Cancer Incidence Research Articles

Gastric cancer patient insights: Patient-reported outcomes and real-world perspectives from the gastric cancer patient community.

362 Background: According to the National Cancer Institute Surveillance, Epidemiology, and End Results Program, an estimated 26,890 patients in the United States will be diagnosed with gastric (stomach) cancer in 2024. Estimated deaths from the disease in 2024 will reach 10,880, with a five-year relative survival rate of 36%. Understanding the need for increased gastric cancer education and awareness, the GI Cancers Alliance created a 12-month series of engagement opportunities to better understand and listen to the gastric cancer patient voice and perspectives. Methods: Our 12-month patient-reported outcomes (PRO) research (September 2023 – August 2024) included an online survey, in person and virtual focus groups, and personalized follow-up interviews. 651 gastric cancer patients and survivors participated in these engagement opportunities, with 89% of participants asking for follow-up personalized interviews. One of our program goals was to reach and interact with patients who often experience barriers in receiving quality cancer care. Our PRO research provided an opportunity to amplify the patient voice and lived experience by engaging patients in medically underserved communities, rural and urban populations, diverse ethnic communities, and patients receiving care in community-based and federally funded oncology centers, and charity (indigent) care. Results: Overarching results from our study suggest that while advances have been made, health equity, racial disparities and barriers in cancer care remain a challenge. 651 patient participants (43% male, 54% female, 3% non-binary) identified their race/ethnicity as: 24% Black/African American, 22% Hispanic, 21% Multiracial, Non-Hispanic/White 19%, Asian/Pacific Islander 7%, Native American 2%, and 5% Other. 69% of patients reported that their clinician did not suggest biomarker testing, nor discuss the role of biomarkers to help make informed treatment decisions. 68% of patients were concerned that they lacked knowledge and options to make informed decisions regarding their treatment. 64% of patients reported they suffered from mental health concerns ranging from severe depression, feelings of hopelessness and anxiety; 63% of patients struggled to afford nutritious food to meet their changing dietary needs, especially post-surgery. Conclusions: Our PRO research underscores the need for increased education and outreach for gastric cancer patient communities experiencing barriers to high quality cancer prevention, early detection, and treatment. By partnering with our 100+ advocacy partner organizations, we will continue to amplify the gastric cancer patient voice by establishing new programming, initiatives, and enhanced outreach addressing the challenges and barriers to quality cancer care for all patients.

Regional variation in trajectories of colon cancer mortality, 2012-2021.

41 Background: Colorectal cancer (CRC) is the fourth most common cancer by incidence in the United States in 2024, and the second most common cause of cancer mortality in Texas. Rates of advanced CRC at diagnosis and cancer related mortality are higher in rural areas. Here we explore the variation in mortality trends across the eleven public health regions (PHR) of Texas from 2012 to 2021. Methods: We conducted a population-based cohort study of colon cancer mortality in Texas over the period 2012 through 2021. We queried the National Cancer Institute Surveillance, Epidemiology and End Results Program (SEER) for county level colon cancer deaths in Texas over the most recent available decade. Counties were aggregated into the eleven public health regions defined by the Texas Department of State Health Services. We calculated age-adjusted mortality rates (AAMRs) per 100,000 population using the direct standardization method based on the age group weights from the 2000 standard US population. Confidence intervals for AAMR were derived by estimating the standard error as the AAMR divided by square root of number of mortalities. The annual percent changes (APC) in AAMR were tested using negative binomial regression. Subgroup analyses included age group, sex, and race/ethnicity. Results: A total of 33,591 colon cancer mortalities were included in the study. Total colon cancer mortalities rose from 2,973 in 2012 to 3,800 in 2021. The statewide AAMR was initially 12.4 (95% CI 12.0 to 12.9), and did not change over the study period (APC -0.1% [95% CI -0.5% to 0.2%]; p = 0.5155) ending at (AAMR 12.5 [95% CI 12.1 to 12.9]). Divergent trajectories for AAMR across public health regions were observed. The largest decline in AAMR (APC -3.9% [95% CI -6.3 to -1.6]; p = 0.0013) occurred in region 10, where the AAMR fell from 14.2% [95% CI 8.6 to 19.7]) to AAMR 11.0 [95% CI 6.8 to 15.1]. Region 6 also saw a significant decrease (APC -1.1% [95% CI -1.8% to -0.4%]; p = 0.0029) falling from AAMR 12.2 [95% CI 11.3 to 13.2] to AAMR 11.2 [95% CI 10.4 to 11.9]. The largest significant increasing trend (APC +2.3% [95% CI 0.6% to 4.1%]; p = 0.0089) for AAMR was observed for region 9 rising from AAMR 12.4 (95% CI 9.6 to 15.3) to AAMR 15.4 (95% CI 12.3 to 18.4). Conclusions: Our analysis showed a significant and increasing trend in CRC related mortality in PHR 9. This region, colloquially termed West Texas, consists of 30 counties of which over 86% are designated as rural. Rural areas struggle with higher poverty, lower degree of higher education attainment, less access to healthcare and physicians, and a higher frequency of uninsured status. West Texas in particular also has a higher rate of smoking and obesity. However, PHR 10, which shares many similarities with PHR 9 such as rurality (83.3%) and similar socioeconomic and geographic challenges, witnessed the greatest decline in AAMR of the eleven PHR's in the same time frame, suggesting the presence of other factors which may be contributing to this increase.

Temporal trends in rural vs urban colon cancer mortality in Texas: A SEER database analysis from 2012 to 2021.

36 Background: Colorectal cancer is a major concern for the U.S. healthcare system, being the fourth most common cancer by incidence in the country with 152,810 cases in 2024. Measuring the burden this disease places on patients and health resources may serve to optimize our approach to the detection, management and resource allocation for combating this ailment. Methods: Our study is a population-based study cohort of colon cancer deaths in Texas. We queried the National Cancer Institute Surveillance, Epidemiology and End Results Program (SEER) for colon cancer deaths in Texas over the most recent available decade, 2012 through 2021. The National Center for Health Statistics Urban-Rural Classification Scheme was used to classify counties according to the 2013 US Census classification: urban (≥ 50,000) and rural (< 50,000). We calculated age-adjusted mortality rates (AAMRs) per 100,000 population using the direct standardization method based on the age group weights from the 2000 standard US population. Confidence intervals for AAMR were derived by estimating the standard error as the AAMR divided by square root of number of mortalities. Differences between AAMR were tested by comparing the 95% confidence intervals (95% CI) for the individual rates. The annual percent change (APC) in AAMR was tested using negative binomial regression. Subgroup analyses included age group, sex, and race/ethnicity. Results: Over the study period, 10.8% of the study population lived in rural areas and 89.2% lived in urban areas. A total of 33,591 colon-cancer deaths were reported during the study period with 5,423 (16.1%) in rural counties and 28,168 (83.9%) in urban counties. At the beginning of the study period the rural AAMR (13.9 [12.7 to 15.1]) was significantly higher than urban AAMR 12.1 [95% CI 11.7 - 12.6]). The rural AAMR rose significantly over the study period (APC 1.1% [95% CI 0.3% - 1.9%]; p = 0.0050) to AAMR 14.9 (95% CI 13.7 to 16.1). In contrast, the urban AAMR did not change over study period (APC -0.3% [95% CI -0.7 to 0.1]; p = 0.1444) and was equal to the initial AAMR 12.1 (95% CI 11.7 to 12.5). On subgroup analyses, males, people ages 25-64 years, Hispanics, Non-Hispanic Blacks, Non-Hispanic Asians, and Non-Hispanic Native Americans in rural areas each had significant and increasing trends in AAMR. Conclusions: Our analysis revealed an increase in AAMR in rural counties of Texas, reflecting a concerning trend with regard to colorectal cancer in this region. This may be due to higher poverty rates, lower level of education, more distance from healthcare facilities and difficulties with transportation faced by rural counties. Furthermore, rural areas also report higher rates of obesity and poor dietary habits. Rural areas also face a shortage of Primary Care Physicians (PCP’s), with metropolitan counties retaining 1.7 times as many PCP’s as rural counties, and 82.5% of counties without a PCP being rural.

Association of social deprivation and colon cancer mortality: A population-based analysis.

25 Background: Colon cancer mortality is largely influenced by social factors, with higher rates seen in deprived areas. The Social Deprivation Index (SDI) measures factors like poverty, education, and unemployment, which have been linked to poor health outcomes. This study examines the relationship between county level social deprivation and colon cancer mortality in Texas. Methods: We conducted a population-based cohort study of colon cancer deaths in Texas. We queried the National Cancer Institute Surveillance, Epidemiology and End Results Program for county level colon cancer deaths in Texas over the most recent available year, 2021. We calculated age-adjusted mortality rates (AAMRs) per 100,000 population using the direct standardization method based on the age group weights from the 2000 standard US population. Confidence intervals for AAMR were derived by estimating the standard error as the AAMR divided by square root of number of mortalities. The SDI by county was linked to mortality rate using Federal Information Processing Standards (FIPS) codes. The significance of the difference between two AAMR was evaluated by determining if the intersection of 95% confidence intervals was empty. The association between SDI and AAMR was tested using both unweighted and weighted Spearman correlation with county population as weight. Results are reported and Spearman correlation and 95% confidence interval (ρ [95% CI]). Sensitivity analysis was performed by considering only the individual components of the SDI. Subgroup analyses included age group, sex, urban counties, rural counties, and race/ethnicity groups. Results: A total of 3,800 colon cancer mortalities were identified in 2023. The statewide AAMR was 12.5 (95% CI 12.1 to 12.9). Out of 254 counties, 29 (11.4%) had an SDI ≤ 25, 61 (24.0%) had 26 ≤ SDI ≤ 50, 87 (34.3%) had SDI 51 ≤ SDI ≤ 75, and 77 (30.3%) had 76 ≤ SDI ≤ 100. Total population in counties with SDI ≥ 76 was 15,106,726 (51.1%) with AAMR 12.959 (12.379 to 13.538). In contrast, the population in counties with SDI ≤ 25 was 4,771,473 (16.1%) with significantly lower mortality (AAMR 9.752 [95% CI 8.879 to 10.625]). The population weighted Spearman correlation between county level SDI and AAMR was positive (ρ = 0.339 [95% CI 0.209 – 0.514]). The unweighted Spearman correlation between county level SDI and AAMR was also positive (ρ = 0.178 [95% CI 0.089 – 0.238]). Households with no vehicle, poverty, and unemployment were most correlated with AAMR while renter occupied housing had no association. The correlation of county level SDI and AAMR were similar for rural counties, urban counties, males, females, Whites, Hispanics and Blacks. Conclusions: This study reveals a significant positive correlation between higher SDI and increased colon cancer mortality at the county level in Texas. The findings highlight the need for targeted public health interventions in deprived areas to reduce mortality and address disparities.

Gender and ethnic disparities in hepatocellular carcinoma: Trends in incidence rates across U.S. populations from 2000 to 2021.

524 Background: Hepatocellular carcinoma (HCC) is a primary malignancy of the liver strongly associated with liver cirrhosis and the etiologies producing cirrhosis. As such, racial and ethnic factors might affect incidence rates of HCC resulting in disparities. While disparities have been reported, the effect of gender within certain populations, particularly Hispanic and non-Hispanic White ancestry, have not been fully explored. This study looks at the changing incidence rates of HCC in the US amongst different populations with a particular focus on the impact of gender on incidence. Methods: Incidence rates of HCC between 2000 and 2021 among different sexes within racial and ethnic groups in the United States were analyzed utilizing delay-adjusted data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. Annual percent change (APC) was calculated by using Joinpoint Regression software. Results: Overall, HCC incidence rates since 2014 to 2021 show a slight decrease (APC, -0.06). While Hispanic men HCC incidence rates declined from 2012 to 2021 (APC, -0.44), Hispanic women incidence have had a steady increase since 2000 (APC, +2.52). Non-Hispanic Black men (APC, -3.07) rates vastly declined from 2015 to 2021 while non-Hispanic black women interestingly experienced a slight decrease in incidence from 2013 to 2021 (APC, -0.34). Non-Hispanic White men experienced stagnant rates of HCC since 2014 (APC, -0.05) while non-hispanic white women (APC, +3.59) showed increasing trends in HCC incidence since 2003. For comparison, non-Hispanic Asian/Pacific Islander men (APC, -2.19) and women (APC, -2.36), which both experienced a decline since 2007. This analysis was repeated without significant change. Further corroborations are necessary to validate these findings. Conclusions: These findings show that while the incidence rates of HCC overall have decreased, this benefit appears to be largely driven in male populations. In contrast, in women, and particularly Hispanic and Non-Hispanic White women, incidence rates have been increasing. This phenomenon likely reflects the changes in etiologies of cirrhosis and HCC. Surveillance strategies and screening might need to be optimized to reflect these trends.

Disparities in liver cancer risk and outcomes in the LGBTQ community: A literature review.

528 Background: Liver cancer continues to be a significant public health concern, particularly among high-risk groups such as individuals with hepatitis infections, alcohol use disorders, and metabolic diseases. While liver cancer disparities have been well-documented among racial and ethnic minority groups, emerging research highlights significant health inequities within the LGBTQ community, including higher rates of risk factors and limited access to screening and care. This literature review aims to assess the extent of liver cancer disparities within the LGBTQ community and identify gaps in prevention, screening, and treatment. Methods: We performed a systematic search across PubMed, Scopus, and Google Scholar for peer-reviewed studies published between 2000 and 2024. The inclusion criteria focused on studies addressing liver cancer risk, prevalence, or outcomes in LGBTQ populations. Data on key liver cancer risk factors such as hepatitis B and C prevalence, alcohol use, obesity, and access to healthcare services were extracted and synthesized. Additionally, we reviewed public health reports and clinical guidelines relevant to LGBTQ health disparities. Results: The review identified significant disparities in liver cancer incidence and mortality among LGBTQ individuals. Hepatitis B infection rates were about 1.5 times higher, and hepatitis C rates up to 1.7 times higher among LGBTQ populations, particularly among gay and bisexual men. Alcohol use disorder was about 30-40% more prevalent in LGBTQ individuals, which further increases the risk of liver cancer. Screening for liver cancer in LGBTQ populations is underutilized, with rates approximately 20% lower than the general population. There were reported delays in diagnosis in LGBTQ community due to stigma, discrimination, and lack of culturally competent healthcare services. While some interventions targeting LGBTQ health have shown promise, the overall lack of targeted liver cancer prevention and treatment strategies remains a significant barrier. Conclusions: LGBTQ individuals face increased liver cancer risk due to a higher prevalence of key risk factors and inadequate healthcare access. Current screening and preventive strategies are insufficient for addressing these disparities. Targeted interventions, including enhanced screening efforts, hepatitis vaccination and treatment programs, and the development of LGBTQ-specific healthcare protocols, are needed to reduce the liver cancer burden in this underserved population. Policymakers and healthcare providers must address the unique needs of LGBTQ individuals to achieve equitable cancer outcomes. Prevalence of liver cancer risk factors in LGBTQ vs. general population. Risk Factor LGBTQ Population (%) General Population (%) Hepatitis B Infection 15 10 Hepatitis C Infection 18 12 Alcohol Use Disorder 25 16 Metabolic Syndrome 22 18 Screening Rate 40 60

Cervical cancer incidence and trends among women aged 15-29 years by county-level economic status and rurality - United States, 2007-2020.

Variations in cervical cancer incidence rates and trends have been reported by sociodemographic characteristics. However, research on economic characteristics is limited especially among younger women in the United States. We analyzed United States Cancer Statistics data to examine age-standardized cervical cancer incidence rates among women aged 15-29 years during 2007-2020. We used an index-based county-level economic classification to rank counties in the top 25 %, middle 25 %-75 %, and bottom 25 %. We assessed differences in incidence using rate ratios and trends using annual percent changes (APCs) from joinpoint regression. Due to impact from the COVID-19 pandemic, trend analysis excluded 2020 data. Analyses were conducted during August-October 2023. During 2007-2020, incidence rates were lower in the top 25 % counties economically than the bottom 25 % or middle 25 %-75 % (1.6 vs 2.1 vs 1.9 per 100,000, respectively). Rates were higher in nonmetropolitan than metropolitan counties across economic groups. Overall, rates declined in all county-level economic strata, especially in the bottom 25 % during 2015-2019 (APC -10.6 %). Rates appeared to decrease in metropolitan counties and women of all races across economic categories. decreases were most evident in the top 25 % of non-Hispanic White women during 2016-2019 and nonmetropolitan counties during 2017-2019. In women aged 15-29 years, declining rates of cervical cancer during 2007-2019 across county-level economic strata may partly reflect effects of human papillomavirus vaccination and cervical cancer screening. Further observed differences by race and rurality may help inform efforts to increase implementation of preventive measures in populations with the highest burden.

Quinazolinones as Potential Anticancer Agents: Synthesis and Action Mechanisms

Quinazolinones, essential quinazoline derivatives, exhibit diverse biological activities with applications in pharmaceuticals and insecticides. Some derivatives have already been developed as commercial drugs. Given the rising cancer incidence, there is a critical need for new anticancer agents, and quinazolinones show promising potential in this domain. The present review focuses on novel advances in the synthesis of these important scaffolds and other medicinal aspects involving drug design, the structure–activity relationship, and action mechanisms of quinazoline and quinazolinone derivatives, to help in the development of new quinazoline and quinazolinone derivatives.

Association between chemotherapy and the risk of developing breast cancer-related lymphedema: a nationwide retrospective cohort study.

Breast cancer-related lymphedema (BCRL) is a well-known complication of breast cancer treatment, which often includes chemotherapy. This study aimed to investigate the association between chemotherapy and the risk of developing BCRL in patients with new-onset breast cancer. This nationwide retrospective cohort study utilized data from the Korean National Health Insurance database and the Korea National Cancer Incidence Database (2006-2017). Using 1:1 propensity score matching, 37,202 participants who received chemotherapy and 37,202 who did not receive chemotherapy were included in the analysis. Cox proportional hazard regression models were employed to examine the association between chemotherapy and the risk of developing BCRL. Among the 74,404 participants, 11,508 (15.5%) were diagnosed with BCRL during the follow-up period. Compared with patients who did not receive chemotherapy, the risk of BCRL was higher in patients undergoing chemotherapy (hazard ratio [95% confidence interval]: 1.95 [1.87-2.04]). Furthermore, compared to patients who did not receive chemotherapy, the risk of BCRL was confirmed in the taxane (3.38 [3.19-3.58]), antimetabolite (1.79 [1.67-1.91]), and anthracycline (1.49 [1.41-1.56]) chemotherapy groups. Chemotherapy administration following a diagnosis of breast cancer increases the risk of BCRL. Therefore, vigilant monitoring for BCRL, particularly in patients undergoing chemotherapy with taxanes, antimetabolites, or anthracyclines, is warranted during follow-up.

Frequency and incidence of oncogenic RAS mutations in patients with metastatic pancreatic ductal adenocarcinoma: Derived from the real-world evidence database Foundation Medicine Insights.

777 Background: Approximately 60,000 patients are diagnosed with pancreatic cancer in the United States annually, with half of all cases diagnosed at the metastatic stage. 1 The most common type, pancreatic ductal adenocarcinoma (PDAC), accounts for ~90% of all pancreatic cancers 2 and is characterized by frequent KRAS oncogenic mutations. Newer investigational therapeutics target HRAS and NRAS, in addition to KRAS. To comprehensively characterize the incidence of RAS mutations in patients with PDAC, we analyzed mutational frequency data from the Foundation Medicine Insights (FMI) database. Methods: NGS-based comprehensive genomic profiling (CGP) data from 27,298 PDAC tissue samples were accessed from the FMI database (May 7, 2024 data cut). Only ‘short variants’ in RAS genes ( KRAS , NRAS , and HRAS) occurring at amino acid positions G12, G13, or Q61 that had a frequency 0.1% or greater were included. To estimate the number of new US cases of RAS -mutant PDAC, pancreatic cancer incidence estimates 3 were adjusted by the derived RAS mutational frequency values. All incidence estimates were rounded to the nearest 100. Results: Oncogenic RAS mutations were identified in 92% of PDAC patients, with nearly all being KRAS (91.8%) and the remaining NRAS (0.2%). No HRAS mutations passed our minimum frequency threshold requirement. Individual RAS mutations with frequency >1% included KRAS G12D (39.9%), KRAS G12V (28.6%), KRAS G12R (14.6%), KRAS Q61H (4.2%), KRAS G12C (1.7%), and KRAS Q61R (1.4%). Applying these RAS mutation rates to reported PDAC incidence, we estimate that ~56,000 new patients with PDAC in USA per year will have tumors harboring an oncogenic RAS mutation, including ~51,000 of those with a RAS G12 mutation specifically. Conclusions: Oncogenic RAS mutations are identified from NGS testing in nearly all patients with advanced PDAC. Both the frequency and diversity of RAS mutations in PDAC suggest that PDAC is largely a RAS-driven cancer and that targeting RAS may be useful broadly in this disease. Mutational frequency and incidence at G12, G13, and Q61 amino acid positions in KRAS and NRAS among patients with PDAC. RAS G12 RAS G13 RAS Q61 RAS mutant Mutational Frequency KRAS 85.7% 0.8% 6.3% 91.8% NRAS 0.1% Below threshold 0.1% 0.2% Incidence KRAS 51,300 600 3,700 55,600 NRAS 100 Below threshold 100 200

Patient perspective: Is intensive screening of women at high risk of breast cancer evidence-based medicine or déjà vu?

In 2023, a breast cancer risk assessment and a subsequent positive test for the BRCA-2 genetic mutation brought me to the uncomfortable intersection of a longstanding career as an advocate for high-quality medical evidence to support shared patient-provider decision making and a new role as a high-risk patient. My search for studies of available risk-management options revealed that the most commonly recommended approach for women with a ⩾20% lifetime breast cancer risk, intensive screening including annual mammography and/or magnetic resonance imaging beginning at age 25-40 years, was supported only by cancer-detection statistics, with almost no evidence on patient-centered outcomes-mortality, physical and psychological morbidity, or quality of life-compared with standard screening or a surgical alternative, bilateral risk-reducing mastectomy. In this commentary, I explore parallels between the use of the intensive screening protocol and another longstanding women's health recommendation based on limited evidence, the use of hormone therapy (HT) for postmenopausal chronic disease prevention, which was sharply curtailed after the publication of the groundbreaking Women's Health Initiative trial in 2002. These declines in HT utilization were followed by marked decreases in breast cancer incidence, providing a compelling lesson on the critical importance of a solid evidentiary basis for women's health decisions. Known harms accompanying the benefits of breast screening-overdiagnosis, psychological effects, and mammography-associated radiation-exposure risks-make empirical measurement of patient-centered outcomes essential. Yet, published research on intensive screening of women at high breast cancer risk has largely ignored these outcomes, leaving patients, providers, and guideline developers lacking the evidence needed for best practice. Outcomes research is both feasible and urgently needed to inform care decisions and health policy for this patient population.

Factors Contributing to Late Breast Cancer Diagnosis at the Brazzaville University Hospital in 2020, Congo: A Cross-Sectional Analytic Study.

Breast cancer is leading the cancer incidence and mortality ranks worldwide. Currently, breast cancer represents 30.1% of all cancers occurring in women in Congo. In sub-Saharan Africa, breast cancer is diagnosed delayed in 70% of cases. The purpose of this work is to study the epidemiological aspects of patients with late diagnosis of breast cancer at the Brazzaville University Hospital, Congo. We carried out a cross-sectional analytic study in the medical oncology service of the University Hospital of Brazzaville. We used systematic, exhaustive sampling. Logistic regression was used for data analysis, and P values ≤5% were considered significant. Data for 182 patients were collected. Delay in diagnosis represented 91.21% of cases. Delay in diagnosis was significantly associated with lack of finance (P = 0.011) and with breast cancer stages greater than 2 (P < 0.001), but the proximity to the center was suggestive. Multivariate analysis revealed an association between diagnostic delay and proximity to the center (P = 0.025) as well as with breast cancer stages greater than 2 (P < 0.001). The delay in breast cancer diagnosis widely discussed in the literature remains relevant in Congo. Routine screening, the construction of a cancer center and its optimal equipment, and the subsidy of care are all critical factors for battling delayed breast cancer diagnosis in Congo.

Prognostic factors for thermo-ablation of liver metastases in colon cancer: A Maltese perspective.

267 Background: Malta is a small Mediterranean archipelago with an annual colon cancer incidence of 300 patients per year and a cumulative 5-year overall survival of 58%. Despite major improvements in therapeutic strategies, colon cancer remains the third leading cause of cancer deaths locally with an annual mortality rate of circa 110 patients per year. Percutaneous thermal ablation of colorectal liver metastases involves exposure of metastatic deposits to temperature extremes using radiofrequency, microwave or cryotherapy. The role of this case series was to examine the prognostic value of clinico-pathological variables to provide insight into patient selection for ablative therapy. Methods: This retrospective analysis of 66 adult patients with colorectal liver oligometastatic disease who underwent thermal ablation between January 2014 and January 2022, reviews demographic and pathological criteria including tumour grade, presence of vascular invasion, mismatch repair and k-RAS &amp; BRAF mutational status, CEA &amp; Ca19.9 assay at time of treatment. Other parameters include metachronous versus synchronous disease, hepatic burden and concurrent chemotherapy. All these co-variables were analysed using the Cox Regression Hazard model to assess their impact on progression free- (PFS) and overall survival (OS). Results: For this patient cohort, the mean PFS and OS were 13.1 and 33.8 months. Our data indicates that most individuals experience progression within the first 10 months, with a gradual decline in PFS for the remaining individuals. A Ca19.9 level within normal limits (p=0.004, HR 0.157-0.700 95% CI) was related to an improved PFS but not OS. The presence of synchronous metastases (p=0.004, HR 0.168-0.715 95% CI) and ablation of one lesion (p=0.013 HR 0.191 (0.052-0.702 95 CI) were favourable prognostic markers for improved OS. k-RAS wt status was a prognostic adverse biomarker for PFS (p=0.002, HR 1.529, 6.686 95% CI). There was a paucity of data for BRAF and MMR status so these were excluded from the final analysis. No statistical survival benefit was noted for patients treated with chemotherapy, and other variables including gender, age, primary tumour sidedness, LVSI or CEA value. Conclusions: There are two surprising trends here- the paucity of survival benefit for the use of chemotherapy in conjunction with ablation and the worse outcome for k-ras wt tumours. We postulate that the absence of BRAF sub-stratification at the time of patient accrual, impacted statistical hazard. This case series suggests that the prognosis and survival of colorectal liver oligometastatic disease is multifactorial and complex, highlighting the need for further genomic and molecular insights.

Causal Exposures in Pancreatic Cancer Incidence: Insights From Mendelian Randomization Studies

ABSTRACTAimPancreatic cancer, marked by its high lethality and poor 5‐year survival rate, requires a thorough understanding of its risk factors and etiological mechanisms. In this review, we collected the latest findings from Mendelian randomization (MR) studies to identify potential causal factors for pancreatic cancer.Method and ResultsThe present analysis encompasses MR studies on the gut and oral microbiomes, non‐malignant phenotypes, blood metabolites, immune cells, and chronic inflammation. Specific gut and oral microbiome species have been identified as potential causal factors for pancreatic cancer, some with protective effects, and others increasing the risk. The review also highlights causal associations between obesity, type 2 diabetes, and pancreatic cancer, as well as the impact of blood metabolites and immune cell phenotypes on disease risk. Additionally, it investigates the causal effects of inflammatory bowel disease, showing a significant risk increase associated with Crohn's disease.ConclusionThese insights emphasize the need for interdisciplinary research and personalized medicine to enhance prevention and treatment strategies for pancreatic cancer.

Optimizing clinical trial design to mitigate racial disparities in pancreatic cancer clinical trial enrollment.

682 Background: Participation in pancreatic ductal adenocarcinoma (PDAC) clinical trials remains dismal among patients from minoritized groups. This study aimed to investigate if clinical trial design, including eligibility criteria, affects representation of minoritized populations. Methods: United States Phase I-IV PDAC clinical trials between 2000-2020 were extracted from the ClinicalTrials.gov database. The Surveillance, Epidemiology, and End Results (SEER) database was used to determine cancer incidence linked with years of trial enrollment. Enrollment fraction (EF) was defined as the number of trial participants divided by the incidence of PDAC in each racial and ethnic group. Representation Quotient (RQ) was defined as the proportion of trial participants divided by proportion of PDAC incidence for each subgroup, where underrepresentation was RQ &lt;1.0. Results: 8451 patients from 228 unique PDAC clinical trials were analyzed. 55.7% (n=128) and 44.3% (n=102) trials reported racial and ethnic demographic data, respectively. Non-Hispanic Black (NHB), Non-Hispanic Asian/Pacific Islander (NHAPI), Non-Hispanic American Indian/Alaskan Native (NHAIAN), and Hispanic patients were underrepresented (Table). NHB patients were more likely to be underrepresented in trials for metastatic PDAC disease (89.4% vs. 73.8% of trials, p=0.035). NHB patients demonstrated an increase in median RQ (0.28 vs. 0.48) in trials from 2000-2010 vs. 2011-2020, while Hispanic patients had a decreased median RQ (0.36 vs. 0.25). Trials with renal insufficiency exclusion criteria without cutoffs or explicit methodology were more likely to accrue NHB patients (RQ 0.88 vs. 0.46, p=0.02), whereas trials that used a creatinine cutoff or the modified Cockcroft-Gault (CG) formula did not significantly affect RQ. Other eligibility criteria including cardiac history, HIV, Hepatitis B/C, and receipt of neoadjuvant therapy did not significantly affect RQ for any racial or ethnic group. Trial location and funding source did not affect RQ for any group. Conclusions: Systemic barriers persist in minority enrollment in PDAC clinical trials. Clinical trial design optimizing inclusive eligibility requirements is a first feasible step in increasing minority clinical trial enrollment. Racial and ethnic representation in pancreatic ductal adenocarcinoma clinical trials. Enrollment Fraction (Median, IQR) Representation Quotient (Median, IQR) NHW 0.28 (0.12-0.62) 1.17 (1.09-1.24) NHB 0.15 (0-0.33) 0.47 (0-0.87) NHAPI 0 (0-0.23) 0 (0-0.45) NHAIAN 0 (0-0) 0 (0-0) Hispanic 0.07 (0-0.21) 0.26 (0-0.68) *Abbreviations: Interquartile Range (IQR), Non-Hispanic Black (NHB), Non-Hispanic Asian/Pacific Islander (NHAPI), Non-Hispanic American Indian/Alaskan Native (NHAIAN).

A Comprehensive Appraisal of Bisbenzylisoquinoline Alkaloids Isolated From Genus Cyclea for Anticancer Potential.

The pharmaceutical industry and academia are continuously searching for novel and effective anticancer lead compounds to ensure patient safety, provide a cure, and surpass all other obstacles. Given the indeterminate nature of cancer etiology, the importance of drugs capable of targeting multiple pathways cannot be overstated. Among naturally occurring compounds, bisbenzylisoquinoline (BBIQ) alkaloids, such as berberine, tetrandrine, chelidonine, and berbamine, have demonstrated significant anticancer potential by modulating diverse signaling pathways. Several of these compounds are currently in clinical trials, highlighting their relevance in cancer treatment. This review emphasizes the need for further investigation into the anticancer properties of BBIQ alkaloids, particularly those isolated from eight Cyclea species in India. With around 27 BBIQ alkaloids identified, these compounds hold promise, especially in combating multidrug resistance-a critical challenge in cancer therapy. Given the rising cancer incidence, these alkaloids warrant a deeper exploration of their therapeutic potential.

Pediatric Cancer Epidemiology for 2021–2023 Based on the Cancer Registry of Indonesia’s National Referral Hospital

Objective: This study aimed to present epidemiological data on pediatric cancers based on the hospital-based cancer registry (HBCR) at Indonesia’s National Referral Hospital. Material and Methods: This descriptive study analyzed data on pediatric cancers from the HBCR for 2021–2023. Demographical data, including age, gender, diagnosis, and admission year, were extracted from the HBCR data. Univariate data analysis was conducted. Results: This study included 344 patients, consisting of 202 males and 142 females. Of those patients, 92 (26.7%) were admitted in 2021, 142 (41.3%) in 2022, and 110 (32%) in 2023. The highest cancer incidence was observed in patients aged 2–5 years (34.9%) and the lowest in those aged &lt;2 years (11.9%). The three most common reported cancers were lymphoid leukemia (47.4%), myeloid leukemia (11.6%), and retinoblastoma (9.6%). Conclusion: Males predominated over females due to the substantial prevalence of leukemia cases. Most pediatric cancers were observed in those aged 2–5 years. While the distributions of cancer varied by age and gender, leukemia remained the leading pediatric cancer.

Temporal trends of liver cancer burden, comparative analysis of risk factors and trend forecasts to 2024 in China, USA, the Republic of Korea, and Mongolia: an analysis based on multiple data sources from Global Burden of Disease 2019, the Global Cancer Observatory, and Cancer Incidence in Five Continents.

Liver cancer represents a significant burden of disease globally, with variations in liver cancer status among countries. In this study, we aimed to evaluate the epidemiological burden of liver cancer in four representative countries - China, the USA, the Republic of Korea, and Mongolia - and cover the highest number of incidence cases, the highest prevalence rates and the burden in developed countries. In addition, we intended to predict the trends in liver cancer in these countries over the next six years. We collected epidemiological data on liver cancer from the Global Burden of Disease 2019, the Global Cancer Observatory, and Cancer Incidence in Five Continents databases to conduct data source triangulation. We calculated time trends using Joinpoint regression and predicted incidence rates using an autoregressive integrated moving average model. Aetiological studies were conducted for different countries based on changes in incidence causes. Between 1990-2019, age-standardised rates (ASR) values for liver cancer declined globally. The downward trend was most pronounced in China, where the average annual percentage change of age-standardised incidence rate (ASIR) reached -3.13 (95% confidence interval (CI) = -2.90, -3.35), much higher than the world average of -1.16 (95% CI = -0.96, -1.36). The ASIR in the USA continued improving and reached 5.23 × 105 in 2019. With age, the ASR for liver cancer in various countries generally shows an upward trend. Hepatitis B virus (HBV) remains the main causative agent of liver cancer in China and Korea. In Mongolia, both HBV and hepatitis C virus account for a large proportion of liver cancer. In the USA, the proportion of liver cancer cases from alcohol consumption has increased annually. The ASR for liver cancer has declined over the past 30 years in most countries but has worsened in some due to ageing and unhealthy lifestyles.

Effect of weight loss following Roux-en-Y gastric bypass on cancer risk: A Mendelian randomization study.

Cancer incidence and development are strongly correlated with obesity, however there is insufficient data to support a causal relationship between intentional weight loss and the prevention or promotion of cancer. We investigated the causal relationship between weight loss following Roux-en-Y gastric bypass (RYGB) and the incidence of 18 cancers using Mendelian randomization (MR). A genome-wide association studies (GWAS) data related to weight loss following RYGB from the GWAS catalog database were used as exposure, and GWAS data related to 18 cancers from the Medical Research Council integrative epidemiology unit open GWAS project were used as outcomes. In order to investigate the causal relationship between exposure and results, we used a two-sample MR approach. The primary analysis technique was inverse variance weighting, with weighted median, and MR-Egger regression utilized as supplemental techniques to confirm the findings. Heterogeneity and horizontal pleiotropy were investigated using a variety of sensitivity studies, including the Cochran Q test, MR-Egger regression pleiotropy test, MR pleiotropy residual sum and outlier, and leave-one-out analysis. We included a total of 4 single-nucleotide polymorphisms as instrumental variables through rigorous quality control screening. Under the limitations of Bonferroni correction threshold (P < 2.78 × 10-3), our results suggest that the weight loss following RYGB has a significant causal relationship with a reduced risk of breast (odds ratio [OR]: 0.784; 95% confidence interval [CI]: 0.762-0.808; P = 2.167e-58) and lung cancer (OR: 0.992; 95% CI: 0.987-0.997; P = .0023), and a potential causal relationship with a decreased risk of hematological cancer (OR: 0.9998462; 95% CI: 0.9997088-0.9999836; P = .028) and an increased risk of cervical cancer (OR: 1.000123; 95% CI: 1.0000313-1.000215; P = .009). Sensitivity analysis confirms the robustness of our analysis results. Genetically predicted weight loss following RYGB has significant causal effects in reducing the risk of breast and lung cancer. It also has potential benefits in lowering the risk of hemotological cancers and increasing the risk of cervical cancer. Considering the limitations of our study, the reliability of its results and the underlying mechanisms require further investigation.

The global, regional burden of pancreatic cancer and its attributable risk factors from 1990 to 2021

BackgroundPancreatic cancer is the 12th most common type of cancer, and the sixth leading cause of cancer-related mortality, worldwide. Up-to-date statistics on pancreatic cancer would provide us with a better understanding of epidemiology and identify the causative risk factors for the prevention of this disease.MethodsThe degree and change patterns of exposure as well as the attributable cancer burden, including incidence, mortality, disability-adjusted life years (DALYs), and prevalence in global and regional, by sex, age, year, for pancreatic cancer, with the data extracted from the Global Burden of Diseases Study (GBD) 2021. All data analyses were conducted using linear regression analysis and the Joinpoint software (version 5.0.1).ResultsIn 2021, 508,533 new cases of pancreatic cancer have been reported; the mortality and prevalence rate increased to 5.95, and 5.12 respectively; and the global DALYs rate increased to 130.33 this year. Besides, the pancreatic cancer-associated rates of incidence, mortality, DALYs, and prevalence were higher in males than in females. In addition, these indicators in the high SDI (Sociodemographic index) region were higher than the global mean. To date, the high fasting plasma glucose remained the major risk factor that influenced the incidence, mortality, DALYs, and prevalence of pancreatic cancer, followed by tobacco and high body mass index (BMI).ConclusionsResults of this study suggest that the burden of pancreatic cancer is increasing generally, therefore, more attention and measures should be taken to cope with this situation.