The Lancet Regional Health: Western Pacific最新文献

{"title":"Evaluating generative AI models for explainable pathological feature extraction in lung adenocarcinoma: grading assessment and prognostic model construction","authors":"Junyi Shen,&nbsp;Anqi Lin,&nbsp;Ting Wei,&nbsp;Jian Zhang,&nbsp;Peng Luo","doi":"10.1016/j.lanwpc.2024.101352","DOIUrl":"10.1016/j.lanwpc.2024.101352","url":null,"abstract":"<div><h3>Background</h3><div>With the widespread application of generative AI (GenAI) models, it is crucial to systematically evaluate their performance in lung adenocarcinoma histopathological assessment. This study aimed to evaluate and compare the performance of three GenAI models with visual capabilities (GPT-4o, Claude-3.5-Sonnet, and Gemini-1.5-Pro) in lung adenocarcinoma histological pattern recognition and grading, and to explore the construction of prognostic prediction models based on GenAI feature extraction.</div></div><div><h3>Methods</h3><div>This retrospective study extracted 310 diagnostic slides from the TCGA-LUAD database for model evaluation. An additional 87 diagnostic pathology slides from local lung adenocarcinoma surgical patients were used for external validation of the prognostic model. Primary outcomes were GenAI grading accuracy and stability, measured by the area under the receiver operating characteristic curve (AUC) and intraclass correlation coefficient (ICC), respectively. Secondary outcomes included the construction and assessment of machine learning-based prognostic prediction models, utilizing features extracted by GenAI, with model performance evaluated using the Concordance index (C-index).</div></div><div><h3>Findings</h3><div>Claude-3.5-Sonnet demonstrated the best overall performance, combining high grading accuracy (average AUC = 0.82) with moderate stability (ICC = 0.59) The optimal machine learning-based prognostic model, constructed using features extracted by Claude-3.5-Sonnet and incorporating clinical variables, showed good performance in both internal and external validation, with an average C-index of 0.72. Meta-analysis demonstrated that this prognostic model effectively stratified patients into risk groups, with the high-risk group showing significantly worse outcomes (Hazard ratio = 6.44, 95% confidence interval = 3.42-12.14).</div></div><div><h3>Interpretation</h3><div>This study demonstrates the potential application value of GenAI models in lung adenocarcinoma histopathological assessment. Claude-3.5-Sonnet demonstrated the highest grading accuracy, and the machine learning-based prognostic model that utilized its feature extraction showed good predictive capabilities. These findings provide new research directions for AI-assisted pathological diagnosis and prognostic prediction, with the potential to improve the management of lung adenocarcinoma patients.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101352"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427528","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":"Impact of neoadjuvant chemotherapy on perioperative nutritional status in breast cancer patients: a prospective cohort study","authors":"Dandan Zhang ,&nbsp;Congyi Ma ,&nbsp;Hexiao Ding ,&nbsp;Ting Liu ,&nbsp;Huan Li","doi":"10.1016/j.lanwpc.2024.101299","DOIUrl":"10.1016/j.lanwpc.2024.101299","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Neoadjuvant chemotherapy (NAC) is effective in reducing tumor size and improving surgical outcomes for patients with inflammatory, unresectable, or locally advanced breast cancer (BC). However, malnutrition frequently occurs during NAC, increasing the risk of perioperative complications and hindering progress in enhanced recovery after surgery. The impact of NAC on overall nutritional status, as well as specific nutritional components, throughout the perioperative period in BC patients remains unclear. This study aims to provide insight by longitudinally tracking the nutritional status of BC patients undergoing NAC compared to those who do not.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a prospective study at a tertiary hospital in China, enrolling BC patients who met the inclusion criteria of a confirmed diagnosis of invasive BC without significant comorbidities. Patients with metastatic disease or a prior history of BC treatment were excluded. After obtaining written informed consent, participants were assigned to either a NAC cohort or a surgery-first cohort based on clinical decision-making factors, such as tumor histology, grade, stage, and estrogen, progesterone, and HER2 receptor status. Baseline data (one day before surgery, T0) and follow-up data (first day after surgery, T1; the seventh day after surgery, T2) were gathered through self-reported questionnaires, blood tests, and InBody 770 (InBody Co., Ltd., Korea) measurements. The primary outcome was nutritional status, assessed by phase angle. Baseline differences between the NAC and surgery-first cohorts were analyzed using independent sample t-tests or the Mann-Whitney U test. Repeated measures ANOVA was used to evaluate changes in the collected data across T0, T1, and T2. This study was approved by the ethics committee of the hospital (No. SL-II2024-199-01).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;This study included 32 breast cancer patients, with 13 enlisted in the NAC cohort and 19 in the surgery-first cohort. Phase angle, albumin, and total protein have significant differences in the baseline data (p &lt; 0.001). Moreover, phase angle significantly decreased in both cohorts (p &lt; 0.001), with a greater reduction in the NAC group (T0: 4.52 ± 0.62, T1: 4.09 ± 0.73, T2: 4.34 ± 0.84) compared to the surgery-first group (T0: 5.13 ± 0.46, T1: 4.55 ± 0.49, T2: 4.90 ± 0.39). In the NAC group, the most prominent changes observed from T0 to T2 were in basal metabolic rate (kcal/day) (from 1224.85±109.82 to 1216.62±100.78), arm circumference (cm) (from 29.21±3.24 to 28.99±3.14), and protein levels (g/dL) (from 7.62±1.00 to 7.58±0.92). Meanwhile, in the surgery-first group, the most prominent changes from T0 to T2 included basal metabolic rate (kcal/day) (from 1217.16±98.23 to 1212.05±102.67), percent body fat (%) (from 33.33±8.61 to 32.96±7.95), and fat-free mass (kg) (from 39.23±4.54 to 38.98±4.76).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;The findin","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101299"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427543","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":"Preparedness for infectious diseases during the Tokyo 2020 Olympic and Paralympic Games: advancing the health system beyond the games","authors":"Chiaki Ikenoue ,&nbsp;Munehisa Fukusumi ,&nbsp;Satoshi Shimada ,&nbsp;Tomoe Shimada ,&nbsp;Motoi Suzuki ,&nbsp;Yoshiyuki Sugishita ,&nbsp;Tamano Matsui ,&nbsp;Tomimasa Sunagawa ,&nbsp;Tomoya Saito","doi":"10.1016/j.lanwpc.2025.101488","DOIUrl":"10.1016/j.lanwpc.2025.101488","url":null,"abstract":"<div><div>Mass international gatherings pose significant health security challenges and demand robust preparedness for infectious diseases. Though demanding, this process can leverage heightened political and social attention to fortify core capacities. Despite Japan's advanced public health system for infectious diseases, there were still areas of vulnerabilities. Preparation for the Tokyo 2020 Olympic and Paralympic Games (Tokyo 2020) strategically enhanced the national system for infectious diseases through a three-step approach: (i) assessing risks, readiness, and gaps; (ii) addressing the identified gaps by strengthening or establishing systems; and (iii) performing operational exercises involving multiple stakeholders. COVID-19, which led to the postponement of Tokyo 2020, brought the strict public health measures taken during the event into focus. However, these primary conventional steps need to be further highlighted. Emphasizing their applicability beyond games time, this approach is a model for countries that host large-scale gatherings.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101488"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394949","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":"A phase 2 study of pembrolizumab in combination with plinabulin and docetaxel in previously treated patients with metastatic non-small cell lung cancer and progressive disease (PD) after immunotherapy (Anti-PD-1/PD-L1 inhibitor) alone or in combination with platinum-doublet chemotherapy","authors":"Yan Xu,&nbsp;Xiaoxing Gao,&nbsp;Minjiang Chen,&nbsp;Xiaoyan Liu,&nbsp;Jing Zhao,&nbsp;Wei Zhong,&nbsp;Mengzhao Wang","doi":"10.1016/j.lanwpc.2024.101306","DOIUrl":"10.1016/j.lanwpc.2024.101306","url":null,"abstract":"<div><h3>Background</h3><div>Immune checkpoint inhibitor (ICI)-based treatment regimens have become the standard of care for first-line treatment of NSCLC. Once progressed, it is not recommended to continue using ICI monotherapy, and the efficacy of chemotherapy is limited (ORR ∼10% with doc), so there is a high unmet clinical need. Plin is a selective immunomodulating microtubule-binding agent which promotes dendritic cell maturation and enhances anti-tumor T cell response, and have the potential to overcome immunotherapy resistance as a novel regimen in combination with pemb and doc. This phase 2 study was aimed to evaluate the efficacy and safety of pemb plus plin and doc in pts with metastatic NSCLC who had progressed after ICI.</div></div><div><h3>Methods</h3><div>In this investigator-initiated, single-arm, open-label, phase 2 trial, metastatic NSCLC pts who acquired resistance after ICI treatment were enrolled (Clinical trial information: <span><span>NCT05599789</span><svg><path></path></svg></span>). Participants received pemb 200 mg D1, plin 30 mg/m2 D1 and doc 75 mg/m2 D1 intravenously for a 21-day cycle. The primary endpoint was investigator-based ORR per RECIST 1.1. The secondary endpoints included PFS, OS, DoR and toxicity. Kaplan-Meier method is used for OS, PFS, and DOR analysis. The study intends to enroll 47 patients with a formal interim analysis at 19 patients enrolled.</div></div><div><h3>Findings</h3><div>38 pts were enrolled and 35 pts evaluable ITT population were analyzed at data cutoff on 10/10/2024. Median follow-up was 8.8 months (M) and median age was 68.0 (50-83) with 77.1% male and 22.9% female. 65.7% were current or former smokers. Histology included 60% with non-squamous, 40% with squamous cell carcinoma. Confirmed ORR was 18.2%. DCR was 89.7% (defined as PR and SD &gt; 4 M), median DoR was 11.4 M, median PFS was 8.3 M (current 6 M PFS rate was 70.4%, 12 M PFS rate was 42.7%), and OS had not been reached. 48.6% of pts experienced G3 or higher treatment-related AEs.</div></div><div><h3>Interpretation</h3><div>With good tolerability, pemb plus plin and doc in pts with metastatic NSCLC who progressed after clinical benefit to ICI demonstrated promising efficacy.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101306"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427890","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":"Longitudinal trajectories of triglyceride glucose index and colorectal cancer mortality in Chinese older adults: a large prospective cohort study","authors":"Lingling Yu,&nbsp;Peng Yin","doi":"10.1016/j.lanwpc.2024.101377","DOIUrl":"10.1016/j.lanwpc.2024.101377","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Colorectal cancer (CRC) is the second leading cause of cancer-related deaths worldwide in 2022. Triglyceride glucose (TyG) index, as a more convenient and reliable predictor of insulin resistance, is associated with cardiometabolic diseases, but its relationship with CRC remains unclear. Although evidence from previous prospective cohort studies indicated that people with higher baseline TyG index were associated with onset of CRC, most of these studies have focused on elevated baseline TyG index levels rather than its dynamic changes over time. This study aimed to evaluate the long-term trajectories of the TyG index and the mortality due to CRC.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We used data from a Multi-center Elderly Health Management Cohort Study in Luzhou and Zunyi, China. Participants aged ≥65 years were enrolled from January 2017 and followed up until December 2021. Baseline data came from annual health examinations from the health management programs for the elderly in basic public health services including standardized questionnaires and laboratory tests. Demographic information, lifestyles, and health conditions were collected. TyG index was calculated by fasting blood glucose and triglycerides. Deaths from all-cause and CRC were obtained from linkage with China's national death registration system. CRC death as underlying cause of death was defined as International Classification of Diseases, 10th revision codes C18-C20. The latent class trajectory modeling method was used to analyze the 5-year TyG index trajectories from registration and the Cox proportional hazards regression model was utilized to examine the relationship between baseline TyG index level, the trajectory of TyG index, and CRC mortality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Among 767,483 older adults, 52.9% were females; the mean age at baseline was 70.4 years. A total of 39,738 deaths (including 700 from CRC) were recorded in a median follow-up of 3.8 years [IQR 2.4-5.2]). Three longitudinal patterns based on the 5-year TyG index were identified: “medium-stable trajectory” (n=374,345, 48.8%), “low-stable trajectory” (n=334,645, 43.6%), and “high-stable trajectory” (n=58,493, 7.6%). Compared with the lowest quartile TyG index in the baseline, there was a borderline significant higher risk of CRC mortality for the highest quartile (hazard ratio 1.23, 95% confidence interval 0.98-1.54, p=0.07) after adjustment for age, sex, years of schooling, alcohol consumption, smoking, exercise frequency, diabetes, hypertension, cardiovascular and cerebrovascular diseases. Compared with medium-stable TyG index pattern, individuals with a high-stable TyG index had lower CRC mortality, with a crude hazard ratio (95% CI) of 0.71 (0.50-0.99). In the fully adjusted model, neither low-stable trajectory group nor high-stable trajectory group showed any significant association with CRC mortality (low-stable trajectory hazard ratio: 0.96 (95% CI: 0.82-1.13); h","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101377"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427968","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":"Post-treatment adverse events ranking in targeted immunotherapy for hepatocellular carcinoma: a network meta-analysis based on risk probability assessment","authors":"Gaoyuan Yang ,&nbsp;Zhicheng Yao","doi":"10.1016/j.lanwpc.2024.101324","DOIUrl":"10.1016/j.lanwpc.2024.101324","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The adoption of targeted and immunotherapeutic drugs in the management of hepatocellular carcinoma (HCC) signifies a pivotal modern therapeutic approach. Nevertheless, a conspicuous gap exists in exhaustive research regarding the adverse effects of these medications in relation to their efficacy and influence on survival outcomes. This systematic review and network meta-analysis aim to assess the diverse frequencies and severities of specific adverse reactions induced by different targeted and immunotherapy interventions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Clinical studies on targeted therapies and immunotherapeutic approaches in hepatocellular carcinoma (HCC) patients were selected from reputable databases including PubMed, Embase, Web of Science, and the Cochrane Library, covering the period from 2008 to 2023. These chosen studies encompassed a variety of treatment regimens. Data processing and evaluation adhered to PRISMA guidelines, utilizing a random-effects model for data synthesis. As all included studies were randomized controlled trials (RCTs), bias assessment followed the Cochrane Risk of Bias Assessment Tool and was assessed using Revman 5.3 software. The Relative Risk (RR) was selected as the effect measure over Odds Ratio (OR) to enable a risk probability analysis that better suited the characteristics of the research findings. To ensure model convergence, researchers generated trajectory plots, density plots, and Brooks-Gelman-Rubin diagnostic plots, and calculated the Potential Scale Reduction Factor (PSRF). Heterogeneity was evaluated by determining the I2 for both direct and indirect comparisons within the network model.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;A meticulous review of pertinent literature was conducted, identifying 13 Randomized Controlled Trials (RCTs) covering 13 treatment protocols for hepatocellular carcinoma (HCC), including first-line and select second-line therapies. This study encompassed a total of 10,760 patients. Initially, adverse events within the same category were consolidated, followed by the sequential construction of a network model to evaluate the risk probabilities associated with various adverse events of different targeted immunotherapy regimens and establish priority rankings. The primary outcomes of the systematic evaluation included 38 types of adverse reactions, graded for severity based on the National Cancer Institute Common Terminology Criteria for Adverse Events 5.0 (CTCAE 5.0). Additionally, statistical analysis was conducted on adverse events related to 28 immune checkpoint inhibitors, with each analyzed comprehensively to assess the risk probability of the corresponding drugs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Cabozantinib, camrelizumab, and their combination therapy for hepatocellular carcinoma (HCC) are linked to an elevated occurrence of prevalent adverse reactions. These reactions encompass elevated aminotransferase levels, fatigue, diarrhe","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101324"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427970","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":"Burden of cirrhosis and other chronic liver diseases and their progression to hepatocellular carcinoma in East Asia Pacific: 1990 to 2021","authors":"Ming Liu ,&nbsp;Chuan Liu ,&nbsp;Tsz Ngai Mok ,&nbsp;Xiaolong Qi ,&nbsp;Wai-Kit Ming","doi":"10.1016/j.lanwpc.2024.101418","DOIUrl":"10.1016/j.lanwpc.2024.101418","url":null,"abstract":"<div><h3>Background</h3><div>Cirrhosis and other chronic liver diseases (CLD), along with liver cancer, present significant health challenges in the East Asia Pacific (EAP) region. This study evaluates the burden of CLD and its progression to hepatocellular carcinoma (HCC) from 1990 to 2021.</div></div><div><h3>Methods</h3><div>Data from the Global Burden of Disease Study 2021 were analyzed to examine trends in CLD burden and annual transition rates to HCC across different etiologies and sociodemographic index (SDI) regions. The estimated annual percentage change (EAPC) was used to assess trends in age-standardized rates (ASR). Correlations between age-standardized DALY rates (ASDR), annual transition rates, and SDI were determined using Spearman’s rank correlation. Risk factors, such as high alcohol and drug use, were also evaluated.</div></div><div><h3>Findings</h3><div>The prevalence of CLD in EAP increased significantly by 43.80% (95% UI: 38.23% to 48.77%) from 1990 to 2021, while the ASDR decreased (EAPC: -2.42% [95% CI: -2.48% to -2.36%]), notably in high and high-middle SDI regions. HBV and HCV remained the leading causes of CLD across all SDI regions, with alcohol use and NAFLD increasingly contributing, particularly in high SDI regions. A significant negative correlation was observed between ASDR and SDI in high (ρ=-0.20, p&lt;0.01), middle (ρ=-0.49, p&lt;0.001), and low-middle (ρ=-0.63, p&lt;0.001) SDI regions. Despite this, high alcohol use and drug use contributed more to DALYs across all SDI regions, and the annual transition rate to HCC was rising (1.09% [0.89% to 1.28%]), with the highest rates in high SDI regions. The transition rate from CLD to HCC is rising in EAP, much exceeding the global rate. High SDI regions showed higher transition rates, particularly among those with chronic hepatitis B, C, and NAFLD including cirrhosis. A significant positive relationship was found between the transition rate from CLD to HCC and SDI in high (ρ=0.60, p&lt;0.001) and low-middle (ρ=0.34, p&lt;0.001) SDI regions.</div></div><div><h3>Interpretation</h3><div>While the EAP region has made progress in reducing the burden of CLD, greater attention is needed for alcohol use and NAFLD. The progression from CLD to HCC warrants increased focus, especially in high SDI regions. Enhanced surveillance for HCC in patients with chronic hepatitis is crucial.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101418"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427605","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":"Integrating primary healthcare into cancer aftercare for older patients post discharge – a pragmatic non-randomized controlled trial","authors":"Ran Li ,&nbsp;Therese Hesketh","doi":"10.1016/j.lanwpc.2024.101304","DOIUrl":"10.1016/j.lanwpc.2024.101304","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The increasing incidence and survival rates of cancers, driven by an ageing population, present a significant challenge to China’s healthcare system. Patients with cancer are managed and followed-up almost exclusively within tertiary care with resulting overburdened services. Recent policy directives recommend that primary healthcare adopt an expanded role in cancer care, especially in follow-up and aftercare. Advantages include easier access and lower out-of-pocket costs compared to tertiary hospitals, but effective coordination between tertiary hospitals and primary healthcare centres (PHCs) for post-discharge cancer care remains limited. We conducted a pragmatic trial integrating PHCs into aftercare of older cancer patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This pragmatic controlled trial was centred at a tertiary oncology hospital in Nantong, Jiangsu province, China, which treats over 80% of local cancer patients, and involved six PHCs —one urban PHC and five township hospitals—serving as step-down facilities. Patients aged 60 and older with lung, breast, colorectal, or prostate cancer were identified by tertiary physicians after hospitalization for surgery, chemotherapy, or radiotherapy. Participants were assigned according to their preference, to either the usual care group, with aftercare from the tertiary hospital, or the intervention group, where the follow-up and aftercare plan was developed and monitored by tertiary physicians, but delivered by PHC doctors. Outcomes measured were hospital admissions within three months, length of hospital stay, and the mean difference in health-related quality of life (HRQoL) at one - and three - months. Subgroup analyses investigated differential effects by treatment types. This trial was registered (ChiCTR2300073108).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Of the 1,722 individuals screened, 755 patients (mean age 70.2years, SD 6.40, 276 females [37%] and 479 males [63%]) were enrolled between May 2023 and April 2024. Ninety participants were assigned to the intervention group and 665 to the usual care group. Patients in the intervention group had significantly lower household incomes. Intervention group patients had 43% fewer admissions to tertiary hospital at one-month (IRR = 0.57, 95% CI: 0.41–0.81, p = 0.001), with no significant difference at three months (IRR = 0.96, 95% CI: 0.78–1.18, p = 0.705). Patients who underwent surgery in the intervention group, had an 83% reduction in hospitalizations at one-month (IRR = 0.17, 95% CI: 0.04–0.76, p = 0.020) and a 61% reduction at three months (IRR = 0.39, 95% CI: 0.18–0.82, p = 0.014), compared to control patients who received surgery. Patients in the intervention group had 4.68 fewer admission days within one-month (95% CI: -7.92 to -1.44, p = 0.005) and 4.26 fewer days within three months (95% CI: -8.47 to -0.06, p = 0.047) compared to the control group. Intervention group patients showed better HRQoL, at one month and ","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101304"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427731","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":"A non-invasive multi-phase CT classifier for predicting pre-treatment enlarged lymph node types in colorectal cancer","authors":"Kui Sun,&nbsp;Junwei Wang,&nbsp;Xin Zhou,&nbsp;Wei Fu","doi":"10.1016/j.lanwpc.2024.101397","DOIUrl":"10.1016/j.lanwpc.2024.101397","url":null,"abstract":"<div><h3>Background</h3><div>Colorectal cancer (CRC) with benign lymph node enlargement (BLNE) (&gt;1 cm) is often associated with better long-term prognosis and favorable outcomes in immunotherapy. However, lymph node enlargement (LNE) can mislead clinicians into considering metastatic lymph node enlargement (MLNE), potentially resulting in misguided therapeutic decisions in unnecessary neoadjuvant therapy and extended lymphadenectomy. This, ultimately, can lead to overtreatment, increasing the risk of postoperative complications and tumor recurrence. Thus, developing a pre-treatment multimodal CT radiomics-based model to assess LNE status is essential.</div></div><div><h3>Methods</h3><div>A total of 319 pre-treatment multimodal CT images of CRC patients with LNE were retrospectively collected from 2015 to 2020 as a development cohort. Additionally, 111 multimodal CT images from 2020 to 2022 were prospectively collected as a validation cohort. Tumor and LNE regions of interest were manually segmented, and 40 patients were randomly re-outlined by another radiologist to extract radiomics features. The intragroup correlation coefficient was calculated to assess the reproducibility of the radiomics features. Following feature screening, multiple predictive models were constructed, including tumor and lymph node models for individual modalities (Tumor<em>_N, _A, _V;</em> Ln<em>_{N, A, V};</em> Ln, lymph node; N, non-contrast phase; A, arterial phase; V, venous phase), along with 15 models combining multiple modalities. The predictive performance of these models was assessed using area under the receiver operating characteristic curve (AUROC) and precision-recall curve (AUPRC), along with sensitivity, specificity, and accuracy.</div></div><div><h3>Findings</h3><div>After validation with the prospective cohort, Tumor<em>_N</em> and Ln<em>_A</em> demonstrated the best predictive performance among single modalities, with AUROC values of 0.626 and 0.781, respectively. Among all models, Ln<em>_NAV</em> exhibited the highest predictive performance, achieving AUROC and AUPRC values of 0.820 and 0.883, respectively, with a sensitivity of 0.708, specificity of 0.848, and overall accuracy of 0.766.</div></div><div><h3>Interpretation</h3><div>Radiomics, as a non-invasive and quantitative approach, can reflect underlying physiopathological information. The incorporation of a multimodal radiomics model yielded excellent performance in predicting pre-treatment LNE status, particularly for BLNE, with a specificity of 0.848. This approach can provide valuable guidance for clinical treatment strategies.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101397"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427816","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":"Predicting total costs and key drivers in breast cancer surgery patients: ensemble machine learning analyses","authors":"Ang Zheng ,&nbsp;Junlin He ,&nbsp;Xin Qin ,&nbsp;Xin Wang","doi":"10.1016/j.lanwpc.2024.101374","DOIUrl":"10.1016/j.lanwpc.2024.101374","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;As breast cancer continues to present a growing global burden, particularly in China, understanding the factors that drive healthcare costs is crucial for informed policy-making and resource allocation. The primary objective was to identify the key predictors of total hospitalisation costs in breast cancer patients undergoing surgery, using machine learning models. A secondary objective was to explore the influence of different treatment types, patient demographics, and hospital characteristics on total expenses.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a multicenter, retrospective study utilising an anonymised healthcare dataset collected from 2016 to 2020 across three provinces of Shanxi, Hainan and Liaoning in China. The study included 19,094 breast cancer patients who underwent surgery, identified using the International Classification of Diseases (ICD-10) codes from C50.0 to C50.9 and corresponding mastectomy procedure codes (19301 to 19307). The analysis incorporated a variety of patient characteristics, comorbidities, and hospital attributes. We applied several ensemble machine learning techniques, including gradient boosting algorithms, to assess the contributions of each variable to total costs, both with and without length of stay (LOS). Permutation importance analysis was performed to rank the key cost drivers. A sensitivity analysis using propensity score matching (PSM) adjusted for age, length of stay, insurance type, admission year (2016–2020), week of admission, hospital level (provincial, municipal, district, or other), hospital location, drug fee, and surgery fee was conducted to validate the robustness of the findings, focusing on variables such as drug ratio and tumor surgery admissions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;The average total hospitalisation cost per admission was 2,649.60 USD, with a standard deviation of 2,110.95 USD. LOS was the most significant predictor, with an approximate increase of 150.00 USD per additional hospital day. Other important factors included hospital location, number of beds, and drug ratio. After excluding LOS, the top cost drivers were drug ratio, number of beds, general hospital admissions, tumor surgery admissions, and radiotherapy. Breast cancer patients with longer lengths of stay, admissions to general hospitals in Northern China, a history of radiotherapy, and a lower drug ratio were associated with the highest total costs. The model demonstrated robust performance, with a root mean squared logarithmic error (RMSLE) of 0.474. In the PSM analysis, patients with a drug ratio exceeding 30% had significantly lower average total costs (1,681.65 USD) compared to those with a drug ratio of 30% or lower, who incurred substantially higher costs (2,696.40 USD, P &lt; 0.001).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;This study underscores the critical role of managing key cost drivers such as LOS and drug ratios in breast cancer surgery. Our results sug","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101374"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427989","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}