Early-stage Cancer Research Articles

Targeted Biopsy Is Sufficient for Men on Active Surveillance for Early-Stage Prostate Cancer.

Serial biopsy is a mainstay for patients on active surveillance (AS) for prostate cancer. mpMRI targeting has become a standard. It is unclear whether targeted biopsy alone reliably identifies the dominant lesion, thereby obviating the need for systematic sampling. Participants enrolled in AS with early-stage prostate cancer (PSA < 20, cT1-2, GG1-2) and underwent 2+ systematic biopsy sessions with or without MR-targeted sampling. The findings for dominant Gleason Grade (GG) and tumor localization were assessed. Among 821 men who underwent MR fusion biopsies, 82% were diagnosed with GG1 and 18% with GG2. Sixty-two percent had their first MR fusion biopsy as diagnostic or confirmatory. Across all fusion biopsies, MRI-targeted detection of GG and/or tumor location overlapped with systematic sampling for 95% of cases. For 5% of cases, systematic biopsy was unique in detecting GG and location outside the target. Most unique lesions detected outside the target had marginally aggressive features: 73% GG2 of low-volume and favorable histologic subtypes. In men with MR fusion biopsies, targeting alone identified the dominant GG and location most of the time (95%); 25% of dominant lesions were contiguous to the target, suggesting that better sampling of the target improves detection. The remaining 5% of men had higher-grade, low-volume disease outside the targeted lesion of which only 2% had aggressive risk features. MR fusion targeting, without systematic sampling, may be sufficient to monitor men on AS. Few high-risk cancers are missed, all of limited volume and favorable histology.

Super multiple primary lung cancers harbor high-frequency BRAF and low-frequency EGFR mutations in the MAPK pathway

The incidence of multiple primary lung cancer (MPLC) is increasing, with some of our surgical patients exhibiting numerous lesions. We defined lung cancer with five or more primary lesions as super MPLCs. Elucidating the genomic characteristics of this special MPLC subtype can help reduce disease burden and understand tumor evolution. In our cohort of synchronous super early-stage MPLCs (PUMCH-ssesMPLC), whole-exome sequencing on 130 resected malignant specimens from 18 patients provided comprehensive super-MPLC genomic landscapes. Mutations are enriched in PI3k-Akt and MAPK pathways. Their BRAF mutation frequency (31.5%) is significantly higher than MPLC with fewer lesions and early-stage single-lesion cancer, while EGFR mutations are significantly fewer (13.8%). As lesion counts increase, BRAF mutations gradually become dominant. Also, invasive lesions more tend to have classic super-MPLC mutation patterns. High-frequency BRAF mutations, especially Class II, and low-frequency EGFR mutations could be a reason for the limited effectiveness of targeted therapy in super-MPLC patients.

Recent advances in surface plasmon resonance for the detection of ovarian cancer biomarkers: a thorough review.

Early detection of ovarian cancer (OC) is crucial for effective management and treatment, as well as reducing mortality rates. However, the current diagnostic methods for OC are time-consuming and have low accuracy. Surface plasmon resonance (SPR) biosensors offer a promising alternative to conventional techniques, as they enable rapid and less invasive screening of various circulating indicators. These biosensors are widely used for biomolecular interaction analysis and detecting tumor markers, and they are currently being investigated as a rapid diagnostic tool for early-stage cancer detection. Our main focus is on the fundamental concepts and performance characteristics of SPR biosensors. We also discuss the latest advancements in SPR biosensors that enhance their sensitivity and enable high-throughput quantification of OC biomarkers, including CA125, HE4, CEA, and CA19-9. Finally, we address the future challenges that need to be overcome to advance SPR biosensors from research to clinical applications. The ultimate goal is to facilitate the translation of SPR biosensors into routine clinical practice for the early detection and management of OC.

An enzymatic reaction-based SERS saliva analysis microporous array chip for chiral differentiation and high-throughput detection of D-amino acids.

ARaman-active boronate modified surface-enhanced Raman scattering (SERS) microporous array chip based on the enzymatic reaction was constructed for reliable, sensitive, and quantitative monitoring of D-Proline (D-Pro) and D-Alanine (D-Ala) in saliva. Initially, 3-mercaptophenylboronic acid (3-MPBA) was bonded to Au-coated Si nanocrown arrays (Au/SiNCA) via Au-S bonding. Following this, H2O2 obtained from D-amino acid oxidase (DAAO)-specific catalyzed D-amino acids (D-AAs) further reduced 3-MPBA to 3-hydroxythiophenol (3-HTP) with a new Raman peak at 882cm-1. Meanwhile, the original characteristic peak at 998cm-1 remained unchanged. Therefore, the I882/I998 ratio increased with increasing content ofD-AAs in the sample to be tested, allowing D-AAs to be quantitatively detected. TheAu/SiNCA with large-area periodic crown structure prepared provided numerous, uniform "hot spots," and the microporous array chip with 16 detection units was employed as the platform for SERS analysis, realizing high-throughput, high sensitivity, high specificity and high-reliability quantitative detection of D-AAs (D-Pro and D-Ala). The limits of detection (LOD) were down to 10.1µM and 13.7µM throughout the linear range of 20-500µM. The good results of the saliva detection suggested that this SERS sensor could rapidly differentiate between early-stage gastric cancer patients and healthy individuals.

Integrating Machine Learning With Nanotechnology For Enhanced Cancer Detection And Treatment

Cancer remains one of the leading causes of mortality worldwide, necessitating the development of more effective diagnostic and therapeutic methods. Advances in both nanotechnology and machine learning (ML) offer promising solutions to these challenges. Nanotechnology enables the manipulation of materials at the molecular or atomic scale, which facilitates precise drug delivery, early-stage cancer detection, and targeted therapies. Machine learning, with its ability to process vast amounts of data and recognize complex patterns, can significantly enhance the efficacy of nanotechnology-based interventions. This paper explores the integration of machine learning with nanotechnology, discussing its applications in cancer detection, diagnosis, and treatment. By analyzing current research, we highlight the synergies between these fields, the technical challenges, and the future potential for developing more personalized and efficient cancer therapies. Furthermore, we consider ethical and safety concerns, along with recommendations for future interdisciplinary research.

Step-by-step: A clinical pathway for stepped care management of fear of cancer recurrence-results of a three-round online delphi consensus process with Australian health professionals and researchers.

Fear of cancer recurrence (FCR) is not routinely addressed in clinical practice, meaning many cancer survivors forego effective interventions. We established expert consensus on a clinical pathway to help health professionals identify and manage FCR in early-stage cancer survivors. Australian health professionals and researchers working with adult cancer survivors participated in a three-round Delphi study promoted via oncology professional bodies and social media. The Round 1 online survey presented 38 items regarding FCR screening, triage, assessment, referral, and stepped care, based on a literature review, related pathways/guidelines, and expert input. Participants rated how representative of best-practice items were on a 5-point scale (strongly disagree-strongly agree), with optional qualitative feedback. Consensus was defined as ≥ 80% of participants strongly/agreeing with items. Items not reaching consensus were re-presented to Round 1 participants in two subsequent rounds with new items, derived from content analysis of qualitative feedback. From 94 participants in Round 1 (89% health professionals), 26/38 (68%) items reached consensus. By round 3, 35/38 (92%) items, including 8 new items, reached consensus. Routine FCR screening and triage conversations and stepped care management (i.e. tailored and staged treatment) were endorsed. However, the timing of FCR screening/triage did not reach consensus. This world-first FCR clinical pathway incorporating contemporary evidence and expert opinion recommends routine screening and triage to stepped care management of FCR. Some pathway components, such as screening or triage timing, may need tailoring for different contexts. Implementation of the pathway could aid routine identification and management of FCR, reducing its burden on cancer survivors and the healthcare system.

Nomogram to Predict Nodal Recurrence-Free Survival in Early Oral Squamous Cell Carcinoma.

This study aimed to develop and internally validate a prognostic nomogram for predicting nodal recurrence-free survival (NRFS) in patients with early-stage oral squamous cell carcinoma (OSCC) with clinically negative neck lymph nodes. The management of early-stage oral cancer patients with clinically negative neck lymph nodes (cN0) remains controversial, especially concerning the need for elective neck dissection. Data from a single institution spanning 2010 to 2020 were utilized to develop and evaluate the nomogram. The nomogram was constructed using multivariable Cox regression and LASSO regression analyses to identify independent risk factors for lymph node metastasis. Internal validation was performed using bootstrap resampling to assess the nomogram's predictive accuracy. A total of 930 cN0 patients with T1 and T2 stage OSCC were randomly divided into training and validation cohorts (8:2 ratio). Independent risk factors for lymph node metastasis included tumor pathological grade (well: reference, moderate/poor: OR 1.69), cT (cT1: reference, cT2: OR 2.01), history of drinking (never: reference, current/former: OR 1.72), and depth of invasion (0 mm < DOI ≤ 5 mm: reference, 5 mm < DOI ≤ 10 mm: OR 1.31). The nomogram, incorporating these variables, demonstrated good predictive accuracy with a C-index of 0.67 (95% CI: 0.58-0.76) in the validation set. In both training and validation groups, the nomogram effectively stratified patients into low-risk and high-risk groups for occult cervical nodal metastases (p < 0.05). The nomogram enables risk stratification and improved identification of occult cervical nodal metastases in clinically node-negative OSCC patients by incorporating tumor-specific and patient-specific risk factors.

Histopathological Study Of Prostate Cancer According To Gleason Score

The aim of this study was to histopathological alternation prostate cancer according Gleason systems . The total number of study samples was (60 ) that taken from men who suffered prostate cancer .patients diagnosed by a specialist doctor. Blood samples taken from all groups for estimation of levels of PSA. Second type of samples was biopsy and paraffin block that taken from PC patients for detection of histopathological alternations depending Gleason score. The result obtained from histopathology method that the prostate cancer in early stage poorly differentiated gland to loss gland formation in advanced early stage.

Single-cell transcriptome analysis reveals immune microenvironment changes and insights into the transition from DCIS to IDC with associated prognostic genes

BackgroundDuctal carcinoma in situ (DCIS) of the breast is an early stage of breast cancer, and preventing its progression to invasive ductal carcinoma (IDC) is crucial for the early detection and treatment of breast cancer. Although single-cell transcriptome analysis technology has been widely used in breast cancer research, the biological mechanisms underlying the transition from DCIS to IDC remain poorly understood.ResultsWe identified eight cell types through cell annotation, finding significant differences in T cell proportions between DCIS and IDC. Using this as a basis, we performed pseudotime analysis on T cell subpopulations, revealing that differentially expressed genes primarily regulate immune cell migration and modulation. By intersecting WGCNA results of T cells highly correlated with the subtypes and the differentially expressed genes, we identified six key genes: FGFBP2, GNLY, KLRD1, TYROBP, PRF1, and NKG7. Excluding PRF1, the other five genes were significantly associated with overall survival in breast cancer, highlighting their potential as prognostic biomarkers.ConclusionsWe identified immune cells that may play a role in the progression from DCIS to IDC and uncovered five key genes that can serve as prognostic markers for breast cancer. These findings provide insights into the mechanisms underlying the transition from DCIS to IDC, offering valuable perspectives for future research. Additionally, our results contribute to a better understanding of the biological processes involved in breast cancer progression.

B-240 Multi-omic blood test for early detection of cancer and pre-cancer

Abstract Background The earlier diagnosis of cancer is vital to improve patient survival. Many liquid biopsy technologies are focused on single tumor-derived biomarkers, which limits test sensitivity, especially for early-stage cancers that do not shed sufficient genetic material into the bloodstream. The Dxcover liquid biopsy employs Multi-Omic Spectral Analysis (MOSA) that interrogates a blood sample with Infrared (IR) radiation and produces a distinctive signature that represents the whole biomolecular profile of the sample. This multi-omic blood test analyzes the full complement of tumor and immune-derived markers present within blood derivatives and could facilitate the earlier detection of cancer. The technology can be tuned for high sensitivity (rule out) or high specificity (rule in) depending on the desired application, clinical priorities and international healthcare markets. Methods Three clinical studies have been completed, assessing the technology for the detection of: (1) brain cancer, (2) multiple cancers, and (3) colorectal cancer (CRC) and pre-cancerous lesions. In the first study, we recruited 988 patients prospectively with non-specific symptoms associated with a brain tumor. Secondly, we carried out a large-scale multi-cancer evaluation (n = 2092 patients), targeting eight different cancers. Moreover, the CREATE (ColoREctal cancer &amp; Adenoma Test Evaluation) feasibility study (3) examined 100 CRC, 92 adenoma samples and 104 colonoscopy screening control patients. Results In study 1, the brain cancer algorithm detected 96% of the patients with brain cancer, and 100% of glioblastomas, the most aggressive primary brain tumor. In the multi-cancer study (2), area under the receiver operating characteristic curve values were calculated for the eight cancer types versus symptomatic non-cancer controls: brain (0.90), breast (0.76), colorectal (0.91), kidney (0.91), lung (0.91), ovarian (0.86), pancreatic (0.84) and prostate (0.86). We also assessed the test performance when all eight cancer types were pooled to classify ‘any cancer’ against non-cancer patients. The cancer versus asymptomatic non-cancer classification detected 64% of stage I cancers when specificity was 99% (overall sensitivity 57%). When tuned for higher sensitivity, this model identified 99% of Stage I cancers (with specificity 59%). In the CREATE study, the test reported promising results for pre-cancer detection; at 90% specificity, the test reported sensitivities of 80% for CRC and 59% for advanced adenomas. Conclusions A rapid liquid biopsy that is sensitive to pre-cancerous lesions and early-stage cancer could substantially improve patient outcomes. There is a low barrier to integrating this blood test into existing diagnostic pathways as the technology is rapid, simple to use, and sample preparation is minimal. In addition, the spectroscopic liquid biopsy has the potential to be combined with other orthogonal tests, such as cell-free DNA, which could provide an efficient route to diagnosis. Cancer treatment can be more effective when given earlier, and this low-cost strategy has the potential to improve patient prognosis.

B-351 Genotoxic Producing Escherichia coli Protects and Promotes Breast Adenocarcinoma

Abstract Background Recent studies have linked certain colibactin producing subphylas of E. coli to colorectal cancer. The bacterium synthesizes colibactin via the pks genomic island containing a series of clbA to clbS genes. The genotoxin causes inter-strand DNA cross-links, which lead to double strand breaks and promotion of colorectal adenocarcinoma. The published studies have prioritized the colorectal regions of the body where E. coli is commonly found, but none have identified the same genotoxic relationship with other types of adenocarcinoma. In this study, we evaluate DNA damage and cellular changes of mammary breast tissue based on high and low levels of colibactin producing E. coli exposure. The goal is to evaluate if colibactin can affect cells in the mammary breast tissue promoting breast adenocarcinoma growth. Methods Two cell lines were acquired from ATCC: primary mammary epithelial cells (PCS-600-010) and MCF-7 breast adenocarcinoma cells (HTB-22). Both cell lines were split into six culture flasks and maintained until ∼80% confluence was reached using the ATCC cell culture protocols. Once all the flasks had reached the target confluence, they were divided into exposure groups of high and low concentrations of colibactin producing E. coli, a group of non-colibactin producing E. coli, a group exposed only to phosphate buffered saline, and a control group with no exposure. Cellular morphology was observed using light microscopy before, after exposure, and every 5 minutes up to 15 minutes. E. coli and colibactin DNA concentrations were quantified using quantitative polymerase chain reaction. Genomic DNA was extracted from each group of cells. The DNA from each group was whole genome sequenced and analyzed for genomic variation. Results The normal cells exposed to E. coli showed immediate lysing and continued to lyse after a 5 minute incubation; however, the adenocarcinoma positive cells showed no lysing up to 30 minutes incubation. Sequencing results show genomic variation between the groups and specific break points associated with the E. coli exposed groups. Conclusions Our results show that the presence of E. coli with mammary breast tissue can destroy normal tissue, promote lysis resistance, and allow adenocarcinoma cells to continue to grow. The colibactin producing E. coli does cause double stranded breaks and can lead to cell death. This new information points out a critical need to monitor the microbiome and infection levels of people at risk or in early stages of cancer to prevent adenocarcinoma growth and destruction of normal tissue. This study indicates that colibactin producing E. coli may play a larger role in tissue damage and promotion of other types of cancer. More research is needed to elucidate the molecular pathway and mechanisms of colibactin, which will lead to new diagnostics or therapeutics that monitor E. coli levels or inhibit colibactin’s toxic effects.

A TED Talk style patient video education intervention to improve care coordination for rural patients with early-stage cancer: A feasibility study.

236 Background: Effective care coordination is a key component of high-quality, patient-centered cancer care. However, cancer patients residing in rural areas often experience substantial barriers to care and suboptimal care coordination. To date, there is a paucity of interventions to improve care coordination for rural cancer patients. In this pilot trial, we assessed the feasibility and preliminary efficacy of a remote, tablet-based patient video education intervention focused on cancer care coordination among rural patients in Hawaii. Methods: We conducted a single-arm pilot study to assess the preliminary effects of a novel, TED-talk style patient video education intervention presented by clinicians and a patient advocate. Video content focused on cancer basics, care coordination, and self-advocacy. Eligible participants were newly diagnosed with early-stage cancer (I-III), within one month of starting adjuvant chemotherapy, able to speak/read English, and residing in rural areas (defined as RUCA ≥ 4). We assessed the feasibility and patient-reports of acceptability and satisfaction using semi-structured interviews. Validated instruments were administered at baseline and post-intervention and used to assess the preliminary effects of the intervention on patients’ perceptions of care coordination (CCI; Care Coordination Instrument) and self-advocacy (adapted Cancer Self-Advocacy Scale; Hagan et al. 2018). Descriptive statistics were used to assess study outcomes. Results: From 01/2022 to 12/2022, 19 patients enrolled on the study (21 approached); 74% were female, 42.1% identified as two or more races, 26.3% Asian, and 21.1% White. Mean age was 52.2. The majority of participants were receiving treatment for breast cancer. Five patients became ineligible after enrolling on the study (disease progression, relocation). 71.4% of eligible patients completed all assessments. No changes were observed in the overall perceptions of care coordination. Improved scores were observed for the CCI communication domain (+4.5; Cohen’s d = -0.76, 95% CI: -1.45, -0.03). For self-advocacy, there was an overall trend for improved scores for the informed decision making and connected strengths subscales. All participants reported high satisfaction with the intervention. Conclusions: Results support the preliminary feasibility, satisfaction, and acceptability of this intervention for rural patients. Although the effects on the overall perceptions of care coordination are unclear, preliminary data suggest that the intervention may improve communication aspects of care coordination and self-advocacy. Further study is needed to evaluate the intervention in other rural areas. Funding support: The HOPE Foundation for Cancer Research/SWOG. Clinical trial information: NCT05162404 .

Feasibility and Safety of ArtiSential for Minimally Invasive Surgery in Early-stage Gynecologic Cancer: Results from the KGOG 4002/GYANT Study

Objectives: The objective is to evaluate the feasibility and safety of ArtiSential for performing minimally invasive surgeries for gynecological cancers. Materials and Methods: We conducted a prospective observational study at 10 Tertiary Institutional Hospitals in Korea between November 2021 and April 2022. Eligible patients were 18 years or older and planned to undergo minimally invasive surgery for gynecologic cancer. We collected baseline characteristics, surgical information, and postoperative outcomes. The primary endpoint was to compare the operation time required for gynecologic cancer surgery using ArtiSential with the reported operation time for surgery using conventional laparoscopic instruments or robots. The secondary endpoints were to evaluate the surgical outcomes of gynecologic cancer surgery using ArtiSential compared to conventional laparoscopic instruments or robots and collect operator feedback on equipment improvements during surgery. Results: Forty patients were enrolled in this study, including 19 with endometrial cancer, 15 with cervical cancer, and 6 with ovarian cancer. The average operation time was 187.0 ± 49.2 min, with no complications encountered during surgery. Pelvic lymph nodes were assessed in 34 patients, with the ArtiSential device utilized in 22 (64.7%) of these patients, at an average assessment time of 40.3 ± 19.4 min. Most surgeons using the ArtiSential device reported that it performed slightly better than conventional laparoscopic instruments. Conclusion: The use of the ArtiSential device in minimally invasive surgery has been demonstrated to be both feasible and safe for the treatment of early-stage gynecologic cancer.

Impact of Medicaid expansion on receipt of pancreatectomy in early-stage pancreatic cancer.

106 Background: Pancreatic cancer is estimated to rank third in cancer-related mortality in 2024 by the American Cancer Society. Despite the proven increase in 5-year survival with pancreatectomy in Early Pancreatic Cancer (EPC), it is nationally underutilized. Medicaid expansion (ME) under the Affordable Care Act is associated with gains in insurance coverage and early cancer diagnosis in patients with pancreatic cancer. However, its impact on the receipt of pancreatectomy in EPC remains unclear. In this study, we looked at the impact of ME on the uptake of pancreatectomy in EPC. Methods: We performed a retrospective observational study using the Surveillance, Epidemiology, and End Results (SEER) database, which included patients diagnosed with EPC (Stage 1 and Stage 2) between 2006 and 2021. Multivariate logistic regression was performed to ascertain the effects of ME on the uptake of pancreatectomy in patients with EPC in states that expanded vs. states that did not, with 2014 as an inflection point for policy implementation. Results: During this study period, 29,384 were diagnosed with EPC, 10,777 patients were diagnosed pre-ME and 18,607 post-ME. The odds of receipt of pancreatectomy for EPC in non-expansion states after 2014 was 20% higher than before 2014. However, this was not statistically significant [AOR – 1.20 (0.98-1.48)]. There was also no significant difference between the odds of receipt of treatment for EPC for ME states before [AOR- 1.27 (1.06-1.51)] and after [AOR-1.21 (1.01-1.44)] 2014. Increasing age, male sex, Black and Hispanic race, having an income lower than $65,000, and living in less populated areas were all associated with lower odds of receipt of pancreatectomy in EPC. Conclusions: ME was not associated with increased uptake of pancreatectomy in EPC. However, prior studies have shown that ME is linked to an earlier stage at pancreatic cancer diagnosis. This suggests that despite earlier diagnosis, other barriers to receiving treatment exist. Future studies are warranted to identify the limitations of policy change to improve outcomes of such aggressive cancer. Logistic regression for receipt of pancreatectomy in early-stage pancreatic cancer. Receipt of Surgical Treatment for Early Pancreatic cancer Adjusted Odds Ratio (95% Confidence Interval) Non- ME States (Pre-Expansion) 1.00 (Reference) Non- ME States (Post -Expansion) 1.20 (0.98-1.48) ME States (Pre-Expansion) 1.27 (1.06-1.51) ME States (Post-Expansion) 1.21 (1.01-1.44) ME- Medicaid expansion.

Oncology care model cost data for breast, lung, and multiple myeloma: Influence of outpatient rehabilitation therapy services.

14 Background: High value cancer care is defined by access to coordinated, appropriate healthcare services that achieve optimal outcomes at a reasonable cost. Evidence supports outpatient cancer rehabilitation (physical, occupational or speech therapy) as a mechanism to improve outcomes such as health-related quality of life, suggesting that integration of these services is beneficial for cancer survivors. However, the impact of outpatient rehabilitation services on healthcare costs is unknown. We aimed to compare cost segments between those who attended community-based outpatient rehabilitation therapy services (Rehab) versus those who did not (Non-rehab). We hypothesized that healthcare costs would be lower for the Rehab group in the following cost segments: emergency department (ED), part D drugs, home health services, skilled nursing facility services (SNF), inpatient rehabilitation facilities (IRF), and hospice. Methods: This is a retrospective cohort study of Medicare beneficiaries who received chemotherapy at a large community oncology practice that participated in the oncology care model (OCM) program from 2018 to 2021. Two data sources were linked, OCM cost data and the rehabilitation medical record. This yielded sufficient sample sizes for analysis of breast, lung, or multiple myeloma (MM) cancer types. Rehab cases were then matched to Non-rehab cases 3:1 based on cancer type, stage, and sex. Cost variables included total cost of care (TCOC) and cost segments using OCM methodology. Mann-Whitney-Wilcoxon statistic (p&lt;.05) was used for analysis. Results: Cases (N=3,033) primarily had early-stage cancer (0 to 2, 74.8%) and were 70.4±7.3 (Rehab) or 71.6±8.5 years old at diagnosis (Non-rehab). Most had breast cancer (81.2%), followed by lung cancer (11.7%) and MM (7.2%). TCOC was $32,387 and $26,257 for the Rehab and Non-rehab groups, respectively. Costs were significantly lower for the Rehab group in five of the six segments analyzed; IRF costs were lower, but not statistically significant (Table). Conclusions: To our knowledge, this is the first study to explore the influence of real-world, outpatient cancer rehabilitation therapy services on the cost of cancer care. Community-based therapy services were associated with significantly lower costs in ED, part D drugs, home health, SNF, and hospice segments. Future studies examining rehabilitation services as a relatively low-cost supportive care option to meet patient needs and enhance high-value care are warranted. Healthcare segment costs for rehab vs. non-rehab cases. Rehab Non-rehab Between-group Difference Mean, (SD) Mean (SD) p-value ED $85 (260) $104 (372) .019 Part D drugs $4,813 (18,221) $5,675 (18,797) &lt;.001 Home health $433 (1,600) $705 (2,118) &lt;.001 SNF $160 (1,988) $386 (3,943) .046 Hospice $75 (770) $198 (1,529) &lt;.001 IRF $245 (2,275) $384 (3,277) .434

Periprostatic adipose tissue inhibits tumor progression by secreting apoptotic factors: A natural barrier induced by the immune response during the early stages of prostate cancer.

Prostate cancer (PCa) is the second most prevalent malignancy in men worldwide. The risk factors for PCa include obesity, age and family history. Increased visceral fat has been associated with high PCa risk, which has prompted previous researchers to investigate the influence of body composition and fat distribution on PCa prognosis. However, there is a lack of studies focusing on the mechanisms and interactions between periprostatic adipose tissue (PPAT) and PCa cells. The present study investigated the association between the composition of pelvic adipose tissue and PCa aggressiveness to understand the role played by this tissue in PCa progression. Moreover, PPAT-conditioned medium (CM) was prepared to assess the influence of the PPAT secretome on the pathophysiology of PCa. The present study included 50 patients with localized PCa who received robot-assisted radical prostatectomy. Medical records were collected, magnetic resonance imaging scans were analyzed and body compositions were calculated to identify the associations between adipose tissue volume and clinical PCa aggressiveness. In addition, CM was prepared from PPAT and perivesical adipose tissue (PVAT) collected from 25 patients during surgery, and its effects on the PCa cell lines C4-2 and LNCaP, and the prostate epithelial cell line PZ-HPV-7, were investigated using a cell proliferation assay and RNA sequencing (RNA-seq). The results revealed that the initial prostate-specific antigen level was significantly correlated with pelvic and periprostatic adipose tissue volumes. In addition, PPAT volume was significantly higher in patients with extracapsular tumor extension. PCa cell proliferation was significantly reduced when the cells were cultured in PPAT-CM compared with when they were cultured in control- and PVAT-CM. RNA-seq revealed that immune responses, and the cell death and apoptosis pathways were enriched in PPAT-CM-cultured cells indicating that the cytokines or other factors secreted from PPAT-CM induced PCa cell apoptosis. These findings revealed that the PPAT secretome may inhibit PCa cell proliferation by activating immune responses and promoting cancer cell apoptosis. This mechanism may act as a first-line defense during the early stages of PCa.

Measuring what really matters: Advocacy-led co-creation and accrual of a pan-cancer QoL survey.

240 Background: Implementing co-creation methods in research may provide vital input to improve accrual, retention, and research value. Advocates for Collaborative Education (ACE), a global coalition of patient, community, research, and policy advocates, used co-creation methodology with patients, survivors, and metavivors to Design, Develop , and Deploy a survey to define and quantify QoL impacts across a large sample of individuals with a diagnosis or history of cancer. Methods: With a defined primary objective to “gain insight into challenges faced by individuals with a history or diagnosis of cancer and how these challenges impact their life and quality of life,” a co-creation team of individuals with lived experience in early stage or metastatic cancers was established. In the Design phase, co-creation team members were interviewed and engaged in discussions on side effect measurement and impact. They were asked a variety of questions, including what side effects they believed were most impactful to QoL, what elements they felt were missing in conversations around QoL, and how accurately they felt QoL was measured in the clinical setting. In the Develop phase, survey questions were developed and vetted with the co-creation team. In the Deploy phase, co-creation team members, advocate members of the ACE community, and aligned advocacy groups, were key to recruiting a broad audience via electronic distribution and social media platforms. Results: Efforts resulted in the co-creation of a six-section, 93 question, IRB-exempt survey. The co-creation team identified 17 treatment-related side effects that were incorporated into the survey. Survey questions asked respondents about perceived severity of side effects, how well informed they felt about possibilities of experiencing these side effects, access to supportive care, side effects of supportive care therapies, and personal preferences for receiving cancer-related information. A unique measurement scale was shaped by the co-creation team to be more reflective of side effect impact on QoL. In five weeks, the survey accrued over 500 responses across a variety of cancer types (15+), stages (0 - IV), ages, statuses, and racial groups. Conclusions: Co-creation methods were used in Design to identify side effect experiences in cancer treatment and validate what matters most to individuals with cancer; in Develop to validate a pan-cancer survey examining what mattered to the audience of interest; and in Deploy to rapidly accrue a large and diverse set of responses through advocacy partnerships. Co-creation also identified layers of side effect management challenges that cannot be reflected in current rubrics for QoL measurement. While co-creation may seem daunting, this study provides a template for effective, quality partnerships between study teams, advocates, and advocacy groups for implementing co-creation methods in the cancer setting.

Development of transition metal oxide platforms for aptasensing of PSA in cell cultures.

In this study, a novel aptasensor based on a transition metal oxide-modified pencil graphite electrode (PGE) was developed for the diagnosis of early-stage prostate cancer (PCa) via monitoring the prostate-specific antigen (PSA), which is the main biomarker for PCa. Single-use PGEs modified with pulsed deposited manganese oxide (MnOx) film were used to attach the amino-terminated aptamer specific to the PSA via carbodiimide chemistry. The designed aptasensor was placed in an electrochemical cell containing ferri/ferrocyanide ions as a redox probe to measure the charge transfer resistances (Rct) of the electrode surface by electrochemical impedance spectroscopy (EIS) to follow the response of each modification step. The effect of the medium pH on the ionic structure of the aptamer molecule according to its pI value and, thus, the reversing of the direction of the response (ΔRct) by the pH change was also discussed. The level of PSA secreted from PCa cells was investigated using impedimetric transduction. The specificity of the aptasensor was validated through selectivity studies against non-specific tumor markers like VEGF and different cancer cell lines including breast cancer and androgen-insensitive prostate cancer. The developed system showcases a label-free, fast, specific, and cost-effective approach for PSA detection, highlighting the importance of medium pH and the electrostatic environment on the aptamer's response. Our work emphasizes the potential for such aptasensors in clinical diagnostics and paves the way for further exploration into using transition metal oxides in biosensing applications.

Thyroid cancer epidemiology in Ireland from 1994 to 2019 – Rising diagnoses without mortality benefit

BackgroundThe epidemiology and management of thyroid cancer has changed radically in the recent past, with rising international incidence of early-stage papillary thyroid cancer (PTC) in particular. In this paper, we review the epidemiology of thyroid cancer in Ireland. MethodsA retrospective cohort study of National Cancer Registry of Ireland data, 1994–2019. ResultsRecords from 4158 patients were analysed. 73 % (n = 3040) were female. The average age was 50.4 years. Patient sex did not change over time (p = 0.662), while age decreased significantly (p < 0.0001). The most common diagnoses were PTC (n = 2,905, 70 %) and follicular thyroid carcinoma (n = 549, 13 %). Incidence rose over threefold (1.8–6.2 cases/100000 person-years). The incidence of T1 PTC rose over twelvefold (0.169–2.1 cases/100000 person-years), while the incidence of stage III and IV disease did not change significantly. Five-year disease-specific survival (DSS) was 85 % and varied significantly by diagnosis – 97 % for PTC versus 5 % for anaplastic thyroid carcinoma. Survival did not change significantly over time. Male sex was a risk factor for more advanced disease (p < 0.0001) but did not independently predict overall survival except in PTC (HR 1.6, p = 0.03). The use of radioactive iodine declined markedly from 49 % to 12.5 %. RAI improved DSS for PTC patients aged over 55 years (p = 0.02) without a notable effect on survival for those under 55 years (p = 0.99). ConclusionThe epidemiology and management of thyroid cancer in Ireland has changed dramatically in a manner reflective of international trends.

Design and Modelling of Continuum Robot for Endoscopic Submucosal Dissection Surgery With Lifting Force Estimation.

Endoscopic submucosal dissection (ESD) is an effective treatment for early-stage gastrointestinal cancers. However, traditional surgical instruments lack accuracy and force-sensing. A new type of continuum robot for ESD is designed. An accurate static model of the proposed continuum robot is established, considering cases where the robot bends into C-shapes and S-shapes. A force estimation method based on an accurate static model is proposed. Then, the accuracy of the static model and force estimation is verified through experiments. Finally, an ex-organ experiment is carried out. The average position error of the proposed static model is 0.72mm, accounting for 2.57% of the total robot length. The average error of force estimation is 19.53mN. By gripping and cutting ex-porcine gastric mucosa, the robot's functionality is validated. This paper contributes to precise control and safe interaction of continuum robots.