High-risk Cancer Research Articles

Simultaneous integrated boost to lateral pelvic lymph nodes during chemoradiotherapy in high-risk rectal cancer.

Preoperative chemoradiotherapy combined with total mesorectal excision (TME) is astandard treatment for locally advanced rectal cancer (LARC). However, lateral pelvic lymph nodes (LPLNs) are often inadequately treated with standard regimens. This study examines the treatment and postoperative outcomes in LARC patients receiving asimultaneous integrated boost (SIB) for LPLNs during long-course chemoradiotherapy. This retrospective study included high-risk LARC patients (UICC, "Union Internationale Contre le Cancer", stageIII) treated with preoperative chemoradiotherapy and SIB to LPLNs. Radiotherapy was delivered to the primary tumor and elective volumes with 50.4 Gy in 28fractions, and anSIB with amedian dose of 60.2 Gy was administered to clinically positive LPLNs. TME quality and postoperative complications were assessed using MERCURY and Clavien-Dindo, respectively. Time-to-event data were analyzed according to Kaplan-Meier. Between 2019 and 2023, 27patients with high-risk LARC and LPLN metastases were treated with chemoradiotherapy. After amedian follow-up of 19months, 2‑year overall survival was 80%, disease-free survival 80%, and local control of dose-escalated lymph nodes 100%. Three patients were managed nonoperatively after aclinical complete response on endoscopy and imaging. Of the 22patients who had surgery, only one had complications higher than Clavien-DindogradeI; TME was graded as MERCURYI in 73%. The SIB approach for LPLNs in LARC is feasible, does not increase postoperative morbidity, and achieves excellent local control. This study supports the consideration of dose-escalated radiotherapy for LPLNs to address high local recurrence risks.

Hereditary Breast Cancer: Comprehensive Risk Assessment and Prevention Strategies

Women carrying pathogenic/likely pathogenic (P/LP) variants in moderate- or high-penetrance genes have an increased risk of developing breast cancer. However, most P/LP variants associated with breast cancer risk show incomplete penetrance. Age, gender, family history, polygenic risk, lifestyle, reproductive, hormonal, and environmental factors can affect the expressivity and penetrance of the disease. However, there are gaps in translating how individual genomic variation affects phenotypic presentation. The expansion of criteria for genetic testing and the increasing utilization of comprehensive genetic panels may enhance the identification of individuals carrying P/LP variants linked to hereditary breast cancer. Individualized risk assessment could facilitate the implementation of personalized risk-reduction strategies for these individuals. Preventive interventions encompass lifestyle modifications, chemoprevention, enhanced surveillance through breast imaging, and risk-reducing surgeries. This review addresses the current literature’s inconsistencies and limitations, particularly regarding risk factors and the intensity of preventive strategies for women with P/LP variants in moderate- and high-penetrance genes. In addition, it synthesizes the latest evidence on risk assessment and primary and secondary prevention in women at high risk of breast cancer.

Machine learning based models for predicting presentation delay risk among gastric cancer patients

ObjectivePresentation delay of cancer patients prevents the patient from timely diagnosis and treatment leading to poor prognosis. Predicting the risk of presentation delay is crucial to improve the treatment outcomes. This study aimed to develop and validate prediction models of presentation delay risk in gastric cancer patients by using various machine learning models.Methods875 cases of gastric cancer patients admitted to a tertiary oncology hospital from July 2023 to June 2024 were used as derivation cohort, 200 cases of gastric cancer patients admitted to other 4 tertiary hospital were used as external validation cohort. After collecting the data, statistical analysis was performed to identify discriminative variables for the prediction of presentation delay and 13 statistically significant variables are selected to develop machine learning models. The derivation cohort was randomly assigned to the training and internal validation set by the ratio of 7:3. Prediction models were developed based on six machine learning algorithms, which are logistic regression (LR), support vector machine (SVM), random forest (RF), gradient boosted trees (GBDT), extremely gradient boosting (XGBoost) and muti-layer perceptron (MLP). The discrimination and calibration of each model were assessed based on various metrics including accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), F1-Score and area under curve (AUC), calibration curves and Brier scores. The best model was selected based on comparing of various metrics. Based on the selected best model, the impact of features to the prediction result was analyzed with the permutation feature importance method.ResultsThe incidence of presentation delay for gastric cancer patients was 39.3%. The developed models achieved performance metrics as AUC (0.893-0.925), accuracy (0.817-0.847), sensitivity (0.857-0.905), specificity (0.783-0.854), PPV (0.728-0.798), NPV (0.897-0.927), F1 score (0.791-0.826) and Brier score (0.107-0.138) in internal validation set, which indicated good discrimination and calibration for the prediction of presentation delay in gastric cancer patients. Among all models, RF based model was selected as the best one as it achieved good discrimination and calibration performance on both of internal and external validation set. Feature ranking results indicated that both of subjective and objective factors have significant impact on the occurrence of presentation delay in gastric cancer patients.ConclusionThis study demonstrated that the RF based model has favorable performance for the prediction of presentation delay in gastric cancer patients. It can help medical staffs to screen out high-risk gastric cancer patients for presentation delay, and to take appropriate and specific interventions to reduce the risk of presentation delay.

Influence of Body Mass Index on the Clinicopathological Features of Papillary Thyroid Carcinoma in a Chinese Population.

Background: Previous studies suggested a relationship between obesity and a high risk of thyroid cancer. However, the association between high body mass index (BMI) and the aggressiveness of papillary thyroid carcinoma (PTC) is controversial. In this study, we aimed to investigate the impact of excess BMI on histopathologic aggressiveness of PTC in a Chinese population. Methods: Between January 2015 and September 2020, 4369 PTC patients who were tested for BRAF mutation at Jiangyuan Hospital were enrolled. Logistic regression analyses were used to evaluate the associations between BMI and clinicopathological features of PTC as well as tumor BRAF mutational status. Results: Of 4369 PTC patients, the mean BMI was 24.06 ± 3.49 kg/m2, and BRAFV600E mutations were detected in 3528 (80.8%) patients. BMI ≥24.0 at initial surgery was associated with tumor multifocality and bilaterality, but not with advanced tumor stage, extrathyroidal extension (ETE), ratio of positive lymph nodes >0.3, distant metastasis, or BRAFV600E mutation. Conclusion: Our present study suggested that compared to patients with a normal BMI, overweight and obese patients had a greater risk of multifocality and bilaterality of PTC. No significant associations were observed between higher BMI and the more advanced tumor-node-metastasis stage or BRAFV600E mutational status.

Neoadjuvant radiochemotherapy in patients with high-risk locally advanced cervical cancer-results of aclinical series.

Neoadjuvant radiochemotherapy (NARCT) is an established standard of care in various tumor entities, promoting high response rates at commonly lower toxicities as compared to adjuvant approaches. This retrospective analysis was designed to investigate NARCT in early-stage high-risk cervical cancer. Forty patients with early-stage high-risk cervical cancer (i.e., L1, V1, G3, N+, > 2/3 stromal invasion, > 4 cmtumor size, borderline resectability) were treated with NARCT prior to surgical resection. Downstagings based on clinical, imaging, and pathological responses were recorded. Survival rates were calculated according to Kaplan-Meier, and prognostic factors were analyzed with uni- and multivariable Cox regression analyses using SPSS software (v.26; IBM Corp., Armonk, NY, USA). Both NARCT and subsequent tumor resection were feasible and conducted in 39of 40patients (95%). Early toxicity was moderate, with no grade3 or higher toxicities following NARCT and surgery. NARCT yielded significant downstaging in all patients, and pathological complete remission (pCR) was achieved in 14patients (36%). After 5years, overall survival (OS), freedom from local progression (FFLP), and freedom from distant progression (FFDP) rates were 84.2%, 75.9%, and 73.1%, respectively. Late proctitis (grade1 in 8%) and urinary cystitis (grade1-3 in 35%) occurred at acceptable rates. In resectable early-stage high-risk cervical cancer, NARCT is feasible and safe. Clinical, imaging, and pathological response rates are high. Impressive long-term survival and tumor control rates at modest toxicities encourage the initiation of aprospective and randomized trial.

Impacts of Postoperative Adjuvant Therapies on the Survival of Women with High-Risk Early-Stage Endometrial Cancer: A Cohort Study

Impacts of Postoperative Adjuvant Therapies on the Survival of Women with High-Risk Early-Stage Endometrial Cancer: A Cohort Study

Sex differences in the risk of bladder cancer among kidney transplant recipients and patients with kidney failure receiving hemodialysis: a nationwide cohort study.

Although both patients with kidney failure (KF) receiving hemodialysis (HD) and kidney transplant (KT) recipients (KTRs) have a high risk of bladder cancer, how this risk changes in the transition from dialysis to KT is unknown. In this study, we aimed to investigate the risk of bladder cancer in KTRs and patients on HD. This was a nationwide longitudinal cohort study of 66,547 participants from the National Health Insurance Service cohort who started HD for KF or received KT from 2002 to 2020. The primary outcome was the diagnosis of bladder cancer, which was defined as the composite of diagnostic codes and either hospitalization or ≥2 outpatient visits for bladder cancer. During mean follow-ups of 4.2 and 7.9 years in the HD and KT groups, respectively, the incidence rates of bladder cancer were 1.1/1,000 and 0.3/1,000 person-years, respectively. In the time-dependent multivariable Cox models, compared to patients on HD, the adjusted hazard ratio (aHR) for bladder cancer among KTRs was 0.36 (95% confidence interval [CI], 0.21-0.60; p<0.001). Among men, this aHR was 0.29 (95% CI, 0.15-0.55; p<0.001); however, no statistically significant association between the kidney replacement therapy modality and the risk of bladder cancer was observed among women. Landmark analysis performed to avoid immortal time bias by redefining time zero as a specific landmark time (2 and 5 years after HD initiation or KT) revealed similar results. The risk of bladder cancer was significantly lower among KTRs than that among patients receiving HD, particularly among men.

Enhancing Identification of High-Risk cN0 Lung Adenocarcinoma Patients Using MRI-Based Radiomic Features.

This study aimed to develop a magnetic resonance imaging (MRI)-based radiomics model to predict high-risk pathologic features for lung adenocarcinoma: micropapillary and solid pattern (MPsol), spread through air space, and poorly differentiated patterns. As a prospective study, we screened clinical N0 lung cancer patients who were surgical candidates and had undergone both 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) and chest CT from August 2018 to January 2020. We recruited patients meeting our proposed imaging criteria indicating high-risk, that is, poorer prognosis of lung adenocarcinoma, using CT and FDG PET/CT. If possible, these patients underwent an MRI examination from which we extracted 77 radiomics features from T1-contrast-enhanced and T2-weighted images. Additionally, patient demographics, maximum standardized uptake value on FDG PET/CT, and the mean apparent diffusion coefficient value on diffusion-weighted image, were considered together to build prediction models for high-risk pathologic features. Among 616 patients, 72 patients met the imaging criteria for high-risk lung cancer and underwent lung MRI. The magnetic resonance (MR)-eligible group showed a higher prevalence of nodal upstaging (29.2% vs. 4.2%, p < 0.001), vascular invasion (6.5% vs. 2.1%, p=0.011), high-grade pathologic features (p < 0.001), worse 4-year disease-free survival (p < 0.001) compared with non-MR-eligible group. The prediction power for MR-based radiomics model predicting high-risk pathologic features was good, with mean area under the receiver operating curve (AUC) value measuring 0.751-0.886 in test sets. Adding clinical variables increased the predictive performance for MPsol and the poorly differentiated pattern using the 2021 grading system (AUC, 0.860 and 0.907, respectively). Our imaging criteria can effectively screen high-risk lung cancer patients and predict high-risk pathologic features by our MR-based prediction model using radiomics.

Human health risk assessment from potentially toxic elements in the soils of Sudan: A meta-analysis.

Potentially toxic elements (PTEs) in soils threaten human health through several exposure pathways. However, health risks posed by PTEs in soils in developing countries have not yet been comprehensively investigated. Thus, such countries lack important information that is needed to implement sustainable solutions. In this study, we assessed the human health risks for 10 PTEs, including arsenic (As), cadmium (Cd), cobalt (Co), chromium (Cr), copper (Cu), mercury (Hg), manganese (Mn), nickel (Ni), lead (Pb), and zinc (Zn), in Sudan focusing on soils affected by anthropogenic activities, such as industrial processes, gold mining, tannery, waste dumping, traffic (affecting roadsides), urban/rural agriculture, river, and coastal sediment land uses (LUs). For this purpose, we did a meta-analysis using 3430 PTE concentrations reported from 981 anthropogenically-affected soils in 76 publications between 1996 and 2024. Ingestion was the most common exposure pathway for both carcinogenic and non-carcinogenic PTEs. Hg and Mn were the main non-carcinogenic PTEs leading to adverse health effects in children in industrially-affected soils and coastal sediments, with average hazard quotient (HQ) and hazard index (HI) values >1. Cr and Ni caused the highest carcinogenic risk to children in all anthropogenically-affected soils as indicated by average incremental lifetime cancer risk values (ILCR >1×10-4). Further major cancer risks for children were caused by As in urban agricultural and industrial LUs, Cd in >70% of all LUs, and Pb at industrial and waste dump sites. Adults were under high cancer risks due to Cd in waste dump (ILCR=9.09×10-4) and Cr and Ni (ILCR >1×10-4) in >75% of all LUs. Cd contributed >50% and >70% to ILCR for children and adults along roadsides, respectively. Our findings can guide future research on the links between soil PTEs and human health risks in developing countries. We recommend establishing effective management strategies to reduce risks to human health based on the presence of PTEs in Sudanese soils.

Risk factors and protective measures for desmoid tumours in familial adenomatous polyposis: retrospective cohort study.

Familial adenomatous polyposis is a cancer-predisposing syndrome caused by germline pathogenic variants of the adenomatous polyposis coli gene, leading to numerous colorectal polyps and a high risk of colorectal cancer. Desmoid tumours have become significant in the management of familial adenomatous polyposis after a colectomy, yet the exact incidence remains undetermined due to a lack of dedicated surveillance. This retrospective study accessed data from the prospectively maintained Hereditary Digestive Tumours Registry from 2000 to 2023. Desmoid-free survival was analysed using Cox regression and Kaplan-Meier curves. A total of 202 patients with familial adenomatous polyposis who underwent colorectal surgery were enrolled. Of the patients, 21 (10.4%) developed intra-abdominal desmoid tumours after surgery. Desmoid tumours were associated with surgical procedure, histology of cancer at the time of surgery, and family history of intra-abdominal desmoid tumours. The overall desmoid-free survival probability at a median follow-up of 84 months was 90%. Histology of cancer at the time of surgery (HR 0.25 (95% c.i. 0.10 to 0.59)), family history of intra-abdominal desmoid tumours (HR 2.92 (95% c.i. 1.22 to 6.97)), an open approach compared with a laparoscopic approach (HR 2.43 (95% c.i. 1.03 to 5.73)), and a proctocolectomy compared with a rectal-sparing total colectomy (HR 3.01 (95% c.i. 1.28 to 7.10)) emerged as significant prognostic factors affecting desmoid-free survival. A minimally invasive rectal-sparing total colectomy appears protective against the development of desmoid tumours. Early surgery does not seem to increase desmoid tumour risk. A dedicated surveillance regimen for desmoid tumours in patients with familial adenomatous polyposis is needed to improve outcomes and quality of life.

Younger age as an independent factor for second primary head and neck cancer in esophageal squamous cell carcinoma patients after curative esophagectomy: A two-center retrospective study.

Postoperative survival of esophageal cancer patients has improved with advances in technology and treatment modalities. However, squamous cell carcinoma (SCC) often affects the esophagus together with the head and neck regions, with second primary head and neck cancer (SPHNC) adversely influencing the patients' quality of life. Therefore, patients with esophageal squamous cell carcinoma (ESCC) should be carefully followed up postoperatively. This study evaluated the risk of developing SPHNCs after an esophagectomy for ESCC. Patients with ESCC who underwent curative esophagectomy from January 2008 to December 2017 from two tertiary medical centers, Taipei Veteran General Hospital and Kaohsiung Veteran General Hospital, were retrospectively reviewed. SPHNC development was documented according to the anatomic region and the cumulative incidence rate and risk factors were analyzed. The median follow-up period of the 435 patients included in our study was 48.5months [interquartile range (IQR) 16.7-92.4months]. Among the ESCC patients after curative esophagectomy, younger age <50 [hazard ratio 4.13, 95% CI: 2.53-6.75, p<0.001) was the only independent factor for developing SPHNCs in the multivariable analysis. The cumulative incidence rate of SPHNCs of patients aged <50years old was 14.3%, 22.1%, and 34.2% after 3, 5, and 10years, respectively. There was a high risk of secondary cancer after ESCC in the upper aerodigestive tract, especially the head and neck regions; therefore, active surveillance is strongly recommended, especially in younger patients.

High levels of fibrotic tumor components are associated with recurrence and intratumoral immune status in advanced colorectal cancer patients

The importance of collagen and elastin remains incompletely understood concerning tumor immunity in cancer tissues. This study explored the clinical significance of collagen and elastin deposition on tumor immunity in advanced colorectal cancer patients. The collagen and elastin contents were assessed simultaneously using elastic van Gieson (EVG) histochemical staining. Immunohistochemical staining was performed to measure the immune cell markers CD3, CD8, CD86, and CD163 in surgically resected primary tumors from 78 pT4 colorectal cancer patients. High collagen, elastin, and EVG scores are associated with aggressive characteristics and short disease-free survival. A high EVG score was identified as an independent predictor of poor disease-free survival. Furthermore, tumors with high collagen and EVG scores exhibited significantly fewer intratumoral CD3 + and CD8 + cells. Evaluating tumor fibrosis using the classical and straightforward EVG staining method could be a reliable predictor of recurrence in high-risk colorectal cancer patients with tumor immune tolerance.

Stomach and duodenal ulcer as a cause of death in patients with cancer: a cohort study

IntroductionNon-cancer deaths are now becoming a significant threat to the health of cancer patients. Death from stomach and duodenal ulcer is linked to cancer due to the side effects of treatment and its pathogenesis. However, guidelines for identifying cancer patients at the highest risk of death from stomach and duodenal ulcer remain unclear.MethodsData of all patients diagnosed with cancer between 2000 and 2021 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Data regarding the causes of death and clinicopathological features such as sex, age, race, marital status, SEER stage, and treatment procedures were extracted. We calculated standardized mortality ratios (SMRs) using the SEER*Stat software V8.4.3.ResultsOf the 6,891,191 cancer patients, 2,318 died of stomach and duodenal ulcer, a rate higher than that in the general population (SMR = 1.58, 95% CI [1.52–1.65]). Stomach and duodenal ulcer-related deaths decreased over time from 870 deaths between 2000 and 2004 to 294 deaths between 2015 and 2019. Among the 2,318 stomach and duodenal ulcer deaths, the highest numbers were observed in patients with prostate cancer (n = 389, 16.8%), and lung and bronchus cancer (n = 255, 11%). Patients with liver and intrahepatic bile duct cancers (SMR = 10.53, 95% CI [8.3-13.18]), and pancreatic cancer (SMR = 6.84, 95% CI [5.11–8.97]) had a significantly higher rate of death from stomach and duodenal ulcer than the general population.ConclusionOur study revealed a significantly higher risk of stomach and duodenal ulcer mortality among patients with cancer in the United States, underscoring the critical need for integrated care strategies that address both cancer and ulcer-related complications. To reduce ulcer-related mortality, we recommend the implementation of targeted prevention protocols, including routine gastrointestinal screenings for high-risk cancer patients, proactive management of ulcer risk factors, and collaboration between oncology, gastroenterology, and surgical teams.Graphical abstract

Gallstones, cholecystectomy, and cancer risk: an observational and Mendelian randomization study.

This study aimed to comprehensively examine the association of gallstones, cholecystectomy, and cancer risk. Multivariable logistic regressions were performed to estimate the observational associations of gallstones and cholecystectomy with cancer risk, using data from a nationwide cohort involving 239 799 participants. General and gender-specific two-sample Mendelian randomization (MR) analysis was further conducted to assess the causalities of the observed associations. Observationally, a history of gallstones without cholecystectomy was associated with a high risk of stomach cancer (adjusted odds ratio (aOR)=2.54, 95% confidence interval (CI) 1.50-4.28), liver and bile duct cancer (aOR=2.46, 95% CI 1.17-5.16), kidney cancer (aOR=2.04, 95% CI 1.05-3.94), and bladder cancer (aOR=2.23, 95% CI 1.01-5.13) in the general population, as well as cervical cancer (aOR=1.69, 95% CI 1.12-2.56) in women. Moreover, cholecystectomy was associated with high odds of stomach cancer (aOR=2.41, 95% CI 1.29-4.49), colorectal cancer (aOR=1.83, 95% CI 1.18-2.85), and cancer of liver and bile duct (aOR=2.58, 95% CI 1.11-6.02). MR analysis only supported the causal effect of gallstones on stomach, liver and bile duct, kidney, and bladder cancer. This study added evidence to the causal effect of gallstones on stomach, liver and bile duct, kidney, and bladder cancer, highlighting the importance of cancer screening in individuals with gallstones.

Prevalence of Human Papillomavirus (HPV) and HPV Vaccination Completion Rates Among Gay and Bisexual Men in Dar es Salaam, Tanzania

High-risk Human Papillomavirus (HPV) is a sexually transmissible virus that causes cancer. Vaccination against HPV is available up to age 45. Gay and bisexual men (GBM) are at high risk for oropharyngeal and anal cancers caused by HPV. As part of a larger study of HPV prevention in GBM, we obtained anal swabs for HPV and offered HPV vaccination to GBM in Dar es Salaam, Tanzania. Participants were recruited by an outreach worker experienced with the GBM subculture using Respondent-Driven Sampling (RDS) from seeds. Eighty-three of a possible one hundred participants (mean age 26) were enrolled, tested, and given a first vaccination dose. Anal swabs were tested for twenty-eight HPV genotypes, both high and low risk for carcinogenicity, and a median of seven different HPV genotypes was found in participants. A total of 87% of participants carried at least one HPV genotype, and 76% carried at least one high-risk genotype. As a result of harassment and unanticipated risk to participants and staff at the unmarked community-based site, this study was terminated before the sample size was reached. Since a full course of vaccine was the standard of care, participants were contacted using the contact method they had provided to arrange follow-up vaccination doses at an alternative clinical site. Twenty-nine percent received the additional vaccination. A further 6% made appointments but did not attend, and another 10% would have received the second vaccination if they were incentivized to attend. The rate of HPV in anal samples was significantly higher than in our study using the same recruitment method in the same city in 2011–2012. The HIV rate was 45%. Anal HPV rates, including high-risk HPV rates, were significantly higher than in a similar population of gay and bisexual men 12 years ago. It is possible to provide HPV vaccination to gay and bisexual men in Tanzania and have approximately 45% potentially re-attend for a second dose if they are incentivized. Great care must be used to situate vaccination to avoid stigma leading to harassment, especially where homosexuality is criminalized. We infer that the high-risk harassment faced by participants and lack of incentive for the second visit depressed the return rate for revaccination.

Cost Analysis of Lymphadenectomy and Lymphedema One Year after Surgery for Endometrial Cancer: A Prospective Longitudinal Observational Multicenter Study

Background: Since the therapeutic effect of lymphadenectomy on long-term survival in endometrial cancer treatment is disputed, a health economic evaluation of lymphadenectomy is important. The primary aim was to evaluate the direct hospital-related and health care-related costs of lymphadenectomy one year after surgery for endometrial cancer. A secondary aim was to evaluate the costs for lymphedema. Methods: This was a prospective longitudinal observational multicenter study. Fifteen Swedish hospitals participated: four university, seven central and four county hospitals. Women with presumed early-stage endometrial cancer assigned for primary surgery were eligible for the study. Between June 2014 and January 2018, 116 women, categorized as having high-risk endometrial cancer, underwent surgery with lymphadenectomy, and 119 categorized as having low-risk endometrial cancer had surgery without lymphadenectomy. The calculations of costs followed the structure of a cost analysis. Results: Lymphadenectomy increased the total costs for surgery within one year after surgery compared with treatment without lymphadenectomy by 71%, (mean (standard deviation) 118,205 Swedish crowns (SEK) (43,116 SEK) vs. 70,451 SEK (31,138 SEK)). The total hospital costs for those who developed lymphedema were 25% higher than for those without lymphedema (115,099 SEK (44,593 SEK) vs. 91,793 SEK (44,062 SEK)). Conclusions: Lymphadenectomy in the treatment of endometrial cancer increased hospital costs significantly. The hospital costs for the primary treatment of endometrial cancer for those who developed lymphedema one year after surgery were moderately higher than for those who did not, mainly due to higher surgical costs for lymphadenectomy, more unplanned outpatient visits, and readmissions that required surgery. Clinical Trial registration: The study has been registered on https://classic.clinicaltrials.gov/ (registration number: NCT02115477).

The Cost-Effectiveness of Sentinel Lymph Node Mapping in High-Risk Endometrial Cancer.

Objectives. The aim was to evaluate the cost-effectiveness of sentinel lymph node (SLN) mapping in comparison to routine pelvic lymphadenectomy for lymph node assessment in patients with high-risk endometrial cancer (EC). Methods. A decision-analytic model was developed to compare SLN mapping with pelvic lymphadenectomy for guiding adjuvant therapy in patients with high-risk endometrioid and non-endometrioid EC, focusing on costs and health outcomes. The input data were obtained from systematic literature searches and expert consensus. Quality-adjusted life years (QALYs) was utilized as the measure of effectiveness. The model was constructed from a healthcare perspective, and the impact of uncertainty was evaluated through sensitivity analyses. Results. The base case analysis indicated that sentinel lymph node mapping is the dominant strategy for lymph node assessment in patients with high-risk endometrial cancer, as it was found to be both more effective and less costly than lymphadenectomy. The improved outcomes and reduced costs associated with SLN mapping primarily result from a decrease in the side effects related to lymph node assessment. Sensitivity analyses demonstrated that the outcome of the model was robust to variations in input values. Conclusion. SLN mapping is the most cost-effective strategy to determine the need for adjuvant therapy in patients with high-risk endometrioid and non-endometrioid endometrial cancer.

Prevalence and predictors of cancer among diabetic individuals in the United States

IntroductionThe increasing prevalence of diabetes in the United States poses a significant public health issue due to its link with a higher cancer risk. This study utilized data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) to ascertain the prevalence of cancer among diabetics and identify key factors affecting this risk. These insights are crucial for crafting effective health interventions to lower the cancer burden.MethodsData from the 2022 BRFSS were analyzed to explore cancer incidence among diabetics in the U.S. With a sample size of 62,689 diabetic individuals, descriptive analyses and survey logistic regression models were used to determine the prevalence and predictors of cancer. The data were recoded based on existing literature, and both unadjusted and adjusted odds ratios were calculated.ResultsThe study found a 13.48% cancer prevalence among diabetic patients. Multivariate logistic regression identified several significant cancer predictors. Age was a major factor, with older adults having higher cancer odds (AOR = 4.14; CI 2.95–5.82). Racial disparities were notable, with Non-Hispanic blacks (AOR = 0.56; CI 0.47–0.67) facing higher odds than Non-Hispanic whites. Female gender were also linked to increased cancer odds (AOR= 1.15; CI 1.38–2.72). Individual without depressive disorder have reduced odds of cancer (AOR = 0.81; CI 0.71–0.92). Physical activity was not a statistically significant predictor of cancer among diabetics when adjusting for other variables.ConclusionsThe study confirmed a higher prevalence of cancer among diabetics compared to the general population, highlighting the need for integrated healthcare strategies prioritizing regular cancer screening and addressing modifiable risk factors like socioeconomic disparities and mental health. These findings offer a solid foundation for public health interventions aimed at reducing the cancer burden in diabetic populations by targeting modifiable behaviors and social determinants of health.

Unraveling the causal relationship between serum minerals and pancreatic cancer: a Mendelian randomization study

BackgroundPancreatic cancer is among the most lethal malignancies, characterized by a poor prognosis and limited modifiable factors. Emerging evidence indicates that serum mineral levels may influence the likelihood of developing pancreatic cancer. However, the causal relationship between serum minerals and pancreatic cancer remains unclear and warrants further investigation.MethodsThis Mendelian randomization (MR) study was conducted to explore the causal effects of serum mineral levels on pancreatic cancer risk. Genetic variants associated with serum mineral levels, including calcium, iron, magnesium, zinc, selenium, and copper, were selected as instrumental variables (IVs) from large-scale genome-wide association study (GWAS) data. Multiple methods, including inverse variance weighting (IVW), MR-Egger, weighted median, weight methods, were employed to perform MR analysis. The effect sizes from the MR analysis, using two independent GWAS summary datasets related to pancreatic cancer, were combined through meta-analysis. The Cochrane Q test, MR-Egger intercept test, MR-PRESSO global test, and leave-one-out test were conducted for sensitivity tests.ResultsOur MR analysis demonstrated a significant causal effect of genetically predicted serum calcium levels on increased pancreatic cancer risk [OR = 1.64, 95% CI 1.05–2.57, P = 0.029 (discovery cohort); OR = 1.52, 95% CI 1.07–2.15, P = 0.019 (validation cohort)], while no significant associations were found for other serum minerals (P > 0.05). Additional meta-analysis reinforces and substantiates this conclusion (pooled OR = 1.56, 95% CI 1.19–2.06, P = 0.001). No evidence of pleiotropy or heterogeneity was detected across multiple sensitivity tests (P > 0.05).ConclusionThis study provides new evidence supporting the causal role of certain serum minerals, particularly calcium, in the development of pancreatic cancer. These findings may help inform future research into preventive strategies or therapies aimed at modulating mineral levels in patients at high risk of pancreatic cancer.

Clinicopathological risk factors for prognosis and therapeutic response of primary central nervous system lymphoma in China: a single-center retrospective analysis of 118 cases.

To investigate the prognostic significance of clinicopathological factors in patients with primary central nervous system lymphoma (PCNSL) in a single center. Patients newly diagnosed with PCNSL at our center were recruited between January 2019 and March 2023. Baseline demographic and clinicopathological data were collected retrospectively. The Kaplan-Meier method and Cox regression analysis were performed for survival analyses. A total of 118 patients were enrolled. The median age was 64 (IQR, 54-68). The median progression-free survival (PFS) and overall survival (OS) were 12.70 (95%CI, 9.73-23.30) months and 36.87 (95%CI, 25.57-NR) months, respectively. KPS < 70 and ECOG ≥ 3 were significantly associated with worse PFS and OS. High International Extranodal Lymphoma Study Group (IELSG) score (IELSG 4-5) and high-risk Memorial Sloan-Kettering Cancer Center (MSKCC) score were also adverse factors for PFS and OS. BTK inhibitors (BTKi) therapy (HR 0.39, 95% CI, 0.18-0.86, p = 0.020) and consolidation therapy (HR 0.19, 95% CI, 0.06-0.64, p = 0.007) were confirmed as independent favorable factors for OS. A high NK lymphocyte proportion was associated with worse OS (p = 0.008). Patients in the high NK lymphocyte group experienced a higher rate of primary tumor resistance (57.14%) than the low NK lymphocyte group (33.33%). KPS < 70, ECOG ≥ 3, IELSG 4-5, and high-risk MSKCC score are adverse factors for PFS and OS. Importantly, BTKi therapy and consolidation therapy are independent favorable factors for OS. Peripheral lymphocyte immunophenotyping could be a potential predictive indicator for prognosis and therapeutic response in PCNSL.