The Lancet Regional Health: Western Pacific最新文献

{"title":"Middle-age cerebral small vessel disease and cognitive function in later life: a population-based prospective cohort study","authors":"Ali Tanweer Siddiquee ,&nbsp;Yoon Ho Hwang ,&nbsp;Soriul Kim ,&nbsp;Sung Jin Shin ,&nbsp;Ji Soo Lee ,&nbsp;June Christoph Kang ,&nbsp;Min-Hee Lee ,&nbsp;Hyeon Jin Kim ,&nbsp;Seung Ku Lee ,&nbsp;Chol Shin","doi":"10.1016/j.lanwpc.2024.101284","DOIUrl":"10.1016/j.lanwpc.2024.101284","url":null,"abstract":"<div><h3>Background</h3><div>Cerebral small vessel disease (cSVD) is a major pathologic substrate of vascular contribution to cognitive impairment. However, population based long-term longitudinal cognitive function data in relation to cSVD are rare. We investigated the relationship between cSVD and cognitive decline over time in middle-aged through elderly population.</div></div><div><h3>Methods</h3><div>This prospective cohort study was conducted in a community-based adult population (avg. age 58.5 ± 6.4) who underwent both magnetic resonance imaging (MRI) and comprehensive neuropsychological tests at baseline (2011–2014). The participants were followed-up with the same neuropsychological test battery 4-yearly in two more cycles (in 2015–2018 and 2019–2022). A total of 2454 participants who were free of dementia and cerebrovascular disease at baseline with cognitive function testing at least 2 time points over the time were analyzed. Data analysis was performed from May 1, 2023 to January 31, 2024. SVD was defined by the presence of any of the visible MRI markers (age-related white matter change, lacunes and cerebral microbleeds) at baseline. The main outcomes were multivariable adjusted mean differences of cognitive test performances by cSVD groups over time. The neuropsychological assessment battery included verbal and visual memory, verbal fluency, Digit Symbol–coding, Trail Making Test–A, and Stroop Test. To examine the relationship between cSVD and cognitive function, we used linear mixed model for repeated measurements to compare the means (95% CIs) by cSVD groups.</div></div><div><h3>Findings</h3><div>Of the total, 908 (37.0%) participants had cSVD on MRI reading at baseline. By location, cSVD were mostly found in the frontal lobe followed by basal ganglia area of the brain. None of the cognitive test scores, except Trail Making Test–A, were significantly different between the cSVD groups at baseline. At 8-year follow-up, participants without cSVD performed significantly better than participants with cSVD in Stroop–color reading [Mean difference 1.19 (95% CI: 0.02–2.36), p = 0.0451] and visual reproduction-recognition [Mean difference 0.11 (95% CI: 0.01–0.21), p = 0.0221]. While no other cognitive tests showed any differential changes by cSVD groups, logical memory (Story Recall Tests) increased and Stroop-word reading decreased over time in both cSVD groups almost identically.</div></div><div><h3>Interpretation</h3><div>Silent cSVD was independently associated with decline in executive functioning over 8-year follow-up period in this Korean middle-aged through elderly general population. Future studies considering wider spectrum of cSVD and longer follow-up durations may help predict further cognitive outcomes.</div></div><div><h3>Funding</h3><div>This study was funded by the <span>Korea Centers for Disease Control and Prevention</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101284"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closing the gap in dementia research by community-based cohort studies in the Chinese population","authors":"Xiaowen Zhou ,&nbsp;Zhenxu Xiao ,&nbsp;Wanqing Wu ,&nbsp;Yuntao Chen ,&nbsp;Changzheng Yuan ,&nbsp;Yue Leng ,&nbsp;Yao Yao ,&nbsp;Qianhua Zhao ,&nbsp;Albert Hofman ,&nbsp;Eric Brunner ,&nbsp;Ding Ding","doi":"10.1016/j.lanwpc.2025.101465","DOIUrl":"10.1016/j.lanwpc.2025.101465","url":null,"abstract":"<div><div>China accounts for 1/5 of the global population and China faces a particularly heavy dementia burden due to its rapidly ageing population. Unique historical events, genetic background, sociocultural factors, lifestyle, and the COVID-19 pandemic further influence cognitive outcomes in the Chinese population. We searched PubMed, Web of Science, and Embase for community-based cohort studies related to dementia in the Chinese population, and summarized the characteristics, methodologies, and major findings published over the last 25 years from 39 cohorts. We identified critical research gaps and propose future directions, including enhancing sample representativeness, investigating China-specific risk factors, expanding exposure measurements to the whole life-span, collecting objective data, conducting administer-friendly domain-specific cognitive assessments, adopting pathological diagnostic criteria, standardizing biobank construction, verifying multi-modal biomarkers, examining social and genetic-environmental aspects, and monitoring post-COVID cognitive health, to approach high quality of dementia studies that can provide solid evidence to policy making and promote global brain health research.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101465"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Highlights of the ESMO Asia Congress 2024","authors":"Jiefang Huang","doi":"10.1016/j.lanwpc.2025.101482","DOIUrl":"10.1016/j.lanwpc.2025.101482","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101482"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143178030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regulatory flexibilities balancing unmet needs, benefits and risks in the approvals of imported cancer drugs in China: a cohort study from 2012 to 2021","authors":"Xiangyun Mao ,&nbsp;Jiachen Xu ,&nbsp;Xiaozhen Liu ,&nbsp;Shu Kong ,&nbsp;Yi Li ,&nbsp;Xiaoyin Bai ,&nbsp;Jiaxuan Yang ,&nbsp;Aaron S. Kesselheim ,&nbsp;Guanqiao Li","doi":"10.1016/j.lanwpc.2025.101483","DOIUrl":"10.1016/j.lanwpc.2025.101483","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;China has historically relied on importing new drugs to fulfill domestic clinical needs. However, stringent requirements for local clinical trials for these imported drugs has often delayed their market approval, restricting timely access for patients. To address this issue, China has implemented regulatory flexibility in certain contexts, allowing for expedited approval processes when appropriate. This study aimed to evaluate the characteristics of novel cancer drugs qualifying for flexible approval in China from 2012 to 2021, focusing on pivotal trials features, clinical benefits, safety profiles, and unmet medical needs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This cohort study identified all newly imported cancer drugs and their indications approved by the China’s National Medical Products Administration (NMPA) from 2012 to 2021. Indications meeting standard requirements were categorized as regular approvals, while those supported by limited clinical data from Chinese patients were classified as flexible approvals. Development strategies, pivotal trials characteristics, and clinical outcomes were extracted from publicly available review documents and drug labels. Unmet medical needs were assessed based on two dimensions: the availability of standard-of-care treatments and the novelty of medicines. We compared the pivotal trial characteristics, efficacy end points, safety (serious adverse events) and the extent of unmet clinical needs, between flexible and regular approvals using Chi-square tests. A random-effects meta-regression was conducted to examine the association between flexible status and hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Among 59 novel cancer drugs approved for importation to China between 2012 and 2021, 56 products with 92 indications were included in this analysis, based on the availability of their review documents. Of these, 48 indications (52%) qualified for flexible approvals, while 44 indications (48%) received regular approvals. The median number of Chinese patients involved in the datasets for flexible approvals was significantly lower than for regular approvals (27 [IQR, 0–62] vs. 165 [IQR, 99–245], p &lt; 0.001). Flexible approvals were more frequently supported by early-phase (18/61 vs. 1/60, p &lt; 0.001) and single-arm (22/61 vs. 1/60, p &lt; 0.001) pivotal trials, with response rates frequently used as the primary endpoint (24/61 vs. 1/60, p &lt; 0.001). Meta-regression analysis revealed that flexible approvals were associated with improved OS (HR 0.61 vs. 0.72, p &lt; 0.01), and a weaker association for PFS (HR 0.39 vs. 0.51, p = 0.03). The rate of serious adverse events was slightly higher, but not significantly, in the flexible approval group than the regular approval group (43% vs. 35%, p = 0.06). Flexible approvals were more likely to be indicated for diseases with no available existing drugs (31/48 vs.","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101483"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143178056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sentinel lymph node biopsy using dye alone in patients with initially cN1 breast cancer and ycN0 status after neoadjuvant therapy: a multicenter diagnostic trial","authors":"Ang Zheng ,&nbsp;Lei Zhang ,&nbsp;Yu Cao ,&nbsp;Dian-Long Zhang ,&nbsp;Fei Ma ,&nbsp;Jian-Yi Li ,&nbsp;Fan Yao ,&nbsp;Li Ma ,&nbsp;Pei-Fen Fu ,&nbsp;Jia Wang ,&nbsp;Jian-Yun Nie ,&nbsp;Ying-Ying Xu ,&nbsp;Bao-Liang Guo ,&nbsp;Feng Jin ,&nbsp;Bo Chen","doi":"10.1016/j.lanwpc.2024.101315","DOIUrl":"10.1016/j.lanwpc.2024.101315","url":null,"abstract":"<div><h3>Background</h3><div>Given the known complications associated with axillary lymph node dissection (ALND) and the limited application of radiolabeled colloid tracking in China, dye-only sentinel lymph node biopsy (SLNB) is proposed as a feasible and alternative surgical treatment strategy for patients with initially clinically node-positive (cN1) breast cancer to a clinically node-negative (ycN0) status after neoadjuvant therapy (NAT). However, the clinical diagnostic performance of dye-only SLNB needs further verification.</div></div><div><h3>Methods</h3><div>We conducted a multicenter diagnostic clinical trial from July 2019 to September 2023 by recruiting 230 patients from 12 participating centers across six provinces in China. Adult women with clinical stage T1-4N1M0 breast cancer and ycN0 status after NAT were eligible. SLNB and ALND were performed sequentially for patients, while a single dye was used to guide sentinel lymph nodes during the operation. The primary endpoint was the false-negative rate (FNR) of SLNB after NAT in women with ycN0 disease. Furthermore, subgroup analyses were conducted by age, body mass index (BMI), the number of SLNs removed and tumor subtype. The trial is registered on <span><span>www.chictr.org.cn</span><svg><path></path></svg></span> (identifier: ChiCTR1900026929) and <span><span>www.isrctn.com</span><svg><path></path></svg></span> (identifier: ISRCTN31364289).</div></div><div><h3>Findings</h3><div>The detection rate of single-dye was 95.22% (219/230). Pathological examinations showed positive lymph node findings in 117 of 230 patients. SLNB was successful in 212 out of the 219 patients (96.80%). The FNR of dye-alone SLNB was 5.98% (7/117; 95% CI, 2.44%-11.94%). Furthermore, the FNR was lower in women under 60 years of age (2.33% vs. 16.13% older than 60 years, <em>P</em>=0.0139), with body mass index under 25 kg/m² (2.60% vs. 12.5%, <em>P</em>=0.0452), and with four or more SLNs (2.53% vs. 13.16% with fewer than four SLNs, <em>P</em>=0.0358). For HR negative/HER-2 positive cases, the FNR was 0%.</div></div><div><h3>Interpretation</h3><div>SLNB with dye alone in patients with initially cN1 breast cancer and ycN0 after neoadjuvant therapy resulted in clinically acceptable rate of FNR. When four or more SLNs are detected, patients with age ≤ 60 years, BMI&lt;25km/m² and Her2-positive would derive additional benefit from dye-alone SLNB.</div></div><div><h3>Funding</h3><div>This trial was funded by Tackling Key Problems and Serving Local Projects of Liaoning Province (ZF20190006, to BC), <span>National Natural Science Foundation of China</span> (82073282 and 82203873, to AZ) and Joint Fund Project of the Science and Technology Program of Liaoning Province (2023012141-JH3/4600, to AZ).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101315"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sorafenib combined with transarterial chemoembolization compared with sorafenib alone in advanced hepatocellular carcinoma (SELECT): a multicenter, phase 3, randomized, controlled trial","authors":"Yan Zhao ,&nbsp;Wei Bai ,&nbsp;Rong Ding ,&nbsp;Nan You ,&nbsp;Lin Zheng ,&nbsp;Lei Li ,&nbsp;Jianbin Wu ,&nbsp;Peng Zhang ,&nbsp;Wukui Huang ,&nbsp;Hui Zhang ,&nbsp;Yongjin Zhang ,&nbsp;Diwen Zhu ,&nbsp;Haiping Li ,&nbsp;Jie Yuan ,&nbsp;Daiming Fan ,&nbsp;Yong Lv ,&nbsp;Guohong Han","doi":"10.1016/j.lanwpc.2024.101300","DOIUrl":"10.1016/j.lanwpc.2024.101300","url":null,"abstract":"<div><h3>Background</h3><div>Patients with advanced hepatocellular carcinoma have poor prognosis. We aimed to investigate the efficacy of sorafenib combined with transarterial chemoembolization in patients with advanced hepatocellular carcinoma.</div></div><div><h3>Method</h3><div>SELECT was a randomized, multi-centre, controlled, phase 3 trial done at twelve centres in China. Eligible patients were aged 18 years or older and had advanced-stage hepatocellular carcinoma, Barcelona Clinic Liver Cancer stage C diseases, Child-Pugh class A liver disease, Eastern Cooperative Oncology Group (ECOG) performance statuses of 0 or 1. Participants were randomly assigned (1:1) with a computer-generated random sequence to sorafenib combined with transarterial chemoembolization or sorafenib alone. The primary endpoint was overall survival. Secondary endpoints were time to progression, tumor response rate, disease control rate and safety. Efficacy was analyzed in the intention-to-treat, per-protocol and as-treated populations. Safety outcomes were analyzed in the safety population. This trial is registered with <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, number NCT01906216.</div></div><div><h3>Findings</h3><div>Between September 7, 2013, and Dec 4, 2019, 199 patients were randomly assigned, 99 to the combination group and 100 to the sorafenib alone group. Protocol adherence was 86% (85 of 99 patients) in the combination group and 56% (56 of 100 patients) in the sorafenib alone group. The most common reason for discontinuation was disease progression (68 [69%] in the combination group and 80 [80%] in the sorafenib alone group). The median age was 55 years (IQR 46-63). 164 (82.4%) of 199 were male and 35 (17.6%) were female. At a median follow-up of 13.6 months (IQR 6.8-28.2), in the intention-to-treat population, median overall survival was 14.9 months (95%CI 10.5-19.3 months) in the combination group versus 11.9 months (95%CI 9.0-14.8 months) in the sorafenib alone group (HR 0.862 [95%CI 0.645-1.150]; P=0.312). Median time to progression survival was significantly longer in the combination group than the sorafenib alone group (10.0 months [95%CI 6.4-13.6 months] vs 5.9 months [95%CI 3.1-8.7 months]; HR 0.686 [95%CI 0.515-0.954]; P=0.016). In the per-protocol and as-treated analyses, both median overall survival and time to progression was significantly improved in the combination group compared with sorafenib alone group.</div></div><div><h3>Interpretation</h3><div>In SELECT trial, sorafenib combined with TACE did not show overall survival benefit over sorafenib alone in intention-to-treat analysis; however, significantly longer overall survival benefit and improved time to progression was observed in both per-protocol and as-treated analyses.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101300"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Framing effects in decision aid-based lung cancer screening: a randomized clinical pilot trial in primary care","authors":"Xiujing Lin,&nbsp;Feifei Huang","doi":"10.1016/j.lanwpc.2024.101307","DOIUrl":"10.1016/j.lanwpc.2024.101307","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The balance of risks and benefits associated with low-dose CT (LDCT) screening necessitates that high-risk individuals make informed decisions about lung cancer screening (LCS) based on their preferences. Patient decision aids (PDAs) can align these choices with patient values, and research indicates that message framing (gain vs. loss) significantly impacts decision-making. Despite extensive public health research on framing effects, there is limited understanding of how these messages can enhance LCS uptake. To address this gap, our research team developed the first LCS PDA in China, the LCS Loss-Gain Balance (LCS-LG-B), which integrates both gain-framed (emphasizing the benefits of healthy behaviors) and loss-framed (highlighting the costs of inaction) approaches. This study aims to investigate the effects of this PDA-based program on LCS behaviors among high-risk Chinese individuals.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;An intervention was designed around the LCS-LG-B to increase LDCT screening rates among high-risk individuals. This intervention included lung cancer risk assessments, education on lung cancer and LCS, shared decision-making exercises, and support for screening behaviors (e.g., smoking cessation resources, LCS information, and patient-doctor communication groups). A randomized clinical pilot trial was conducted with 72 high-risk lung cancer individuals in southeastern China from May 10, 2023, to February 10, 2024, with follow-up until October 10, 2024. Participants were randomly assigned to either the loss-framed or gain-framed version of the LCS-LG-B. Outcomes assessed at baseline (T0), immediately after the intervention (T1), and at one (T2), three (T3), and six months (T4) included LCS knowledge, health beliefs, decision conflict, self-efficacy, preparation, regret, and LDCT rates. Data were analyzed using a generalized linear mixed model and Chi-square tests, and the study is registered at the Chinese Clinical Trial Registry (ChiCTR2300071171).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Sixty participants (30 from each group) completed all outcome measurements. Significant improvements were noted in decision conflict (F = 50.177, P &lt; 0.001), self-efficacy (F = 57.505, P &lt; 0.001), preparation (F = 45.599, P &lt; 0.001), regret (F = 8.886, P &lt; 0.001), LCS knowledge (F = 70.981, P &lt; 0.001), health beliefs (F = 21.149, P &lt; 0.001), perceived barriers (F = 20.020, P &lt; 0.001), and perceived benefits (F = 3.098, P = 0.016). The mean perceived risk score was significantly higher in the loss-framed group at T2 (D = 1.533, P = 0.004), T3 (D = 1.900, P &lt; 0.001), and T4 (D = 1.267, P = 0.017). However, there were no significant differences between groups in decision conflict, self-efficacy, preparation, regret, and LCS knowledge at T1, T2, T3, and T4 (P &gt; 0.050). After the intervention, 12 participants (40.00%) in the loss-framed group underwent LDCT compared to 8 (26.67%) in the gain-fra","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101307"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consolidative and salvage thoracic radiotherapy (TRT) in extensive-stage small-cell lung cancer (ES-SCLC) with first-line chemoimmunotherapy: a retrospective study from a single cancer center","authors":"Aihua Lan ,&nbsp;Huiling Dong ,&nbsp;Zhiqin Zheng ,&nbsp;Xiao Chu ,&nbsp;Zhengfei Zhu","doi":"10.1016/j.lanwpc.2024.101373","DOIUrl":"10.1016/j.lanwpc.2024.101373","url":null,"abstract":"<div><div>Extensive-stage small-cell lung cancer (ES-SCLC) continues to have poor outcome despite the survival improvements achieved by chemoimmunotherapy. Controversy exists regarding the survival effectiveness of consolidative thoracic radiotherapy (cTRT), and the role of salvage thoracic radiotherapy (sTRT) remains unexplored in the immunotherapy era. To address these issues, we conducted this retrospective study to investigate the impacts of cTRT and sTRT in ES-SCLC, and to compare the survival benefits of the two treatment regimes. ES-SCLC patients without baseline brain metastases receiving standard first-line chemoimmunotherapy were included in our study, cohorts were divided by treatment with cTRT, sTRT and no TRT. Kaplan-Meier survival curve and log-rank test were performed for comparison of survival between different groups. Univariable and multivariate analyses were carried out for further estimating the survival effectiveness of TRT. A total of 100 ES-SCLC patients without baseline brain metastases were included in our study, with 24 (24.0%) were allocated to the cTRT group, 18 (18.0%) were allocated to the sTRT group, and 58 (58.0%) to the No TRT group. cTRT dramatically decreased the rate of intrathoracic failure compared to sTRT and No TRT (29.4% vs. 60.0%). Moreover, patients who received cTRT had better overall survival (OS) compared to those who did not receive cTRT (median OS, not reached vs. 14.1 months; HR=0.40, 95% CI: 0.22-0.70, P=0.01). However, cTRT did not show significantly superior OS compared to sTRT alone (median OS, not reached vs. 21.0 months; HR=0.67, 95% CI: 0.27-1.66, P=0.39). In contrast, patients with only thoracic oligo-progression receiving sTRT (N=13) harbored better OS compared to patients with the same progression pattern in No TRT group (N=20) (median OS, 28.6 vs. 13.8 months; HR=0.44, 95% CI: 0.20-0.98, P=0.04). In conclusion, our study demonstrated in the chemoimmunotherapy era that cTRT greatly reduced the rate of initial intrathoracic failure and significantly improved the OS of ES-SCLC. Additionally, sTRT showed similar OS benefits with cTRT, and exhibits better OS compared to No TRT.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101373"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptability and accuracy of artificial intelligence–assisted sponge cytology for screening of esophageal squamous cell carcinoma and adenocarcinoma of the esophagogastric junction: a multi-center cohort study","authors":"Zhiyuan Fan ,&nbsp;Shanrui Ma ,&nbsp;Ye Gao ,&nbsp;Feifan He ,&nbsp;Xinqing Li ,&nbsp;Wenqiang Wei","doi":"10.1016/j.lanwpc.2024.101292","DOIUrl":"10.1016/j.lanwpc.2024.101292","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Esophageal squamous cell carcinoma (ESCC) and adenocarcinoma of the esophagogastric junction (AEJ) present significant health challenges in China, often diagnosed at advanced stages with poor prognoses. Screening is the pivotal strategy to relieve the burden of ESCC and AEJ in high-risk areas. Even though endoscopy has proven effective in the early detection of both cancers in high-prevalence regions, its invasiveness and resource-intensiveness make it impractical for large-scale screening. Therefore, developing a less invasive and readily accessible method with good diagnostic accuracy to identify high-risk individuals before endoscopy is urgently needed. We aim to evaluate the acceptability and accuracy of artificial intelligence (AI)-assisted sponge cytology tests using a novel cell collection device for ESCC and AEJ screening in Chinese high-risk regions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Participants aged 50 years or older were recruited in five high-risk regions of ESCC and AEJ. Cells from esophagus and esophagogastric junction were collected using a novel and minimally invasive capsule sponge, and cytology slides were scanned by a trained AI system. The qualitative outcomes (indicating the location of abnormal cells) and quantitative outcomes (counts of total scanned cells, potentially abnormal cells and 105 cytological features) were reported. Participants scored acceptability immediately following the procedure on a scale of 0 (least) to 10 (most acceptable). Endoscopy was performed subsequently with biopsy as needed. Feature selection was performed using Boruta algorithm. Lasso logistic regression model was developed to predict a composite outcome of high-grade lesions (ESCC, AEJ and high-grade intraepithelial neoplasia), with cytological features and epidemiological features as the predictive features. Model performance was primarily measured with the area under the receiver operating characteristic curve (AUC). Internal validation of the prediction models was performed using the 1000-bootstrap resample.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;A total of 1852 participants were enrolled and completed the study procedure. No serious adverse events were documented during the cell collection process, and acceptability scores were 10 (72.1%), 9 (19.8%), 8 (3.8%), 7 (1.5%) and 6 (0.9%). 30 (1.6%) participants were diagnosed with high-grade lesions confirmed by endoscopic biopsy. The lasso logistic model achieved an AUC of 0.902 (95%&lt;em&gt;CI&lt;/em&gt;: 0.851, 0.952) for detecting high-grade lesions, outperforming that of the cytological diagnosis and the sole use of abnormal cell counts. Internal validation of the model by bootstrap analysis was used, and the mean AUC of the model was 0.9 (95%&lt;em&gt;CI&lt;/em&gt;: 0.845, 0.944).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;We demonstrate the safety and acceptability of AI-assisted sponge cytology in high-risk regions, with high accuracy for detecting ESCC, AEJ and their precursor","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101292"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tumescence and sharp versus electrocautery dissection in minimal access mastectomy: a real-world retrospective cohort study","authors":"Yiwen Lu,&nbsp;Xinyu Ou,&nbsp;Zhihan Liu,&nbsp;Shicheng Su","doi":"10.1016/j.lanwpc.2024.101342","DOIUrl":"10.1016/j.lanwpc.2024.101342","url":null,"abstract":"<div><h3>Background</h3><div>Tumescence and sharp or electrocautery techniques have been employed during skin flap development in minimal access nipple-sparing mastectomy (NSM) with immediate prosthesis breast reconstruction. Our study evaluated the impact of techniques on complications after this surgery.</div></div><div><h3>Methods</h3><div>In this real-world retrospective cohort study, 5436 individuals undergoing NSM from 12 centers in China were identified. After exclusions and propensity score matching (PSM), a total of 1252 female breast cancer patients who underwent minimal access NSM with immediate prosthesis breast reconstruction between January 2016 and December 2022 were included. The effect of surgical techniques on the perioperative outcomes and postoperative complications was investigated using logistic regression analysis. The level of significance was set at P&lt; .05.</div></div><div><h3>Findings</h3><div>After PSM, we found that patients in the tumescence and sharp dissection group (n=313) experienced significantly lower rates of necrotic complications (5.8% vs 13.0%; P= .001), infection (2.6% vs 5.6%; P= .041), implant loss (0.3% vs 2.2%; P= .025), and had shorter mean operation time (median [IQR] min, 177.0 [132.0-219.0] min, and 201.0 [143.0-249.0] min; P&lt; .001), compared with those in the electrocautery dissection group (n=939).</div></div><div><h3>Interpretation</h3><div>Tumescence and sharp dissection might be a better option in skip flap development during minimal access NSM with immediate prosthesis breast reconstruction, in regard to operation time and surgical complications. A limitation is the variation in surgeons’ skills across multiple centers.</div></div><div><h3>Funding</h3><div><span>National Key Research and Development Program of China</span> (2023YFC3404500), the <span>Natural Science Foundation of China</span> (92057210, 82125017, 82173064, 92359302, 82322030), <span>Science and Technology Program of Guangzhou</span> (202103000070, 202201020479), and the <span>New Cornerstone Science Foundation</span> through the New Cornerstone Investigator Program and the XPLORER PRIZE.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101342"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}