JNCI Cancer Spectrum最新文献

{"title":"Evaluating patient diversity in early phase clinical trials in Australia through a prospective multicenter nonrandomized cohort study.","authors":"Udit Nindra, Joanne Tang, Jun Hee Hong, Martin Hong, Christina Teng, Joe Wei, Andrew Killen, Adam Cooper, Kate Wilkinson, Weng Ng, Charlotte Lemech, Wei Chua, Abhijit Pal","doi":"10.1093/jncics/pkaf035","DOIUrl":"10.1093/jncics/pkaf035","url":null,"abstract":"<p><strong>Background: </strong>Early phase clinical trials continue to have difficulty with enrolling real-world populations with many minorities being underrepresented. Reasons for this include patient or clinician perception as well as cultural, linguistic, or social barriers. In Australia, there is currently no prospective data in the early phase clinical trial space regarding recruitment of priority populations.</p><p><strong>Methods: </strong>Patient Diversity in Early Phase Clinical Trials was a multicenter, prospective, cohort study involving 2 major early phase clinical trial centers in Sydney, Australia. All participants who were consented to an early phase clinical trial between August 2023 and August 2024 were enrolled. Participants completed a baseline demographic survey, which included cultural and linguistic status, sexual orientation, socioeconomic status, and regional diversity.</p><p><strong>Results: </strong>A total of 114 participants were recruited. Median age was 63 years (range = 25-83 years) with predominance for female participants (52%). No participant reported a nonbinary gender. All participants reported their sexuality as heterosexual, with no LGBTQIA+ participants recruited. A total of 34 (30%) participants were identified as culturally diverse, while 28 (25%) were linguistically diverse. One patient identified as Indigenous Australian. Of the participants, 26% were born overseas, with 44% having at least 1 parent born overseas. The majority were living in households with family members, with 8% of participants living alone.</p><p><strong>Conclusion: </strong>Patient Diversity in Early Phase Clinical Trials is the first prospective study that provides granular description of social, cultural, linguistic, economic, and sexual diversity among early phase clinical trial participants. Certain subgroups are underrepresented, including those with sexual diversity, gender diversity, and Indigenous backgrounds. Ongoing efforts to monitor and promote inclusion of diverse populations in clinical trials are vital.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tumor localization strategies of multicancer early detection tests: a quantitative assessment.","authors":"Christopher Tyson, Kevin H Li, Xiting Cao, James M O'Brien, Elliot K Fishman, Elizabeth K O'Donnell, Carlos Duran, Vijay Parthasarathy, Seema P Rego, Omair A Choudhry, Tomasz M Beer","doi":"10.1093/jncics/pkaf011","DOIUrl":"10.1093/jncics/pkaf011","url":null,"abstract":"<p><strong>Background: </strong>Multicancer early detection tests may expand cancer screening. Characterizing diagnostic resolution approaches following positive multicancer early detection tests is critical. Two trials employed distinct resolution approaches: a molecular signal to predict tissue of origin and an imaging-based diagnostic strategy. This modeling study characterizes diagnostic journeys and impact in a hypothetical population of average-risk multicancer early detection-eligible patients.</p><p><strong>Methods: </strong>A mathematical expression for diagnostic burden was derived using positive predictive value (PPV), molecular tissue of origin localization accuracy, and numbers of procedures associated with each diagnostic outcome. Imaging-based and molecular tissue of origin-informed strategies were compared. Excess lifetime cancer risk due to futile radiation exposure was estimated using organ-specific diagnostic imaging radiation doses.</p><p><strong>Results: </strong>Across all PPVs and localization performances, a molecular tissue of origin strategy resulted in a higher diagnostic burden (mean = 3.6 [0.445] procedures vs mean = 2.6 [0.100] procedures) for the imaging strategy. Estimated diagnostic burden was higher for molecular tissue of origin in 95.5% of all PPV and tissue of origin accuracy combinations; at least 79% PPV and 90% accuracy would be required for a molecular tissue of origin-informed strategy to be less burdensome than imaging. The maximum rate of excess cancer incidence from radiation exposure for multicancer early detection false-positive results (individuals aged 50-84 years) was 64.6 of 100 000 (annual testing, 99% specificity), 48.5 of 100 000 (biennial testing, 98.5% specificity), and 64.6 of 100 000 (biennial testing, 98% specificity).</p><p><strong>Conclusions: </strong>An imaging-based diagnostic strategy is more efficient than a molecular tissue of origin-informed approach across almost all PPV and tissue of origin accuracy combinations. The use of an imaging-based approach for cancer localization can be efficient and low-risk compared with a molecular-informed approach.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parental loss at age birth to 21 years and daughters' breast cancer and tumor characteristics.","authors":"Corinna Keeler, Nickilou Y Krigbaum, Barbara Cohn, Piera Cirillo","doi":"10.1093/jncics/pkaf004","DOIUrl":"10.1093/jncics/pkaf004","url":null,"abstract":"<p><strong>Background: </strong>Adverse events in childhood are linked to cancer risk across the life course, but evidence is lacking regarding parental death during childhood and breast cancer characteristics. We investigated whether women who experienced parental loss in childhood have a higher incidence of breast cancer and are at higher risk of aggressive disease.</p><p><strong>Methods: </strong>The Child Health and Development Studies (CHDS) consists of more than 15 000 families that enrolled during mothers' pregnancies between 1959 and 1967; family members were followed for cancer incidence and cause-specific mortality. We constructed an analytical cohort of all live-born CHDS daughters (N = 9169) linked to their parents' cause and date of death. We estimated adjusted hazard ratios of incident breast cancer, disease stage at diagnosis, and tumor hormone receptor expression for parental loss in Cox models adjusted for race, maternal breast cancer, and paternal age. Generalized linear models estimated associations between breast density and parental loss among a subsample of CHDS daughters (n = 610) with available mammography reports.</p><p><strong>Results: </strong>In total, 137 CHDS daughters were diagnosed with breast cancer by age 52 years, and 654 daughters had lost 1 or both parents when they were 21 years of age or younger. Loss of both parents was associated with breast cancer incidence (adjusted hazard ratio =  4.69, 95% CI = 1.68 to 13.04); late-stage disease at diagnosis (adjusted hazard ratio =  9.47, 95% CI = 1.38 to 64.84); and ERBB2 (formerly HER2)-positive, progesterone receptor-negative, and estrogen receptor-negative tumors. Loss of mother or father was associated with ERBB2-positive tumors. Breast density in the premenopause window was associated with loss of a mother or both parents.</p><p><strong>Conclusion: </strong>In a multigenerational cohort with well-defined cancer outcomes and validated cause-of-death data, life-course risk of breast cancer was 4.69 times higher among participants who had lost both parents during childhood. Subanalyses showed that parental loss was associated with late stage at diagnosis and tumor hormone markers of aggressive disease. Parental death during childhood could be added to medical histories to indicate a need for counseling on prevention and early detection of breast cancer.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genome-wide association study and Mendelian randomization analyses reveal insights into bladder cancer etiology.","authors":"Susanna C Larsson, Jie Chen, Xixian Ruan, Xue Li, Shuai Yuan","doi":"10.1093/jncics/pkaf014","DOIUrl":"10.1093/jncics/pkaf014","url":null,"abstract":"<p><strong>Background: </strong>The causes of bladder cancer are not completely understood. Our objective was to identify blood proteins and modifiable causal risk factors for bladder cancer by combining genome-wide association study (GWAS) and Mendelian randomization (MR) analyses.</p><p><strong>Methods: </strong>We first performed a GWAS meta-analysis of 6984 bladder cancer case patients and 708 432 control individuals from 3 European databases. Next, we conducted 2-sample MR and colocalization analyses using data from the present GWAS and published GWAS meta-analyses on plasma proteins and modifiable factors.</p><p><strong>Results: </strong>Genome-wide association study meta-analysis uncovered 17 bladder cancer susceptibility loci, of which 3 loci were novel. Genes were enriched in pathways related to the metabolic and catabolic processes of xenobiotics and cellular detoxification. Proteome-wide MR analysis based on cis-acting genetic variants revealed that higher plasma levels of glutathione S-transferases were strongly associated with a reduced risk of bladder cancer. There is strong evidence of colocalization between GSTM1 and bladder cancer. Finally, multivariable MR analyses of suspected risk factors for bladder cancer revealed independent causal associations between smoking and adiposity, particularly abdominal obesity, and risk of bladder cancer.</p><p><strong>Conclusions: </strong>Findings from this large-scale GWAS and multivariable MR analyses highlight the key role of detoxification processes, particularly glutathione S-transferase 1, as well as smoking and abdominal obesity in bladder cancer etiology.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social determinants of health and variability in treatment for patients with early-stage non-small cell lung cancer.","authors":"Molly Scannell Bryan, Xiaohan Hu, Monika A Izano, Hina Mohammed, Marianna Wicks, Thomas Brown, George Simon, Henry Kaplan, Anna Berry","doi":"10.1093/jncics/pkae117","DOIUrl":"10.1093/jncics/pkae117","url":null,"abstract":"<p><strong>Background: </strong>In non-small cell lung cancer, social determinants of health (SDOH) influence treatment, but SDOH with geographic precision are infrequently used in real-world research because of privacy considerations. This research aims to characterize the influence of census tract-level SDOH on treatment for stage I and IIa non-small cell lung cancer.</p><p><strong>Methods: </strong>Patients diagnosed between January 1, 2017, and September 30, 2022, with stage I or IIa non-small cell lung cancer in the Syapse Learning Health Network had their addresses geocoded and linked to 6 census tract-level indicators of SDOH (the Centers for Disease Control and Prevention and Agency for Toxic Substances and Disease Registry Social Vulnerability Index, percentage housing burden, percentage broadband internet access, primary care shortage area, and rurality). Clinical and demographic characteristics were ascertained from medical records. Nested multinomial logistic regression models estimated associations between SDOH and initial treatment using 2-sided Wald tests. The collective statistical significance of SDOH was assessed using a likelihood ratio test comparing nested models. Descriptive statistics described time to treatment initiation.</p><p><strong>Results: </strong>Among 3595 patients, 58% were initially treated with surgery, 29% with radiation, and 12% with \"other.\" Two SDOH variables were associated with increased relative risk for radiation therapy compared with surgery: living in primary care shortage areas (relative risk = 1.61, 95% CI = 1.23 to 2.10) and living in nonmetropolitan areas (relative risk = 1.45, 95% CI = 1.02 to 2.07). The likelihood ratio test suggested that the 5 SDOH variables collectively improved the treatment model. Further, patients in areas with high Social Vulnerability Index, low internet access, and high housing burden initiated treatment later.</p><p><strong>Conclusion: </strong>When using precise estimates of geospatial SDOH, these measures were associated with treatment and should be considered in analyses of cancer outcomes.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11901590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening for comprehensive social needs in patients with cancer: a narrative review.","authors":"Isabel Arana, Raymond Liu, Lawrence Kushi, Erin Hahn, Meera Ragavan","doi":"10.1093/jncics/pkaf012","DOIUrl":"10.1093/jncics/pkaf012","url":null,"abstract":"<p><strong>Background: </strong>Patients with cancer who report social needs have worse quality of life, lower health-care access, and suboptimal health outcomes. However, screening for social needs does not happen systematically, and successful screening tools, strategies, and workflows have seldom been described. The downstream effects of screening including resource navigation have also not been well characterized. The objective of this narrative review was to fill these gaps.</p><p><strong>Methods: </strong>Two investigators searched PubMed and Embase for studies that implemented a patient-facing social screening tool among patients with cancer between 2008 and 2023 using search terms including social screening, social  needs, and cancer.</p><p><strong>Results: </strong>We identified 19 articles that met study inclusion criteria. The most common tool used was the validated Health Leads Social Toolkit. Most often, screening tools were administered electronically, sent directly to patients, and captured needs at a single time point during a patient's diagnosis. Screening response rates ranged between 10% and 60%. Less than half of the studies described downstream resource navigation for patients who screened positive for social needs. Only 1 study evaluated the impact of screening on clinical outcomes and quality of life. Screening for patients who do not speak English or who belong to historically racial, ethnic, and gender minority groups was limited.</p><p><strong>Conclusions: </strong>Screening for social needs has been shown to be feasible across delivery systems with numerous validated tools available. However, gaps remain in generalizability to diverse patient populations. Future work must identify how screening workflows can be successfully incorporated into routine clinical workflows.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11917213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do trial benefits predict real-world gains in metastatic castration resistant prostate cancer.","authors":"Sarah Axeen, Alice J Chen, Darius N Lakdawalla, Neal Masia, Alexander Niyazov, Bhakti Arondekar, Stephen J Freedland","doi":"10.1093/jncics/pkaf018","DOIUrl":"10.1093/jncics/pkaf018","url":null,"abstract":"<p><strong>Background: </strong>It is important to understand the relationship between drug efficacy measured in randomized clinical trials (RCTs) and real-world drug effectiveness. We estimate how RCT overall survival (OS) and RCT radiographic progression-free survival (rPFS) benefits predict the association between treatments and real-world OS gains for metastatic castration-resistant prostate cancer (mCRPC) drugs.</p><p><strong>Methods: </strong>Using the National Cancer Institute list of approved cancer drugs and the National Comprehensive Cancer Network Treatment Guidelines, we identified all pharmaceutical therapies for mCRPC approved between 2010 and 2019. We obtained RCT OS and rPFS hazard ratios from the pivotal trials used for Food and Drug Administration (FDA) approval, and we estimated real-world OS hazard ratios using the Optum Clinformatics Extended DataMart Databases. We modeled real-world OS hazard ratios as a function of both RCT OS and RCT rPFS hazard ratios using Cox proportional hazards regressions, adjusted for year of diagnosis, age, race, and Elixhauser Comorbidity Index.</p><p><strong>Results: </strong>When we did not account for nonrandom real-world selection of patients into receiving a newly approved therapy (ie, \"treatment selection bias\"), real-world OS gains were 15% lower than associated RCT OS and RCT rPFS benefits. However, after accounting for treatment selection bias in real-world settings, real-world OS gains were almost 28% greater than RCT OS and RCT rPFS benefits. Association between treatment and OS gains increased the longer a new therapy was on the market.</p><p><strong>Conclusions: </strong>After adjusting for treatment selection bias, RCT OS and RCT rPFS estimates serve as useful, or even conservative, predictors of RW OS gains.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Easy ensemble classifier-group and intersectional fairness and threshold (EEC-GIFT): a fairness-aware machine learning framework for lung cancer screening eligibility using real-world data.","authors":"Piyawan Conahan, Lary A Robinson, Trung Le, Gilmer Valdes, Matthew B Schabath, Margaret M Byrne, Lee Green, Issam El Naqa, Yi Luo","doi":"10.1093/jncics/pkaf030","DOIUrl":"10.1093/jncics/pkaf030","url":null,"abstract":"<p><strong>Background: </strong>We use real-world data to develop a lung cancer screening (LCS) eligibility mechanism that is both accurate and free from racial bias.</p><p><strong>Methods: </strong>Our data came from the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial. We built a systematic fairness-aware machine learning framework by integrating a Group and Intersectional Fairness and Threshold (GIFT) strategy with an easy ensemble classifier-(EEC-) or logistic regression-(LR-) based model. The best LCS eligibility mechanism EEC-GIFT* and LR-GIFT* were applied to the testing dataset and their performances were compared to the 2021 US Preventive Services Task Force (USPSTF) criteria and PLCOM2012 model. The equal opportunity difference (EOD) of developing lung cancer between Black and White smokers was used to evaluate mechanism fairness.</p><p><strong>Results: </strong>The fairness of LR-GIFT* or EEC-GIFT* during training was notably greater than that of the LR or EEC models without greatly reducing their accuracy. During testing, the EEC-GIFT* (85.16% vs 78.08%, P < .001) and LR-GIFT* (85.98% vs 78.08%, P < .001) models significantly improved sensitivity without sacrificing specificity compared to the 2021 USPSTF criteria. The EEC-GIFT* (0.785 vs 0.788, P = .28) and LR-GIFT* (0.785 vs 0.788, P = .30) showed similar area under receiver operating characteristic curve values compared to the PLCOM2012 model. While the average EODs between Blacks and Whites were significant for the 2021 USPSTF criteria (0.0673, P < .001), PLCOM2012 (0.0566, P < .001), and LR-GIFT* (0.0081, P < .001), the EEC-GIFT* model was unbiased (0.0034, P = .07).</p><p><strong>Conclusion: </strong>Our EEC-GIFT* LCS eligibility mechanism can significantly mitigate racial biases in eligibility determination without compromising its predictive performance.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-gene risk score for prediction of clinical outcomes in treatment-naïve metastatic castrate-resistant prostate cancer.","authors":"Muhammad Zaki Hidayatullah Fadlullah, David Nix, Cameron Herberts, Corinne Maurice-Dror, Alexander W Wyatt, Bogdana Schmidt, Brayden Fairbourn, Aik-Choon Tan, Liang Wang, Manish Kohli","doi":"10.1093/jncics/pkaf025","DOIUrl":"10.1093/jncics/pkaf025","url":null,"abstract":"<p><strong>Background: </strong>To determine the performance of a multi-gene copy number variation (MG-CNV) risk score in metastatic tissue and plasma biospecimens from treatment-naïve metastatic castration-resistant prostate cancer (mCRPC) patients for prediction of clinical outcomes.</p><p><strong>Methods: </strong>The mCRPC tissue and plasma cell-free DNA (cfDNA) biospecimen sequencing results obtained from publicly accessed cohorts in dbGaP, cBioPortal, and an institutional mCRPC cohort were used to develop a MG-CNV risk score derived from gains in AR, MYC, COL22A1, PIK3CA, PIK3CB, NOTCH1 and losses in TMPRSS2, NCOR1, ZBTB16, TP53, NKX3-1 in independent cohorts for determining overall survival (OS), progression-free survival (PFS) to first-line androgen receptor pathway inhibitors (ARPIs). The range of the risk scores for each cohort was dichotomized into \"high-risk\" and \"low-risk\" groups and association with OS/PFS determined. Univariate and multivariable Cox proportional hazards regressions were applied for survival analyses (P < .05 for statistical significance).</p><p><strong>Results: </strong>Of 1137 metastatic tissue-plasma biospecimens across all cohorts, 699/1137 were treatment-naive mCRPC (235/699 metastatic tissue; 464/699 plasma-cfDNA), and 311/1137 were matched tissue-cfDNA pairs. In multivariable analysis, the MG-CNV risk score derived from metastatic tissue or in cfDNA was statistically significantly associated with OS with high score associated with short survival (hazard ratio = 2.65, confidence interval = 1.99 to 3.51; P = 1.35-11) and shorter PFS to ARPIs (median PFS of 7.8 months) compared with 14 months in patients with low-risk score.</p><p><strong>Conclusions: </strong>A molecular risk score in treatment-naïve mCRPC state obtained either in metastatic tissue or cfDNA predicts clinical survival outcomes and offers a tumor biology-based tool to design biomarker-based enrichment clinical trials.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inequities in palliative care delivery to patients with HIV and stage IV cancers in the United States (2004-2020).","authors":"Jessica Y Islam, Yi Guo, Kea Turner, Amir Alishahi Tabriz, Yu Chen Lin, Denise C Vidot, Susan T Vadaparampil, Anna E Coghill, Marlene Camacho-Rivera, Gita Suneja","doi":"10.1093/jncics/pkae118","DOIUrl":"10.1093/jncics/pkae118","url":null,"abstract":"<p><strong>Background: </strong>People with HIV diagnosed with stage IV cancer are less likely to receive palliative care compared with those without HIV. Our objective was to evaluate inequities in palliative care receipt among people with HIV with stage IV cancer in the United States.</p><p><strong>Methods: </strong>We used the National Cancer Database (2004-2020), including adults (aged 18-89 years) with HIV with the 14 most common cancers that occur among people with HIV. Palliative care was defined as treatment provided with noncurative intent. Our main exposures included percent quartiles (Q) of adults without a high school degree (educational attainment) and median income quartiles within the patient's zip code. We used hierarchical multivariable Poisson regression to estimate adjusted prevalence ratios with 95% confidence intervals (CIs), adjusting for age, sex, year of diagnosis, race and ethnicity, and cancer type.</p><p><strong>Results: </strong>Among the included 10 120 people with HIV with stage IV cancer, 72% were men, 51% were either non-Hispanic Black or Hispanic or Latinx, 38% were aged 60 years and older, and 97% resided in urban areas; 14% received palliative care. Non-Hispanic Black people with HIV living in zip codes with lower quartiles of educational attainment were more likely to receive palliative care compared with those in the highest quartile (Q1 vs Q4: adjusted prevalence ratio = 1.93, 95% CI = 1.29 to 2.86). For income overall, compared with those in the highest quartile (Q4) of income, those in the lowest quartile had 26% higher likelihood of receiving palliative care (Q1 vs Q4: adjusted prevalence ratio = 1.26, 95% CI = 1.05 to 1.52), particularly among non-Hispanic Black adults (Q1 vs Q4: adjusted prevalence ratio = 1.67, 95% CI =1.25 to 2.22; Q2 vs Q4: adjusted prevalence ratio = 1.48, 95% CI = 1.09 to 2.01).</p><p><strong>Conclusions: </strong>Palliative care use among people with HIV with stage IV cancer is low. Contextual poverty plays a role in palliative care delivery to people with HIV and cancer, particularly among non-Hispanic Black people with HIV.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}