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Gastric cancer is the third most common cause of cancer deaths worldwide. Despite evidence-based recommendation for treatment, the current treatment patterns for all stages of gastric cancer remain largely unexplored. This study investigates trends in the treatments and survival of gastric cancer. The National Cancer Database was used to identify gastric adenocarcinoma patients from 2004&ndash, 2016. Chi-square tests were used to examine subgroup differences between disease stages: Stage I, II/III and IV. Multivariate analyses identified factors associated with the receipt of guideline concordant care. The Kaplan&ndash, Meier method was used to assess three-year overall survival. The final cohort included 108,150 patients: 23,584 Stage I, 40,216 Stage II/III, and 44,350 Stage IV. Stage specific guideline concordant care was received in only 73% of patients with Stage I disease and 51% of patients with Stage II/III disease. Patients who received guideline consistent care had significantly improved survival compared to those who did not. Overall, we found only moderate improvement in guideline adherence and three-year overall survival during the 13-year study time period. This study showed underutilization of stage specific guideline concordant care for stage I and II/III disease.

Although cancer survival rates are improving, pediatric patients with cancer still face numerous stressors. Using an integrative approach, a literature review was conducted to identify stressors and synthesize effective coping strategies among pediatric patients with cancer. The CINAHL® Complete, ProQuest, and PubMed® databases were searched for relevant studies using key terms. Eight studies were included in the final analysis. Three factors contributing to everyday stressors of pediatric patients with cancer and four major coping categories were identified.

Background RNA editing exerts critical impacts on numerous biological processes and thus are implicated in crucial human phenotypes, including tumorigenesis and prognosis. While previous studies have analyzed aggregate RNA editing activity at the sample level and associated it with overall cancer survival, there is not yet a large‐scale disease‐specific survival study to examine genome‐wide RNA editing sites’ prognostic value taking into account the host gene expression and clinical variables. Methods In this study, we solved comprehensive Cox proportional models of disease‐specific survival on individual RNA‐editing sites plus host gene expression and critical demographic covariates. This allowed us to interrogate the prognostic value of a large number of RNA‐editing sites at single‐nucleotide resolution. Results As a result, we identified 402 gene‐proximal RNA‐editing sites that generally predict adverse cancer survival. For example, an RNA‐editing site residing in ZNF264 indicates poor survival of uterine corpus endometrial carcinoma, with a hazard ratio of 2.13 and an adjusted p‐value of 4.07 × 10−7. Some of these prognostic RNA‐editing sites mediate the binding of RNA binding proteins and microRNAs, thus propagating their impacts to extensive regulatory targets. Conclusions In conclusion, RNA editing affects cis‐regulatory elements and predicts adverse cancer survival., RNA editing events have been shown to be associated with cancer, and drug sensitivity. We show that for the first time, RNA editing level is associated poor cancer prognosis after adjusting for host gene expression and other phenotypical variables.

Aim: The aim of this study is to evaluate the efficacy and toxicity of trastuzumab emtansine (T-DM1) in cases with metastatic breast cancer (mBC) in different lines of treatment. Method: Retrospective analysis of T-DM1 results of human epidermal growth factor receptor 2 (Her2) positive 414 cases with mBC from 31 centers in Turkey. Findings: Except 2, all of the cases were female with a median age of 47. T-DM1 had been used as second-line therapy in 37.7% of the cases and the median number of T-DM1 cycles was 9. Progression-free survival (PFS) and overall survival (OS) times were different according to the line of treatment. The median OS was found as 43, 41, 46, 23 and 17 months for 1st, 2nd, 3rd, 4th and 5th line, respectively (p = 0.032) while the median PFS was found as 37, 12, 8, 8 and 8 months, respectively (p = 0.0001). Treatment was well tolerated by the patients. The most common grade 3–4 adverse effects were thrombocytopenia (2.7%) and increased serum gamma-glutamyl transferase (2%). Discussion: The best of our knowledge this is the largest real-life experience about the safety and efficacy of T-DM1 use in cases with mBC after progression of Her2 targeted treatment. This study suggests and supports that T-DM1 is more effective in earlier lines of treatment and is a reliable option for mBC. © 2021 Taylor & Francis Group, LLC.

Metastatic bone disease is a common sequela of malignancy and can lead to significant morbidity on patients. Systemic medical therapies and oncology surgery have greatly enhanced cancer survival rates over recent decades. Orthopaedic surgeons occupy a key position within the multidisciplinary team and coordinate surgical care for bone metastases where appropriate. This review describes the investigations for, and management of, patients with metastases to the appendicular skeleton. National guidelines exist to help orthopaedic clinicians and departments optimize patient care and outcomes. We outline and illustrate the freely available OPTIModel app from the Netherlands, which is an innovative, straightforward and useful tool for prognostic evaluation and suggestion of loco-regional treatment options for patients with symptomatic long bone metastases.

The fundamental understanding of how Cancer initiates, persists and then progresses is evolving. High-resolution technologies, including single-cell mutation and gene expression measurements, are now attainable, providing an ever-increasing insight into the molecular details. However, this higher resolution has shown that somatic mutation theory itself cannot explain the extraordinary resistance of cancer to extinction. There is a need for a more Systems-based framework of understanding cancer complexity, which in particular explains the regulation of gene expression during cell-fate decisions. Cancer displays a series of paradoxes. Here we attempt to approach them from the view-point of adaptive exploration of gene regulatory networks at the edge of order and chaos, where cell-fate is changed by oscillations between alternative regulators of cellular senescence and reprogramming operating through self-organisation. On this background, the role of polyploidy in accessing the phylogenetically pre-programmed "oncofetal attractor" state, related to unicellularity, and the de-selection of unsuitable variants at the brink of cell survival is highlighted. The concepts of the embryological and atavistic theory of cancer, cancer cell "life-cycle", and cancer aneuploidy paradox are dissected under this lense. Finally, we challenge researchers to consider that cancer "defects" are mostly the adaptation tools of survival programs that have arisen during evolution and are intrinsic of cancer. Recognition of these features should help in the development of more successful anti-cancer treatments.

Eukaryotic elongation factor 2 kinase (eEF-2K) is an unusual alpha kinase involved in protein synthesis through phosphorylation of elongation factor 2 (EF2). eEF-2K is highly overexpressed in breast cancer, and its activity is associated with significantly shortened patient survival and proven to be a potential molecular target in breast cancer. The crystal structure of eEF-2K remains unknown, and there is no potent, safe, and effective inhibitor available for clinical applications. We designed and synthesized several generations of potential inhibitors. The effect of the inhibitors at the binding pocket of eEF-2K was analyzed after developing a 3D target model by using a domain of another ?-kinase called myosin heavy-chain kinase A (MHCKA) that closely resembles eEF-2K. In silico studies showed that compounds with a coumarin-chalcone core have high predicted binding affinities for eEF-2K. Using in vitro studies in highly aggressive and invasive (MDA-MB-436, MDA-MB-231, and BT20) and noninvazive (MCF-7) breast cancer cells, we identified a lead compound that was highly effective in inhibiting eEF-2K activity at submicromolar concentrations and at inhibiting cell proliferation by induction of apoptosis with no toxicity in normal breast epithelial cells. In vivo systemic administration of the lead compound encapsulated in single lipid-based liposomal nanoparticles twice a week significantly suppressed growth of MDA-MB-231 tumors in orthotopic breast cancer models in nude mice with no observed toxicity. In conclusion, our study provides a highly potent and in vivo effective novel small-molecule eEF-2K inhibitor that may be used as a molecularly targeted therapy breast cancer or other eEF-2K-dependent tumors. © 2021 American Chemical Society. 1R01CA244344; University of Texas MD Anderson Cancer Center; Türkiye Bilimsel ve Teknolojik Araştirma Kurumu, TÜBITAK: 215S008, TUBITAK-BIDEB 2214A This study was funded by The Scientific and Technological Research Council of Turkey (TUBITAK) (grant number 215S008 and TUBITAK-BIDEB 2214A program, F.C.O.) and The University of Texas-MD Anderson Cancer Center Bridge fund (B.O. and N.K.) and NIH-NCI 1R01CA244344 grants (B.O. and N.K.).

Introduction Accurate information on cause of death is essential for correct breast cancer-specific mortality assessment. However, registration and coding of cause of death is prone to error since determining the exact underlying condition related to the death is challenging. In this study, an expert review of medical files was done to determine the principal cause of death for breast cancer patients of a Belgian tertiary hospital. The retrieved cause of death was compared to death certificate information to assess concordance between both sources. Secondly, the impact of discordant reporting on cause-specific survival (CSS) and other net survival approaches were examined. Methods Breast cancer patients diagnosed and treated at University Hospitals Leuven (UHL) between 2009 and 2014 with follow-up until December 31st, 2016, were included in the study. Information on cause of death was obtained from death certificates (following ICD-10 rules) and medical files. The latter were reviewed by a board of experts at UHL. Agreement was calculated using Cohen’s kappa coefficient, and reasons for discordant reporting were assessed. CSS was calculated based on cause of death information from both sources using the Kaplan-Meier method. These survival estimates were compared to the relative survival probability (RS) using the Ederer II and Pohar Perme method. Results A total of 2,862 patients were included, of whom 354 died after a median follow-up of 54.6 months. We found overall substantial agreement (kappa-value of 0.69 (95% C.I.: 0.62-0.77)) between cause of death reported by death certificates and medical files (Table 1). In 84.8% of cases, there was concordance between both methods. When comparing to medical files, misattribution of breast cancer-specific death in death certificates (4.5% of cases) was linked to the presence of comorbidities (43.7%), metastases (37.5%), or unspecified causes (18.8%). Five-year CSS based on medical files (93.1% (95% C.I.: 91.9-94.1)) was only slightly higher compared to CSS based on death certificates (92.3% (95% C.I.: 91.2-93.4)). RS measures using Ederer II and Pohar Perme were comparable to CSS measures. Conclusions Overall, substantial agreement of cause of death was seen between death certificates and medical files. Attribution of cause death to comorbidities was the most common reason for discordant reporting of breast cancer-specific death. Five-year breast cancer-specific survival was slightly higher based on cause of death information from medical files, compared to death certificates. Periodic reviews and implementation of ICD-10 guidelines for classification of cause of death could improve accuracy in cause of death annotation. Table 1: Discordance for the principal cause of death between medical files and death certificatesmedical filesother causesbreast cancerdeath certificatesother causes136 (38.4%)16 (4.5%)152 (42.9%)breast cancer38 (10.7%)164 (46.3%)202 (57.1%)174 (49.2%)180 (50.9%)354 (100%) Citation Format: Hava Izci, Tim Tambuyzer, Jessica Vandeven, Jérôme Xicluna, Hans Wildiers, Kevin Punie, Nynke Willers, Eva Oldenburger, Els Van Nieuwenhuysen, Patrick Berteloot, Ann Smeets, Ines Nevelsteen, Liesbet Van Eycken, Harlinde De Schutter, Patrick Neven, Geert Silversmit, Freija Verdoodt. Cause of death discordance between death certificates and medical files: Impact on cancer survival assessment in a Belgian case study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-63.

International audience; Background: Experienced pancreatic surgeons, for whom complexity is not an issue, must decide at the end of neoadjuvant therapy whether to continue or discontinue surgery, when pancreatectomy with vascular resection is planned in patients with pancreatic ductal adenocarcinoma (PDAC). Objective: Our study aimed to determine preoperative factors that can predict short postoperative survival in such situations. Methods: Overall, 105 patients with borderline or locally advanced PDAC received neoadjuvant FOLFIRINOX (followed by chemoradiation in 22% of patients) and underwent pancreatectomy with segmental venous and/or arterial resection at two high-volume centers. The primary endpoint was overall survival (OS) of < 1 year after surgery for patients who did not die from the surgery. Results: Tumors were classified as borderline in 78% of cases and locally advanced in 22% of cases. Mean CA19-9 at diagnosis was 934 U/mL, which significantly decreased to 213 U/mL (p < 0.01) after a median of six cycles of FOLFIRINOX. Pancreaticoduodenectomy was performed most often (76%). The vast majority of patients underwent venous resection (92%), and a simultaneous arterial resection was performed in 16 patients (15%). The severe morbidity rate and 30- and 90-day mortality rates were 21%, 8.5%, and 10.4%, respectively. The median OS after surgery was 23 months. In the multivariate analysis, preoperative CA19-9 ≥ 450 U/mL was the only preoperative factor independently associated with OS of < 1 year (p = 0.044). Conclusion: The preoperative CA19-9 value should be considered in the clinical decision-making process when complex vascular resection is required. © 2021, Society of Surgical Oncology.

Background: Travel distance to care facilities may shape urban–rural cancer survival disparities by creating barriers to specific treatments. Guideline-supported treatment options for women with early stage breast cancer involves considerations of breast conservation and travel burden: Mastectomy requires travel for surgery, whereas breast-conserving surgery (BCS) with adjuvant radiation therapy (RT) requires travel for both surgery and RT. This provides a unique opportunity to evaluate the impact of travel distance on surgical decisions and receipt of guideline-concordant treatment. Materials and Methods: We included 61,169 women diagnosed with early stage breast cancer between 2004 and 2013 from the Surveillance Epidemiology and End Results (SEER)-Medicare database. Driving distances to the nearest radiation facility were calculated by using Google Maps. We used multivariable regression to model treatment choice as a function of distance to radiation and Cox regression to model survival. Results: Women living farthest from radiation facilities (>50 miles vs.

In the field of medicine, several recent studies have shown the value of Artificial Neural Networks, decision trees, logistic regression are playing a major role as the predictor, and classification methods. The research has been expanded to estimate the incidence of breast, lung, liver, ovarian, cervical, bladder and skin cancer. The main aim of this paper is to develop models of logistic regression, Artificial Neural Networks, and Decision trees using the same input and output variables and to compare their success in predicting breast cancer survival in woman. To find the best model for breast cancer survival, the sensitivity and specificity of all these models are measured and evaluated with their respective confidence intervals and the ROC values.

Objective Like most real-world data, electronic health record (EHR)–derived data from oncology patients typically exhibits wide interpatient variability in terms of available data elements. This interpatient variability leads to missing data and can present critical challenges in developing and implementing predictive models to underlie clinical decision support for patient-specific oncology care. Here, we sought to develop a novel ensemble approach to addressing missing data that we term the “meta-model” and apply the meta-model to patient-specific cancer prognosis. Materials and Methods Using real-world data, we developed a suite of individual random survival forest models to predict survival in patients with advanced lung cancer, colorectal cancer, and breast cancer. Individual models varied by the predictor data used. We combined models for each cancer type into a meta-model that predicted survival for each patient using a weighted mean of the individual models for which the patient had all requisite predictors. Results The meta-model significantly outperformed many of the individual models and performed similarly to the best performing individual models. Comparisons of the meta-model to a more traditional imputation-based method of addressing missing data supported the meta-model’s utility. Conclusions We developed a novel machine learning–based strategy to underlie clinical decision support and predict survival in cancer patients, despite missing data. The meta-model may more generally provide a tool for addressing missing data across a variety of clinical prediction problems. Moreover, the meta-model may address other challenges in clinical predictive modeling including model extensibility and integration of predictive algorithms trained across different institutions and datasets.

Background: Although equine assisted activities and therapies (EAAT) are rapidly increasing, as are cancer survival rates, little is known about the engagement of cancer survivors in EAAT. One may conceptualize equine or horse related activities as occurring in rural areas; however, the rural status of EAAT centers are not fully reported.Purpose: To explore the rural status of EAAT centers, and whether EAAT is provided for cancer survivors and the more common service for post-traumatic stress disorder at those centers.Method: A quantitative descriptive analysis was conducted of publicly available data after an exempt status decision of an Institutional Review Board. Services using EAAT for those with terminal illnesses, post-traumatic stress disorder and cancer survivors were examined. Rural status was evaluated for all organizational members (N = 784) of Professional Association of Therapeutic Horsemanship International (PATH Intl.). Roy adaptation model was used as a theoretical framework in this project.Findings: All types of the organizational members, cluster in urban areas more than rural areas. Significant relationship (p = 0.039) was found between rural status and type of membership, where more urban than rural centers were premier accredited center members. Most of the contacted and responding centers stated that they do provided EAAT for cancer survivors (n = 204); however, only (n = 26) centers have programs specifically designed for cancer survivors.Conclusion: There are not only less EAAT rural than urban centers, but rural centers also tend to have lower quality level membership based on PATH Intl. standards. Although EAAT is provided for cancer survivors, identifying effective ways to provide EAAT and standardization of programs for cancer survivors is recommended. DOI: http://doi.org/10.14574/ojrnhc.v20i2.601

Miguel Angel Luque-Fernandez is supported by a Miguel Servet I Investigator award (Grant CP17/00206) and a project grant EU-FEDER-FIS PI-18/01593 from the Instituto de Salud Carlos III, Madrid, Spain. Danilo Alvares is supported by the National Fund for Scientific and Technological Development (FONDECYT, Chile) grant number 11190018., Cancer survival represents one of the main indicators of interest in cancer epidemiology. However, the survival of cancer patients can be affected by several factors, such as comorbidities, that may interact with the cancer biology. Moreover, it is interesting to understand how different cancer sites and tumour stages are affected by different comorbidities. Identifying the comorbidities that affect cancer survival is thus of interest as it can be used to identify factors driving the survival of cancer patients. This information can also be used to identify vulnerable groups of patients with comorbidities that may lead to worst prognosis of cancer. We address these questions and propose a principled selection and evaluation of the effect of comorbidities on the overall survival of cancer patients. In the first step, we apply a Bayesian variable selection method that can be used to identify the comorbidities that predict overall survival. In the second step, we build a general Bayesian survival model that accounts for time-varying effects. In the third step, we derive several posterior predictive measures to quantify the effect of individual comorbidities on the population overall survival. We present applications to data on lung and colorectal cancers from two Spanish population-based cancer registries. The proposed methodology is implemented with a combination of the R-packages mombf and rstan. We provide the code for reproducibility at https://github.com/migariane/ BayesVarImpComorbiCancer., Miguel Servet I Investigator award CP17/00206 EU-FEDER-FIS PI-18/01593, Instituto de Salud Carlos III, Comision Nacional de Investigacion Cientifica y Tecnologica (CONICYT) CONICYT FONDECYT 11190018

Background Oral cancer is the sixth most prevalent cancer worldwide. Public knowledge in oral cancer risk factors and survival is limited. Aim To come up with machine learning (ML) algorithms to predict the length of survival for individuals diagnosed with oral cancer, and to explore the most important factors that were responsible for shortening or lengthening oral cancer survival. Methods We used the Surveillance, Epidemiology, and End Results database from the years 1975 to 2016 that consisted of a total of 257880 cases and 94 variables. Four ML techniques in the area of artificial intelligence were applied for model training and validation. Model accuracy was evaluated using mean absolute error (MAE), mean squared error (MSE), root mean squared error (RMSE), R 2 and adjusted R 2. Results The most important factors predictive of oral cancer survival time were age at diagnosis, primary cancer site, tumor size and year of diagnosis. Year of diagnosis referred to the year when the tumor was first diagnosed, implying that individuals with tumors that were diagnosed in the modern era tend to have longer survival than those diagnosed in the past. The extreme gradient boosting ML algorithms showed the best performance, with the MAE equaled to 13.55, MSE 486.55 and RMSE 22.06. Conclusion Using artificial intelligence, we developed a tool that can be used for oral cancer survival prediction and for medical-decision making. The finding relating to the year of diagnosis represented an important new discovery in the literature. The results of this study have implications for cancer prevention and education for the public.

PURPOSE While cancer survival is improving across most developed nations, those improvements are not shared equally within their population. Using high-quality national data, we have reviewed the extent to which cancer survival inequities are persisting for indigenous Māori compared with non-Māori New Zealanders and the extent to which these disparities are driven by deprivation, comorbidity, and stage of disease. METHODS Incident cases of cancer (2007-2016) were extracted from the New Zealand Cancer Registry and linked to mortality and hospitalization data. Descriptive, Kaplan-Meier, and Cox regression methods were used to compare survival outcomes between Māori and non-Māori. RESULTS Māori continue to have poorer survival than non-Māori for 23 of the 24 most common causes of Māori cancer death, with the extent of this disparity ranging from 12% to 156%. The magnitude of these disparities varies according to deprivation, comorbidity, and stage. Of note, there was a tendency for survival disparities to be largest among those with no comorbidity. CONCLUSION Māori continue to experience substantial cancer survival inequities. These observations are in keeping with reports from previous decades, which suggest that these disparities persist despite heightened attention. Reduction of the cancer burden on Māori and achievement of equitable survival outcomes require us to prevent cancer for Māori where we can, diagnose Māori patients early when we cannot, and once diagnosed, deliver equitable care to Māori patients at each step along the treatment path.

Background: This study quantifies the number of potentially “avoided”cancer deaths due to differences in 10-year relative survival between three time periods, reflecting temporal improvements in cancer diagnostic and/or treatment practices in Australia. Methods: National population-based cohort of 2,307,565 Australians ages 15 to 89 years, diagnosed with a primary invasive cancer from 1985 to 2014 with mortality follow-up to December 31, 2015. Excess mortality rates and crude probabilities of cancer deaths were estimated using flexible parametric relative survival models. Crude probabilities were then used to calculate “avoided cancer deaths” (reduced number of cancer deaths within 10 years of diagnosis due to survival changes since 1985–1994) for all cancers and 13 leading cancer types. Results: For each cancer type, excess mortality (in the cancer cohort vs. the expected population mortality) was significantly lower for more recently diagnosed persons. For all cancers combined, the number of “avoided cancer deaths” (vs. 1985–1994) was 4,877 (1995–2004) and 11,385 (2005–2014) among males. Prostate (1995–2004: 2,144; 2005–2014: 5,099) and female breast cancer (1,127 and 2,048) had the highest number of such deaths, whereas Conclusions: Screening and early detection likely contributed to the high number of “avoided cancer deaths” for prostate and female breast cancer, whereas early detection remains difficult for lung and pancreatic cancers, highlighting the need for improved preventive and screening measures. Impact: Absolute measures such as “avoided cancer deaths” can provide a more tangible estimate of the improvements in cancer survival than standard net survival measures.

Background There is no consistent evidence about the appropriate treatment strategies for gastric signet ring cell carcinoma (GSRC) to improve prognosis. We conducted a population‐based study to examine the effects of combined modality therapies on survival outcomes using the Surveillance, Epidemiology, and End Results (SEER) data. Methods Analyses included stage II‐III primary GSRC patients who were diagnosed between 2006 and 2016. Therapies were categorized as gastrectomy group, adjuvant chemotherapy (CT) group, neoadjuvant radiotherapy (RT) group, and adjuvant chemoradiotherapy (CRT) group. Survival analyses were conducted by Kaplan‐Meier method and Cox proportional hazards models and subgrouped by gender, tumor site, stage at diagnosis, and number of lymph nodes removed. Results Of the 1717 cases of stage II‐III primary GSRC, the mean (SD) age was 59.6 (13.3) years, and over a half were male (52.8%). A total of 39.9% patients received adjuvant CRT and the 5‐year overall survival (OS) rate was 34.6%. The median OS of patients treated with adjuvant CRT was significantly longer than that of the gastrectomy group (33 months vs 24 months, aHR = 0.71, 95% CI: 0.59, 0.84). Although the crude model showed a significant association between adjuvant CT and total survival (cHR = 0.81, 95% CI: 0.68, 0.96), the effect measure turned null in the multivariable and sub‐group analysis. We did not find the significant effect of neoadjuvant RT. Conclusions In this study, GSRC patients with stage II‐III experienced improved overall survival after receiving adjuvant CRT, which provides several treatment implications. More clinical trials will be needed to verify the conclusion derived from this study., The adjuvant CRT can improve overall survival of patients with primary locally advanced GSRC, and the effect of adjuvant CT and neoadjuvant RT was not found.

The ultimate goal of all medical activity is to restore patients to a state of complete physical, mental, and social wellbeing. In cancer, it is assumed that this can only be obtained through the complete eradication of the tumor burden. So far, this strategy has led to a substantial improvement in cancer survival rates. Despite this, more than 9 million people die from cancer every year. Therefore, we need to accept that our current cancer treatment paradigm is obsolete and must be changed. The new paradigm should reflect that cancer is a systemic disease, which affects an individual patient living in a particular social reality, rather than an invading organism or a mere cluster of mutated cells that need to be eradicated. This Hippocratic holistic view will ultimately lead to an improvement in health and wellbeing in cancer patients. They deserve nothing less.

AIM: In 1999, a cooperative tripartite cancer research and training agreement was signed between Ireland (IE), Northern Ireland (NI) and the United States (US) National Cancer Institute, giving rise to the All-Ireland Cancer Consortium (AICC). We wished to consider if AICC increased the amount/impact of cancer research on the island of Ireland and what effect this enhanced research activity had on cancer services and cancer outcomes.METHODS: As comparator, we chose the city regions of Copenhagen and Lund & Malmö, whose physical connection was greatly improved following construction of bridges between Denmark and Sweden around the time AICC was established. We analysed cancer research outputs from all four geographical regions in the Web of Science (1988-2017), with a particular focus on citations and journal impact factors. We evaluated disability-adjusted life years (DALYs) as an indicator of change in health status.RESULTS: Research outputs increased in all four regions, but more in IE/NI than in the Scandinavian cities, while collaboration between IE and NI and both the US and the Rest of Europe increased even more substantially. Citation scores also showed a greater improvement for IE and NI. Journal citation impact factors indicated that IE/NI papers were increasingly being published in more highly cited journals. Research-enabled cancer service provision improved on the island of Ireland, with concomitant increases in cancer survival.CONCLUSION: The AICC collaborative agreement delivered significant additionality on the island of Ireland, promoting transnational cooperation, enhancing cancer research activity, and underpinning improved cancer services and better cancer outcomes.

Survival outcomes were assessed in cancer patients from whom cancer tissue was analyzed with Illumina Hi-Seq ribonucleic acid (RNA) sequencing (RNA-Seq) (accessible on National Cancer Institute Genomic Data Commons (GDC) and The Cancer Genome Atlas (TCGA)). Cancer-relevant genes with the most significant correlations with the clinical outcome of overall survival were assessed in Kaplan Meier survival analysis plots. In addition, clinical variables as well as the interaction of clinical variables and cancer relevant genes were assessed in survival analysis. Results show that TP53, BRCA1, NBN, MADIL1, and EP300 were significant predictors of overall survival for prostate cancer patients. While these genes and clinical variables (Gleason Score group and biochemical recurrence) were significant predictors of overall survival when assessed separately, the combination of gene levels along with Gleason score groups provided the most predictive power for overall survival. In this study, cancer-relevant genes predicted survival outcomes, although various genes may interact with genes currently known to contribute to cancer. These findings indicate that multiple cancer types should be assessed together to determine which genes are relevant for cancer in general and for specific cancer types. Future studies will assess all RNA sequencing results available on the Genomic Data Commons, including those not yet associated with cancer. These findings have implications for assessing gene-gene interactions and gene-environment interactions prostate cancer as well as for other types of cancer.

Worldwide breast cancer ranks first in mortality and incidence rates in women over 20 years old. Rather than one disease, breast cancer is a heterogeneous group of diseases that express distinct molecular profiles. Neoadjuvant chemotherapy is an important therapeutic strategy for breast cancer patients independently of their molecular subtype, with the drawback of resistance development. In addition, chemotherapy has adverse effects that combined with resistance could contribute to lower overall survival. Although great efforts have been made to find diagnostic and prognostic biomarkers for breast cancer and for response to targeted and immune therapy for this pathology, little has been explored regarding biomarkers of response to anthracyclines and taxanes based neoadjuvant chemotherapy. This work aimed to evaluate the molecular profile of patients who received neoadjuvant chemotherapy to identify differentially expressed genes (DEGs) that could be used as biomarkers of chemotherapy response and overall survival. Breast cancer patients who were candidates for neoadjuvant chemotherapy were enrolled in this study. After treatment and according to their pathological response, they were assigned as sensitive or resistant. To evaluate DEGs, Gene Ontology, Kyoto Encyclopedia Gene and Genome (KEGG), and protein–protein interactions, RNA-seq information from all patients was obtained by next-generation sequencing. A total of 1985 DEGs were found, and KEGG analysis indicated a great number of DEGs in metabolic pathways, pathways in cancer, cytokine–cytokine receptor interactions, and neuroactive ligand-receptor interactions. A selection of 73 DEGs was used further for an analysis of overall survival using the METABRIC study and the ductal carcinoma dataset of The Cancer Genome Atlas (TCGA) database. Nine DEGs correlated with overall survival, of which the subexpression of C1QTNF3, CTF1, OLFML3, PLA2R1, PODN, KRT15, HLA-A, and the overexpression of TUBB and TCP1 were found in resistant patients and related to patients with lower overall survival.

Objective: Raising cancer awareness among adolescents should lead to early diagnosis and improve their survival rate into adulthood. This study aims to identify knowledge of cancer risk factors, symptoms and barriers to seek medical help among Omani adolescents. Methods: A cross-sectional study with Omani adolescents (aged 15-17 years) has been conducted in six schools in Muscat, the capital of Oman. The general Cancer Awareness Measure questionnaire was used to collect the data. Results: A total of 481 adolescents participated. The average recognition of cancer risk factors and symptoms was low (36.8% and 39.6%, respectively). Cancer risk factors and/or symptoms significantly recognised more in girls compared to boys (χ2 = 10.136; Odds ratio [OR] = 2.13 ; 95% confidence interval [CI]= 0.33-3.41; P = 0.001); older (age 17 year) versus younger (aged 15 and 16 years) (χ2 = 6.075; OR = 11.68; 95% CI: 1.11-2.53; P = 0.014); those with existing co-morbidities compared to those without (χ2 = 4.955; OR = 0.41; 95% CI: 0.18-0.92; P = 0.026); and those who knew someone with cancer compared to those who did not (χ2 = 15.285; OR 2.70; 95% CI: 1.62-4.49; P

ObjectiveTo provide the first international comparison of oesophageal and gastric cancer survival by stage at diagnosis and histological subtype across high-income countries with similar access to healthcare.MethodsAs part of the ICBP SURVMARK-2 project, data from 28 923 patients with oesophageal cancer and 25 946 patients with gastric cancer diagnosed during 2012–2014 from 14 cancer registries in seven countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK) were included. 1-year and 3-year age-standardised net survival were estimated by stage at diagnosis, histological subtype (oesophageal adenocarcinoma (OAC) and oesophageal squamous cell carcinoma (OSCC)) and country.ResultsOesophageal cancer survival was highest in Ireland and lowest in Canada at 1 (50.3% vs 41.3%, respectively) and 3 years (27.0% vs 19.2%) postdiagnosis. Survival from gastric cancer was highest in Australia and lowest in the UK, for both 1-year (55.2% vs 44.8%, respectively) and 3-year survival (33.7% vs 22.3%). Most patients with oesophageal and gastric cancer had regional or distant disease, with proportions ranging between 56% and 90% across countries. Stage-specific analyses showed that variation between countries was greatest for localised disease, where survival ranged between 66.6% in Australia and 83.2% in the UK for oesophageal cancer and between 75.5% in Australia and 94.3% in New Zealand for gastric cancer at 1-year postdiagnosis. While survival for OAC was generally higher than that for OSCC, disparities across countries were similar for both histological subtypes.ConclusionSurvival from oesophageal and gastric cancer varies across high-income countries including within stage groups, particularly for localised disease. Disparities can partly be explained by earlier diagnosis resulting in more favourable stage distributions, and distributions of histological subtypes of oesophageal cancer across countries. Yet, differences in treatment, and also in cancer registration practice and the use of different staging methods and systems, across countries may have impacted the comparisons. While primary prevention remains key, advancements in early detection research are promising and will likely allow for additional risk stratification and survival improvements in the future.

BackgroundDue to the fact that the definition of gastric signet ring cell cancer (GSRC) was still controversial in the past decades, the prognosis affected by the proportion of signet ring cells within gastric cancer is uncertain. This study compared the clinicopathological features and prognosis of GSRC with the various proportions of signet ring cells.MethodsWe collected GSRC cases without metastasis who underwent curative (R0) resection between 2011 and 2018. Individuals who were in the low-proportion signet ring cell group (LSRC, 50%) through propensity score matching (1:1). We used Cox proportional hazard regression to calculate the adjusted hazard ratios (HR) and 95% confidence intervals (CI) and explored interactions with gender and stage.ResultsWe had 1:1 matched individuals including 231 cases from the LSRC group and 231 cases from the HSRC group. Patients with HSRC had a significantly higher overall survival rate in the multivariable model (aHR = 0.56, 95%CI = 0.38, 0.84) compared with those with LSRC. The association of HSRC appeared to be more substantial among individuals at early stage and N0 stage (p-interaction < 0.01).ConclusionsThis study confirms that GSRC with different proportions of signet ring cells could affect the survival of the patient. Further clinical studies should be developed in the future to provide an appropriate treatment strategy for GSRC.

The objective of this research was to determine if the engagement/participation in health promotion activities of cancer survivors in the United States (US) changed between 2006 and 2015. We pooled two independent cross-sectional data of cancer survivors using Medical Expenditure Panel Surveys from 2006 (N = 791; weighted N = 9,532,674) and 2015 (N = 1067; weighted N = 15,744,959). Health promoting activities consisted of past year influenza immunization, routine physical examination, and dental visit. Self-care included maintaining normal weight, not smoking, and engagement in recommended vigorous physical activity. We conducted unadjusted and adjusted logistic regression analyses to examine the change in engagement in health promoting activities over time. We found rates of annual influenza immunization (66.8% vs 70.3%), dental visit (71.8% vs 70.3%), and normal weight (33.9% vs 33.5%) did not change from 2006 to 2015. The percent with physical examination (90.8% vs 93.8%; P = .03) and non-smokers increased (87.9% vs 91.2; P = .04). Between 2006 and 2015, despite guidelines and recommendations for personalized cancer survivorship health plans, health promoting activities among cancer survivors did not change significantly.

Endometrial cancer (EC) is the most common gynecological tumor in high-income countries, and its incidence has increased over time. The most critical risk factor for EC is the long-term unopposed exposure to increased estrogens both exogenous and endogenous. Machine learning can be used as a promising tool to resolve longstanding challenges and support identification of the risk factors and their correlations before the clinical trials and make them more focused. In this paper we present the results of the research of the correlation analysis of Endometrial cancer risk factors. The study was performed with EC patients of the Almazov center in Saint-Petersburg, Russia. All women involved in the current study underwent radical surgical intervention due to EC. After initial cancer treatment, they were referred to the Almazov center outpatient specialists for follow-up visits. Many of them were readmitted of the inpatient clinic due to relapse. We extracted a variety of parameters related to lifestyle, dietary habits, socioeconomic, and reproductive features from the inpatient and outpatient databases of Almazov center. The medical records of the women with enough data were included in the study. Prediction of Progression-free survival (PFS) and overall survival (OS) were analyzed respectively. The AUC of ROC was calculated for PFS = 0.93 and for OS = 0.94.

In the recent decade, the importance of DNA damage repair (DDR) and its clinical application have been firmly recognized in prostate cancer (PC). For example, olaparib was just approved in May 2020 to treat metastatic castration-resistant PC with homologous recombination repair-mutated genes, however, not all patients can benefit from olaparib, and the treatment response depends on patient-specific mutations. This highlights the need to understand the detailed DDR biology further and develop DDR-based biomarkers. In this study, we establish a four-gene panel of which the expression is significantly associated with overall survival (OS) and progression-free survival (PFS) in PC patients from the TCGA-PRAD database. This panel includes DNTT, EXO1, NEIL3, and EME2 genes. Patients with higher expression of the four identified genes have significantly worse OS and PFS. This significance also exists in a multivariate Cox regression model adjusting for age, PSA, TNM stages, and Gleason scores. Moreover, the expression of the four-gene panel is highly correlated with aggressiveness based on well-known PAM50 and PCS subtyping classifiers. Using publicly available databases, we successfully validate the four-gene panel as having the potential to serve as a prognostic and predictive biomarker for PC specifically based on DDR biology.

To compare survival outcomes between primary surgery and primary radiation therapy (RT) in patients with human papillomavirus (HPV)-negative oropharyngeal squamous cell carcinoma (OPSCC).A retrospective observational cohort study.National Cancer Database.A National Cancer Database review was conducted of 2635 patients with HPV-negative OPSCC who underwent surgery or RT ± chemotherapy between 2010 and 2014. Univariate analysis was performed on all variables and entered into a multivariate model. The main outcome was overall survival (OS).A total of 2635 patients with HPV-negative OPSCC were organized into 4 groups based on cancer staging. In group 1 (T1-2 N0-1; n = 774), up-front surgery had significantly better 5-year OS (76.2%) than RT (56.8%; adjusted hazard ratio [aHR], 1.76; P = .009; 95% CI, 1.15-2.69) and chemoradiation therapy (CRT; 69.5%; aHR, 1.56; P = .019; 95% CI, 1.08-2.26). In group 2 (T3-4 N0-1; n = 327), no significant difference existed between surgery and CRT (5-year OS, 51.3% vs 52.4%; aHR, 0.96; P = .88; 95% CI, 0.54-1.69). In group 3a (T1-2 N2-3; n = 807), surgery with adjuvant treatment showed significantly better 5-year OS than CRT (78.6% vs 68.8%; aHR, 1.51; P = .027; 95% CI, 1.05-2.18). In group 3b (T3-4 N2-3; n = 737), surgery with adjuvant treatment was not statistically associated with better 5-year OS as compared with CRT (61.0% vs 43.7%; aHR, 1.53; P = .06; 95% CI, 0.98-2.39).Primary surgery may provide improved survival outcomes in many cases of HPV-negative OPSCCs. These data should be used in weighing treatment options and may serve as a basis to better delineate treatment algorithms for HPV-negative disease.

Objective: To analyze insurance status effect on overall survival (OS) and disease-specific survival (DSS) in laryngeal cancer. Study Design: Cross-sectional population analysis. Setting: Surveillance, Epidemiology, and End Results (SEER) database. Participants: Laryngeal cancer patients from 2007 to 2016. Main Outcome Measures: Kaplan-Meier method with log-rank statistic analyzed OS and DSS by insurance status. Multivariable cox proportional hazard modeling generated survival prognostic factors. Results: Of 19 667 laryngeal cancer cases, initial disease presentation was stage I: 7770 patients (39.5%), stage II: 3337 patients (17.0%), stage III: 3289 patients (16.7%), and stage IV: 5226 patients (26.6%). Patients had non-Medicaid insurance (15 523, 78.9%), had Medicaid (3306, 16.8%), or were uninsured (891, 4.5%). Mean and median OS for insured, Medicaid, and uninsured patients were 60.5, 49.6, and 56.6 and 74.0, 40.0, and 65.0 months, respectively. Following multivariable analysis, OS for insured, Medicaid, and uninsured patients was stage I: 87.9, 82.8, and 88.4 ( P Conclusion: Insured laryngeal cancer patients had prolonged OS and DSS compared to Medicaid and uninsured patients. Medicaid patients had equivalent survival outcomes to uninsured patients. Level of Evidence: 2c.

Background World Trade Center (WTC)-exposed responders may be eligible to receive no-cost medical monitoring and treatment for certified conditions, including cancer. The survival of responders with cancer has not previously been investigated. Methods This study compared the estimated relative survival of WTC-exposed responders who developed cancer while enrolled in two WTC medical monitoring and treatment programs in New York City (WTC-MMTP responders) and WTC-exposed responders not enrolled (WTC-non-MMTP responders) to non-responders from New York State (NYS-non-responders), all restricted to the 11-southernmost NYS counties, where most responders resided. Parametric survival models estimated cancer-specific and all-cause mortality. Follow-up ended at death or on December 31, 2016. Results From January 1, 2005 to December 31, 2016, there were 2,037 cancer cases and 303 deaths (248 cancer-related deaths) among WTC-MMTP responders, 564 cancer cases, and 143 deaths (106 cancer-related deaths) among WTC-non-MMTP responders, and 574,075 cancer cases and 224,040 deaths (158,645 cancer-related deaths) among the NYS-non-responder population. Comparing WTC-MMTP responders with NYS-non-responders, the cancer-specific mortality hazard ratio (HR) was 0.72 (95% confidence interval [CI] = 0.64-0.82), and all-cause mortality HR was 0.64 (95% CI = 0.58-0.72). The cancer-specific HR was 0.94 (95% CI = 0.78-1.14), and all-cause mortality HR was 0.93 (95% CI = 0.79-1.10) comparing WTC-non-MMTP responders to the NYS-non-responder population. Conclusions WTC-MMTP responders had lower mortality compared with NYS-non-responders, after controlling for demographic factors and temporal trends. There may be survival benefits from no-out-of-pocket-cost medical care which could have important implications for healthcare policy, however, other occupational and socioeconomic factors could have contributed to some of the observed survival advantage.

Cancer management is an active domain of research in machine learning applications. Cancer survival prediction is such an application. However, most of the studies use online datasets due to easy availability and a larger number of instances. Real-world datasets in medical applications are challenging to collect but may give some critical insights relevant to local people. In this paper, a real-world dataset of metastatic prostate cancer patients has been collected from an Indian hospital and analyzed for cancer survival prediction. The authors identified some significant survival predictors and classified them into three categories. The significance of each of the categories is examined using machine learning algorithms. Quality of life attributes gave better prediction results than diagnostic and treatment attributes indicating that a metastatic patient’s survival can be well anticipated using his overall health and comorbidities than his initial diagnostic attributes.

Background: Expression of kallikrein-11 (KLK11) has been found to be related to the prognosis of various human cancer types but its physiological functions in the steps of breast cancer (BC) progression are still unknown. Materials and Methods: BC and adjacent normal breast tissue samples were collected from 28 patients. KLK11 expression levels were determined by real-time polymerase chain reaction for each sample and associations with known prognostic features were statistically analyzed. Results: Although there was slight up-regulation in tumor tissues overall, significant down-regulation of KLK11 expression in tumor tissue was observed in the elderly and in patients with perineural invasion. Furthermore, tumor size, grade, mitotic score, necrosis, calcification, lymphatic invasion, hormone receptor status and Ki67 expression were associated with altered KLK11 level. Conclusion: Changes in expression levels of KLK11, associated with patient characteristics, might be used as complementary data in order to predict clinical outcome and prognosis in BC. Scientific Research Projects Coordination Unit of Istanbul UniversityIstanbul University [12974] The study was supported by a grant from the Scientific Research Projects Coordination Unit of Istanbul University (Project No: 12974).

Background and objective We aimed to investigate the survival time and its related factors among cancer patients with co-morbid tuberculosis (TB) in Thailand. Methods We conducted this retro-prospective cohort study on cancer patients without co-morbid TB using the data from population-based cancer registry of Khon Kaen, TB databases from the Khon Kaen Central Hospital, and the Region 7 Office of Disease Prevention and Control from 2001 to 2015 to determine the onset of TB after cancer. The cancer patients were then followed up until 2017 to assess their survival status. The Kaplan-Meier method, log-rank test, and Cox proportional hazard regression were used to estimate cumulative survival curves, compare various survival distributions, and adjusted hazard ratios. Results Lung, head and neck, and liver cancers led to a significantly different survival time between patients with and without co-morbid TB. After adjustment, it was found that patients suffering from lung, head and neck, or liver cancer and co-morbid TB had significantly lower risk of death than those without co-morbid TB. Based on the stratified analysis, lung cancer patients with distant metastasis and co-morbid TB had 3.01-fold and 2.99-fold significantly increased risk of death compared to those without co-morbid TB. Conclusion We found that cancer patients with co-morbid TB were at lower risk of death compared with those without co-morbid TB. In addition to cancer stage, it seems that cancer comorbidity with TB could modify the risk of death for lung cancer patients.There is a need for further studies to support our findings including other related risk factors. .

BackgroundHepcidin is a polypeptide hormone mainly produced by hepatocytes to modulate systemic iron balance. A drastic downregulation of the hepcidin gene was found in liver cancers. However, there is a paucity of information about the clinical significance of hepcidin gene downregulation in liver cancers.MethodsHepcidin expression profiles were assessed using multiple public datasets via several bioinformatics platforms. Clinical and pathological information was utilized to stratify patients for comparison. Patient survival outcomes were evaluated using the Kaplan-Meier plotter, a meta-analysis tool. Tumor immune infiltration was analyzed using the single sample gene set enrichment analysis (ssGSEA) approach on the Cancer Genome Atlas (TCGA) dataset. Hepcidin antagonist Fursultiamine was used to treat liver cancer HepG2 and Huh7 cells together with Sorafenib.ResultsHepcidin gene was predominantly expressed in benign liver tissues but drastically decreased in liver cancer tissues. Hepcidin reduction in liver cancers correlated with risk factors like non-alcoholic fatty liver disease (NAFLD) and liver fibrosis, as well as cancer grade and tumor stage. Hepcidin downregulation was associated with a rapid cancer progression and worse disease-specific survival, especially in patients of the White race without alcohol consumption history. Hepcidin expression in liver cancer tissues positively correlated with the bone morphogenetic protein-6 (BPM6)/interleukin-6 (IL6) cytokines and cytotoxic immune infiltration. Blocking hepcidin action with its antagonist Fursultiamine moderately reduced Sorafenib-induced apoptotic cell death in HepG2 and Huh7 cells.ConclusionHepcidin downregulation in liver cancers correlated with liver cancer risk factors, cancer aggressiveness, cytotoxic immune cell infiltration, and patient survival outcomes. BMP6/IL6 pathway insufficiency is a potential cause of hepcidin downregulation in liver cancers.

Advances in screening methods and pharmacological treatments are increasing the life expectancy of cancer patients. During recent decades, the community of long-term disease-free cancer survivors (LCS) has grown exponentially, raising the issues related to cancer follow-up. Cancer relapse and other cancer-related diseases, as well as lifestyle, influence cancer survival. Recently, the regulatory role of microRNAs (miRNAs) in gene expression and their involvement in human diseases, including cancer, has been identified. Extracellular circulating miRNAs (ECmiRNAs) have been found in biological fluids and specific ECmiRNAs have been associated with cancer development and progression or with a therapy response. Here, we focus on the pivotal role of ECmiRNAs as biomarkers in cancer diagnosis and prognosis. Then, we discuss the relevance of ECmiRNAs expression in cancer survivors for the identification of specific ECmiRNAs profiles as potential tools to assess cancer outcome and to control LCS follow-up.

Multiple primary malignancies (MPM) are described as two or more primary tumors within the same individual. The impact of MPM on the tumor microenvironment among patients with melanoma is poorly understood. Here, we describe this unique group of patients who have both advanced melanoma and at least one other primary malignancy and report their survival outcomes. In this study, patients with advanced melanoma and a second primary malignancy were identified. Medical records were reviewed for cancer treatment history. Kaplan-Meier methods were used to derive survival curves and estimate overall survival (OS), and log-rank tests were used to compare OS. Among 11 MPM patients, the most common non-melanoma cancers were breast (n = 3) and thyroid (n = 3). Median OS was 153.5 months for all patients. Median OS for synchronous MPM (sMPM) and metachronous MPM (mMPM) were 83.1 and 196.7 months, respectively (p= 0.10). Median OS was not reached when melanoma was diagnosed first, and 153.5 months when diagnosed second (p= 0.45). For six patients receiving immunotherapy for melanoma, there was a 100% complete response rate. In conclusion, patients with melanoma are at risk of secondary malignancies, including breast and thyroid cancer. The timing of secondary malignancies may impact prognosis. Further study of the impact of immunotherapy on MPM is warranted.

Background Persistent smoking after cancer diagnosis is associated with increased overall mortality (OM) and cancer mortality (CM). According to the 2020 Surgeon General's report, smoking cessation may reduce CM but supporting evidence is not wide. Use of deep learning-based modeling that enables universal natural language processing of medical narratives to acquire population-based real-life smoking data may help overcome the challenge. We assessed the effect of smoking status and within-1-year smoking cessation on CM by an in-house adapted freely available language processing algorithm. Materials and methods This cross-sectional real-world study included 29 823 patients diagnosed with cancer in 2009-2018 in Southwest Finland. The medical narrative, International Classification of Diseases-10th edition codes, histology, cancer treatment records, and death certificates were combined. Over 162 000 sentences describing tobacco smoking behavior were analyzed with ULMFiT and BERT algorithms. Results The language model classified the smoking status of 23 031 patients. Recent quitters had reduced CM [hazard ratio (HR) 0.80 (0.74-0.87)] and OM [HR 0.78 (0.72-0.84)] compared to persistent smokers. Compared to never smokers, persistent smokers had increased CM in head and neck, gastro-esophageal, pancreatic, lung, prostate, and breast cancer and Hodgkin's lymphoma, irrespective of age, comorbidities, performance status, or presence of metastatic disease. Increased CM was also observed in smokers with colorectal cancer, men with melanoma or bladder cancer, and lymphoid and myeloid leukemia, but no longer independently of the abovementioned covariates. Specificity and sensitivity were 96%/96%, 98%/68%, and 88%/99% for never, former, and current smokers, respectively, being essentially the same with both models. Conclusions Deep learning can be used to classify large amounts of smoking data from the medical narrative with good accuracy. The results highlight the detrimental effects of persistent smoking in oncologic patients and emphasize that smoking cessation should always be an essential element of patient counseling., Highlights • Deep learning/universal language modeling was used to extract smoking status of cancer patients. Good accuracy was observed. • Those who continue smoking after cancer diagnosis had increased CM compared to never smokers. • Recent within-1-year cessation reduced this mortality. • Detrimental effects of smoking were observed in multiple types of early- and advanced-stage cancers, including the elderly. • We conclude that smoking cessation support should always be included in cancer care.

Background Neuroblastoma (NB) is the most common extracranial solid tumor in children. It is known for high heterogeneity and concealed onset. In recent years, the mechanism of its occurrence and development has been gradually revealed. The purpose of this study is to summarize the clinical characteristics of children with NB and abnormal chromosome 10, and to investigate the relationship between the number and structure of chromosome 10 abnormalities and NB prognosis. Methods Chromosome G-banding was used at the time of diagnosis to evaluate the genetics of chromosomes in patients with NB and track their clinical characteristics and prognosis. All participants were diagnosed with NB in the Medical Oncology Department of the Beijing Children’s Hospital from May 2015 to December 2018 and were followed up with for at least 1 year. Results Of all 150 patients with bone marrow metastases, 42 were clearly diagnosed with chromosomal abnormalities. Thirteen patients showed abnormalities in chromosome 10, and chromosome 10 was the most commonly missing chromosome. These 13 patients had higher LDH and lower OS and EFS than children with chromosomal abnormalities who did not have an abnormality in chromosome 10. Eight patients had both MYCN amplification and 1p36 deletion. Two patients had optic nerve damage and no vision, and one patient had left supraorbital metastases 5 months after treatment. Conclusions The results indicated that chromosome 10 might be a new prognostic marker for NB. MYCN amplification and 1p36 deletion may be related to chromosome 10 abnormalities in NB. Additionally, NB patients with abnormal chromosome 10 were prone to orbital metastases.

Impact of geography on prognostic outcomes of 21,509 patients with metastatic colorectal cancer enrolled in clinical trials: an ARCAD database analysis\ud Show less\ud Jun Yin*, Shaheenah Dawood*, Romain Cohen, Jeff Meyers, John Zalcberg, Takayuki Yoshino, Matthew Seymour, Tim Maughan, Leonard Saltz, Eric Van Cutsem, Alan Venook, Hans-Joachim Schmoll, Richard Goldberg, Paulo Hoff, J. Randolph Hecht, Herbert Hurwitz, Cornelis Punt, Eduard Diaz Rubio, Miriam Koopman, Chiara Cremolini, Volker Heinemann, Christophe Tournigard, Carsten Bokemeyer, Charles Fuchs, Niall Tebbutt, John Souglakos, Jean-Yves Doulliard, Fairooz Kabbinavar, Benoist Chibaudel, Aimery de Gramont, Qian Shi, Axel Grothey, Richard AdamsFirst Published June 30, 2021 Research Article\ud https://doi.org/10.1177/17588359211020547\ud Article information \ud Article has an altmetric score of 7 Open AccessCreative Commons Attribution, Non Commercial 4.0 License\ud Article Information\ud Volume: 13\ud Article first published online: June 30, 2021; Issue published: January 1, 2021\ud Received: December 29, 2020; Accepted: May 05, 2021\ud Jun Yin*\ud Department of Health Sciences Research, Mayo Clinic, 200 First Street, SW Rochester, MN 55905, USA\ud Shaheenah Dawood*\ud Mediclinic City Hospital: North Wing, Dubai Health Care City, Dubai UAE\ud Romain Cohen\ud Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA\ud Jeff Meyers\ud Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA\ud John Zalcberg\ud School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia\ud Takayuki Yoshino\ud Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan\ud Matthew Seymour\ud NIHR Clinical Research Network, Leeds, UK\ud Tim Maughan\ud CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK\ud Leonard Saltz\ud Memory Sloan Kettering Cancer Center, New York, NY, USA\ud Eric Van Cutsem\ud Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium\ud Alan Venook\ud Department of Medicine, The University of California San Francisco, San Francisco, CA, USA\ud Hans-Joachim Schmoll\ud Klinik fur Innere Med IV, University Clinic Halle, Saale, Germany\ud Richard Goldberg\ud Department of Oncology, West Virginia University, Morgantown, WV, USA\ud Paulo Hoff\ud Centro de Oncologia de Brasilia do Sirio Libanes: Unidade Lago Sul, Siro Libanes, Brazil\ud J. Randolph Hecht\ud Ronald Reagan UCLA Medical Center, UCLS Medical Center, Santa Monica, CA, USA\ud Herbert Hurwitz\ud Duke Cancer Institute, Duke University, Durham, NC, USA\ud Cornelis Punt\ud Department of Medical Oncology, University of Amsterdam, Amsterdam, The Netherlands\ud Eduard Diaz Rubio\ud Department Oncology, Hospital Clínico San Carlos, Madrid, Spain\ud Miriam Koopman\ud Department of Medical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands\ud Chiara Cremolini\ud Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy\ud Volker Heinemann\ud Department of Medical Oncology and Comprehensive Cancer Center, University of Munich, Munich, Germany\ud Christophe Tournigard\ud Hopital Henri Mondor, Creteil, France\ud Carsten Bokemeyer\ud Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany\ud Charles Fuchs\ud Director of Yale Cancer Center, Boston, MA, USA\ud Niall Tebbutt\ud Sydney Medical School, University of Sydney, Sydney, Australia\ud John Souglakos\ud University of Crete, Heraklion, Greece\ud Jean-Yves Doulliard\ud University of Nantes Medical School, Nantes, France\ud Fairooz Kabbinavar\ud UCLA Medical Center, Santa Monica, CA, USA\ud Benoist Chibaudel\ud Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France\ud Aimery de Gramont\ud Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France\ud Qian Shi\ud Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA\ud Axel Grothey\ud West Cancer Center, Germantown, TN, USA\ud Richard Adams\ud Cardiff University and Velindre Cancer Center, Cardiff, UK\ud \ud Corresponding Author:\ud \ud yin.jun@mayo.edu\ud *Co-first authors.\ud \ud https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).\ud Abstract\ud Background:\ud Benchmarking international cancer survival differences is necessary to evaluate and improve healthcare systems. Our aim was to assess the potential regional differences in outcomes among patients with metastatic colorectal cancer (mCRC) participating in international randomized clinical trials (RCTs).\ud \ud Design:\ud Countries were grouped into 11 regions according to the World Health Organization and the EUROCARE model. Meta-analyses based on individual patient data were used to synthesize data across studies and regions and to conduct comparisons for outcomes in a two-stage random-effects model after adjusting for age, sex, performance status, and time period. We used mCRC patients enrolled in the first-line RCTs from the ARCAD database, which provided enrolling country information. There were 21,509 patients in 27 RCTs included across the 11 regions.\ud \ud Results:\ud Main outcomes were overall survival (OS) and progression-free survival (PFS). Compared with other regions, patients from the United Kingdom (UK) and Ireland were proportionaly over-represented, older, with higher performance status, more frequently male, and more commonly not treated with biological therapies. Cohorts from central Europe and the United States (USA) had significantly longer OS compared with those from UK and Ireland (p = 0.0034 and p

Not available, Research letter

Long noncoding RNA NALT1-induced gastric cancer invasion and metastasis via NOTCH signaling pathway

Background The present study aimed to assess whether the widespread concern of inferior cancer survival in adolescents and young adults (AYAs) compared with children and adults holds true in a Nordic setting with important differences in healthcare organisation compared with the United States (e.g. free access to healthcare) and the United Kingdom (e.g. young teenagers are treated in paediatric departments). Methods Five-year relative survival was calculated for 17 diagnostic groups in patients diagnosed in 2000–2013 in three diagnostic age categories: children (0–14 years), AYAs (15–24 years) and adults (25–34 years). Results For 13 out of 17 diagnostic groups examined, there was no difference in survival between AYAs and neighbouring age categories. For acute lymphoblastic leukaemias, astrocytomas, rhabdomyosarcomas and non-rhabdomyosarcoma soft tissue sarcomas we found survival in children to be superior to that in AYAs. For these four diagnostic groups, the rate of survival improvement over three calendar periods (1980–1989, 1990–1999 and 2000–2013) was not particularly low in AYAs compared with neighbouring age categories. Conclusions The present study suggests that in an affluent setting with free access to healthcare, meaningful differences in survival between AYA patients and either childhood or adult patients are a phenomenon of the past for most AYA cancer diagnostic groups.

Objective. To examine the distribution of stage at diagnosis for 12 cancers in Kuwait, to estimate stage-specific net survival at 1 and 5 years after diagnosis, and to assess differences in stage-specific survival between Kuwait and the United States. Material and Methods. Data were obtained from the Kuwait Cancer Registry, for Kuwaiti patients diagnosed during 2000–2013, with follow-up to 31 December 2015. The distribution of Surveillance Epidemiology and End Results (SEER) Summary Stage for 12 malignancies was examined. We estimated net survival by stage up to 5 years after diagnosis, controlling for background mortality with life tables of all-cause mortality in the general population by single year of age, sex, and calendar period. Survival estimates were age-standardised using the International Cancer Survival Standard (ICSS) weights. Results. Only 14.2% of patients were diagnosed at a localised stage and 38.9% at the regional stage. The proportion of patients with known stage was 88.9% during 2000–2004 but fell to 59.4% during 2010–2013. During 2005–2009, 1- and 5-year survival for colon, rectal, breast, cervical, and prostate cancer was about 90% or higher for patients diagnosed at the localised stage. During 2004–2009, the proportion of patients diagnosed at a localised stage was lower in Kuwait than in the US for colon, breast, and lung cancer. Age-standardised 5-year net survival for all stages combined was lower in Kuwait than the US for colon, lung, and breast cancer, but stage-specific survival was similar. Conclusion. Since stage-specific survival is similar in Kuwait and the US, late stage at diagnosis is likely to be a major contributing factor to the overall lower survival in Kuwait than in the US. Increasing public awareness of cancer risk factors and symptoms and investment in early detection will be vital to reduce the proportion of patients diagnosed at a late stage and to improve survival.

Background Frailty is a syndrome characterized by weakness, slow gait, weight loss, exhaustion, and low activity. We sought to determine whether frailty was associated with age or stage in newly diagnosed patients with pancreatic ductal adenocarcinoma (PDAC), and determine its association with survival. Methods Consecutive patients with newly diagnosed PDAC of all stages underwent baseline assessment. Frailty (per Fried criteria) was defined as having three or more abnormalities in: grip strength, gait speed, weight loss, self‐reported exhaustion, or self‐reported physical activity. Baseline clinicodemographic characteristics, anatomic stage, performance status, and laboratory markers of prognosis were included. The association between baseline characteristics, frailty, and survival was determined. The associations of individual frailty measures with age, stage, comorbidities, and performance status were examined. Body composition was measured from computed tomographic images using SliceOMatic software. Results Of 150 patients enrolled, 8 were excluded because they did not have PDAC on final diagnosis. The median age was 65 years (range, 32‐89). Seventy‐nine patients (55.6%) were sarcopenic, and 36 (25.4%) were frail. Frailty was associated with increasing comorbidities (P = 0.03) and worse performance status (P

Purpose Studies suggest that regular use of metformin may decrease cancer mortality. We investigated the association between diabetes medication use and cancer survival. Materials and Methods The current study includes 633 breast, 890 colorectal, 824 lung, and 543 gastric cancer cases identified from participants of two population-based cohort studies in Shanghai. Information on diabetes medication use was obtained by linking to electronic medical records. The associations between diabetes medication use (metformin, sulfonylureas, and insulin) and overall and cancer-specific survival were evaluated using time-dependent Cox proportional hazards models. Results After adjustment for clinical characteristics and treatment factors, use of metformin was associated with better overall survival among colorectal cancer patients (hazards ratio [HR], 0.55; 95% confidence interval [CI], 0.34 to 0.88) and for all four types of cancer combined (HR, 0.75; 95% CI, 0.57 to 0.98). Ever use of insulin was associated with worse survival for all cancer types combined (HR, 1.89; 95% CI, 1.57 to 2.29) and for the four cancer types individually. Similar associations were seen for diabetic patients. Sulfonylureas use was associated with worse overall survival for breast or gastric cancer (HR, 2.87; 95% CI, 1.22 to 6.80 and HR, 2.05; 95% CI, 1.09 to 3.84, respectively) among diabetic patients. Similar association patterns were observed between diabetes medication use and cancer-specific survival. Conclusion Metformin was associated with improved survival among colorectal cancer cases, while insulin use was associated with worse survival among patients of four major cancers. Further investigation on the topic is needed given the potential translational impact of these findings.

Purpose of Review This review summarizes a selection of epidemiologic research assessing the associations between carbohydrate intake and cancer incidence and survival. Evidence for plausible biological mechanisms is also considered. Recent Findings The mechanistic paradigm explaining the relationship between carbohydrates and cancer risk has been contested by numerous observational studies. Summary Carbohydrates have conventionally been ascribed a deleterious role in the field of cancer research due to previous preclinical findings. A breadth of studies suggests that complex carbohydrate intake is inversely associated with risk of a number of cancer types. Data from studies assessing simple carbohydrates and cancer risk are mixed. Furthermore, recommendations for subsequent studies are framed.

Background: Socioeconomic inequality in survival after cancer have been reported in several countries and also in Denmark. Changes in cancer diagnostics and treatment may have changed the gap in su...

Background: Marital status has been reported as an independent prognostic factor for survival in various cancers, but it has been rarely studied in renal clear cell carcinoma (ccRCC). In this study, we aimed to assess the impact of marital status on the survival of ccRCC patients. Methods: We retrospectively investigated the Surveillance, Epidemiology, and End Results (SEER) database and identified 68599 of ccRCC patients between 1973 and 2015. These patients were divided into married, single, divorced and widowed groups. The survival differences among these groups were assessed by Kaplan-Meier method and log-rank test. Multivariate Cox regression analyses were performed to identify the overall survival (OS) and cancer-specific survival (CSS) independent factors. Furthermore, 1:1 propensity score matching (PSM) analysis was performed to minimize the potential confounding factors. Results: Of the 68599 ccRCC patients, 44553 (64.95%) patients were married, 7410 (10.80%) were divorced, 10663 (15.54%) were single, and 5973 (8.71%) were widowed. The 5-year OS was 79.0%, 73.8%, 77.3%, and 66.4 % in the married, divorced, single, and widowed groups, respectively (p = 0.001) and the corresponding 5-year CSS rates were 85.5%, 83.3%, 80.8%, 76.5%, respectively. Multivariate Cox regression analysis marital status was the independent prognostic factor for OS and CSS. Compared with the married patients, the divorced, single, and widowed patients faced increased higher mortality risks for OS and CSS. In stratified analyses by sex, surgery conditions and cancer stages, those unmarried patients still had worse prognosis. The results were further confirmed in the 1: 1 matched group. Conclusion: Unmarried ccRCC patients experienced worse survival than their married counterparts. Among the unmarried patients, the widowed suffered the highest mortality risks for OS and CSS.