Disparities in Stage at Diagnosis in an Equal-access Integrated Delivery System: A Retrospective Cohort Study of 7244 Patients With Bladder Cancer

BackgroundDisparities in bladder cancer survival by race/ethnicity and gender are likely related to differences in diagnosis. We assessed disparities in stage at diagnosis and potential contributing factors within a large, integrated delivery system.Patients and MethodsWe conducted a retrospective cohort study of 7244 patients with bladder cancer age ≥ 21 years diagnosed from January 2001 to June 2015 within Kaiser Permanente Southern California. Bivariate analyses compared stage at diagnosis – as well as comorbidities, health plan membership length, and health care utilization prior to diagnosis – by race/ethnicity, gender, and age. Multivariable generalized linear mixed models with urologist as a random effect were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for diagnosis of muscle-invasive bladder cancer (MIBC) versus non–muscle-invasive bladder cancer.ResultsIn multivariable analyses, stage at diagnosis varied significantly by race/ethnicity (P < .001). Non-Hispanic black patients had significantly higher odds of being diagnosed with MIBC than non-Hispanic white patients (OR, 1.33; 95% CI, 1.05-1.67), whereas Asian patients had significantly lower odds (OR, 0.67; 95% CI, 0.49-0.91). Women were significantly more likely to be diagnosed with MIBC than men (OR, 1.40; 95% CI, 1.22-1.61). Non-Hispanic black women had the highest proportion (39%) of MIBC diagnoses. Among Hispanic and Asian patients, a greater proportion of diagnoses occurred at younger ages.ConclusionsHealth care coverage within an equal-access system did not eliminate disparities in stage at diagnosis by race/ethnicity or gender. Studies are needed to identify etiologic factors and aspects of care delivery (eg, patient-physician interactions) that may affect the diagnostic process to inform efforts to improve health equity.     

纤维蛋白原/白蛋白比值比对可手术乳腺癌患者预后的影响

目的探讨纤维蛋白原/白蛋白比值比(FAR)对可手术乳腺癌患者预后的影响。 方法依据纳入、排除标准，收集中国医学科学院北京协和医院2013年1～12月收治的520例Ⅰ～Ⅲ期可手术乳腺癌患者临床资料进行回顾性研究。在术前检测血浆纤维蛋白原和白蛋白水平。将纤维蛋白原与白蛋白质量浓度比值乘以100定义为FAR。根据受试者工作特征曲线确定FAR最佳临界值，并依据最佳临界值将受试者分为高FAR组(FAR>6.99)147例和低FAR组(FAR≤6.99)343例。采用Kaplan-Meier法和log-rank检验评估2组患者的DFS和OS，用Cox比例风险回归模型分析患者DFS和OS的影响因素。 结果log-rank检验显示，高FAR组患者的DFS和OS均比低FAR组差(χ²＝32.885、16.320，P均<0.001)。Cox比例风险回归模型单因素分析和多因素分析均显示：高FAR为患者DFS的独立危险因素(HR＝4.092，95%CI：2.425～6.903，P<0.001；HR＝4.226，95%CI：2.476～7.212，P<0.001);高FAR为患者OS的独立危险因素(HR＝3.907，95%CI：1.913～7.978，P<0.001；HR＝4.320，95%CI：2.087～8.942，P<0.001)。 结论术前高FAR患者的无疾病进展时间更短，OS率更低。术前FAR水平有望成为预测乳腺癌患者预后的有效指标。     

未来提高胰腺癌临床诊治效果的十大方向

胰腺癌是恶性程度极高的消化系统肿瘤。近10年来, 由于治疗理念的更新和有效治疗方案的普及, 其治疗效果有所提高。然而, 胰腺癌总体疗效仍不尽如人意, 患者5年生存率仍仅为10%左右。如何进一步提高胰腺癌诊治水平, 是未来肿瘤学研究和临床实践的头等大事。作者团队基于既往临床和科研经验, 针对胰腺癌早期预防、早诊早治、分子分型、精准治疗、新药开发、方案联合、手术技术和策略改变、模型建立和数据库开发、传统中医药的创新和治疗理念的突破等, 提出十大热点和未来方向供大家参考。期待未来十年中, 胰腺癌诊治研究有突破性进展, 真正做到"可防可控"。     

细胞力学在皮肤科的研究进展

【摘要】 细胞力学是一门新兴的交叉学科，以研究细胞的力学特性与细胞生命活动以及组织、器官、机体生理过程的关系为主。通过对力学信号的感受和响应机制，细胞参与皮肤、骨、眼等多器官组织的生理活动以及疾病的发生发展，包括皮肤组织再生、重建、适应性变化和多种皮肤病的发病，因此成为近年皮肤病研究的热点。本文综述近年来细胞力学的基础研究和其在瘢痕、压疮、白癜风、皮肤肿瘤、毛发疾病等方面的研究和应用进展，为皮肤病治疗提供可能的方法和策略。     

多原发结直肠癌的临床特征和预后

目的探讨多原发结直肠癌的临床特征和预后。方法回顾性分析南京医科大学第一附属医院2013年1月至2018年12月收治的42例多原发结直肠癌患者的临床资料,对其临床病理特征、诊治及预后进行总结。结果符合多原发结直肠癌诊断的患者42例,占同期收治的所有结直肠癌患者的1.20%(42/3499),病理类型以腺癌为主。其中,同时性多原发癌32例,年龄38~86岁,中位年龄66岁,共发现73处结直肠癌灶,多位于近端结肠、乙状结肠及直肠;共检出淋巴结527枚,阳性10枚(1.9%),淋巴结阳性患者占同时性多原发癌的37.5%(12/32);27例为双原发癌,3例为三原发癌,2例为五原发癌;1、3年总生存率分别为83.75%和74.38%。异时性多原发癌10例,年龄33~86岁,第一癌多位于直肠和乙状结肠区域,第二癌多位于升结肠区域;共检出淋巴结276枚,阳性率12.3%(34枚),1、3年总生存率分别为100.00%和66.67%。结论多原发结直肠癌在临床上不少见,其分布有一定规律。临床中应引起重视,提高早期诊断率。应早期手术治疗以提高患者的生存率。     

Early assessment with magnetic resonance imaging for prediction of pathologic response to neoadjuvant chemotherapy in triple-negative breast cancer: Results from the phase III BrighTNess trial

IntroductionThe ability of breast magnetic resonance imaging (MRI) to predict pathologic complete response (pCR) to neoadjuvant systemic therapy (NST) varies across biological subtypes. We sought to determine how well breast MRI findings following initial treatment on the phase III BrighTNess trial correlated with pCR in patients with triple negative breast cancer (TNBC).MethodsBaseline and mid-treatment imaging and pathologic response data were available in 519 patients with stage II-III TNBC who underwent NST as per protocol. MRI complete response (mCR) was defined as disappearance of all target lesion(s) and MRI partial response (mPR) as a ≥50% reduction in the largest tumor diameter.ResultsOverall, mCR was demonstrated in 116 patients (22%), whereas 166 (32%) had mPR and 237 (46%) had stable/progressive disease (SD/PD). The positive predictive value (PPV), negative predictive value, and overall accuracy of the mid-treatment MRI for pCR were 78%, 56%, and 61%, respectively; accuracy did not differ significantly between gBRCA mutation carriers and non-carriers (52% vs. 63%, p = 0.10). When compared to patients with SD/PD, those with mPR or mCR were 3.35-fold (95% CI 2.07–5.41) more likely to have pCR at surgery. MRI response during NST was significantly associated with eligibility for breast-conserving surgery following completion of treatment (93.1% for mCR vs. 81.6% for SD/PD, p < 0.001).ConclusionsComplete response on mid-treatment MRI in the BrighTNess trial had a PPV of 78% for demonstration of pCR after completion of NST in TNBC. However, a substantial proportion of patients with mPR or SD/PD also achieved a pCR.Clinical trial registrationNCT02032277.     

2020年美国癌症协会普通风险人群的子宫颈癌筛查建议解读

        美国癌症协会（ACS）于2020年7月30日更新了普通风险人群的子宫颈癌筛查建议［1］。ACS建议25岁女性初始子宫颈癌筛查，25~65岁首选每5年1次主要HPV检测（强烈建议）；若不能进行主要HPV检测，建议每5年1次联合检测（结合细胞学检查及HPV检测），或每3年1次仅细胞学检查（可接受）。 浏览更多请关注本刊微信公众号及当期杂志。     

长链非编码RNA在结直肠癌中的研究进展

长链非编码RNA（LncRNA）是近十年来肿瘤领域分子机制研究的热点之一，被证实在生物体内对基因的表达具有调控作用，与肿瘤的发生与发展密切相关。结直肠癌是一种严重危害人类健康的恶性肿瘤，研究发现许多LncRNA在结直肠癌中表达失调。异常表达的LncRNA作为关键的调控因子，参与了多种生物学过程，影响肿瘤细胞的增殖和凋亡、侵袭转移及调节肿瘤耐药。研究LncRNA在肠癌中的作用机制可以为结直肠癌临床治疗提供一些新思路。此外，LncRNA还可作为一种潜在的生物标志物用于结直肠癌早期诊断及预后评估。     

慢性阻塞性肺疾病患者肺癌高危筛查的研究进展

肺癌和慢性阻塞性肺疾病(COPD)是两种密切相关的疾病,对公共卫生有很大影响。每年对胸部进行低剂量计算机断层扫描的筛査可以显著降低肺癌病死率。COPD与肺癌发病风险增加有关。流行病学研究发现COPD患者与无气流阻塞的患者相比,肺癌风险增加2〜4倍。COPD合并肺癌发病风险增加似乎是由于肺气肿引起的。肺气肿已被证明是一个重要的肺癌危险因素。COPD合并肺癌筛査评分以确定COPD合并肺癌发病高危人群,是COPD人群肺癌筛查的一项有益的探索.需要更多临床实践的证明。