR calculated for the period, were as follows: 2000 to 2009: 169.59 cases/100,000 Indigenous individuals; and 2010 to 2018: 188.05 cases/100,000 Indigenous individuals. Conclusions: Cancer incidence among Indigenous adults in Brazil increased substantially from 2000 to 2018, with cervical and breast cancers being the most prevalent. Despite improvements in early detection, a significant proportion of cases remain diagnosed at advanced stages. These findings highlight the need for targeted public health efforts to improve screening, early diagnosis, and access to culturally tailored cancer care. This study provides critical insights to inform future cancer prevention and control efforts tailored to Indigenous populations in Brazil.

Suboptimal practices in harm reporting: a meta-epidemiological study on metrics, recurrence, and exposure duration in clinical trials.

Suboptimal practices in harm reporting: a meta-epidemiological study on metrics, recurrence, and exposure duration in clinical trials.

The Effect of Semaglutide and GLP-1 RAs on Risk of Nonarteritic Anterior Ischemic Optic Neuropathy.

The Effect of Semaglutide and GLP-1 RAs on Risk of Nonarteritic Anterior Ischemic Optic Neuropathy.

Clinical outcomes of proton beam therapy for inoperable stage I-IIA non-small cell lung cancer: Japanese nationwide registry study.

Clinical outcomes of proton beam therapy for inoperable stage I-IIA non-small cell lung cancer: Japanese nationwide registry study.

Interventions for SARS-CoV-2 prevention among Jailed adults: A network-based modeling analysis.

Interventions for SARS-CoV-2 prevention among Jailed adults: A network-based modeling analysis.

Risk and predictors of late second primary malignancies in long-term breast, prostate, colon, and rectal cancer survivors.

1642 Background: In older, long-term (5-year) cancer survivors, mortality risks from aging and treatment-related effects may surpass those of their index cancer. Second primary malignancies (SPMs) occurring 5-10 years post-diagnosis are understudied in older patients. This study aims to quantify SPM risk, identify predictors, and describe prevalent SPM sites in older survivors of breast, prostate, colon, and rectal cancer to guide survivorship care. Methods: This retrospective cohort study analyzed patients aged 66+ with stage I-III cancer diagnosed between 2003-2011 using the SEER-Medicare database. Eligible patients survived ≥5 years post-diagnosis and had continuous Medicare Parts A & B enrollment from 1 year pre-diagnosis to 1 year post-diagnosis. The primary outcome was late SPMs occurring 5-10 years after index cancer diagnosis. Covariates included demographics, comorbidities, index cancer characteristics, treatment, and early SPMs (diagnosed within 5 years). Least absolute shrinkage and selection operator for variable selection and 5-year restricted mean survival time regression models were used. Cumulative late SPM incidence was calculated with mortality as a competing risk. The prevalence of specific SPMs was calculated as a proportion relative to the total number of SPMs within each cohort, and categorized as hematologic, predominantly screen-detected (breast, prostate, colorectal), or other solid tumors. Results: Of the 88,227 long-term survivors included with median age of 73.3 (IQR 69.5-78), 6.2% developed early SPMs and 8.2% (7,231) developed late SPMs. The 5-year cumulative incidence of late SPMs was 8.6%, highest in prostate (9.2%) and lowest in breast (6.7%) cancer survivors. Non-screenable cancers had the highest 5-year risk (6.2%), followed by screen-detected (1.3%) and hematologic malignancies (1.1%). Lung was the most common SPM overall (18.4% of SPMs), including in survivors of breast (21%), rectal (19.2%) and colon (16.5%) cancers, while prostate was most common in rectal cancer survivors (17.0%). Diagnosis of SPM in the early ( < 5 years) survivorship cohort was associated with shorter time to a new late SPM, particularly in prostate cancer survivors (RMST Ratio 0.97, 95% CI 0.96-0.98). Treatments and high-risk disease features showed no significant associations with occurrence of late SPMs. Conclusions: Late SPMs were diagnosed in 8.6% of older, long-term cancer survivors. Lung cancer was the most common SPM overall. Some screen-detected SPMs, such as prostate were also common which is notable in a population aging out of screening guidelines. Prediction of SPMs was limited by the absence of modifiable risk factors, genetic data, and family history in SEER-Medicare data. Early SPMs were the sole predictor of late SPMs while treatment and index cancer features showed no effect, suggesting other drivers of late SPM development in older survivors.

Long-term effects and effect heterogeneity of lifestyle and metformin interventions on type 2 diabetes incidence over 21 years in the US Diabetes Prevention Program randomised clinical trial.

Long-term effects and effect heterogeneity of lifestyle and metformin interventions on type 2 diabetes incidence over 21 years in the US Diabetes Prevention Program randomised clinical trial.

Hypoparathyroidism After Total Thyroidectomy: A Population-Based Analysis of California Databases.

Hypoparathyroidism After Total Thyroidectomy: A Population-Based Analysis of California Databases.

Brain metastasis incidence with bireociclib in HR+/HER2- advanced breast cancer: Pooled analysis of BRIGHT-1 and BRIGHT-2 study.

e13057 Background: Brain metastases (BM) significantly impact prognosis of patients (pts) with breast cancer (BC). Meta-analysis showed that hormone receptor positive (HR+)/human epidermal growth factor receptor 2 negative (HER2-) metastatic BC (MBC) had a pooled cumulative BM incidence of 15% with an incidence of 0.05 (95%CI: 0.03–0.08) per patient-year (Kuksis et al, Neuro Oncol 2021). Bireociclib, a novel CDK4/6 inhibitor, demonstrated favorable blood-brain barrier penetration and brain tissue distribution in preclinical study, and pronounced efficacy for HR+/HER2- advanced BC (ABC) in clinical study. Here we report the incidence of BM among pts with HR+/HER2- ABC after bireociclib treatment. Methods: We conducted a pooled analysis of HR+/HER2- ABC pts from BRIGHT-1 (NCT04539496) and BRIGHT-2 (NCT05077449) study. The cumulative incidence of BM was calculated using survival analysis, with incidence defined as events per total patient-years at risk. Results: A total of 697 ABC pts without BM at baseline were pooled for analysis. The baseline characteristics were showed in the table. In the pts receiving bireociclib containing regimens (n = 596), the pooled cumulative incidence of BM was 2.36% with an incidence of 0.0114 (95%CI: 0.0047, 0.0181) per patient-year. Median time from first dose or randomization to onset of BM was 7.36 months (n = 12). In heavily pretreated MBC pts (n = 264), the cumulative incidence of BM and the corresponding incidence per patient-year was 3.15% and 0.0144 (95%CI: 0.0030, 0.0259), respectively. Comparative analysis in the pts who failed prior first-line endocrine therapy revealed that cumulative incidence of BM and incidence per patient-year were 1.36% and 0.0070 (95%CI:0.0000, 0.0149) in bireociclib plus fulvestrant group (n = 297) and 8.16% and 0.0141 (95%CI: 0.0000, 0.0336) in placebo plus fulvestrant group (n = 101), respectively. Conclusions: This pooled analysis demonstrates numerically lower incidence of BM in HR+/HER2- MBC pts treated with bireociclib containing regimens, suggesting bireociclib's potential to reduce BM occurrence and inhibit intracranial lesions in ABC. Clinical trial information: NCT04539496 , NCT05077449 . BIRE treated pts (N=596) BIRE Monotherapy (N=264) BIRE+FUL (N=269) PBO+FUL (N=101) Follow-up time (Md, mo) 24.4 26.9 21.3 18.9 Age (Md, IQR, years) 54 (47, 62) 53 (46, 61) 54 (47, 63) 55 (48, 62) ECOG (0 vs 1, %) 31.2 vs 68.8 28.0 vs 72.0 36.4 vs 63.6 44.6 vs 55.4 HR status (ER+PR+ vs ER+PR-, %) 79.5 vs 18.6 77.3 vs 18.9 79.6 vs 20.1 71.3 vs 28.7 Ki-67 (Md, IQR, %) 30 (15, 40) 30 (15, 40) 30 (15, 40) 25 (10, 40) Visceral mets (liver vs lung, %) 38.4 vs 47.0 51.5 vs 52.3 32.0 vs 41.3 36.6 vs 44.6 Disease setting (locoregional vs metastatic, %) 3.0 vs 97.0 0 vs 100 5.6 vs 94.4 4.0 vs 96.0 Prior ET for metastatic disease (Number of regimens ≤1 vs >1, %) 66.6 vs 33.4 25.0 vs 75.0 99.6 vs 0.4 100 vs 0 Prior chemotherapy for metastatic disease (Number of regimens ≤1 vs >1, %) 79.7 vs 20.3 54.5 vs 45.5 100 vs 0 100 vs 0

Cardiovascular risk factor severity and adverse cardiovascular events: A report from the Childhood Cancer Survivor Study (CCSS).

12055 Background: Among survivors of childhood cancer, more severe grades of CVRFs are associated with increased risk for adverse cardiovascular events (ACE). The impact of low severity CVRFs has not been defined. Methods: Among 25,723 long-term survivors of childhood cancer, CVRF severity was graded using longitudinal self-report: Grade 1 conditions are reported but not on medications; Grade 2 are prescribed medications. Cumulative incidence of CVRFs were estimated into the 6 th decade of life with death and Grade 2 CVRFs a competing risk event for Grade 1 CVRFs. Starting at 1st report of a CVRF, multivariable piecewise-exponential models were used to estimate relative rates (RR) of heart failure (HF), myocardial infarction (MI), valvular disease (VD), arrhythmia, and cardiac death relative to survivors without hypertension (HTN), diabetes (DM), and hyperlipidemia (HLD), all as time-dependent covariates. Results: The median age of survivors was 35y (range 9-70) and 26y (range 7-52) from cancer diagnosis. Cumulative incidence by age 55 of Grade 1 HTN, DM, and HLD were 7.8% (CI 7.1-8.5%), 4.3% (CI 3.8-4.9%), and 10.8% (CI 9.9-11.6%), respectively. The cumulative incidences of Grade 2 HTN, DM, and HLD were 37.9% (CI 36.4-39.3%), 14.0% (13.0-15.0%), 31.3% (29.9-32.7%), respectively. Grade 2 CVRFs were significantly associated with an increased RR for nearly all ACE (table). Grade 1 CVRFs were also significantly associated for most ACE; often with a similar magnitude as Grade 2 CVRFs. Grade 1 vs no HTN was associated with a 2 to 5-fold significantly increased RR of HF, MI, VD, arrhythmia, and cardiac death. Grade 1 vs no DM was associated with an increased RR of HF (1.9, CI 1.1-3.4). Grade 1 vs no HLD was associated with an increased RR of MI (2.9, 1.9-4.2) and arrhythmia 2.1 (1.2-3.5). Conclusions: Grade 1 CVRFs are associated with increased risk for ACE. These data suggest a role for more aggressive treatment of Grade 1 CVRFs among survivors. Relative rates of ACE among survivors by CVRF severity. Individual models for each CVRF vs no respective CVRF (ref) HF MI VD Arrhythmia Cardiac death RR (95% CI) RR (95% CI) RR (95% CI) RR (95% CI) RR (95% CI) HTN Grade 1 2.9 (1.9-4.4) 3.6 (2.4-5.3) 4.7 (3.0-7.5) 2.8 (1.6-4.8) 1.9 (1.1-3.3) HTN Grade 2 7.2 (6.1-8.6)* 7.1 (5.9-8.5)* 4.7 (3.7-6.1) 5.3 (4.2-6.7) 1.5 (1.1-2.0) DM Grade 1 1.9 (1.1-3.4) 1.5 (0.7-3.0) 0.8 (0.3-2.5) 1.5 (0.6-3.7) 0.6 (0.1-2.2) DM Grade 2 2.5 (1.9-3.2) 2.7 (2.2-3.5) 2.2 (1.6-3.1) 2.3 (1.6-3.2) 1.8 (1.3-2.6) HLD Grade 1 1.5 (0.95-2.4) 2.9 (1.9-4.2) 1.5 (0.8-2.8) 2.1 (1.2-3.5) 1.2 (0.6-2.2) HLD Grade 2 3.8 (3.2-4.7)* 6.5 (5.4-7.8)* 3.8 (2.9-4.8)* 3.1 (2.4-4.0) 1.1 (0.8-1.4) Models adjusted for sex, race, current age, age at diagnosis, current smoking, obesity, sedentary lifestyle, anthracycline and heart radiation dose. Models fitted separately for each ACE. No respective CVRF as referent group. *Grade 2 vs Grade 1 condition above, p<0.05.

Neuroendocrine Deficits and Weight Development Before and After Proton Therapy in Children With Craniopharyngioma.

Our objective was to analyse tumour- and treatment-related factors influencing endocrine morbidity and obesity pre- and post-proton beam therapy (PBT) in paediatric patients with craniopharyngioma. A total of 65 patients at the onset of PBT were included in the analysis within our prospective registry study. The data pertaining to endocrine deficits and BMI prior to PBT were retrieved from the medical records on a retrospective basis. Cumulative incidences (CI) of endocrinopathies, age- and sex-adjusted BMI standard deviation scores (BMI-SDS) were calculated. Before PBT, 90.8% had ≥1 neuroendocrine deficit. Diabetes insipidus (DI) was attributed to surgery in 96%. Patients with postoperative DI had a higher 3-year CI of adrenocorticotropic hormone and thyroid-stimulating hormone deficiency rates compared to those without DI (p < .001). At PBT start, 47.7% had already panhypopituitarism compared to 67.7% at the last follow-up (FU). Median FU post-PBT was 3.2 years (range, 1.0-9.6). Post-PBT, 38.2% remained free of additional hormone deficiencies. A trend towards lower endocrine morbidity scores for patients who received PBT during their primary treatment compared to irradiation at progression did not reach statistical significance (p = .068). The BMI-SDS increase from diagnosis to the start of radiotherapy was significantly greater than from the start of PBT to the end of FU (mean BMI-SDS increase: 0.61, ±1.16 vs. 0.13, ±0.84, p = 0.019), with a median time of 10.2 and 38.4 months, respectively. In the multivariate analysis, hypothalamic involvement (p = .042) and the BMI-SDS level at diagnosis (p = .006) were identified as clinical factors indicating severe obesity at FU (BMI-SDS ≥+2). Panhypopituitarism is frequently observed in paediatric patients with craniopharyngioma prior to PBT. The potential benefits of early PBT on endocrine outcomes require further investigation through longer FU periods. The greatest increase in weight occurred before radiotherapy. Endocrine deficiencies and weight gain are multifactorial and require close monitoring.

Social determinants of health (SDOH) and late mortality among survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS).

10021 Background: Neighborhood-level SDOH may increase disparities in adverse cancer-related outcomes. The US CDC-constructed Social Vulnerability Index (SVI) reflects 4 SDOH domains (socioeconomic status [SES]; household composition; minority status/language; housing/transportation) and captures the vulnerability of underserved communities. The impact of neighborhood-level SDOH on late mortality among survivors of childhood cancer is not known. Methods: Analyses included 5-year survivors in the US diagnosed in 1970-1999 participating in the CCSS, a multi-institutional retrospective cohort study. We evaluated geocoded SVI quintiles (Q1 to Q5, from least to most vulnerable) based on residential addresses and personal SES factors including income, education level, and health insurance status collected at CCSS baseline. The impact of SVI and personal-level SES on all-cause and cause-specific mortality rates were evaluated using cumulative incidence and relative rates (RRs) from piecewise exponential regression models adjusted for age, sex, diagnosis age, and treatments. Results: Among 20,261 survivors with geocode data (mean age at cancer diagnosis and baseline evaluation, 7y and 24y respectively, with a mean follow up of 17y), 2,439 survivors died. All-cause late mortality was greater in survivors living in more vulnerable areas (Q5 vs. Q1, at 20y: 14.7% vs. 10.8%, P&lt;0.001). We observed a dose-response relationship between worsening SVI and the all-cause mortality rate (Q5 vs. Q1 RR 1.52, 95% CI 1.32-1.76, P trend &lt;0.001) as well as for mortality rates due to specific health causes (Table). Among the SDOH domains, neighborhood SES (Q5 vs. Q1 RR 1.68, 95% CI 1.45-1.95) showed the strongest association with all-cause mortality followed by household composition (RR 1.43, 95% CI 1.24-1.66). Notably, these findings remained largely consistent after adjusting for personal-level SES as well as in analyses stratified by income and insurance coverage. Conclusions: Living in socially vulnerable neighborhoods during young adulthood is associated with a ~50% increased risk for late mortality among survivors of childhood cancer and is largely unaffected by favorable personal-level SES. Policies and interventions targeting neighborhood-level SDOH during the transition to survivorship care are needed to reduce mortality risk in this population. Adjusted RRs and 95% confidence intervals for overall and cause-specific mortality. SVI All cause Subsequent neoplasm cause Cardiovascular cause Other health causes Q2 1.00 (0.88 - 1.14) 0.90 (0.74 - 1.11) 1.09 (0.76 - 1.55) 1.09 (0.85 - 1.39) Q3 1.16 (1.02 - 1.32) 1.03 (0.84 - 1.27) 1.18 (0.82 - 1.70) 1.24 (0.97 - 1.59) Q4 1.24 (1.08 - 1.42) 1.12 (0.90 - 1.39) 1.29 (0.88 - 1.90) 1.44 (1.11 - 1.86) Q5 1.52 (1.32 - 1.76) 1.35 (1.07 - 1.69) 1.54 (1.02 - 2.33) 1.83 (1.38 - 2.42) SVI Q1 (least vulnerable) is the referent.

Bilateral mastectomy and breast cancer morality for invasive lobular carcinoma: A SEER-based study.

585 Background: Many women with unilateral breast cancer opt for bilateral mastectomy. While removing the unaffected contralateral breast lowers the risk of second primary cancers, there is no benefit on breast cancer mortality. Studies have not investigated whether this holds true for invasive lobular carcinoma (ILC). To estimate the 20-year risk of breast cancer mortality in women with stage I-III unilateral ILC and compare survival outcomes between unilateral lumpectomy, unilateral mastectomy and bilateral mastectomy. Methods: This retrospective cohort study used the Surveillance, Epidemiology, and End Results (SEER) database to identify women diagnosed with unilateral invasive lobular carcinoma (ILC) between 2000 and 2020. The cohort was followed for up to 20 years to assess contralateral breast cancer and breast cancer-specific survival. We estimated crude mortality rates, 20-year cumulative breast cancer mortality, and hazard ratios by surgical treatment group. Kaplan-Meier was used for cumulative risk, and Cox proportional hazards models for unadjusted and adjusted hazard ratios with 95% confidence intervals. P-values &lt; 0.05 were considered significant. Results: We identified 58,861 women with unilateral ILC. Of which, 34,561 (59%) had lumpectomy, 18,894 (32%) had unilateral mastectomy, and 5406 (9.1%) had bilateral mastectomy. The mean age (in years) was 64 ±11 for unilateral lumpectomy, 62 ±13 for unilateral mastectomy, and 57±11 for bilateral mastectomy (p &lt; 0.0001). The mean tumour size was smallest in the lumpectomy group (1.9±1.5 cm) compared with 3.6± 3 cm in both unilateral and bilateral mastectomy groups (p &lt; 0.0001). The 20-year cumulative invasive contralateral breast cancer risk was 7.3% for lumpectomy, 7.5% for unilateral mastectomy, and 0.3% for bilateral mastectomy. The 20-year cumulative breast cancer mortality was 13.4% in the lumpectomy group, 30.2% in unilateral mastectomy group and 24.3% in bilateral mastectomy group. However, after adjusting for demographic, clinical, and treatment variables, we observed no difference in breast cancer mortality rates among unilateral mastectomy patients versus lumpectomy patients (adjusted hazard ratio [aHR], 1.01; 95% CI, 0.94–1.08), and a statistically significant reduction in breast cancer mortality rates among bilateral mastectomy patients compared to lumpectomy patients (aHR, 0.90; 95% CI, 0.82–1.00; p value 0.04). Conclusions: In this cohort of invasive lobular breast cancer, bilateral mastectomy patients had a significantly lower risk of contralateral breast cancer and, after adjusting for differences in the surgical treatment groups, had a 10% lower rate of breast cancer mortality as compared to lumpectomy patients.

Impacts of disinfection methods in a granular activated carbon (GAC) treatment system on disinfected drinking water toxicity.

Impacts of disinfection methods in a granular activated carbon (GAC) treatment system on disinfected drinking water toxicity.

The Estimated Lifetime Risk of Revision After Primary Knee Arthroplasty is Influenced by Implant Design and Patient Age: Data from the National Joint Registries

The Estimated Lifetime Risk of Revision After Primary Knee Arthroplasty is Influenced by Implant Design and Patient Age: Data from the National Joint Registries

Low Success Rate of Closed Reductions when Treating Dislocations after Reverse Shoulder Arthroplasty: A Study by the ASES Complications of RSA Multicenter Research Group

Low Success Rate of Closed Reductions when Treating Dislocations after Reverse Shoulder Arthroplasty: A Study by the ASES Complications of RSA Multicenter Research Group

Multivariate analysis of potentially toxic metal contents in soil and vegetables: Enrichment, bioconcentration, translocation from soil to vegetables, and assessment of human health toxicity.

Multivariate analysis of potentially toxic metal contents in soil and vegetables: Enrichment, bioconcentration, translocation from soil to vegetables, and assessment of human health toxicity.

Feasibility of circulating tumor DNA-based minimal residual disease (ctDNA-MRD)-guided adjuvant chemotherapy in patients with stage II-III gastric cancer (GC): An adaptive trial (MRD-GATE).

4061 Background: Although adjuvant chemotherapy (ACT) is the standard treatment for stage II-III GC, this strategy lacks precision treatment options, and many patients cannot tolerate the adverse events (AEs) of ACT. ctDNA-MRD detection has been shown to predict recurrence risk. The aim of this study (NCT06157216) was to evaluate the feasibility of MRD-guided treatment in these patients. Methods: Patients with stage II-III GC who underwent R0 resection and D2 gastrectomy were enrolled. Tumor-informed ctDNA-MRD testing was performed at baseline (28 days after surgery) and subsequently at 3, 6, 9, 12, 18, 24, 30, and 36 months after surgery. ACT was tailored according to MRD status: baseline MRD-negative (MRD (-)) patients received de-escalated therapy (observation for stage II and S-1 monotherapy for stage III) and switched to combined ACT (SOX, S-1 plus oxaliplatin, or XELOX, capecitabine plus oxaliplatin) if MRD became positive, while baseline MRD-positive (MRD (+)) patients underwent combined ACT. The primary endpoint was 3-year disease-free survival rate (yDFSr). Secondary endpoints included the treatment de-escalation rate, DFS by MRD status, cumulative recurrence risk (CRR), 3-year overall survival rate (yOSr) and safety. Results: 65 patients were enrolled, with a median age of 60 years (range: 34-83), and 83.1% (54/65) were male, 31 patients had stage II and 34 patients had stage III GC. At baseline, 21.5% patients (14/65) were MRD(+) and received combination ACT. Among the 51 baseline MRD(-) patients, 45 received de-escalated therapy at onset (9 received combination ACT after MRD conversion) and 6 received combination ACT. The median follow-up time was 13.3 (range: 9.3-15.7) months. In the intention-to-treat population, the overall 1-yDFSr was 86.2% (90% CI: 79.4-93.5%), the 1-yOSr was 96.9% (90% CI: 93.5-100%) and the CRR was 13.8% (95% CI: 6.5-24.7%). The treatment de-escalation rate was 69.2% (45/65, 95% CI: 56.6-80.1%). Grade 3-4 AEs occurred in 24.6% (95% CI: 14.8%-36.9%) of patients. Baseline MRD (+) patients had a shorter DFS compared to MRD (-) ones (1-yDFSr: 57.1% vs. 94.1%, HR = 9.66, 95% CI: 2.40-38.81, log-rank P &lt; 0.0001). Patients with sustained MRD (-) had the best DFS (1-yDFSr: 100%), while those with sustained MRD (+) had the shortest DFS. Patients with MRD conversion from positive to negative or from negative to positive had intermediate DFS (1-yDFSrs: 72.7% and 70.0%, respectively). In 9 patients with recurrence, ctDNA-MRD positivity identified recurrence a median of 3.4 months earlier than radiology. Conclusions: MRD-guided ACT for stage II-III GC significantly reduced the ACT rate, and increased the de-escalated CT rate, resulting in good disease-free survival and fewer side effects. The results of this MRD-guided precision of ACT deserve to be confirmed by large randomized clinical trials. Clinical trial information: NCT05585580 .

Phase 2 Trial of Stereotactic Body Radiation Therapy with Dose Escalation Using Simultaneous Integrated Boost for Spinal Metastases.

Phase 2 Trial of Stereotactic Body Radiation Therapy with Dose Escalation Using Simultaneous Integrated Boost for Spinal Metastases.