Low-dose computed tomography (LDCT) lung cancer screening is recognized as a "teachable moment" for smoking cessation. However, evidence of its impact on smoking behavior is inconsistent, with limited research on incidental smoking-related findings, such as coronary artery calcification (CAC) or emphysema, and on sustained abstinence among former smokers. We comprehensively evaluated the effects of LDCT findings and physician counseling on smoking behaviors in both current and former smokers. A retrospective cohort study was conducted on 763 individuals who underwent national lung cancer screening at the Korean National Cancer Center between 2019 and 2021. Smoking status was assessed at a 2-year follow-up. Multivariable logistic regression was used to assess the association of CT findings and physician counseling with smoking cessation initiation (current smokers) and abstinence maintenance (former smokers). Among current smokers, higher Lung Imaging Reporting and Data System (Lung-RADS) categories (aOR = 18.84), moderate-to-severe CAC (aOR = 2.18), and emphysema (aOR = 1.95) were significantly associated with increased odds of quitting. Similarly, these findings significantly predicted sustained abstinence in former smokers, with CAC showing a particularly strong effect (aOR = 5.30). Physician counseling independently increased the odds of cessation in current smokers (odds ratio = 2.04) and abstinence maintenance in former smokers (odds ratio = 5.38). The effect of counseling did not significantly differ by the severity of low-dose computed tomography (LDCT) findings. Incidental smoking-related LDCT findings, particularly CAC and emphysema, are potent predictors of smoking behavior change. Physician counseling further enhances cessation outcomes, underscoring the value of integrating comprehensive counseling based on all relevant radiological findings into screening protocols. This study demonstrates that incidental smoking-related Low-dose computed tomography findings, such as coronary artery calcification and emphysema, strongly influence both smoking cessation in current smokers and sustained abstinence in former smokers, independent of malignant findings. Physician counseling significantly enhances these behavioral changes regardless of CT result severity. By highlighting the additive value of integrating structured smoking cessation counseling with interpretation of all salient radiological findings, the results support expanding lung cancer screening programs beyond cancer detection to serve as effective interventions for tobacco control, ultimately improving long-term health outcomes.

This study aimed to assess the association between inflammatory cytokines and the risk of gastric cancer (GC). We conducted a case-cohort study using Korean National Cancer Center Community (KNCCC) cohort data to investigate the associations between pro-inflammatory, anti-inflammatory cytokines, inflammatory mediators, and GC risk in the Korean general population (GC cases: n=159, subcohort: n=822). Serum levels of inflammatory cytokines were measured using Quantikine enzyme-linked immunosorbent assay and analyzed using a Cox proportional hazards regression model. Compared to those with the lowest serum interleukin 6 (IL-6) levels, the risk of GC significantly increased in the second (hazard ratio [HR], 3.48; 95% confidence interval [CI], 1.73 to 6.99), third (HR, 3.74; 95% CI, 1.91 to 7.29), and fourth quartiles (HR, 3.79; 95% CI, 1.93 to 7.48). Elevated levels of interleukin 1β (IL-1β) (HR, 1.57; 95% CI, 1.12 to 2.21) and interferon-γ (IFN-γ) (HR, 2.49; 95% CI, 1.73 to 3.58) were also associated with an increased risk of GC. The findings of this study indicate associations between pro-inflammatory cytokines (IL-6, IL-1β, and IFN-γ) and the risk of GC, suggesting that regulating these cytokine levels may aid in GC prevention.

BackgroundInsulin-mediated pathways plausibly explain the pathogenesis of colorectal cancer (CRC). The triglyceride-glucose index (TyG) is a surrogate of insulin resistance (IR), but its association with CRC in the Korean population has not been evaluated.MethodsFrom the 2004–2013 Korean Genome and Epidemiology Study, 98,800 participants aged 40–69 years were followed through 2020. Data on CRC incidence were obtained from the Korean National Cancer Center registry. Cox regression models and restricted cubic splines were fitted to examine the association between the TyG; In [(triglycerides) × (fasting glucose)/2] and CRC incidence. Joint effects of modifiable lifestyle factors and TyG on CRC risk were also investigated.ResultsMedian follow-up time was 10.6 years, and 699 CRC cases were observed. A unit-increment in TyG was associated with increased risk of CRC combined (hazard ratio, HR: 1.28, and 95% confidence interval, CI: 1.12–1.46), colon (1.29, 1.10–1.54), and rectal cancer (1.24, 1.01–1.52). Associations were dose-dependent, with linear associations observed for CRC and colon, but non-linear associations were observed for rectal cancer. A high TyG index (above 8.4) combined with overweight/obesity was linked to an increased risk of CRC (1.31, 1.07–1.61) and colon cancer (1.33, 1.03–1.72). When combined with low fruit and vegetable intake, the risks were higher for CRC (1.40, 1.12–1.74) and colon cancer (1.57, 1.18–2.09). Combined with high red meat consumption, the risks were elevated for CRC (1.32, 1.05–1.65) and colon cancer (1.52, 1.15–2.02).ConclusionsA high TyG index was associated with a higher risk of colorectal cancer, and the risk was highest among participants with a high BMI, low fruit and vegetable intake, and high intake of red meat, suggesting a role of both insulin resistance and modifiable lifestyle in colorectal cancer development.Supplementary InformationThe online version contains supplementary material available at 10.1007/s44197-024-00282-w.

Determining the effect of dietary factors on cancer is a crucial issue when accounting for the effect of other major risks, such as smoking and drinking. A total of 15,563 adults from the Korean National Cancer Center Community Cohort were analyzed to determine and to compare the effect of dietary factors on stomach and colorectal cancer in overall and in the subgroup of non-smokers (or urinary cotinine concentrations <5 ng/mg) and non-drinkers with Cox proportional-hazard models. During the mean follow-up (13.7 years), 469 and 299 cases of stomach and colorectal cancer were identified, respectively. The preventive effect of vegetable, fish, and soybean/tofu intake on colorectal cancer was found in women after adjustment for smoking, drinking, BMI, and sociodemographic factors. In the subgroup analysis of non-smokers and non-drinkers, the effect on colorectal cancer was increased in women (≥1 time/week vs. almost never, vegetables: hazard ratio (HR) 0.30, 95% confidence interval (CI) 0.13-0.69; fish: HR 0.46, 95% CI 0.26-0.83), and the fresh fish intake effect on stomach cancer was newly identified in men (HR 0.36, 95% CI 0.15-0.86). These effects were more pronounced and additionally shown in other dietary factors such as soybean or tofu in women and vegetables and fish in men, when subjects with <5 ng/mg urinary cotinine concentrations applied. The protective effect of healthy eating on the risk of stomach and colorectal cancer were different by smoking and drinking status. Rigorous control of smoking and drinking effects is necessary when measuring the effect of dietary factors on cancer, properly.

Recent studies have shed light on alterations to the proinflammatory tumor microenvironment as a significant carcinogenic mechanism. Despite previous studies on associations between proinflammatory cytokines and lung cancer risk, few studies have been conducted in Asian populations. This study aimed to investigate associations between proinflammatory cytokines and lung cancer risk, considering histological types, in the Korean general population. We carried out a case-cohort study on the Korean National Cancer Center Community (KNCCC) cohort (lung cancer cases: 136, subcohort: 822). Pre-diagnostic serum levels of proinflammatory cytokines (i.e., IL-6, TNF-α, IL-1β, IFN-γ, and IL-10) were measured using Quantikine® ELISA. A Cox proportional-hazards regression analysis was conducted. In this study, serum levels of IL-6, IL-1β, and IFN-γ were associated with lung cancer risk. IL-6 was associated with lung cancer, regardless of the histological type. IL-1β had an association only with adenocarcinoma, while IFN-γ had an association only with squamous-cell carcinoma. This study shows associations between serum levels of IL-6, IL-1β, and IFN-γ and lung cancer risk, underscoring the potential of these cytokines to act as risk biomarkers. The utilization of these biomarkers for risk prediction may hold the promise of facilitating the identification of the high-risk population.

Hepatocellular carcinoma (HCC) is a major cause of death in many countries, including South Korea. To provide useful and sensible advice for clinical management of patients with HCC, the Korean Liver Cancer Association and National Cancer Center Korea Practice Guideline Revision Committee have recently revised the practice guidelines for HCC management. However, there are some differences between practice guidelines and real-life clinical practice. In this review, we describe some key recommendations of the 2022 version of practice guidelines and the real-life clinical situation in South Korea, together with discussion about efforts needed to reduce the difference between guidelines and real-life clinical practice.

We compared cost-effectiveness parameters between inpatient and home-based hospice-palliative care services for terminal cancer patients in Korea. A decision-analytic Markov model was used to compare the cost-effectiveness of hospice-palliative care in an inpatient unit (inpatient-start group) and at home (home-start group). The model adopted a healthcare system perspective, with a 9-week horizon and a 1-week cycle length. The transition probabilities were calculated based on the reports from the Korean National Cancer Center in 2017 and Health Insurance Review & Assessment Service in 2020. Quality of life (QOL) was converted to the quality-adjusted life week (QALW). Modeling and cost-effectiveness analysis were performed with TreeAge software. The weekly medical cost was estimated to be 2,481,479 Korean won (KRW) for inpatient hospice-palliative care and 225,688 KRW for home-based hospice-palliative care. One-way sensitivity analysis was used to assess the impact of different scenarios and assumptions on the model results. Compared with the inpatient-start group, the incremental cost of the home-start group was 697,657 KRW, and the incremental effectiveness based on QOL was 0.88 QALW. The incremental cost-effectiveness ratio (ICER) of the home-start group was 796,476 KRW/QALW. Based on one-way sensitivity analyses, the ICER was predicted to increase to 1,626,988 KRW/QALW if the weekly cost of home-based hospice doubled, but it was estimated to decrease to -2,898,361 KRW/QALW if death rates at home doubled. Home-based hospice-palliative care may be more cost-effective than inpatient hospice-palliative care. Home-based hospice appears to be affordable even if the associated medical expenditures double.

Abstract Background: Angiogenesis is known to be related with poor survival. However, previous clinical studies with anti-angiogenetic agents failed to show a clear overall survival benefit and one of the reasons was lack of appropriate biomarker. Therefore, the identification of biomarkers that may identify patients who might benefit from target agents against angiogenesis may be the key to determining which patients would benefit from these therapies. This study aimed to find biomarker which can reflect angiogenesis of the tumor and serve as a prognostic factor. Methods: Patients with stage I-III breast cancer who completed planned treatment were included. Data were retrospectively collected from the Wonju Severance Christian Hospital database of Yonsei University and the Korean National Cancer Center database. Results: 534 patients were enrolled in this study. Patients were divided into two groups according to the cut-off value (31.4) of proportional ratio between maximum Hounsfield unit (HU) of tumor and maximum HU of aortic arch (maximum tumor - aorta ratio, TAR), and analyzed with clinico-pathological factors. Tumor stage was significantly related with higher TAR [TI vs T2-T3, 29.5% vs 50.6%, p &amp;lt; 0.001]. While estrogen receptor positivity was not related with TAR. Human Epiermal growth factor Rceptor-2 showed higher frequency in high TAR [high TAR vs. low TAR, 17.6% vs. 28.1%, p = 0.006]. Kaplan-Meier curve with log rank test showed significantly worse distant recurrence free survival in high TAR group (p &amp;lt; 0.001) Cox proportional hazard model indicated that age, ER negativity, and high TAR were significant risk factors for distant relapse. Conclusion: TAR measured by CT performed before treatment can be used as a prognostic factor for overall and distant relapse-free survival in patients with breast cancer. We believe TAR could be a potential biomarker to select patients who will benefit from target agents based on anti-angiogenesis. Key words: breast neoplasms, computed tomography, Hounsfield unit, survival analysis. Table 1.Baseline characteristics of patientsCharacteristicsNumber (n = 534) (%)Age54.4 ± 11.5HistopathologyInfiltrating ductal carcinoma498 (93.3)Infiltrating lobular carcinoma19 (3.6)Others17 (3.2)T stageT025 (4.7)T1280 (52.4)T2198 (37.1)T331 (5.8)Tumor size (cm)2.4 ± 1.8N stageN0356 (66.5)N1116 (20.6)N249 (9.2)N319 (3.6)Unknown1 (0.2)ER (+) *297 (55.6)PR (+) **274 (51.3)HER 2 (+) ***128 (24.0)ER, estrogen receptor; PR, progesterone receptor; HER2, human epidermal growth factor receptor 2; * Data were missing in 3 patients ** Data were missing in 2 patients *** Data were missing in 4 patients. Table 2.Relationship between TAR and clinico-histologic factorsClinico-pathologic factorsLower TAR(&amp;lt; 31.4 %) (n = 200)Higher TAR(≥ 31.4) (n = 334)p-valueAge56.2 ± 11.253.4 ± 11.60.007T stage (2 – 3)59 (29.5 %)169 (50.6 %)&amp;lt; 0.001Present lymph node metastasis62 (31.0 %)116 (34.7 %)0.395ER (+) *122 (61.3 %)175 (52.7 %)0.053PR (+) **109 (54.8 %)165 (49.5%)0.243HER – 2 (+) ***35 (17.6 %)93 (28.1 %)0.006TAR, Maximum Hounsfield unit of tumor aorta ratio; ER, estrogen receptor; PR, progesterone receptor; HER2, human epidermal growth factor receptor 2* Data were missing in 3 patients ** Data were missing in 2 patients *** Data were missing in 4 patients Citation Format: Kwangmin Kim, In-Jeong Cho, Hany Noh, Hyangsook Choi, Seok Hahn, Seung Taek Lim, Jong-In Lee, Airi Han. Prognostic significance of Hounsfield unit of tumor in patients with breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-08-19.

A Possible Role of Angiogenin in Intergenerational Transmission of Diet-Induced Metabolic Stress

A Role of Alkbh5 at the Early Stage of Cell Differentiation in C2C12 Cells

No published studies have prospectively evaluated the association between urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) levels and lung cancer risk in the general population. Here, we conducted a prospective community-based cohort study in the Republic of Korea to evaluate the relationship between urinary NNAL levels and lung cancer risk using prediagnostic urine samples. This prospective cohort study was based on the Korean National Cancer Center Community Cohort. During the follow-up period, 173 primary lung cancer cases were identified. Total urinary NNAL levels were measured by liquid chromatography-tandem mass spectrometry, and data were analyzed using multivariable Cox proportional hazards regression models. The risk of lung cancer was significantly increased per unit of natural log-transformed urinary NNAL (HR, 1.27; 95% CI, 1.09–1.48), after adjusting for age, region, entry year into the cohort, education achievement, alcohol consumption status, BMI, smoking status, and urinary cotinine levels. Cox proportional-hazards models with NNAL quartiles also showed positive dose-response relationships with risk of lung cancer. A significantly increased risk of lung cancer was found in the fourth quartile of urinary NNAL levels (HR, 3.27; 95% CI, 1.37–7.79, P for trend < 0.01). After stratification with sex, the significant association remained in only men. Urinary NNAL levels are associated with the risk of lung cancer in the general population, and this association is independent from the quantification of cigarette smoking and nicotine uptake.

Serum concentrations of persistent organic pollutants and colorectal cancer risk: A case-cohort study within Korean National Cancer Center Community (KNCCC) cohort

OBJECTIVESThis study was performed to identify the effect of physical activity at work on obesity and to analyze the contribution of socioeconomic factors and health behaviors to this association, which has been relatively little studied.METHODSFrom the Korean National Cancer Center Community Cohort, a total of 5,587 adults (2,125 men; 3,462 women) aged more than 30 years living in rural areas were enrolled. Information on socio-demographic factors, health behaviors, and body mass index was gathered using face-to-face interviews and measurements of height and weight.RESULTSInverse associations were identified between vigorous-intensity physical activity at work and obesity in both men and women, while no association was found between vigorous-intensity physical activity during leisure time and obesity. High household income was independently associated with a lower risk of obesity among those who had low levels of vigorous-intensity physical activity at work. Vigorous physical activity at work showed an inverse association with obesity in rural areas where heavy manual labor is common.CONCLUSIONSOur findings indicate the necessity to account for various types of physical activity to improve the assessment and prevention of obesity.

Background: This study aimed to determine the effects of metabolic syndrome (MetS) on colorectal cancer (CRC) using propensity score (PS) methods. Methods: The study subjects were 2417 men and 4568 women from the Korean National Cancer Center (KNCC) Community Cohort enrolled between 2003 and 2010. Odds risks (ORs) and 95% confidence intervals (CIs) using PS matching analysis, regression models adjusted by the PS or stratified into five strata according to PS, and PS weighting methods were calculated. Results: In women, MetS and abnormally high triglyceride (TG) levels were associated with CRC risk using the PS matching analysis (ORs, for MetS, 2.19 (95% CI, 1.10–4.33); for abnormal TG levels, 2.08 (95% CI, 1.07–4.02)). However, there were no significant associations between MetS and TG levels and CRC risk in men. Conclusions: Our study might provide additional evidence that deteriorated metabolic profiles increase the risk of CRC in women rather than men. Thus, this may have an important role in effective population-level interventions for deteriorated metabolic profiles at an early stage.

When radiologists interpret hepatic focal lesions seen on dynamic magnetic resonance imaging (MRI) scans, it is important not only to distinguish malignant lesions from benign ones but also to distinguish nonhepatocellular carcinoma (HCC) malignancies from HCCs. In addition, most major guidelines, including those of the American Association for the Study of Liver Disease, European Association for the Study of the Liver, and Korean Liver Cancer Association and National Cancer Center, allow for the noninvasive imaging diagnosis of HCC in at-risk patients. However, ~40% of HCC cases show atypical imaging features mimicking non-HCC malignancies. Furthermore, several benign and malignant lesions, such as flash-filling hemangioma and intrahepatic mass-forming cholangiocarcinoma, frequently look like HCC. In contrast, although multiparametric MRI options, including hepatobiliary phase and diffusion-weighted imaging, provide useful information that could help address these challenges, there remain several unresolved issues with regard to the noninvasive diagnostic criteria characterizing HCC. In this article, we discuss the typical imaging features and challenging situations related to primary liver cancers in MRI, while considering how to make a correct diagnosis. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 3.

The Asian Approach to the Management of Gastrintestinal Cancer Patients During the COVID-19 Pandemic Era

Impact of environmental exposure to persistent organic pollutants on lung cancer risk

Abstract Background: Recent studies suggest that the low-dose environmental exposure of persistent organic pollutants (POPs) may develop prostate cancer or breast cancer based on prospective cohort study design. This study investigates a relationship between environmental exposures to POPs and the development of colorectal cancer (CRC) in the general population. Methods: We conducted a case-cohort study based on the Korean National Cancer Center Community Cohort, which included 16,304 adults who enrolled from 1993 to 2010 and followed by 2016 for the cancer incidence. We included 104 CRC cases and 235 adults in a subcohort and assessed their serum lipid-adjusted levels of 19 organochlorine pesticides (OCPs) and 32 polychlorinated biphenyls (PCBs). Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for determining the association between POPs and risk of CRC were estimated using logistic regression analyses, controlling for following covariates: age, sex, education, physical activity, meat consumption, vegetable/fruit consumption, drinking, smoking, obesity, pesticides use experience, and residential areas. Results: Natural log-transformed cis-heptachlor epoxide and p,p’-DDD were significantly associated with increased risk of CRC [ORcis-heptachlor epoxide = 1.29, 95% CI: 1.03-1.62; ORp,p’-DDD = 1.63, 95% CI: 1.11-2.41] and increased ORs were also estimated for the highest versus lowest tertiles of these two metabolites [ORcis-heptachlor epoxide = 2.64, 95% CI: 1.24-5.6, p-trend = 0.021; ORp,p’-DDD = 3.51, 95% CI: 1.58-7.78, p-trend = 0.004]. Also, there was a significant association between natural log-transformed PCB 52 and risk of CRC (ORPCB 52 = 1.54, 95% CI: 1.06-2.24). Conclusion: Higher exposure to POPs, such as cis-heptachlor epoxide, p,p’-DDD, and PCB 52, was associated with the elevated risk of CRC. Our findings from a community-based prospective cohort provide evidence on the relationship between environmental exposure of POPs and CRC in the general population. Citation Format: Jinsun Kim, Eun Young Park, Byungmi Kim, Min Kyung Lim, Jin-Kyoung Oh. Environmental exposure to persistent organic pollutants (POPs) and primary colorectal cancer risk: A case-cohort study in a community-based perspective cohort [abstract]. In: Proceedings of the AACR Special Conference on Environmental Carcinogenesis: Potential Pathway to Cancer Prevention; 2019 Jun 22-24; Charlotte, NC. Philadelphia (PA): AACR; Can Prev Res 2020;13(7 Suppl): Abstract nr A16.

Survival in Untreated Hepatocellular Carcinoma: A National Cohort Study

The definition of early extrahepatic bile duct cancer might be different from that of other gastrointestinal cancer because of the differences of histologic features including the lack of muscularis mucosa and submucosal layer in bile duct. The purpose of this study was to evaluate the concept of early extrahepatic bile duct cancer in Korea. We evaluated seventynine cases of extrahepatic bile duct cancer who had received curative resection in Severence Hospital, Yonsei University from March 1986 to October 2005. We retrosptectively reviewed the medical records and analyzed variable prognostic factors to define early extrahepatic bile duct cancer. Invasion limited to the mucosa was noted in 5 cases (6.3%), fibromuscular layer in 12 cases (15.2%), adventitia of fibromuscular layer and serosa in 26 cases (32.9%), and invasion of adjacent organs in 36 cases (45.6%). Disease free 5-year survival according to the depth of invasion were 80.7% in tumor confined within mucosa, 80.0% within fibromuscular layer, 57.2% within adventitia of fibromuscular layer and serosa, and 51.5% in tumor with invasion of adjacent organ. There was no significant difference in the survival rate between patients with tumor confined to mucosa and patients with tumor invasion limited to the fibromuscular layer. However, the survival rate of patients with tumor limited to the mucosa or fibromuscular layer was significantly higher than that of patients with tumor invaded beyond fibromusular layer. In early cancer, there were more papillary polypoid type in gross finding and papillary adenocarcinoma in pathologic finding when compared to advanced cancer. Early extrahepatic bile duct cancer can be defined as the tumor invasion limited to the mucosa and fibromuscular layer.