Risk as a pattern over time: Delineation of time-dependent risk factors in biological,psychological, and social variables in cancer patients

Background

Survival in cancer patients is associated with a multitude of biological, social, and psychological factors. Although it is well established that all these factors add to overall mortality, it is not well understood how the predictive power of these parameters changes in a comprehensive model and over time.

Methods

Patients who attended the authors’ outpatient clinic were invited to participate. The authors followed 5180 mixed cancer patients (51.1% female; mean age, 59.1 years [SD = 13.8]) for up to 16 years and analyzed biological (age, sex, cancer site, anemia), psychological (anxiety, depression), and social variables (marital status, education, employment status) potentially predicting overall survival in a Cox proportional hazards model.

Results

The median survival time for the entire sample was 4.3 years (95% confidence interval, 4.0–4.7). The overall survival probabilities for 1 and 10 years were 76.8% and 38.0%, respectively. Following an empirical approach, the authors split the time interval into five periods: acute, subacute, short-term, medium-term, and long-term. A complex pattern of variables predicted overall survival differently in the five periods. Biological parameters were important throughout most of the time, social parameters were either time-independent predictors or tended to be more important in the longer term. Of the psychological parameters, only depression was a significant predictor and lost its predictive power in the long-term.

Conclusions

The findings of this study allow the development of comprehensive patient-specific models of risk and resilience factors addressing biopsychosocial needs of cancer patients, paving the way for a personalized treatment plan that goes beyond biomedical cancer care.     

一体化管理的老年综合评估护理模式对前列腺癌患者心理因素和生活质量的影响

目的探讨对前列腺癌患者采用一体化管理老年综合评估(CGA)护理模式对其心理因素和生活质量的影响。方法选取2020年3月至2021年3月在南京市第一医院就诊,确诊为前列腺癌,且首次行腹腔镜下前列腺癌根治术的患者96例,随机分为对照组、观察1组、观察2组,各32例。对照组为住院后采用常规护理模式进行护理,观察1组为入院后行CGA干预组,观察2组为一体化管理的CGA干预组。三组患者分别在干预前、出院时,进行焦虑自评量表(SAS)、抑郁自评量表(SDS)测评;在干预前、术后30 d,进行生活质量核心量表QLQ-C30(V3.0)和前列腺癌特异性补充量表QLQ-PR25测评。结果出院时,观察2组SAS、SDS评分显著优于对照组及观察1组(P<0.05);术后30 d,观察2组生活质量QLQ-C30、QLQ-PR25评分显著优于对照组及观察1组(P<0.05)。结论一体化管理CGA护理模式可有效改善前列腺癌患者的心理状态,提高其术后生活质量。     

Gastrointestinal cancer characteristics in Lebanon

Background and study aimsGastrointestinal (GI) cancer is one of the top five common cancers in Lebanon. To implement a strategy for screening and early diagnosis through the initiation of prevention programs, a detailed study of GI cancers in Lebanon was conducted by focusing on the frequency and characteristics of each type.Patients and MethodsThis retrospective study was conducted in Lebanon between 2001 and 2015 and included patients diagnosed with different GI cancer types. Data were collected from the registry of the National Institute of Pathology (NIP). The frequency of each type was calculated according to sex, age at diagnosis, anatomic location, histological type, and stage.ResultsThe total number of patients diagnosed with GI cancers who had their histology done at the NIP between 2001 and 2015 was 5239. The sex (male/female) ratio was 1.016, with a mean age of 62.2 years. Colorectal cancer ranked first among GI cancers, with more than half of the cases (53.4%). More than 70% of the cases were located on the left side, followed by gastric (15.5%) and pancreatic (12.7%) cancers. Regarding gastric cancer, cardia became the dominant location. A shift from squamous cell carcinoma to adenocarcinoma in esophageal cancer was found during this period. Also, most GI cancers in Lebanon were diagnosed in the late stages.ConclusionThis study is the first to evaluate GI cancers in Lebanon, which will help in screening strategies and burden studies.     

Patterns of Medical Care Cost by Service Type for Patients With Recurrent and De Novo Advanced Cancer

ObjectivesThere is limited knowledge about the cost patterns of patients who receive a diagnosis of de novo and recurrent advanced cancers in the United States.MethodsData on patients who received a diagnosis of de novo stage IV or recurrent breast, colorectal, or lung cancer between 2000 and 2012 from 3 integrated health systems were used to estimate average annual costs for total, ambulatory, inpatient, medication, and other services during (1) 12 months preceding de novo or recurrent diagnosis (preindex) and (2) diagnosis month through 11 months after (postindex), from the payer perspective. Generalized linear regression models estimated costs adjusting for patient and clinical factors.ResultsPatients who developed a recurrence <1 year after their initial cancer diagnosis had significantly higher total costs in the preindex period than those with recurrence ≥1 year after initial diagnosis and those with de novo stage IV disease across all cancers (all P < .05). Patients with de novo stage IV breast and colorectal cancer had significantly higher total costs in the postindex period than patients with cancer recurrent in <1 year and ≥1 year (all P < .05), respectively. Patients in de novo stage IV and those with recurrence in ≥1 year experienced significantly higher postindex costs than the preindex period (all P < .001).ConclusionsOur findings reveal distinct cost patterns between patients with de novo stage IV, recurrent <1-year, and recurrent ≥1-year cancer, suggesting unique care trajectories that may influence resource use and planning. Future cost studies among patients with advanced cancer should account for de novo versus recurrent diagnoses and timing of recurrence to obtain estimates that accurately reflect these care pattern complexities.     

Curcumin Encapsulated into Biocompatible Co-Polymer PLGA Nanoparticle Enhanced Anti-Gastric Cancer and Anti-Helicobacter Pylori Effect

Background: The current disadvantages (high cost, toxicity, resistance) of chemotherapy for gastric cancer opted people for alternative therapy from natural source. Curcumin (natural product) possess multiple biological activities but low bio-availability limits their uses as therapeutic. The Nano-formulation of curcumin increased the bioavailability and productivity of anti-cancer and anti-bacterial properties. The present study was initiated to determine the anti-cancer and anti-bacterial effect of Nano curcumin against gastric cancer and H. pylori. Methods: Curcumin loaded PLGA nanoparticles (CUR-NPs) was prepared by single emulsion solvent evaporation method. The MIC were determined using agar dilution method to find the anti-H. Pylori activity of Nano curcumin. The cytotoxicity of Nano curcumin was evaluated by MTT assay and the apoptotic effect (cell cycle arrest and morphology change) was shown by PI staining and microscopy. Results: The MIC of nanocurcumin and curcumin for all four H. pylori strains were 8 µg/ml and 16 µg/ml respectively. The inhibition rate of gastric cancer cells after treatment with curcumin was increased from 6% to 67% for 24h, from 8% to 75% for 48h, from 10% to 83% for 72h. In case of nanocurcumin, the inhibition rate increased from 7% to 69% for 24h, 11% to 87% for 48h and 16% to 97% for 72h. The IC50 of curcumin and Nano-curcumin were 24.20 µM and 18.78 µM respectively for 72 h. The population of cells in sub-G0 population increased from 4.1% in the control group to 24.5% and 57.8% when treated with curcumin and nanocurcumin respectively. After 72h of treatment with nanocurcumin, the apoptotic cells population increased as compared to native curcumin treated cells. Conclusion: The Nano curcumin might be used as a potential therapeutics against gastric cancer and H. Pylori. There is need of further in vivo study in order to validate CUR-NPs activity.     

前列腺癌早期诊断的研究进展北大核心

前列腺癌(prostate cancer, PCa)是中老年男性常见恶性肿瘤之一,目前尚缺乏有效的晚期癌症治疗方法,因此早期诊断对于降低PCa死亡率至关重要。近年来,较多研究开发出多种新型诊断方法以改善对PCa诊断的准确性,同时避免过度诊疗,但其有效性及实用性尚需进一步验证。本文对目前新型生物标志物、联合成像技术及风险预测模型等的早期诊断技术进行总结,以期为临床研究提供指导作用。     

乳腺对比增强能谱X线摄影的研究现状北大核心

对比增强能谱X线摄影(contrast enhancement spectral mammography, CESM)是在普通X线检查的基础上结合血管造影剂进行检查的一种新技术,是通过注射造影剂有效消除组织重叠对病灶的遮盖,实现对肿块真实形态显示,并提供血供信息。目前临床上对CESM进行了一系列的研究,本文就CESM成像原理、对乳腺癌的诊断、应用前景几个方面进行综述。     

几何不确定性鲁棒优化在肝癌立体定向放疗中的应用

目的:分析基于几何不确定性的鲁棒优化计划对肝癌立体定向放疗（SBRT）剂量分布的影响。方法:选取12例肝癌SBRT患者，对每例制作3个调强计划:①基于PTV（ITV-PTV 5 mm）的常规优化（PTV-Based Plan）；②基于ITV非均匀几何不确定性（本中心计算的不确定性值:进出方向7 mm，左右和前后方向4 mm）的鲁棒优化（Robust Planactual）；③基于ITV均匀5 mm几何不确定性的鲁棒优化（Robust Plan5 mm）。所有计划都以95%的PTV满足处方剂量作为目标，以等中心均匀偏移4、5、7 mm计算扰动剂量评估鲁棒性。结果:计划①②③的均匀性指数（HI）分别为0.083±0.027、0.099±0.035、0.096±0.026，不具有统计学意义；计划①②③的适形性指数（CI）分别为0.98±0.02、1.02±0.05、1.00±0.04，计划②③相对于计划①的CI具有统计学意义。计划③的正常肝组织平均受量和V2500相对于计划①②分别下降了4.1%、2.5%和5.4%、3.0%，且具有统计学意义（P=0.034、P=0.021和P=0.004、P=0.004），计划②相对于计划①的正常肝组织平均受量和V2500不具有统计学意义（P=0.308和P=0.182），但下降了1.6%和2.5%。对于其鲁棒性，计划②③的5 mm-D99%、5 mm-D98%、5 mm-D95%的剂量-体积直方图带宽（DVHBW）差值相对于计划①更小，随着摆位不确定度的增大，其DVHBW差值越大。结论:在肝脏SBRT治疗中，采用鲁棒优化能够提高靶区剂量分布质量，即使在摆位不确定度有所增加的情况下，仍可以保证ITV的剂量覆盖同时不增加正常组织的照射剂量。     

Diagnostic pitfalls in needle core biopsy of the breast

Breast core biopsies are a standard component of the triple approach that includes clinical examination, imaging and tissue sampling. Conventional cores, diagnostic vacuum assisted biopsy and vacuum assisted excisions are established methods for sampling and managing breast lesions. It is important to be aware of the potential pitfalls in the technical handling and interpretation of the limited core biopsy samples. Here, we present a clinically oriented, well illustrated overview of the common diagnostic pitfalls based on the author's diagnostic and second opinion practice, emphasize the value of clinicopathological correlation and provide histological tips and clues with useful immunohistochemistry to aid the reporting pathologists in their daily interpretation of breast core biopsies.