Higher 5-year Survival Rate Research Articles

Five-year cancer survival rates in Monastir, Tunisia

Abstract Background Cancer is a major public health problem worldwide. To the best of our knowledge, there is no Tunisian population-based registry studies investigating cancer survival in Tunisia. The objectives of our study were to estimate the five-year cancer survival rates in the province of Monastir, Tunisia. Methods We performed a retrospective cohort study including patients originating from Monastir diagnosed with cancer between 2002 and 2014. Data were collected from the cancer register of the center. Patients were followed until December 2022. Results In total, 9318 cancer cases were identified of whom 5741 were included for the survival analysis. The 5-year cancer survival rate, all sites combined, was 46% (95% CI: 45-47.3). Among the 10 most frequent cancer sites in Monastir, cancers having the lowest 5-year survival rates were lung cancer in men (18.2% (95% CI: 15.6-20.7)) and stomach cancer in both sexes (32.1% (95% CI: 23.4-40.7) and 25.3% (95% CI: 16-34.5) in men and women respectively). The cancers with the highest 5-year survival rates among men were skin cancer (other than malignant melanoma) (64% (95% CI: 54.5-73.4)), prostate cancer (59.1% (95% CI:54.7-63.4)) and colon cancer (55.1% (95% CI: 47.7-62.4). In women, cervical cancer (70% (95% CI: 61.8-78.1), skin cancer (other than malignant melanoma) (66.2% (95% CI: 55.1-77.2) and breast cancer (63.8% (95% CI:58.8-67.7)) were those with the highest 5-year survival rates. Patients ≥ 65 years had the lowest 5-year survival rates for almost all cancer sites in both genders. Conclusions Our study has shown that cancer survival rates in Tunisia remain low compared to developed countries. The widespread implementation of cancer control programs including healthy lifestyle, education, screening and early detection are urgently needed. Key messages • The 5-year cancer survival rate, all sites combined, in Monastir was 46% (95% CI: 45-47.3). • Cancers with the lowest 5-year survival rates in Monastir were lung cancer in men and stomach cancer in both sexes.

Surgical Outcomes After Preoperative Embolization in Hypervascular Spinal Metastases: A Propensity Scored Study of 191 Patients.

Retrospective propensity-score matched, case control study at 2 academic tertiary care centers. To assess the effect of PE on (1) intraoperative blood loss, defined as conventional estimates of blood loss (EBL) and hemoglobin mass loss, and (2) secondary outcomes in patients with spinal metastases from hypervascular histologies. Preoperative embolization (PE) intends to reduce blood loss during surgery for spinal metastases of hypervascular tumors such as renal cell carcinoma. However, studies investigating the effect of PE in hypervascular tumors often consist of small cohorts, do not correct for confounding factors, and have conflicting results. After propensity score matching (PSM), 46 PE patients were matched to 46 non-PE patients without baseline differences. The constraints of PSM did not allow analysis of patients with tumor volumes>9cm3. Multiple linear regression models were fitted for EBL and hemoglobin mass loss. Poisson regression models were fitted for both intraoperative and postoperative transfusions. There was no difference in EBL (948mL [IQR 500-1750] vs. 1100mL [IQR 388-1925], P=0.68) and hemoglobin mass loss (201g [IQR 119-307] vs. 232g [IQR 173-373], P=0.18) between PE and non-PE patients. Other than higher 1-year survival rates (65% vs. 43%, P=0.05) in PE-patients, there were no differences in secondary outcomes. In multiple regression analyses, PE was not associated with decreased intraoperative blood loss, hemoglobin mass loss or perioperative blood transfusions. Our study demonstrated that, for tumors <9cm3, PE did not reduce EBL, hemoglobin mass loss or perioperative blood transfusions in patients undergoing spine surgery for metastases from hypervascular histologies. These findings suggest that urgent spine surgeries indicated for hypervascular histologies should not be delayed based on the availability of PE and accurate detection of pre-operative hypervascularity, beyond histology, will likely be an important determination of future PE utilization for spinal metastases. Treatment Benefits, Level III.

Comparison of the Efficacy of Transcatheter Arterial Chemoembolization Combined with Radiofrequency Ablation Versus Monotherapy in Patients with Liver Cancer.

This study assesses the effectiveness of combining transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) in treating hepatocellular carcinoma (HCC). Retrospective analysis of 125 HCC patients treated from 2020 to 2021, divided into two groups: monotherapy using TACE (n = 63), and a combined approach of RFA and TACE (n = 62). Comparison factors included clinical efficacy, liver function, tumor markers, complications, quality of life, and prognosis. The combined treatment group showed higher effectiveness (p < 0.05), improved liver function and tumor marker levels 4 weeks post-treatment (p < 0.05), significantly fewer complications (p < 0.05), and enhanced quality of life at the year-long follow-up (p < 0.05). The prognosis was better in the combination group, demonstrated by fewer recurrences and higher 1-year survival rates (p < 0.05). The dual approach of TACE and RFA shows improved results for HCC patients, including improved liver function, reduced tumor markers, fewer complications, and superior quality of life and prognosis. Consequently, combined treatment approach is endorsed for clinical practice.

Expression and prognostic impact of VDAC3 in colorectal adenocarcinoma.

Colorectal adenocarcinoma (COAD) is a malignant tumor with high mortality and low 5-year survival rate. Voltage-dependent anion channel 3 (VDAC3) is the least understood isoform of voltage-dependent anion-selective channels in the mitochondrial outer membrane. In this thesis, we aimed to investigate the prognostic value of VDAC3 and provide new insights into colon adenocarcinoma. We utilized The Cancer Genome Atlas (TCGA) database, Gene Expression Omnibus (GEO) database, Human Protein Atlas online database, and the University of ALabama at Birmingham CANcer data analysis Portal (UALCAN) database to analyze VDAC3 expression in COAD and assess patient survival rates. Univariate and multivariate Cox regression analyses were employed to evaluate VDAC3's prognostic significance for COAD. Gene set variation analysis (GSVA) was utilized to explore COAD-related signaling pathways associated with VDAC3. Additionally, we predicted the relationship between VDAC3 expression and anticancer drug sensitivity using the CellMiner database. In the TCGA database, VDAC3 demonstrated elevated expression levels in COAD, which was further validated by findings from the GEO database. Survival analysis conducted using Kaplan-Meier (K-M) curves highlighted that the patients with decreased VDAC3 expression exhibited significantly shorter overall survival durations. VDAC3 expression demonstrated correlation with COAD pathological stage. VDAC3 gene mutation was linked to COAD outcomes. Cox regression analysis showed that VDAC3 was an independent predictor. In addition, GSVA analysis showed that VDAC3 was closely related to mitochondria-related biological processes and involved in the occurrence and development of mitochondria-related diseases. Finally, analysis of the CellMiner database predicted that VDAC3 expression was positively correlated with chelerythrine and cladribine, but negatively correlated with Ergenyl. Our study suggests that VDAC3 may be a potential biomarker for early diagnosis, prognosis, and treatment of COAD.

Three-year follow-up study reveals improved survival rate in NSCLC patients underwent guideline-concordant diagnosis and treatment.

No studies in China have assessed the guideline-concordance level of the first-course of non-small cell lung cancer (NSCLC) diagnosis and treatment and its relationship with survival. This study comprehensively assesses the current status of guideline-concordant diagnosis (GCD) and guideline-concordant treatment (GCT) of NSCLC in China and explores its impact on survival. First course diagnosis and treatment data for NSCLC patients in Liaoning, China in 2017 and 2018 (n=1828) were used and classified by whether they underwent GCD and GCT according to Chinese Society of Clinical Oncology (CSCO) guidelines. Pearson's chi-squared test was used to determine unadjusted associations between categorical variables of interest. Logistic models were constructed to identify variables associated with GCD and GCT. Kaplan-Meier analysis and log-rank tests were used to estimate and compare 3-year survival rates. Multivariate Cox proportional risk models were constructed to assess the risk of cancer mortality associated with guideline-concordant diagnosis and treatment. Of the 1828 patients we studied, 48.1% underwent GCD, and 70.1% underwent GCT. The proportions of patients who underwent both GCD and GCT, GCD alone, GCT alone and neither GCD nor GCT were 36.7%, 11.4%, 33.5% and 18.4%, respectively. Patients in advanced stage and non-oncology hospitals were significantly less likely to undergo GCD and GCT. Compared with those who underwent neither GCD nor GCT, patients who underwent both GCD and GCT, GCD alone and GCT alone had 35.2%, 26.7% and 35.7% higher 3-year survival rates; the adjusted lung cancer mortality risk significantly decreased by 29% (adjusted hazard ratio[aHR], 0.71; 95% CI, 0.53-0.95), 29% (aHR, 0.71; 95% CI, 0.50-1.00) and 32% (aHR, 0.68; 95% CI, 0.51-0.90). The 3-year risk of death is expected to be reduced by 29% if patients with NSCLC undergo both GCD and GCT. There is a need to establish an oncology diagnosis and treatment data management platform in China to monitor, evaluate, and promote the use of clinical practice guidelines in healthcare settings.

Abstract PO3-10-07: Leveraging AI to identify factors influencing access to care and their association with overall survival- a multiracial Breast Cancer cohort

Abstract Introduction: Data from the Centers for Disease Control and Prevention (CDC) labels each US state based on its 5-Year Relative Survival of Breast Cancer (BC) patients (pts). Data is categorized into four “survival groups'', each representing a range of 5-year survival percentages. Using real-world data, this study characterized the populations in each survival group, examining pt knowledge and education about their disease as well as preferences and factors influencing their decision to explore clinical trial (CT) opportunities. Methods: Leal is an AI-based platform that employs self-reported medical profiles to match cancer pts with CTs. This study involved a diverse cohort of 14,509 BC pts who completed the questionnaire. The geographic distribution of pts across US states was analyzed, taking into account the state’s 5-year BC survival %. Four groups were defined as follows: Group A (86.4 - 89.4%), Group B (89.4 - 90.4%), Group C (90.4 - 91.5%), and Group D (92.0 - 95.0%). Parameters such as race, willingness to travel, insurance coverage, performance of genetic testing, and biomarker knowledge were considered in the analysis. Results: We found significant variations in registration rates on the Leal platform across groups. The Highest registration rate was recorded for Group D which has the highest 5-year survival rate (p&amp;lt; 0.0001). Group A which has the lowest 5-year relative survival had a significantly higher proportion of African Americans compared to group D (14% vs 4%, p &amp;lt; 0.0001). Moreover, while there was no difference in the percentage of pts undergoing Next-Generation Sequencing (NGS) in both groups, a larger proportion of pts in Group D demonstrated proficiency in interpreting the test reports (p = 0.05). Although no significant differences were found in the proportion of pts who were aware of their treatment (tx) history between the two groups, whites in both groups exhibited greater knowledge of their tx (p = 0.001). Additionally, pts in Group D showed a significantly higher willingness to travel longer distances to participate in CTs (p=0.001), and a larger percentage of them had insurance coverage. Conclusions: This study used data from CDC that categorized US states into four groups based on BC pts’ 5-Year Survival. CT participation is associated with better clinical outcomes, especially for pts with poorer prognosis. In agreement, we show a higher signup rate to the Leal platform in States with higher 5-year relative survival, possibly pointing to higher CT education and knowledge among pts in those states. This is further supported by higher proficiency in interpreting NGS reports, resulting in better-optimized CT options on the Leal platform. Group A was also characterized by a reduced willingness to travel for a CT and a larger proportion of pts without health insurance. Those are significant barriers for CT enrollment, and ultimately limit access to optimal care and may impact outcomes. Gaps in knowledge of key disease parameters such as tx history were observed for African Americans, regardless of geographic location, highlighting the need to focus on minority populations even in states where the survival rate is relatively high. In agreement, the proportion of African Americans in group A was markedly higher, correlating with current disparities in access to tx and poorer outcomes. AI-based platforms are optimized for the exact identification of barriers to access to care and for enabling relevant healthcare and support organizations to effectively address individual patient issues, consequently increasing access to CTs, particularly among different racial and ethnic populations. Citation Format: Michal Safran, Yelena Lapidot, Tzvia Bader, Avital Gaziel. Leveraging AI to identify factors influencing access to care and their association with overall survival- a multiracial Breast Cancer cohort [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-10-07.

Clinical and socioeconomic determinants of survival in biliary tract adenocarcinomas.

Despite advances in detection and treatments, biliary tract cancers continue to have poor survival outcomes. Currently, there is limited data investigating the significance of socioeconomic status, race/ethnicity, and environmental factors in biliary tract cancer survival. To investigate how socioeconomic status and race/ethnicity are associated with survival. Data from the Surveillance, Epidemiology, and End Results database for biliary and gallbladder adenocarcinomas were extracted from 1975 to 2016. Socioeconomic data included smoking, poverty level, education, adjusted household income, and percentage of foreign-born persons and urban population. Survival was calculated with Cox proportional hazards models for death in the 5-year period following diagnosis. Our study included 15883 gallbladder, 11466 intrahepatic biliary, 12869 extrahepatic biliary and 7268 ampulla of Vater adenocarcinoma cases. When analyzing county-specific demographics, patients from counties with higher incomes were associated with higher survival rates [hazard ratio (HR) = 0.97, P <0.05]. Similarly, counties with a higher percentage of patients with a college level education and counties with a higher urban population had higher 5-year survival rates (HR = 0.96, P = 0.002 and HR = 0.97, P = 0.004, respectively). Worse survival outcomes were observed in lower income counties while higher income and education level were associated with higher 5-year overall survival among gallbladder and biliary malignancies.

Abstract 2220: Associations between post-diagnostic lifestyle and dietary patterns with prostate cancer survival in the Multiethnic Cohort

Abstract Background: Prostate cancer (PCa) remains a leading cause of cancer-related death among men despite high 5-year survival rates for localized and regional diseases. This study evaluated healthy lifestyle and dietary patterns in relation to PCa survival in a multiethnic population. Methods: We prospectively followed 2,603 men with non-metastatic PCa in the Multiethnic Cohort (MEC) for a median duration of 10.9 years (497 African American, 754 Japanese American, 577 Latino, 129 Native Hawaiian, and 646 White men) starting in 1993. We documented 1,321 deaths, including 196 from PCa. Lifestyle pattern was assessed after diagnosis by a previously reported PCa Behavior Score, which includes BMI, physical activity, and smoking, and a modified version including diet (based on the sum of saturated fat, whole milk, alcohol, and processed meat intake). We also evaluated six indices of inflammatory and insulinemic potential of diet and lifestyle patterns (E-DII, EDIP, EDIH, ELIH, EDIR, and ELIR); and three indices of plant-based diets: an overall plant-based diet index (PDI), a healthful PDI (hPDI), and an unhealthful PDI (uPDI). We used Cox proportional hazards models to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the relationship between each index with PCa-specific and all-cause mortality. We adjusted for education, race/ethnicity, smoking, BMI, physical activity (if not part of the score), family history of PCa, and first course of treatment. Results: Across the five racial/ethnic groups, Japanese American men exhibited healthier lifestyle and dietary patterns post-diagnosis, while African American and Native Hawaiian men tended to have less healthy behaviors. The PCa Behavior Score was statistically significantly associated with a reduced risk of all-cause mortality (HR per point=0.71, 95% CI 0.63-0.80), and a similar trend persisted when incorporating diet into the score. The PDI was statistically significantly inversely associated with all-cause mortality (HR per SD=0.90, 95% CI 0.83-0.97), while the uPDI showed a positive association (HR=1.10, 95% CI 1.12-1.18). None of the lifestyle or dietary patterns were associated with PCa mortality (p-values&amp;gt;0.05). No clear trends were observed for inflammatory and insulinemic dietary patterns after PCa diagnosis with all-cause or PCa-specific mortality. Conclusion: Adopting a healthy lifestyle and diet was associated with longer overall survival among men with PCa. We did not find these practices to be associated with a lower risk of PCa-specific mortality among men diagnosed with non-metastatic disease. However, 85% of the observed deaths during follow-up were due to other causes; this underscores the importance of counseling all men, including those with non-metastatic prostate cancer on health behaviors to manage comorbidities. Citation Format: Anqi Wang, Erin L. Van Blarigan, Iona Cheng, June M. Chan, Peggy Wan, Song-Yi Park, Fei Chen, Loic Le Marchand, Lynne Wilkens, Stacey A. Kenfield, Christopher A. Haiman. Associations between post-diagnostic lifestyle and dietary patterns with prostate cancer survival in the Multiethnic Cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2220.

Evaluation of Prosthodontic Complications in Screw-Retained and Cement-Retained Crowns in Dental Implants: An Original Research

ABSTRACT Aim: Single-tooth implant restorations, whether screw-retained or cement-retained, are essential for prosthodontic rehabilitation despite having low design flexibility, cosmetic appeal, and high 5-year survival rates. Materials and Methods: A study involving 14 patients with missing mandibular first molars used 28 implants and cement-retained and screw-retained prostheses. Patients had a single edentulous gap, adequate dental hygiene, and sufficient bone volume at the implant site. The study adhered to the Helsinki Declaration, followed WHO 2007 safety guidelines, and evaluated soft tissue, bone height, and bone loss. Data analysis included the Student’s t-test and Mann–Whitney U-test. Results: In patients between the ages of 17 and 46, single-implant restorations were compared with cement- and screw-retained at 6 months. Abutment screw loosening and peri-implant soft-tissue traits did not differ significantly from one another. Conclusion: The study compared screw- and cement-retained implant restorations in 28 single-tooth implant-supported prostheses over a 6-month functional loading period, finding no significant improvement in either approach.

Larynx-preserving treatment strategy for patients with resectable cervical esophageal squamous cell carcinoma.

311 Background: Preservation of the larynx is an important treatment strategy for cervical esophageal squamous cell carcinoma (CESCC), because surgery for CESCC often involves laryngectomy. At our hospital, we actively perform dCRT (cisplatin + 5-fluorouarcil + radiation 60Gy) to preserve laryngeal function. In this study, we compared the treatment results of esophagectomy and definitive chemoradiation (dCRT) for resectable CESCC and examined larynx-preserving treatment strategies. Methods: Patients who were treated for resectable CESCC at our hospital from January 2003 to March 2019 were divided into surgery group and dCRT group for the initial treatment. All patients were eligible for both treatments. The treatment results were compared retrospectively. Results: Of all 61 patients, 23 patients received surgery and 38 received dCRT. There was no significant difference in patients’ characteristics between 2 groups. In surgery group, 19 cases lost their laryngeal function by surgery (82.6%). Recurrence was observed in 7 cases, of which only 3 case was local. In CRT group, 33 cases (86.8%) achieved complete response, of which 16 cases relapsed. 8 cases (21.1%) lost their laryngeal function by additional surgery after dCRT. There was no significant difference in 5-year survival rate between two groups (surgery, 60.8%; dCRT, 70.1%; p = 0.750). In dCRT group, 5-year laryngeal-preserving survival rate was 64.8%, and esophageal stenosis before treatment was the independent risk factor for non-larynx preservation. 5-year laryngeal-preserving survival rate was 78.5%, and 5-year survival rate was 85.4% for non-stenotic cases in dCRT group, which were significantly higher than those for stenotic cases. 5-year laryngeal-preserving survival rate was also high in the patients with Ce localized tumor (72.6%). In those patients, non-stenotic patients and cT1-T3 patients had significantly high 5-year laryngeal-preserving survival rate (87.5% and 92.3%). Conclusions: dCRT for CESCC was comparable to surgery in terms of long-term prognosis, and the rate of larynx preservation was high. Among the cases where the tumor was localized to Ce, the laryngeal preservation rate was particularly high in non-stenotic cases and cases with cT1-T3, and dCRT should be actively indicated for these cases.

Dual targeting of the androgen receptor and PI3K/AKT/mTOR pathways in prostate cancer models improves antitumor efficacy and promotes cell apoptosis.

Prostate cancer is a frequent malignancy in older men and has a very high 5-year survival rate if diagnosed early. The prognosis is much less promising if the tumor has already spread outside the prostate gland. Targeted treatments mainly aim at blocking androgen receptor (AR) signaling and initially show good efficacy. However, tumor progression due to AR-dependent and AR-independent mechanisms is often observed after some time, and novel treatment strategies are urgently needed. Dysregulation of the PI3K/AKT/mTOR pathway in advanced prostate cancer and its implication in treatment resistance has been reported. We compared the impact of PI3K/AKT/mTOR pathway inhibitors with different selectivity profiles on in vitro cell proliferation and on caspase 3/7 activation as a marker for apoptosis induction, and observed the strongest effects in the androgen-sensitive prostate cancer cell lines VCaP and LNCaP. Combination treatment with the AR inhibitor darolutamide led to enhanced apoptosis in these cell lines, the effects being most pronounced upon cotreatment with the pan-PI3K inhibitor copanlisib. A subsequent transcriptomic analysis performed in VCaP cells revealed that combining darolutamide with copanlisib impacted gene expression much more than individual treatment. A comprehensive reversal of the androgen response and the mTORC1 transcriptional programs as well as a marked induction of DNA damage was observed. Next, an in vivo efficacy study was performed using the androgen-sensitive patient-derived prostate cancer (PDX) model LuCaP 35 and a superior efficacy was observed after the combined treatment with copanlisib and darolutamide. Importantly, immunohistochemistry analysis of these treated tumors showed increased apoptosis, as revealed by elevated levels of cleaved caspase 3 and Bcl-2-binding component 3 (BBC3). In conclusion, these data demonstrate that concurrent blockade of the PI3K/AKT/mTOR and AR pathways has superior antitumor efficacy and induces apoptosis in androgen-sensitive prostate cancer cell lines and PDX models.

Lateral lymph node dissection can increase overall survival and 5‑year survival rate of rectal cancer patients: A meta‑analysis.

Rectal cancer is one of the most malignant tumors, and postoperative recurrence and metastasis are the main reasons for treatment failure. Lymph node metastasis is the main metastatic pathway of rectal cancer. The present study aimed to investigate the role of lateral lymph node dissection (LLND) in patients with rectal cancer using a meta-analysis. Articles in Chinese and English related to the application of LLND in patients with rectal cancer were retrieved and eligible studies were selected for data analysis. Evaluation indicators included the 5-year survival rate, recurrence rate, urinary system function and operation time. The random-effects model was utilized for the analysis. A total of 10 studies that met the eligibility criteria were selected, comprising 2,272 patients, including 1,101 cases in the LLND group and 1,171 cases in the non-LLND group. No significant difference was found between the two groups in terms of local recurrence rate, 5-year disease-free survival (DFS) rate, and DFS rate at the follow-up. It is noteworthy that cases in the LLND group had no significantly longer overall survival, but had a higher 5-year survival rate. However, cases in the LLND group had a longer operation time and worse urinary dysfunction. The results remained consistent throughout separate analyses for different research quality sources. The present meta-analysis showed that LLND provided a specific advantage in prolonging survival time. However, it was associated with prolonged operation time and an increased incidence of urinary dysfunction.

The Impact of the COVID-19 Pandemic on One-Year Mortality in Geriatric Hip Fracture: A Retrospective Cohort Study.

The COVID-19 pandemic has profoundly impacted global healthcare systems, necessitating substantial shifts in patient care strategies. The pandemic's onset led to drastic operational changes in hospitals, including reduced bed capacity and staffing levels, which could have further influenced the mortality outcomes for geriatric patients. The study aimed to assess the impact of the COVID-19 pandemic on 1-year mortality rates of surgically treated geriatric hip fractures. This retrospective, single-center cohort study included 346 participants aged 65 and above who underwent surgical treatment for hip fractures. We compared mortality rates between the pre-COVID and COVID eras. Data included demographics, treatment, complications, and COVID-19 status. The independent samples t test and Chi-square tests (or Fisher's exact test) were used for comparisons for era cohorts. Survival probabilities were assessed using Kaplan-Meier, while multivariate analysis identified mortality predictors. 175 patients were included in the pre-COVID era, and 171 patients were included in the COVID era. During the COVID era, the 30-day mortality rate was 11.7% (compared to 13.7% in the pre-COVID era, p = 0.573), and the 1-year mortality rate was 43.9% (compared to 49.1% in the pre-COVID era, p = 0.325). The overall 1-year mortality rate was 46.5%. Patients who underwent surgery within 48hours had a higher 1-year survival rate (60.5%) compared to those with delayed surgery (51.2%), p = 0.031. Additionally, patients not admitted to the ICU had a higher 1-year survival rate (74.7%) than those who were admitted (44.9%), p < 0.001. 70.1% of the total deaths occurred within the first 90days. Elderly patients with hip fractures experienced high mortality rates before and during the pandemic. This study demonstrates that the 1-year mortality rates of geriatric hip fractures were not significantly affected by the pandemic. The findings emphasize the importance of pandemic preparedness and prompt surgeries and attentive ICU care in reducing mortality rates.

Рак желчного пузыря: заболеваемость, факторы риска, диагностика

Aim. To analyze current data on the incidence, risk factors, diagnostic methods and prevention of gallbladder cancer (GBC). Key points. GBC is a malignant tumor arising from the epithelium of the gallbladder, characterized by local and vascular invasion, extensive regional lymphogenous and hematogenous metastasis. GBC is the most common malignant tumor of the biliary tract, characterized by high malignancy and low 5-year survival rate. In international recommendations, gastrointestinal tract is considered as a natural stage of the course of biliary pathology: dyskinesia — cholecystitis — cholelithiasis — GBC. Globally, the incidence of GBC varies significantly among different geographic regions, reaching 27 per 100,000 population in Chile. In Russia, according to the Federal State Statistics Service, the incidence of GBC in 2019 was 1.4 per 100 thousand among men, and 2.5 per 100 thousand among women. The incidence of GBC is associated with female gender and increasing age. In the pathogenesis of gallstones, decisive importance is attached to long-term inflammatory changes in the epithelium due to mechanical trauma to the mucous membrane of the gallbladder by stones and a probable increase in the proportion of secondary bile acids in the bile. In the diagnosis of GBC, the recommendations of the Japanese Society of Hepato-Biliary-Pancreatic Surgery, in the first step, particular importance is attached to ultrasound examination of the abdominal organs and biochemical blood test. For a more detailed study, computed tomography, magnetic resonance imaging, magnetic resonance cholangiopancreatography, endosonography, retrograde cholangiopancreatography, oral cholangioscopy and positron emission tomography are useful. Gallstone disease is one of the five most significant risk factors. The remaining 4 leading risk factors for GBC — ethnicity, genetic predisposition, lifestyle factors (excess weight) and biliary tract infections — are common risk factors for patients with cholelithiasis. The risk of developing GBC increases significantly in patients with stones larger than 2 cm and with the duration of the pathology for more than 5 years. Another significant risk factor for GBC is patients with gallbladder polyps, therefore the article presents the main recommendations of European associations for the management of patients with gallbladder polyps. Conclusion. GBC is currently considered as a possible and natural stage in the course of cholelithiasis. The risk of developing GBC increases significantly in patients with cholelithiasis and gallbladder polyps. Considering the above, diagnosis of possible complications in elderly patients with cholecystitis and gallstone disease should include a thorough clinical, laboratory and instrumental examination. Preventive measures for people with risk factors for GBC should include optimizing diet, weight loss, and, if possible, expanding the physical activity regime. Taking ursodeoxycholic acid preparations helps reduce the content of hydrophobic bile acids in bile and reduces the likelihood of complications of biliary pathology. Keywords: gallbladder cancer, cholelithiasis, gallbladder polyps, diagnosis, morbidity.

Resveratrol restrains colorectal cancer metastasis by regulating miR-125b-5p/TRAF6 signaling axis.

Colorectal cancer is one of the most common malignancies with a high incidence, metastatic tendency and low 5-year survival rate. Resveratrol, a polyphenolic compound has been shown to inhibit colorectal cancer metastasis in recent studies. Its underlying molecular mechanism remains to be elucidated. Our findings demonstrated that miR-125b-5p, acting as a tumor suppressor, was conspicuously down-regulated in both colorectal cancer tissues and cell lines. The expression of miR-125b-5p negatively correlated with the expression of its direct target TNF receptor associated factor 6 (TRAF6). Both miR-125b-5p overexpression and TRAF6 knockdown inhibited metastasis of colorectal cancer cells. In addition, we uncovered that resveratrol up-regulated miR-125b-5p by increasing its stability and suppressed TRAF6-induced signal pathway in a dose/time-dependent manner. Resveratrol could significantly curtail the migration and invasion of colorectal cancer cells, which was counteracted by miR-125b-5p knockdown or TRAF6 overexpression. These results indicated that resveratrol could restrain colorectal cancer metastasis by promoting miR-125b-5p/TRAF6 signaling axis. Furthermore, lung metastasis models of colorectal cancer were constructed by tail vein injection. Down-regulation of miR-125b-5p could facilitate colorectal cancer metastasis in vivo, which could be impeded by resveratrol. In conclusion, our findings delineated the miR-125b-5p/TRAF6 signaling axis as a novel molecular mechanism underlying the metastatic process in colorectal cancer, as well as a prospective therapeutic target. Resveratrol disrupts colorectal cancer metastasis by activating miR-125b-5p/TRAF6 signal pathway and might improve the clinical outcome of colorectal cancer patients with low expression of miR-125b-5p.

Protocol of the HISTOTHERM study: assessing the response to hyperthermia and hypofractionated radiotherapy in recurrent breast cancer.

Breast cancer is globally the leading cancer in women, and despite the high 5-year survival rate the most frequent cause of cancer related deaths. Surgery, systemic therapy and radiotherapy are the three pillars of curative breast cancer treatment. However, locoregional recurrences frequently occur after initial treatment and are often challenging to treat, amongst others due to high doses of previous radiotherapy treatments. Radiotherapy can be combined with local hyperthermia to sensitize tumor cells to radiation and thereby significantly reduce the required radiation dose. Therefore, the combination treatment of mild local hyperthermia, i.e. locally heating of the tissue to 39-43°C, and re-irradiation with a reduced total dose is a relevant treatment option for previously irradiated patients. The mechanisms of this effect in the course of the therapy are to date not well understood and will be investigated in the HISTOTHERM study. Patients with local or (loco)regional recurrent breast cancer with macroscopic tumors are included in the study. Local tumor control is evaluated clinically and histologically during the course of a combination treatment of 60 minutes mild superficial hyperthermia (39 - 43°C) using water-filtered infrared A (wIRA) irradiation, immediately followed by hypofractionated re-irradiation with a total dose of 20-24 Gy, administered in weekly doses of 4 Gy. Tumor and tumor stroma biopsies as well as blood samples will be collected prior to treatment, during therapy (at a dose of 12 Gy) and in the follow-up to monitor therapy response. The treatment represents the standard operating procedure for hyperthermia plus re-irradiation. Various tissue and blood-based markers are analyzed. We aim at pinpointing key mechanisms and markers for therapy response which may help guiding treatment decisions in future. In addition, quality of life in the course of treatment will be assessed and survival data will be evaluated. The study is registered at the German Clinical Trials Register, Deutsches Register Klinischer Studien (DRKS00029221).

Pyroptosis in glioma: Current management and future application.

Glioma, the predominant form of central nervous system (CNS) malignancies, presents a significant challenge due to its high prevalence and low 5-year survival rate. The efficacy of current treatment methods is limited by the presence of the blood-brain barrier, the immunosuppressive microenvironment, and other factors. Immunotherapy has emerged as a promising approach, as it can overcome the blood-brain barrier. A tumor's immune privilege, which is induced by an immunosuppressive environment, constricts immunotherapy's clinical impact in glioma. Pyroptosis, a programmed cell death mechanism facilitated by gasdermins, plays a significant role in the management of glioma. Its ability to initiate and regulate tumor occurrence, progression, and metastasis is well-established. However, it is crucial to note that uncontrolled or excessive cell death can result in tissue damage, acute inflammation, and cytokine release syndrome, thereby potentially promoting tumor advancement or recurrence. This paper aims to elucidate the molecular pathways involved in pyroptosis and subsequently discuss its induction in cancer therapy. In addition, the current treatment methods of glioma and the use of pyroptosis in these treatments are introduced. It is hoped to provide more ideas for the treatment of glioma.

Abstract A126: Differential survival among Medicare beneficiaries diagnosed with breast cancer in California

Abstract This study examines the differences in breast cancer survival among Medicare beneficiaries enrolled in either Traditional Medicare (TM) or Medicare Advantage (MA) plans during 1999-2017 in California. Medicare is federal health insurance for people of age 65 or older. Beneficiaries can choose between TM (directly administered by the Federal government) or MA (offered by private companies) plans. California (CA) has the largest number of Medicare beneficiaries of any state (6.6 million), nearly half (49%) of them enrolled in MA plans. Due to different management mechanisms, detailed claims data are not routinely submitted and available for MA enrollees as for TM, making objective assessment for the claimed MA advantages and effectiveness hard to find. Medicare beneficiaries often find it challenging to choose between TM and MA during the Medicare open enrollment period or make changes between these two types of plans. The National Cancer Institute’s (NCI) Surveillance, Epidemiology, and End Results (SEER) Program, routinely link its cancer registry data with Medicare to provide detailed information about Medicare beneficiaries aged 65 and older diagnosed with cancer. Using the SEER-Medicare linked data for the state of California (CA), we were able to compare the survival differences among Medicare beneficiaries with female breast cancer (BC) stratified by TM or MA enrollment in CA during 1999-2017. We identified a total of 189,517 women Medicare beneficiaries who had BC, of which 83,223 (43.9%) enrolled in TM and never had MA, while 106,294 (56.1%) ever enrolled in MA regardless of the length of MA coverage. Because Medicare enrollment is on monthly basis and enrollees may change plans during the annual open enrollment period each year. Therefore, among the MA enrollees, we found 61,006 (57.4%) who switched between MA and TM from time to time (MA switch), in contrast to 45,288 (42.6%) who were in MA for the entire study period (MA only). We calculated 5-year observed survival rates from all causes of death among these Medicare beneficiaries with BC, using Kaplan-Meier method. We found that MA switch group had the highest 5-year survival of 81.5% (95% CI: 81.2%-81.8%), followed by MA only (72.6%, 95% CI: 72.1%-73.0%) and TM (72.5%, 95% CI: 72.2%-72.8%) groups. The survival advantage of the MA switch group is evident across race/ethnicity. Asian MA switchers had the highest 5-year survival rate (87.3%) followed by Hispanic (83.3%), Non-Hispanic White (80.5%), and Non-Hispanic Black (75.9%). In a multivariate Cox proportional hazards regression analysis, controlling for sociodemographic and clinical characteristics (i.e., age at diagnosis, race and ethnicity, poverty indicator, summary stage of tumor, marital status, urbanization, and number of cancers), MA switch group displayed a statistically significant (α&amp;lt;0.05) mortality reduction of 25% as compared to the TM group. No significant differences between TM and MA only group was found. More informed and proactive Medicare beneficiaries are associated with the best health outcomes. Citation Format: Lihua Liu Liu, Ying Yan, Sue E. Kim. Differential survival among Medicare beneficiaries diagnosed with breast cancer in California [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A126.

Health economic analysis of inpatient prostate cancer treatment in Austrian hospitals

Abstract Background Prostate cancer (PrC) is the fourth most prevalent type of cancer worldwide. Its high incidence and 5-year survival rates contributing to high inpatient care costs make it an important public health issue. In Austria, surgery has been the most common inpatient procedure for PrC, despite clinical recommendations not clearly indicating its benefits over alternatives. No health economic comparison of these procedures has considered the period after treatment yet. We bridge this gap by analysing the health economic impact of treatment pathways. Methods We use a large administrative dataset of all inpatient PrC patients in Austria who received either only surgery or only radiation therapy from 2005-2014 (n = 34,286). To assess the health economic impact, we used diagnosis-related-group (DRG) points and length of stay (LOS). Monthly DRG points and LOS for each patient ±12-months around the index procedure were analysed using the difference in difference (DID) method. We controlled for age, and physical comorbidity burden using Charlson Comorbidity Index (CCI) scores. Results Looking at unadjusted averages, patients in the surgery group were significantly younger and had a lower CCI compared to the radiation group. Consequently, the surgery group had lower nominal average DRG points and LOS. However, when controlling for age and CCI, we found that radiation treatment was less resource intensive. A DID estimation found a shorter average LOS and lower DRG points for the radiation group compared to surgery for the 12 months post index. Conclusions We found significant additional costs and LOS times for surgical pathways following risk adjustment in Austria. This implies a potential excess burden of ∼4,400 hospitalisation days and ∼4 million DRG points (€4.8m) a year for the healthcare system during the observed period. Considering international evidence on higher patient burden in surgical pathways, these findings may call for clinical reconsiderations of PrC care. Key messages • Patient characteristics of different inpatient treatment pathways for PrC in Austria were very heterogenous. • Health economic outcomes in the post treatment period for PrC inpatient treatment were significantly better for radiation treatment compared to surgery.

Surgical Outcomes of Infective Native Aortoiliac Aneurysms in a Chilean Academic Center

Infective native aortic aneurysms (INAAs), formerly called mycotic aneurysms, remain an uncommon disease with significant heterogeneity among cases; hence, there is lack of solid evidence to opt for the best treatment strategy. The present study aims to describe a 20-year experience at a single institution treating this uncommon condition. Retrospective study of all patients treated for INAA at a single academic hospital in Santiago, Chile, between 2002 and 2022. Clinical characteristics are described, as well as operative outcomes per type of treatment. Nonparametric Mann-Whitney U-test or Kruskal-Wallis tests were performed when appropriate, and results were reported as median and ranges. Survival at given timeframes was determined by a Kaplan-Meier curve, with analysis performed through a Cox regression model. During the study period, 1,798 patients underwent aortic procedures at our center, of which 35 (1.9%) were treated for INAA. Of them, 25 (71.4%) were male. One patient had 2 INAAs. Median age was 69.5years (range: 34-89years). Of the 36 INAAs, the most frequent location was the abdominal and thoracic aorta in 20 (55.5%) and 11 (30.5%) cases, respectively, followed by the iliac arteries in 4 (11.1%) cases. One (2.7%) patient presented a thoracoabdominal INAA. Overall, endovascular treatment associated with long-term antibiotics was used in 20 (57.1%) patients: 4 of them underwent hybrid treatment. Fifteen (42.8%) patients underwent direct aortic debridement followed by in situ or extra anatomic revascularization. There was a significant difference in age between both treatment strategies (a median of 76.5years for endovascular versus a median of 57years for open, P=0.011). The median hospital stay was 15days (range: 2-70days). The early complications rate (<30 postoperative days) was 20% (n=7). Early mortality rate (inhospital or before postoperative 30days) was 14.2% (n=5). Median follow-up was 33months (range: 6-216months). The overall survival rates at 1, 3, and 5 years were 69.9% (standard error [SE] 8.0), 61.7% (SE 9.8), and 50.9% (SE 11.8), respectively. Five-year survival rate of patients undergoing endovascular treatment compared with open approach was 45.9% (SE 15.1) versus 80.0% (SE 17.8), respectively (P=0.431). There were no significant differences in survival between open and endovascular treatment, hazard ratio 3.58 (confidence interval 95%: 0.185-1.968, SE±0.45 P=0.454). Patients treated by endovascular approach were older than patients treated by open approach. Even though, the open group had a higher 5-year survival rate than the endovascular group, not statically significance differences were found between treatments.