Association between tuberculosis infections and non-pulmonary malignancies: a nationwide population-based study

Background:

In addition to lung cancers, tuberculosis infections have been associated with increased risk of non-pulmonary malignancies in case reports. Our population-based study employed standardized incidence ratios (SIRs) to systemically survey non-pulmonary cancer risks after tuberculosis infections.

Methods:

Data of patients who had newly diagnosed tuberculosis, were aged 20 years or older, and had no prior cancer or tuberculosis were sampled from the Taiwan National Health Insurance database between 2000 and 2010. SIRs compared cancer incidence in patients with tuberculosis infections to the general population. SIRs of specific cancers were further analyzed with respect to gender and time after tuberculosis infections.

Results:

After a follow-up period of 28 866 person–years, 530 tuberculosis cases developed cancers compared with 256 cases in the general populations (2.07, 95% confidence interval (CI), 1.90–2.26). The SIR of non-pulmonary malignancies was also increased (1.71, 95% CI, 1.54–1.90). For males, SIRs were increased within 1 year after tuberculosis diagnosis for the following cancers: head and neck, esophageal, colorectal, liver, lung, melanomas, and Hodgkin''s disease. SIRs were increased for liver, biliary, lung, and bladder cancers beyond the first year after tuberculosis diagnosis. For females, SIRs were increased for leukemia, esophageal, and lung cancers within the first year, and only for leukemia beyond 1 year post diagnosis.

Conclusion:

Having found increased risks of several cancers that differ with gender and time after tuberculosis diagnosis, physicians may consider these factors in patients following tuberculosis diagnosis.     

An analysis of first-time enquirers to the CancerBACUP information service: variations with cancer site, demographic status and geographical location.

A retrospective comparison of cancer incidence data and, where relevant, population data with 16,955 first-time users (patients, relatives and friends) of a national cancer information service (CancerBACUP) during the period April 1995 to March 1996 is presented. The number of events observed was compared with the number of events expected, were the national rates of cancer incidence and population demographics apply. Standardized incidence ratios (SIRs) (observed - expected ratios) were used to indicate any differences. Statistically significant differences (P < 0.001) in the observed and expected sex, age and primary site distribution of patients enquired about were found. Statistically significant differences (P < 0.001) were also identified for the age, employment status, socioeconomic class and geographical location of first-time enquirers (patients, relatives and friends). Enquiries about brain, testis and breast cancers and non-Hodgkin's lymphoma (NHL) were substantially higher than expected; enquiries about bladder, lung, stomach and colorectal cancers were much lower than expected. As the service is provided via a freephone number, it is available to all, and users might be expected to be randomly distributed across the variables listed. The underlying reasons for the differences identified need to be investigated, and the role of information in the care of cancer patients should be formally evaluated.     

Epidemiology of the breast cancer patients registered at Institute of Radiotherapy and Nuclear Medicine, Peshawar, Pakistan

In Pakistan, malignant diseases are increasing day by day, but no epidemiological cancer study on large scale has been designed. The main objective of this study was to provide a baseline data on frequency, morphological types, gender and age distribution etc., of breast cancer in North-West Frontier Province and Federally Administered Tribal Areas of Pakistan, and to compare it with the published data. In this context, 2134 breast cancer patients (2059 female and 75 male) registered at Institute of Radiotherapy and Nuclear Medicine, Peshawar from 1995 to 2001, were studied. Crude incidence, standardized incidence ratios (SIR, world) and age-specific incidence rates (ASIR) were determined both for male and female patients. Same morphological distribution was found in both genders. Moreover, breast cancer was found to be the most common malignancy among the women (96.49%). Male to female breast cancer ratio was found to be 3.5 times higher than the reported data. The highest ASIR of ∼10.6/100 000 per year among women was observed in the age group of 55–59 years. In men, the highest ASIR of 0.84/100 000 per year was observed in the age group of 65–69 years. The SIR (world) for women was 3.15/100 000 per year, while for male this was 0.13/100 000 per year.     

Risk of nonovarian cancer in a nationwide-based study of nearly 5000 women with borderline ovarian tumors in Denmark

Evidence regarding cancer risk after borderline ovarian tumors (BOTs) is limited. We conducted a nationwide cohort study examining the incidence of nonovarian cancers in women with serous or mucinous BOTs compared with the general female population with up to 41 years of follow-up. Through the nationwide Pathology Registry, we identified nearly 5000 women with BOTs (2506 serous and 2493 mucinous) in Denmark, 1978 to 2018. We computed standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) as relative risk estimates of specific nonovarian cancers. Compared with general female population rates, women with serous BOTs had increased rates of particularly malignant melanoma (SIR = 1.9; 95% CI: 1.3-2.6), thyroid cancer (SIR = 3.0; 95% CI: 1.4-5.4) and myeloid leukemia (SIR = 3.2; 95% CI: 1.5-5.8), and women with mucinous BOTs had elevated rates of lung cancer (SIR = 1.7; 95% CI: 1.3-2.1), pancreatic cancer (SIR = 1.9; 95% CI: 1.2-2.9) and myeloid leukemia (SIR = 2.3; 95% CI: 0.9-4.7). We found no convincing association with neither breast nor colorectal cancer in women with BOTs. This is the first large nationwide study showing that women with specific types of BOTs have increased risks of several nonovarian cancers, likely due to some shared risk factors or genetic characteristics.     

Considerations of treatment standardization from the procession of NCCN guideline of esophagealcancer

Esophageal carcinoma is one of the most common malignant tumors, especially in China which is the high incidence area. As a result of mild symptoms of early-stage esophageal cancer, the majority of patients cannot be diagnosed until they develop to advanced cancer, and the treatment outcome of surgery or chemoradiotherapy is still unsatisfactory at present. The guidelines of esophageal cancer issued by National Comprehensive Cancer Network (NCCN) are regarded as important reference tools by clinical oncolog...     

江苏省昆山市1993-2014年白血病死亡趋势分析

目的 探究江苏省昆山市1993-2014年白血病死亡趋势。方法 江苏省昆山市1993-2014年白血病死亡病例来源于昆山市历年的死因监测;计算历年白血病粗死亡率,以及中国2000年人口年龄构成标化的死亡率（age standardized rate, ASR）;使用年度变化百分比（annual percentage change, APC）及其95%CI评价白血病死亡率在年份之间变化趋势。结果 江苏省昆山市1993-2014年期间白血病死亡总例数为570例,占全肿瘤比例2.19%;其中男312例,女258例。白血病粗死亡率在男女合计（APC=1.5, 95%CI: 0.0~3.0, P=0.0604）、男性人群（APC=0.8,95%CI: -0.6~2.2, P=0.2756）及女性人群中（APC=2.7, 95%CI: 0.0~5.4, P=0.0622）均没有明显的变化趋势。1993-2014年白血病中标死亡率在男女合计（APC=1.5, 95%CI: 0.0~3.0, P=0.0604）、男性（APC=-0.7, 95%CI: -2.4~1.0, P=0.4087）以及女性（APC=0.4, 95%CI: -2.3~3.1, P=0.7612）人群中均没有明显变化趋势。结论 虽然白血病死亡率变化趋势不明显,但是因白血病死亡的例数逐年增加,在全人群中开展白血病预防控制十分必要。     

非小细胞肺癌组织中Treg与PET/CT SUVmax的相关性及其对预后的影响

目的:探讨非小细胞肺癌(non-small cell lung carcinoma,NSCLC)组织中Foxp3+调节性T细胞(regulatory T cell,Treg)与18F-脱氧葡萄糖(fluorodeoxyglucose,FDG) PET/CT原发灶最大标准摄取值(maximum standardized uptake value,SUV-max)的相关性及其对临床预后的影响.方法:收集2008年3月至2014年10月天津医科大学肿瘤医院收治的122例原发性NSCLC患者的临床、影像、病理、组织标本及随访资料.采用免疫组化法检测肺癌组织中Treg浸润情况.采用Kaplan-Meier法分析患者生存情况,并分析Treg浸润情况与原发灶SUVmax的相关性,及与各临床病理因素的关系.结果:Treg浸润情况与原发灶SUVmax呈正相关(r=0.291,P=0.001).Treg及SUVmax均以临界值(cut off)值分高低两组,单因素分析显示Treg、SUVmax是影响患者预后的危险因素;临床资料分析显示,肿瘤越大、肿瘤分期越高,Treg浸润越严重(P＜0.05).Cox多因素分析显示肿瘤TNM分期(HR=7.537,95％CI:1.191-2.855,P=0.006)为患者生存的独立预后影响因子.结论:NSCLC组织中Treg浸润与PET/CT SUVmax正相关,PET/CT SUVmax可提示NSCLC患者肿瘤微环境中Treg浸润情况,对判断患者临床预后及临床用药有一定的指导作用.     

Chemotherapy response evaluation with FDG-PET in patients with colorectal cancer.

BACKGROUND: The aim of this prospective study was to evaluate the value of F-18-fluorodeoxyglucose-positron emission tomography (FDG-PET) for early assessment of chemotherapy response in patients with advanced colorectal cancer. METHODS: Dynamic FDG-PET was carried out before and at 2 (n = 50) and 6 months (n = 19) after the start of treatment. Quantitative Patlak analysis [metabolic rate of glucose (MRGlu)] and a simplified method to measure glucose metabolism [standardized uptake value (SUV)] were evaluated. The predictive value of changes in glucose metabolism was assessed with Cox proportional regression analysis. Overall survival (OS) and progression-free survival (PFS) were calculated using Kaplan-Meier estimates. RESULTS: There was an increase in the rates of death (P = 0.049 for DeltaMRGlu PET1-2; P = 0.017 for DeltaSUV PET1-2; P = 0.032 for DeltaMRGlu PET1-3; P = 0.048 for DeltaSUV PET1-3) and progression (P = 0.026 for DeltaMRGlu PET1-2; P = 0.035 for DeltaSUV PET1-2; P = 0.041 for DeltaMRGlu PET1-3; P = 0.081 for DeltaSUV PET1-3) associated with worse response as assessed by PET on Cox proportional regression analysis. The OS and PFS analysis showed a significant predictive value at broad ranges of DeltaMRGlu and DeltaSUV cut-off levels. CONCLUSION: The degree of chemotherapy-induced changes in tumor glucose metabolism is highly predictive for patient outcome. The use of FDG-PET for therapy monitoring seems clinically feasible since simplified methods (SUV) are sufficiently reliable.     

Risk of specific types of ovarian cancer after borderline ovarian tumors in Denmark: A nationwide study

Population-based evidence regarding risk of ovarian cancer after a borderline ovarian tumor (BOT) is sparse. We aimed to examine the incidence of specific types of ovarian cancer in women with serous or mucinous BOTs in a nationwide cohort study with up to 36 years of follow-up. Using the nationwide Danish Pathology Data Bank, we identified 4,281 women with a BOT (2,058 serous BOTs and 2,223 mucinous BOTs) in Denmark during 1978–2012. We computed standardized incidence ratios (SIRs) to compare the incidence of ovarian cancer among women with BOTs compared to general population rates. We found that a serous BOT was especially and strongly associated with subsequent serous ovarian cancer (SIR = 9.2; 95% CI: 6.8–12.2), and that a mucinous BOT was strongly related to mucinous ovarian cancer (SIR = 18.6; 95% CI: 10.8–29.8). The SIRs remained elevated ≥10 years after a serous BOT and up to 5–9 years after a mucinous BOT. The increased incidence of serous ovarian cancer in women with a serous BOT was mostly pronounced in women <50 years at the serous BOT diagnosis. In conclusion, women with a serous BOT experience long-term increased incidence of serous ovarian cancer, and women with a mucinous BOT have long-term elevated incidence of mucinous ovarian cancer compared to the general population. This is the first population-based study to show compelling evidence of the histo-specific increased risk of ovarian cancer following specific types of BOTs. Thus, these results are supportive of the hypothesis that BOTs may be precursor lesions to carcinomas of the corresponding histologic type.     

SUVmax、Ki-67、p53、EGFR对三阴性乳腺癌新辅助化疗疗效的预测价值

目的 探讨18F-FDG PET/CT化疗前SUVmax、Ki-67、p53、EGFR对三阴性乳腺癌（TNBC）及非三阴性乳腺癌（非TNBC）对新辅助化疗完全病理缓解（pathologic complete response, pCR）率的预测价值。方法 初治TNBC患者27例,非TNBC患者184例,在新辅助化疗前行18F-FDG PET/CT显像并测量其SUVmax,取化疗前乳腺肿瘤组织进行Ki-67、p53、EGFR免疫组织化学分析并计算化疗后完全pCR率。结果 TNBC新辅助化疗前的SUVmax明显高于非TNBC的SUVmax（P=0.045）,TNBC新辅助化疗后pCR率明显高于非TNBC（P＜0.001）。在TNBC以及非TNBC中,达到pCR组的化疗前SUVmax与未达到pCR组之间差异无统计学意义（P＞0.05）。Ki-67、p53、EGFR阳性表达组的pCR率与阴性表达组之间差异无统计学意义（P＞0.05）。结论 TNBC对新辅助化疗的敏感度高于非TNBC,且TNBC化疗前SUVmax高于非TNBC,提示TNBC具有较高的能量代谢。化疗前SUVmax以及Ki-67、p53、EGFR不能预测TNBC及非TNBC新辅助化疗的pCR。     

肺腺癌PET/CT代谢指标与免疫细胞标志物表达水平的相关性

目的：分析肺腺癌18F-FDG PET/CT代谢指标与免疫细胞标志物表达水平的相关性，探讨其在肺腺癌治疗及判断预后中的作用。方法：回顾性分析2008 年4 月至2014 年8 月在天津医科大学肿瘤医院收治并接受PET/CT检查的85 例肺腺癌患者的临床资料，应用免疫组织化学法检测癌组织中CD3、CD8、CD68、CD163、CD11c、Foxp3、PD-1 和PD-L1 的表达水平，采用Pearson相关性检验PET/CT各指标[肿瘤原发灶最大摄取标准值（SUVmax）、标准摄取值峰值（SUVpeak）和平均标准摄取值（SUVmean）]与CD68+肿瘤相关巨噬细胞（CD68+TAM）和肿瘤代谢指标[肿瘤代谢体积（MTV）、糖酵解总量（TLG）]的相关性，Kaplan-Meier 法分析肿瘤代谢与免疫指标和患者生存的相关性。结果：SUVmax、SUVpeak和SUVmean与CD68+ TAM的表达水平在肺腺癌患者中呈负相关（r=-0.253、-0.265、-0.263，均P<0.05)，与PD-1+TIL表达水平呈正相关（r=0.427、0.402、0.395，均P<0.01）。MTV、TLG与Foxp3+Treg、PD-1+TIL 表达水平呈正相关（r=0.313、0.307、0.29、0.407，均P<0.01）。Kaplan-Meier 法生存分析发现，SUVmax、SUVmean、CD11c+DC、PD-L1+细胞和TLG水平与患者预后（PFS或OS）显著相关（均P<0.05）。结论：肿瘤原发灶代谢状态与肿瘤浸润免疫细胞标志物表达显著相关，该两项中的部分指标与患者预后显著相关，提示18F-FDG PET/CT检测指标反映的肿瘤代谢和微环境免疫状态对肺腺癌患者预后判断及免疫治疗具有重要的参考价值。     

Pelvic lymph node F‐18 fluorodeoxyglucose uptake as a prognostic biomarker in newly diagnosed patients with locally advanced cervical cancer

BACKGROUND:

The objective of the current study was to evaluate the prognostic significance of the maximum standardized uptake value (SUV_max) of F‐18 fluorodeoxyglucose (FDG) as measured by positron emission tomography (PET) in pelvic lymph nodes in patients with cervical cancer.

METHODS:

The authors studied cervical cancer patients with pelvic lymph node metastasis, as evidenced on FDG‐PET, who were treated between November 2003 and October 2008. The maximum dimension and SUV_max for the most FDG‐avid pelvic lymph node (SUV_PLN) and the SUV_max of the primary cervical tumor (SUV_cervix) were recorded from the FDG‐PET/computed tomography (CT) scan. The SUV_PLN was analyzed for its association with treatment response, pelvic disease recurrence, disease‐specific survival, and overall survival.

RESULTS:

The population was comprised of 83 women with International Federation of Gynecology and Obstetrics (FIGO) stages IB1 to IIIB cervical cancer. The average SUV_PLN was 6.9 (range, 2.1‐33.0), whereas the average SUV_cervix was 14.0 (range, 3.2‐38.4). The SUV_cervix and SUV_PLN were found to be weakly correlated (correlation coefficient [R²] = 0.301). The average size of the pelvic lymph nodes was 2.1 cm (range, 0.6‐7.9 cm), and was also found to be only weakly associated with the SUV_PLN (R² = 0.225). The SUV_PLN was found to be correlated with an increased risk of persistent disease after treatment (P = .0025), specifically within the pelvic lymph node region (P = .0003). The SUV_PLN was found to be predictive of an increased risk of ever developing pelvic disease recurrence (P = .0035). Patients with a higher SUV_PLN were found to have significantly worse disease‐specific (P = .0230) and overall survival (P = .0378) using Kaplan?Meier evaluation. A Cox proportional hazards model for the risk of pelvic disease recurrence was performed including SUV_PLN, patient age, and tumor stage, and found only an increased SUV_PLN to be an independent predictor.

CONCLUSIONS:

SUV_PLN is a prognostic biomarker, predicting treatment response, pelvic recurrence risk, and disease‐specific survival in patients with cervical cancer. Cancer 2010. © 2010 American Cancer Society.     

Psychosocial impacts of a camping experience for children with cancer and their siblings

BACKGROUND: We conducted a prospective two-group evaluation of pediatric cancer patients and their siblings regarding experiences and affective changes resulting from a 1-week summer camp experience. METHODS: The patients and siblings were assessed prior to camp (Baseline), at the end of camp (Follow-up 1), and again 4-6 months later (Follow-up 2). Assessments included standardized tests for depressive affects, social competency, and a measure of pleasure and participation in camp activities. RESULTS: Sixty-six children were assessed, including 31 (47%) patients and 35 (53%) siblings. Ages ranged from 7 to 17 years. Of the patient campers 19 (61%) had leukemia or lymphoma and 12 (39%) had solid tumors. Results showed marked changes in affective symptoms for patient campers over time (improvements), not shown by sibling campers. For patient campers these affective changes were not present immediately after camp, but were quite significant when measured 4-6 months later. Both patient and sibling campers reflected the same positive memories and pleasure in camp activities over time. For neither group did memories or pleasure fade over time. The camping experience did not have differential impacts on first time versus returning campers. Twelve campers (18% of sample) indicated suicidal ideation on the measure of depressive affects. They did well at camp and presented no special management issues. CONCLUSION: Expectations appear substantially different for patient versus sibling campers. The camping experience appeared to impact these groups differently, with patient campers impacted in ways not experienced by sibling campers.     

1992～2003年哈尔滨市南岗区居民恶性肿瘤减寿分析对比研究

[目的]了解1992～2003年哈尔滨市南岗区居民恶性肿瘤死亡变化情况及其对居民健康和社会的危害,为制定21世纪初哈尔滨市南岗区恶性肿瘤防治工作重点和策略提供依据.[方法]主要采用标化死亡率、标化减寿率、平均减寿年数、标化工作寿命损失率和平均工作寿命损失年数等指标进行前后6年对比分析.[结果]恶性肿瘤总体造成的人群寿命损失和工作寿命损失呈平稳变化趋势.男性膀胱癌,女性膀胱癌、食管癌和白血病引起人群寿命损失和工作寿命损失下降幅度最大,而男性鼻咽癌和食管癌,女性鼻咽癌、宫颈癌引起人群寿命损失和工作寿命损失上升幅度最大.[结论]在做到巩固其他恶性肿瘤防治效果的同时,应当进一步加强对男性白血病和食管癌以及年轻女性宫颈癌的防治工作.