History Of Cancer Research Articles

Association between family history with lung cancer incidence and mortality risk in the Asia Cohort Consortium.

Family history of lung cancer (FHLC) has been widely studied but most prospective cohort studies have primarily been conducted in non-Asian countries. We assessed the association between FHLC with risk of lung cancer (LC) incidence and mortality in a population of East Asian individuals. A total of 478,354 participants from 11 population-based cohorts in the Asia Cohort Consortium were included. A Cox proportional hazards regression model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). A total of 7,785 LC incident cases were identified. FHLC (any LC subtype) was associated with an increased risk of LC incidence (HR = 1.45, 95% CI = 1.30-1.63). The positive association was observed in men and women (HR = 1.44, 95% CI = 1.26-1.66 in men; HR = 1.47, 95% CI = 1.22-1.79 in women), and in both never-smokers and ever-smokers (HR = 1.43, 95% CI = 1.18-1.73 in never-smokers; HR = 1.46, 95% CI =1.27-1.67 in ever-smokers). FHLC was associated with an increased risk of lung adenocarcinoma (HR = 1.63, 95% CI: 1.36-1. 94),squamous cell carcinoma (HR = 1.88, 95% CI: 1.46-2.44), and other non-small cell LC (HR = 1.94, 95% CI: 1.02-3.68). However, we found no evidence of significant effect modification by sex, smoking status, and ethnic groups. In conclusion, FHLC was associated with increased risk of LC incidence and mortality, and the associations remained consistent regardless of sex, smoking status and ethnic groups among the East Asian population.

Incidence, In-Hospital and Long-Term Mortality, and Sequelae of Epidermal Necrolysis in Adults

The incidence of epidermal necrolysis (EN), including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), varies across studies. While in-hospital mortality rates range from 15% to 20%, contributors to long-term mortality have been rarely evaluated and remain unknown. To assess the incidence of and compare factors associated with in-hospital mortality and postdischarge mortality and sequelae among patients with EN. This cohort study used French Health System data from January 1, 2013, to December 31, 2022, and included all adult patients (aged ≥18 years) with EN identified using International Statistical Classification of Diseases, Tenth Revision codes combined with a validated algorithm. Epidermal necrolysis. Incidence, in-hospital mortality, postdischarge mortality, and sequelae were assessed as main outcomes. Factors associated with mortality were assessed using a multivariable Cox proportional hazards model. A total of 1221 adult patients with EN (median [IQR] age, 66 [49-79] years; 688 females [56.3%]) were included. Incidence was 2.6 (95% CI, 2.5-2.7) cases per million person-years. The in-hospital mortality rate was 19% (95% CI, 17%-21%) and postdischarge mortality rate, 15% (95% CI, 13%-17%) for an overall mortality of 34% (95% CI, 31%-36%). In multivariable analysis, factors associated with in-hospital mortality were age (adjusted hazard ratio [AHR], 1.03 per year of age; 95% CI, 1.02-1.04 per year of age), history of cancer (AHR, 2.04; 95% CI, 1.53-2.72), dementia (AHR, 1.85; 95% CI, 1.12-3.07), liver disease (AHR, 1.81; 95% CI, 1.24-2.64), and EN severity (TEN vs SJS: AHR, 2.14; 95% CI, 1.49-3.07). Cancer, liver disease, and dementia remained associated with postdischarge mortality (AHR, 3.26 [95% CI, 2.35-4.53], 1.86 [95% CI, 1.11-3.13], and 1.95 [95% CI, 1.11-3.43], respectively). Conversely, EN initial severity was not associated with mortality after hospital discharge (TEN vs SJS: AHR, 0.95; 95% CI, 0.60-1.47), but acute complications remained associated (AHR, 2.14 [95% CI, 1.26-3.63] and 2.44 [95% CI, 1.42-4.18] for acute kidney injury and sepsis, respectively). The main sequelae were ophthalmologic and mood disorders. The findings of this cohort study suggest that although EN is a rare condition, it is associated with high rates of in-hospital and postdischarge mortality among patients who are older and have comorbid conditions. However, in contrast with in-hospital mortality, postdischarge mortality is not associated with EN initial severity but with acute in-hospital complications (eg, acute kidney injury and sepsis). Future studies are needed to construct models to estimate long-term outcomes and sequelae in patients with EN.

Risk of Death From Other Diseases in Lung Cancer Patients After Sublobar Resection Versus Lobectomy.

A recent Japanese phase three clinical trial for lung cancer suggested a possible advantage of segmentectomy over lobectomy in terms of death from other diseases. This study aimed to compare the risk of death from other diseases based on surgical procedures in lung cancer patients without recurrence. We retrospectively reviewed 2121 patients without disease recurrence after curative resection for lung cancer at our institution. Patient characteristics and overall survival were compared between sublobar resection and lobectomy. The sublobar group (n = 595) had a significantly higher proportion of women, non-smokers, patients without comorbidities, patients with a history of other cancers, and patients with earlier-staged disease when compared with the lobectomy group (n = 1526). The overall survival was significantly longer in the sublobar group than in the lobectomy group (p = 0.0034). After adjusting for background characteristics in an analysis of 488 patients, the overall survival had a trend to be longer in the sublobar group than in the lobectomy group (p = 0.071). Our results suggested that the risk of death from other diseases was potentially higher after lobectomy than after sublobar resection. Although several clinical factors could influence the results, these results may support the benefit of sublobar resection, assuming that the curability of both procedures is similar.

Keratinocyte Carcinoma: Canadian Landscape and an Evidence-based Approach to Follow-up

Dermatologists play a vital role in the early detection, prevention and effective management of skin cancer in patients with a prior history of the disease. Regular monitoring and timely interventions greatly enhance the overall prognosis and quality of life for patients with skin cancer. Dermatologists possess the requisite expertise to accurately diagnose and oversee the management of cutaneous skin cancers. Skin cancer screening via total body skin exam (TBSE) is often considered one of the safest, easiest, and most cost-effective tests in medicine. Despite dermatologists’ ability to offer such invaluable care for this patient population, offering routine skin checks for all patients with a prior history of skin cancer becomes exceptionally challenging given the high demand for dermatology care across Canada. It is important for dermatologists to maximize the efficiency of care during TBSEs by adhering to evidence-based guidelines when determining the frequency and duration of follow-up. These guidelines also provide a solid foundation for discussions with patients regarding the rationale for discharge back to their primary care provider.

Patterns of dietary quality, physical activity, and sleep duration among cancer survivors and caregivers.

Fruit and vegetable intake (FVI), moderate-to-vigorous physical activity (MVPA), and sleep duration are each independently associated with cancer-related and general health outcomes among cancer survivors. Past research suggests that health behaviors cluster among cancer survivors, with caregivers demonstrating similar patterns. This analysis examined co-occurrence of FVI, MVPA, and sleep duration among cancer survivors and informal cancer caregivers and identified sociodemographic and clinical correlates of health behavior engagement. Using data from the Health Information National Trends Survey (HINTS), an exploratory latent profile analysis (LPA) was conducted among those self-reporting a history of cancer or identifying as a cancer caregiver. The LPA model was fit with daily self-reported FVI (cups/d), MPVA (minutes/d) and sleep duration (hours/d). Multinomial logistic regression models were used to predict profile membership based on sociodemographic and clinical characteristics. Four health behavior profiles were identified (Least Engaged-No MVPA, Least Engaged-Low MVPA, Moderately Engaged, and Highly Engaged). The largest profile membership was Least Engaged-No MVPA, capturing 37% of the sample. Profiles were most distinguished by MVPA, with the lowest variance in sleep duration. Participants reporting higher FVI also often reported greater MVPA and longer sleep duration. Profile membership was significantly associated with age, relationship status, education, income, rurality, alcohol use, self-efficacy, psychological distress, BMI, and cancer type. This study identified four health behaviors patterns and sociodemographic correlates that distinguished those patterns among cancer survivors and caregivers drawn from a nationally representative sample. Results may help identify for whom health behavior interventions could be of greatest benefit.

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.

Chronic Ischemic Gastritis in a Patient With a History of Cancer and Atherosclerotic Disease

ABSTRACT Chronic mesenteric ischemia is an uncommon disease presenting with nonspecific symptoms. The large number of differential diagnoses may result in diagnostic delays and progression to acute mesenteric ischemia. A 74-year-old woman with a history of breast cancer and carotid atherosclerosis complained of postprandial abdominal pain, vomiting, and weight loss. Endoscopic examination showed active chronic gastritis Helicobacter pylori negative. Contrast-enhanced computed tomography revealed stenosis in the mesenteric arterial district. Chronic gastritis resistant to treatment in a patient complaining of postprandial abdominal pain and weight loss should be investigated for chronic mesenteric ischemia, although history of cancer could be a misleading factor.

Cancer as an Independent Mortality Risk in Chronic Thromboembolic Pulmonary Hypertension

BackgroundThe management of chronic thromboembolic pulmonary hypertension (CTEPH) has advanced significantly in recent years, thereby improving patient prognosis. However, the impact of cancer on the outcomes of patients with CTEPH under current treatment remains unclear. This study aimed to investigate the prevalence of cancer in patients with CTEPH and determine how comorbid cancer affects their prognosis and clinical course. MethodsData from an ongoing Japanese prospective cohort study were analyzed. Prevalence and primary cancer sites were evaluated. The association of a history of cancer with a composite endpoint, including all-cause death, lung transplantation, and worsening of CTEPH, as well as venous thromboembolism and bleeding events, was assessed. ResultsOf the 1,270 patients in the cohort, 134 (10.6%) had a history of cancer, with the most common primary sites being the breast in women and the prostate in men. The incidence of composite outcome and all-cause death was higher in those with a history of cancer (p<0.001, log-rank test). In the Cox proportional hazard model, age- and sex-adjusted hazard ratios for the composite outcome and all-cause death were 2.69 (95% confidence interval, 1.48–4.89, p=0.001) and 4.25 (95% confidence interval, 1.98–9.10, p<0.001), respectively, for patients with a history of cancer. No significant differences in venous thromboembolism and bleeding events were observed between patients with and those without a history of cancer. ConclusionsA history of cancer, with a prevalence of 10.6%, is an independent risk factor for mortality in patients with CTEPH undergoing the currently recommended treatment.

Effects of loneliness on healthcare utilization and medical expenditures in US cancer survivors.

368 Background: Loneliness is associated with increased mortality risk in cancer survivors. However, effects of loneliness on healthcare utilization are understudied. This study examined associations of loneliness with having emergency room (ER) visit, usual source of care, and hospitalization in US adults with and without cancer history. Methods: We identified 1,844 cancer survivors and 9,517 adults without a cancer history from the 2021 Medical Expenditure Panel Survey. Loneliness was measured by 3 questions on feeling lack of companionship, left out, and isolated from others. Scores for each question were summed to create a total loneliness score, which was categorized into low/no loneliness (3-5) and high loneliness (6-9) based on previous literature. Separate logistic regression models were used to assess association of loneliness and whether having ER visit, usual source of care, and hospitalization. All models adjusted for age, region, sex, race, non-cancer health conditions, activity limitation, marital status, education, health insurance, and cancer diagnosis. We used a cancer history by loneliness interaction term to examine the differential associations of loneliness and healthcare utilization by cancer history. Results: 2,367 (23%) adults without a cancer history and 450 (22%) cancer survivors reported loneliness. All adults averagely aged over 50, with more female (non-cancer: 57.1 vs 49.9%, cancer: 68.0 vs 55.9%) and those with non-cancer health conditions ≥3 (non-cancer: 20.6 vs 15.4%, cancer: 54.0 vs 44.4%) in the loneliness group. Cancer history modified the association between loneliness and ER visit (interaction term p-value 0.04), but didn’t modify the association with having usual source of care (p=0.38) or hospitalization (p=0.87). Loneliness was associated with having ER visit (OR 1.49, 95% CI 1.11-2.00) in cancer survivors while not in non-cancer patients (OR 1.08, 95% CI 0.92-1.27). No significant association was observed between loneliness and having usual source of care or hospitalization. Conclusions: Loneliness is associated with ER visit in US cancer survivors. Findings warrant further study of impact of loneliness on clinical outcomes in cancer survivors, with the aim of enhancing strategies to mitigate loneliness and optimize healthcare utilization. Association of loneliness and healthcare utilization. No Cancer History (9,517, 85%) Cancer History (1,844, 15%) Loneliness No (7,150, 77%) Yes (2,367, 23%) No (1,394, 78%) Yes (450, 22%) Odds ratio Having ER visit Ref 1.08 (0.92-1.27) Ref 1.49 (1.11-2.00) Having usual source of care 1.08 (0.89-1.30) 0.90 (0.62-1.30) Having hospitalization 0.93 (0.79-1.09) 0.96 (0.62-1.48)

Income, wealth, and debt among families with a history of cancer.

350 Background: Cancer survivors and their families often experience financial hardship due to high out-of-pocket medical costs and lost income from time away from work during treatment for patients and informal family caregivers. Little is known about detailed income, wealth, and debt among families with a history of cancer. Methods: The 2021 Panel Study of Income Dynamics was used to identify families with a cancer history. Family characteristics included survey response person’s age, sex, marital status, and race and ethnicity, number of dependent children living in the family, and time since cancer diagnosis. For families with multiple cancer diagnoses, time since cancer diagnosis was calculated according to the most recent cancer diagnosis. Family income was assessed by total income in tax year 2020, which consisted of combined taxable and transfer income of the response person, spouse/partner, and other family members. Wealth with and without equity (i.e., value of home minus mortgage) were assessed by sum of values of different types of assets (e.g. savings, checking, bonds, retirement accounts) net of debts (e.g., credit card debt, student loans, and medical bills). Results: A total of 701 families were identified with a cancer history. Within families, half of cancer survivors were 18-64 years and the other half were &gt;65 years at the survey. About two thirds were married or living with partners, three fourths of response persons were male, one fifth had dependent children living in the same family, two thirds were non-Hispanic white, and two thirds of cancer survivors were diagnosed &gt; 6 years prior to the survey. The median family income was $67,498 (inter-quartile range: $33,480 to $121,200), and the median wealth with and without equity were $188,000 and $5,5000, respectively. Moreover, 29.9% of families had credit debt (median: $4,500; inter-quartile range [IQR]: $1800-$14,000); 11.3% of families carried student loans (median: $4,500; IQR: $15,000-$60,000); and 10.7% of families had outstanding medical bills (median: $4,000; IQR: $2,000-$9,000). Conclusions: Families with a history of cancer have multiple types of debts, including medical debt, even years after diagnosis. Efforts to identify changes in wealth and income before and after cancer diagnosis are warranted. Income, wealth, and debt among families with a history of cancer. Family income Wealth without equity Wealth with equity Mean (Std) Median (IQR) Mean (Std) Median (IQR) Mean (Std) Median (IQR) $94,776(123,870) $67,498(33,480, 121,200) $459,956(1,142,647) $5,5000(4,000, 391,364) $649,912(1,307,959) $188,000(30,400, 645,000) Credit card debt (n=693) Student loans (n=698) Medical bills (n=627) n (%) Mean (Std) Median (IQR) n (%) Mean (Std) Median (IQR) n (%) Mean (Std) Median (IQR) 207(29.9%) $8,832 (10,300) $4,500(1800, 14,000) 79(11.3%) $55,948(75,256) $35,000(15,000, 60,000) 67(10.7%) $13,309(32,525) $4000(2,000, 9,000)

Differentiating primary from metastatic ovarian tumors of gastrointestinal origin by CT

PurposeTo determine differentiating CT imaging features of primary ovarian cancers from ovarian metastases of gastrointestinal origin. MethodsRetrospective study of 50 patients with new ovarian lesions on CT, half were primary ovarian cancers and half gastrointestinal metastases. Two blinded independent readers described tumor characteristics on CT (size, laterality, margin, etc.) and ancillary features (ascites, peritoneal seeding, lymphadenopathy, etc.). Patient age, sex, cancer history, and tumor marker levels for CA-125 and CEA were collected. Wilcoxon test and Pearson's chi-squared test were used for statistical analysis. Results50 patients with mean age of 62.1 years were included. Ovarian metastases were more likely to be cystic/mainly cystic (p=0.013), have smooth margins (p=0.011), and have no/mild enhancement (p<0.001). Primary ovarian lesions were associated with moderate to large volume of ascites (p=0.047) and more commonly seen with lymphadenopathy (p=0.008). Laterality was not significantly different between the two groups. CA-125 level was more commonly elevated in primary ovarian lesions (87% vs 50%, p=0.018), and with much higher values (1076.5 vs 155.1, p=0.013). CEA level was more commonly elevated in metastatic ovarian lesions (83.3% vs 15.4%, p<0.001), and with higher values (72.4 vs 2.1, p<0.001). ConclusionOvarian metastases were more frequently smooth-margined and cystic with little enhancement. Primary ovarian lesions were more commonly associated with lymphadenopathy and larger volume of ascites. Tumor markers CEA and CA-125 were more frequently elevated in metastatic and primary lesions, respectively. Cancer history was the only variable that increased the odds of metastasis and therefore it is important to always correlate with history of cancer.

Treatment patterns of goserelin 3.6 mg once monthly and 10.8 mg every three months in women with breast cancer: A real-world analysis.

391 Background: Goserelin is a gonadotropin-releasing hormone agonist used for ovarian function suppression in the treatment of pre- and peri-menopausal patients with breast cancer. Goserelin, administered as a subcutaneous implant, is available in doses of 3.6 mg once monthly or 10.8 mg every three months; goserelin 3.6 mg is approved in the US, and both the 3.6 mg and 10.8 mg doses are approved by Health Canada and the European Medicines Agency. A study utilizing US real-world evidence was conducted to characterize treatment patterns of patients treated with goserelin 3.6 mg and/or 10.8 mg. Methods: Electronic health record data of adult patients with a history of breast cancer and with ≥2 prescriptions of goserelin between 1 January 2017 – 31 December 2022 were identified through TriNetX. Index date was the initiation of goserelin administration. Patients were followed until 15 March 2024. Patient demographics, treatment adherence, and healthcare resource utilization (HCRU) were examined and summarized using descriptive analytics. Results: Overall, 3,620 patients were identified: 2,870 treated with goserelin 3.6 mg, 410 with goserelin 10.8 mg, and 340 who switched from goserelin 3.6 mg to 10.8 mg. Peak utilization of goserelin 10.8 mg (36.6%) and peak dosage switching (26.5%) occurred in 2020. Across groups, mean age at index date was 42.2–44.4 years, and patients were white (64.1–67.6%), black (11.8%–13.9%), Asian (8.0%–11.8%), and American Indian and/or Alaskan native (0.3%–2.9%). Of patients with known BMI, BMI mostly ranged between 18.5–24.9 kg/m 2 in all groups. Patients who switched from goserelin 3.6 mg to 10.8 mg had the longest median treatment duration (776 days) (Table). Patients treated with goserelin 10.8 mg remained on treatment for a median of 426 days; 74.4% of these patients were treatment-adherent (Table). In comparison, patients treated with goserelin 3.6 mg had a shorter median treatment duration (226 days) and were less adherent (56.4%) (Table). HCRU during the 12 months after index date was broadly similar across groups. Conclusions: Treatment with goserelin 10.8 mg every three months is associated with greater adherence and longer treatment duration, compared with 3.6 mg once monthly, in patients with a history of breast cancer. Patients who switched from goserelin 3.6 mg to 10.8 mg were treatment-adherent for nearly two years, consistent with clinical recommendations. Goserelin 3.6 mg (n = 2,870) Goserelin 10.8 mg (n = 410) Switched from goserelin 3.6 mg to 10.8 mg (n = 340) Median duration of treatment (days) 264 429 776 Median time to switch (days) — — 218 Patients adherent* to dosing schedule 1,608 (56.4%) 306 (74.4%) — Status as of March 15, 2024 Discontinued goserelin 2,018 (70.8%) 261 (64.3%) 173 (50.9%) Death 88 (3.1%) 10 (2.5%) 3 (0.9%) *Defined as: ≤36 days between prescriptions (3.6 mg) or ≤108 days between prescriptions (10.8 mg).

Using a Polygenic Risk Score to Improve the Risk Prediction of Non-Small Cell Lung Cancer in Taiwan.

Low-dose computed tomography (LDCT) can help reducing lung cancer mortality. In Taiwan, the existing screening criteria revolve around smoking habits and family history of lung cancer. The role of genetic variation in non-small cell lung cancer (NSCLC) development is increasingly recognized. In this study, we aimed to investigate the potential benefits of polygenic risk scores (PRSs) in predicting NSCLC and enhancing the effectiveness of screening programs. We conducted a retrospective cohort study that included participants without prior diagnosis of lung cancer and later received LDCT for lung cancer screening. Genetic data for these participants were obtained from the project of Taiwan Precision Medicine Initiative. We adopted the model of genome-wide association study-derived PRS calculation using 19 susceptibility loci associated with the risk of NSCLC as reported by Dai et al. We studied a total of 2,287 participants (1,197 male, 1,090 female). More female participants developed NSCLC during the follow-up period (4.4% v 2.5%, P = .015). The only risk factor of NSCLC diagnosis among male participants was age. Among female participants, independent risk factors of NSCLC diagnosis were age (adjusted hazard ratio [aHR], 1.08 [95% CI, 1.04 to 1.11]), a family history of lung cancer (aHR, 3.21 [95% CI, 1.78 to 5.77]), and PRS fourth quartile (aHR, 2.97 [95% CI, 1.25 to 7.07]). We used the receiver operating characteristics to show an AUC value of 0.741 for the conventional model. With the further incorporation of PRS, the AUC rose to 0.778. The evaluation of PRS for NSCLC prediction holds promise for enhancing the effectiveness of lung cancer screening in Taiwan especially in women. By incorporating genetic information, screening criteria can be tailored to identify individuals at higher risks of NSCLC.

Uptake of germline genetic testing in patients with advanced breast, ovarian, pancreatic, or prostate cancer.

19 Background: With FDA approval of PARP inhibitors for treatment of BRCA1/2 -associated advanced breast, ovarian, pancreatic, and prostate cancer, National Comprehensive Cancer Network guidelines for germline genetic testing (GGT) have expanded for patients with these tumor types since 2019. We aimed to analyze factors associated with GGT uptake in these patient populations. Methods: We conducted a retrospective cohort study among patients diagnosed with metastatic breast and prostate cancer and all stages of ovarian and pancreatic cancer in 2020-2023 at Columbia University Irving Medical Center in New York City. We extracted data from the electronic medical record on demographics (age at diagnosis, sex, race/ethnicity, Jewish ancestry, marital status) and clinical characteristics (tumor type, year of diagnosis, family history of cancer, receipt of somatic testing, genetic counseling, targeted therapy). The primary outcome was receipt of GGT. Descriptive statistics were generated and multivariable logistic regression analyses were used to estimate the association between demographic/clinical factors and GGT uptake. Results: Among 884 evaluable patients, mean age was 67 years (SD, 14) and the study population included 45% Whites, 15% Blacks, 21% Hispanics, and 9% Asians/Others; 14% had Jewish ancestry. Only 16% were seen by a genetic counselor, 66% had undergone GGT, and 57% had somatic testing. After adjustment for confounders, younger age, Jewish ancestry, later year at diagnosis, and family history of breast or pancreatic cancer were significantly associated with GGT uptake. Patients with pancreatic or prostate cancer were about 60% less likely to undergo GGT compared to patients with ovarian cancer. Patients who had somatic testing were over 4.5-fold more likely to receive GGT. No significant differences were observed based upon sex or race/ethnicity. Among patients who underwent GGT, 20% were found to have a PV and over half of patients who received targeted therapy had PVs detected. Conclusions: We observed increasing use of oncologist-led GGT over time with over 65% of patients with advanced breast, ovarian, pancreatic, or prostate cancer undergoing testing, of which 20% had PVs detected. Given the evolution of targeted therapies and the potential downstream impact of known PVs for family members, under-utilization of GGT in patients with pancreatic and prostate cancer as well as older individuals should be addressed in future studies.

Predictors and Interdependence of Quality of Life in a Random Sample of Long-Term Young Breast Cancer Survivors and Their Biological Relatives.

Quality of life (QOL) among young breast cancer survivors (YBCS) is often worse than QOL of older breast cancer survivors or age-matched peers without a history of cancer. Families commonly support YBCS, particularly during treatment, but little is known about long-term YBCS and family member QOL. The purpose of this study was to identify demographic, clinical, and psychosocial predictors of physical and mental QOL in YBCS and biological relatives and investigate associations between their QOL (i.e., QOL interdependence). This secondary data analysis includes a random sample of long-term YBCS (≤ 45 years old at diagnosis) and up to two female relatives at baseline (post-treatment) and 18-month follow-up. The sample consists of 189 dyads (YBCS and one relative) and 121 triads (YBCS and two relatives). Actor-partner interdependence models (APIMs) were used to estimate the influence of YBCS's and relatives' demographic, clinical, and psychosocial factors on their own QOL (actor effects) and the other persons' QOL (partner effects). For YBCS and relatives, QOL at the baseline was associated with their QOL at 18-months. YBCS's perceived cancer risk was associated with their own and relatives' QOL. Older relatives' physical QOL at baseline was associated with younger relatives' physical QOL at follow-up. Age, race, marital status, years since diagnosis, education, out-of-pocket costs of care, routine sources of care, income, family support, fear of recurrence, anxiety, and depression were also significant predictors of QOL. Findings revealed independent and interdependent effects on QOL. These predictors point to potential targets of support for families. ClinicalTrials.gov ID: NCT01612338.

Highly sensitive detection platform-based diagnosis of oesophageal squamous cell carcinoma in China: a multicentre, case–control, diagnostic study

Early detection and screening of oesophageal squamous cell carcinoma rely on upper gastrointestinal endoscopy, which is not feasible for population-wide implementation. Tumour marker-based blood tests offer a potential alternative. However, the sensitivity of current clinical protein detection technologies is inadequate for identifying low-abundance circulating tumour biomarkers, leading to poor discrimination between individuals with and without cancer. We aimed to develop a highly sensitive blood test tool to improve detection of oesophageal squamous cell carcinoma. We designed a detection platform named SENSORS and validated its effectiveness by comparing its performance in detecting the selected serological biomarkers MMP13 and SCC against ELISA and electrochemiluminescence immunoassay (ECLIA). We then developed a SENSORS-based oesophageal squamous cell carcinoma adjunct diagnostic system (with potential applications in screening and triage under clinical supervision) to classify individuals with oesophageal squamous cell carcinoma and healthy controls in a retrospective study including participants (cohort I) from Sun Yat-sen University Cancer Center (SYSUCC; Guangzhou, China), Henan Cancer Hospital (HNCH; Zhengzhou, China), and Cancer Hospital of Shantou University Medical College (CHSUMC; Shantou, China). The inclusion criteria were age 18 years or older, pathologically confirmed primary oesophageal squamous cell carcinoma, and no cancer treatments before serum sample collection. Participants without oesophageal-related diseases were recruited from the health examination department as the control group. The SENSORS-based diagnostic system is based on a multivariable logistic regression model that uses the detection values of SENSORS as the input and outputs a risk score for the predicted likelihood of oesophageal squamous cell carcinoma. We further evaluated the clinical utility of the system in an independent prospective multicentre study with different participants selected from the same three institutions. Patients with newly diagnosed oesophageal-related diseases without previous cancer treatment were enrolled. The inclusion criteria for healthy controls were no obvious abnormalities in routine blood and tumour marker tests, no oesophageal-associated diseases, and no history of cancer. Finally, we assessed whether classification could be improved by integrating machine-learning algorithms with the system, which combined baseline clinical characteristics, epidemiological risk factors, and serological tumour marker concentrations. Retrospective SYSUCC cohort I (randomly assigned [7:3] to a training set and an internal validation set) and three prospective validation sets (SYSUCC cohort II [internal validation], HNCH cohort II [external validation], and CHSUMC cohort II [external validation]) were used in this step. Six machine-learning algorithms were compared (the least absolute shrinkage and selector operator regression, ridge regression, random forest, logistic regression, support vector machine, and neural network), and the best-performing algorithm was chosen as the final prediction model. Performance of SENSORS and the SENSORS-based diagnostic system was primarily assessed using accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). Between Oct 1, 2017, and April 30, 2020, 1051 participants were included in the retrospective study. In the prospective diagnostic study, 924 participants were included from April 2, 2022, to Feb 2, 2023. Compared with ELISA (108·90 pg/mL) and ECLIA (41·79 pg/mL), SENSORS (243·03 fg/mL) showed 448 times and 172 times improvements, respectively. In the three retrospective validation sets, the SENSORS-based diagnostic system achieved AUCs of 0·95 (95% CI 0·90-0·99) in the SYSUCC internal validation set, 0·93 (0·89-0·97) in the HNCH external validation set, and 0·98 (0·97-1·00) in the CHSUMC external validation set, sensitivities of 87·1% (79·3-92·3), 98·6% (94·4-99·8), and 93·5% (88·1-96·7), and specificities of 88·9% (75·2-95·8), 74·6% (61·3-84·6), and 92·1% (81·7-97·0), respectively, successfully distinguishing between patients with oesophageal squamous cell carcinoma and healthy controls. Additionally, in three prospective validation cohorts, it yielded sensitivities of 90·9% (95% CI 86·1-94·2) for SYSUCC, 84·8% (76·1-90·8) for HNCH, and 95·2% (85·6-98·7) for CHSUMC. Of the six machine-learning algorithms compared, the random forest model showed the best performance. A feature selection step identified five features to have the highest performance to predictions (SCC, age, MMP13, CEA, and NSE) and a simplified random forest model using these five features further improved classification, achieving sensitivities of 98·2% (95% CI 93·2-99·7) in the internal validation set from retrospective SYSUCC cohort I, 94·1% (89·9-96·7) in SYSUCC prospective cohort II, 88·6% (80·5-93·7) in HNCH prospective cohort II, and 98·4% (90·2-99·9) in CHSUMC prospective cohort II. The SENSORS system facilitates highly sensitive detection of oesophageal squamous cell carcinoma tumour biomarkers, overcoming the limitations of detecting low-abundance circulating proteins, and could substantially improve oesophageal squamous cell carcinoma diagnostics. This method could act as a minimally invasive screening tool, potentially reducing the need for unnecessary endoscopies. The National Key R&D Program of China, the National Natural Science Foundation of China, and the Enterprises Joint Fund-Key Program of Guangdong Province. For the Chinese translation of the abstract see Supplementary Materials section.

TCT-987 Outcomes of Percutaneous Coronary Intervention in Patients With Active Cancer or a History of Cancer: A Systematic Review and Meta-Analysis

TCT-987 Outcomes of Percutaneous Coronary Intervention in Patients With Active Cancer or a History of Cancer: A Systematic Review and Meta-Analysis

Prevalence of anal high-risk human papillomavirus (HR-HPV) types in people living with HIV and a history of cancer.

Referral tertiary care hospital for adult patients with cancer. We reviewed data of patients from the AIDS Cancer Clinic on antiretroviral therapy in chronic control who were consecutively referred for high-resolution anoscopy (HRA), where they underwent anal evaluation, collection of specimens for anal cytology and anal human papillomavirus (HPV) followed by HRA with directed biopsy if needed. A total of 155 patients were included; 149 (96.1%) were men, all of them men who have sex with men (MSM); the median age was 39 (IQR 32-47) years; 105 (67.7%) with Kaposi sarcoma, 40 (25.8%) with non-Hodgkin lymphoma and 10 (6.4%) with other neoplasms; only 7 (4.5%) had active cancer. The prevalence of HR-HPV infection was 89% (n=138) (95% CI 83-93) with at least one HR-HPV infection, and 62% (96) had coinfection with at least two types; the median HR-HPV types of coinfection were 3 (IQR 2-4). The number of patients infected with HPV 16 was 64 (41.3%, 95% CI 33.8-49.3), HPV 18 was 74 (47.7%, 95% CI 39.9-55.7) and with both 35 (22.6%). Some 59 patients (38%) had high-grade squamous intraepithelial lesions (HSIL) and 49 (31.6%) had low-grade squamous intraepithelial lesions (LSIL). The prevalence of HR-HPV and HSIL among patients aged ≤35 and >35 years was the same. In this cohort of PLWHIV with a history of malignancy we found a high prevalence of HR-HPV 16 and 18 and anal HSIL, even in persons aged ≤35 years. These data highlight the importance of anal cancer screening in PLWHIV and history of malignancy.

Association Between Systemic Immune-Inflammation Index and Psoriasis, Psoriasis Comorbidities, and All-Cause Mortality: A Study Based on NHANES.

The relationship between systemic immune-inflammation index (SII) and psoriasis and its prognosis is not yet clear. In this study, the correlation between SII and psoriasis, psoriasis comorbidities, and all-cause mortality was investigated based on the National Health and Nutrition Examination Survey (NHANES). The study population was derived from five NHANES cycles: 2003-2006, 2009-2014, and survival follow-up was as of December 31, 2019. The association between SII and psoriasis and its comorbidities was analyzed using weighted multivariate logistic regression models. Weighted COX regression was used to calculate hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs). Restricted cubic spline, subgroup and sensitivity analyses were also used. Logarithmic conversion was performed on SII(log2SII) to reduce the impact of outliers. A total of 21,431 participants were included in this study. As a continuous variable, log2SII was significantly associated with psoriasis in the fully adjusted model [OR = 1.20(1.04-1.39), p = .01]. log2SII remained positively associated with psoriasis after excluding participants with a history of cancer or cardiovascular disease (CVD), or non-Hispanic black participants. Among psoriasis patients, log2SII was significantly associated with metabolic syndrome (MetS) [OR = 1.68(1.19,2.38), p = .004] and all-cause mortality [HR = 1.48(1.09,1.99), p = .01]. Similar results were consistently observed when SII was analyzed as a categorical variable (in quartiles). This study suggested a positive association between SII and the prevalence of psoriasis. Among psoriasis patients, SII was positively correlated with MetS and all-cause mortality.

Uptake of Risk-Reducing Surgeries in an International Real-World Cohort of Hispanic Women.

Women with pathogenic variants (PVs) in breast cancer (BC) and ovarian cancer (OC) associated genes are candidates for cancer risk-reducing strategies. Limited information is available regarding risk-reducing surgeries (RRS) among Hispanics. The aim of this study was to describe the uptake of RRS in an international real-world experience of Hispanic women referred for genetic cancer risk assessment (GCRA) and to identify factors affecting uptake. Between July 1997 and December 2019, Hispanic women, living in the United States or in Latin America, enrolled in the Clinical Cancer Genomics Community Research Network registry were prospectively included. Demographic characteristics and data regarding RRS were obtained from chart reviews and patient-reported follow-up questionnaires. Median follow-up was 41 months. Among 1,736 Hispanic women referred for GCRA, 27.2% women underwent risk-reducing mastectomy (RRM), 25.5% risk-reducing salpingo-oophorectomy (RRSO) and, 10.7% both surgeries. Among BRCA carriers, rates of RRM and RRSO were 47.6% and 56.7%, respectively. In the multivariate analyses, being a carrier of a BC susceptibility gene (odds ratio [OR], 3.44), personal history of BC (OR, 6.22), living in the US (OR, 3.90), age ≤50 years (OR, 1.68) and, family history of BC (OR, 1.56) were associated with a higher likelihood of undergoing RRM. Carrying an OC susceptibility gene (OR, 6.72) was associated with a higher likelihood of undergoing RRSO. The rate of RRS among Hispanic women is suboptimal. PV carriers, women with personal history of cancer, and those with a family history of cancer were more likely to have RRS, with less uptake outside the US. Understanding personal and systemic factors influencing uptake may enable interventions to increase risk appropriate uptake of RRS.