Clinical Medicine Insights-Oncology最新文献

{"title":"First-Line Modified FOLFIRINOX in Metastatic Pancreatic Cancer: Real-World Outcomes and Prognostic Factors From a Vietnamese Cohort.","authors":"Huy Van Nguyen, Phuong Thi Dinh, Thang Tran, Cuc Thi Hoang","doi":"10.1177/11795549261426101","DOIUrl":"https://doi.org/10.1177/11795549261426101","url":null,"abstract":"<p><strong>Background: </strong>Metastatic pancreatic cancer is an aggressive malignancy with limited survival despite intensive chemotherapy. While modified FOLFIRINOX (mFOLFIRINOX) has illustrated efficacy, its real-world data are limited in low-resource healthcare systems. This study evaluated efficacy and toxicity and identified prognostic factors of mFOLFIRINOX as a first-line therapy for Vietnamese patients with metastatic pancreatic cancer.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 36 patients receiving mFOLFIRINOX as first-line therapy. All patients received peg-filgrastim as the primary prophylaxis. An application of flexible treatment approach-interruption was permitted between cycles under physician guidance. Progression-free survival (PFS), overall survival (OS), tumor response, and adverse events were assessed. Prognostic factors were analyzed using log-rank tests and Cox regression models.</p><p><strong>Results: </strong>The median follow-up was 15.6 months (95% confidence interval [CI] 3.8-27.3). The overall response rate (ORR) was 30.6 %, and the disease control rate (DCR) was 66.6%. The median progression-free survival was 6.7 (95% CI 5.4-8) months, and the median overall survival was 12.5 (95% CI 9.5-15.4) months. Grade 3 or 4 toxicities were mainly hematologic, including neutropenia in 33.4%, and anemia in 5.6% of patients. No cases of febrile neutropenia were observed. Univariate analyses identified performance status (PS) and age under 60 years as associated with improved outcomes. In multivariate Cox regression, PS remained an independent prognostic factor for overall survival.</p><p><strong>Conclusion: </strong>mFOLFIRINOX regimen demonstrated efficacy and manageable toxicity in Vietnamese patients with metastatic pancreatic cancer. An individualized approach involving treatment interruptions was observed in patients with relatively favorable outcomes. These findings support the feasibility of the regimen in real-world settings.</p>","PeriodicalId":48591,"journal":{"name":"Clinical Medicine Insights-Oncology","volume":"20 ","pages":"11795549261426101"},"PeriodicalIF":1.9,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12936372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Febrile Neutropenia in Patients With Newly Diagnosed Diffuse Large B-Cell Lymphoma Undergoing Initial R-CHOP Treatment.","authors":"Liang-Ying Chen, Che-An Tsai, Po-Wei Liao, Ling-Chiao Teng, Cheng-Hsien Lin, Yu-Chen Su, Chieh-Lin Jerry Teng","doi":"10.1177/11795549261423995","DOIUrl":"https://doi.org/10.1177/11795549261423995","url":null,"abstract":"<p><strong>Background: </strong>Febrile neutropenia (FN) frequently occurs as a complication among patients with diffuse large B-cell lymphoma (DLBCL) receiving their initial rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy. This study aimed to identify the risk factors for FN and create a reliable predictive model for FN using machine learning methods.</p><p><strong>Methods: </strong>This retrospective study evaluated 238 patients newly diagnosed with DLBCL and treated with the R-CHOP regimen. Logistic regression was used to identify the risk factors for FN. In addition, a machine learning model was developed to predict the occurrence of FN.</p><p><strong>Results: </strong>The incidence rate of FN was 23.9%. Univariate analysis revealed significant associations between FN and bone marrow involvement (odds ratio [OR], 2.78; 95% confidence interval [CI], 1.36-5.66; <i>P</i> = .005), stage III and IV disease (OR, 3.39; 95% CI, 1.69-6.84; <i>P</i> = .001), Eastern Cooperative Oncology Group Performance Status score of ⩾ 2 (OR, 2.75; 95% CI, 1.13-6.67; <i>P</i> = .025), lactate dehydrogenase levels ⩾ 240 U/L (OR, 2.68; 95% CI, 1.35-5.32; <i>P</i> = .005), and involvement of at least 2 extranodal sites (OR, 2.69; 95% CI, 1.44-5.02; <i>P</i> = .002). Machine learning techniques were applied to construct predictive models for FN, achieving C-statistics of 0.751 to 0.879 in cross-validation and 0.692 to 0.861 in independent training and testing experiments. Notably, patients with FN (57.6%) had a substantially inferior 5-year overall survival (OS) rate than those without FN (77.1%) (<i>P</i> = .007).</p><p><strong>Conclusions: </strong>Patients with DLBCL who develop FN after their first R-CHOP treatment have a significantly worse OS than those without FN. Tailored prophylaxis with granulocyte-colony stimulating factor and antibiotics may be essential in this population. Models with moderate to strong predictive power can be designed using various artificial intelligence techniques.</p>","PeriodicalId":48591,"journal":{"name":"Clinical Medicine Insights-Oncology","volume":"20 ","pages":"11795549261423995"},"PeriodicalIF":1.9,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12923925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Patterns of Biomarker Testing in Colorectal, Lung, and Prostate Cancers: Insights From the NIH <i>All of Us</i> Research Program.","authors":"Patrick J Kiel, Mark W McGiffin, Michael A Preston","doi":"10.1177/11795549261417371","DOIUrl":"https://doi.org/10.1177/11795549261417371","url":null,"abstract":"<p><strong>Background: </strong>Biomarker testing is central to precision oncology, yet real-world implementation across cancer types and populations remains inconsistent. Social determinants of health (SDoH) may influence testing uptake and exacerbate disparities in access to targeted therapies.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using Version 7 of the NIH <i>All of Us</i> Research Program Curated Data Repository. Adults diagnosed with colorectal cancer (CRC), non-small cell lung cancer (NSCLC), or prostate cancer were identified using standardized condition codes. Biomarker testing was determined through Current Procedural Terminology (CPT) and Logical Observation Identifiers Names and Codes (LOINC) for panel-based and single-gene assays. Logistic regression assessed associations between sociodemographic factors and documented biomarker testing, using robust modeling for the combined cohort and stepwise regression for individual cancer types.</p><p><strong>Results: </strong>Among 11 415 eligible participants, only 2.4% (n = 277) had documented biomarker testing, with 71.1% receiving panel-based assays. In the combined model, unemployment was significantly associated with higher odds of testing (odds ratio [OR] = 1.68; 95% confidence interval [CI] = 1.06-2.66), while college education showed a marginal association (OR = 1.48; 95% CI = 0.95-2.30). In cancer-specific models, NSCLC testing was predicted by education alone (OR = 1.70), while CRC testing was associated with unemployment (OR = 2.44), higher income (OR = 1.90), and smoking history. No significant predictors were found for prostate cancer.</p><p><strong>Conclusion: </strong>Despite national guidelines, biomarker testing remains underutilized and unevenly distributed across sociodemographic groups. These findings should be interpreted as exploratory, reflecting the fidelity of structured electronic health record (EHR) documentation rather than definitive utilization. Leveraging the scale and diversity of <i>All of Us</i> highlights both equity gaps and documentation limitations, positioning the program as a valuable platform for hypothesis generation in precision oncology.</p>","PeriodicalId":48591,"journal":{"name":"Clinical Medicine Insights-Oncology","volume":"20 ","pages":"11795549261417371"},"PeriodicalIF":1.9,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12907478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Prognostic Significance of KRAS, NRAS, and BRAF Mutations in Colorectal Cancer: A Systematic Review and Meta-Analysis.","authors":"Mathew Oyelami, Odinaka Mgbeke, Abraham Agaya Obadiah, Aminatulahi Egbeyemi, Ewarld Marshall","doi":"10.1177/11795549261417367","DOIUrl":"10.1177/11795549261417367","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) remains a global health issue with high morbidity and mortality. According to molecular profiling, genetic mutations such as KRAS, NRAS, and BRAF play a significant role in tumor biology, treatment effectiveness, and patient prognosis. The exact effect of these alterations on overall survival (OS) is, however, unclear. This systematic review and meta-analysis estimated the combined effect of KRAS, NRAS, and BRAF mutations on CRC survival relative to wild-type tumors.</p><p><strong>Methods: </strong>This study focused on research conducted in the last decade and was registered on PROSPERO (Reg No: CRD420251003000). Search was done using PubMed, EMBASE, MEDLINE, and Google Scholar. Cohort, case control, and randomized controlled trials reporting Overall Survival Hazard Ratios (HRs) for CRC patients with and without KRAS, NRAS, or BRAF mutations were considered. Multiple reviewers independently extracted and assessed data quality using the Newcastle-Ottawa Scale. For heterogeneity, pooled HRs were computed using a random-effects model. Publication bias was determined by funnel plot asymmetry.</p><p><strong>Results: </strong>Nine trials with 3096 participants qualified. Compared to wild-type CRC, KRAS, NRAS, and BRAF mutations were substantially linked with lower overall survival (pooled HR > 1, <i>P</i> < .05). KRAS mutations were most common and consistently associated with poor survival, while BRAF mutations had the largest impact. Mild funnel plot asymmetry suggested publication bias, but risk-of-bias assessment showed moderate to high methodological quality across trials.</p><p><strong>Conclusions: </strong>This meta-analysis shows that KRAS, NRAS, and BRAF mutations are important for adverse prognostic markers in colorectal cancer, linked to reduced overall survival. Routine molecular testing for these mutations is vital to enable personalized treatment, improve patient stratification, and enhance clinical outcomes in colorectal cancer management.</p>","PeriodicalId":48591,"journal":{"name":"Clinical Medicine Insights-Oncology","volume":"20 ","pages":"11795549261417367"},"PeriodicalIF":1.9,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12868589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bevacizumab Plus EGFR-TKIs vs EGFR-TKIs Alone for Advanced EGFR-Mutant NSCLC: A Meta-Analysis.","authors":"Zexian Wang, Yaru Guo, Xiaohan Qin, Zhiling Wan, Xiaojin Wu, Chen Liu","doi":"10.1177/11795549251414657","DOIUrl":"10.1177/11795549251414657","url":null,"abstract":"<p><strong>Background: </strong>The goal of this comprehensive meta-analysis was to evaluate the efficacy and safety of combining Epidermal Growth Factor Receptor (EGFR)-tyrosine kinase inhibitors (TKIs) with bevacizumab vs EGFR-TKI monotherapy in advanced non-small-cell lung cancer (NSCLC) patients harboring EGFR-sensitizing mutations.</p><p><strong>Methods: </strong>From inception until October 2023, we retrieved eligible studies comparing EGFR-TKIs combined with bevacizumab to EGFR-TKI monotherapy for the treatment of NSCLC with EGFR-sensitizing mutations. These studies were obtained from databases including CNKI, Wanfang, CBM, VIP, PubMed, Embase, Cochrane Library, and Web of Science. The International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) registration number is 2023120059.</p><p><strong>Results: </strong>This meta-analysis of 14 randomized controlled trials demonstrated that the combination significantly improved key efficacy outcomes compared to monotherapy. Superior partial response (odds ratio [OR] = 1.33, <i>P</i> = .05), objective response rate (OR = 1.52, <i>P</i> = .005), and reduced disease progression (OR = 0.31, <i>P</i> = .009) were observed. Furthermore, it significantly enhanced 1-year PFS (OR = 2.04, <i>P</i> < .00001), 2-year PFS (OR = 1.38, <i>P</i> = .02), and 1-year overall survival (OR = 1.41, <i>P</i> = .04). The safety profile was manageable, with no significant increase in rash (<i>P</i> = .72) or pneumonitis (<i>P</i> = .16). Expected increases in diarrhea, hypertension, and proteinuria were observed.</p><p><strong>Conclusions: </strong>The combination of bevacizumab and EGFR-TKIs provides substantial short-to-medium-term survival benefits with an acceptable safety profile for patients with advanced EGFR-mutant NSCLC. These findings support its use as a valuable first-line treatment option for this population.</p>","PeriodicalId":48591,"journal":{"name":"Clinical Medicine Insights-Oncology","volume":"20 ","pages":"11795549251414657"},"PeriodicalIF":1.9,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and Safety of Atezolizumab Plus Bevacizumab in Unresectable Hepatocellular Carcinoma: A Multicenter, Retrospective Real-World Study in China.","authors":"Minghua Shao, Binbin Tan, Chao Fan, Ying Fu, Hailei Chen, Ping Liu, Hui Zhang","doi":"10.1177/11795549251414656","DOIUrl":"10.1177/11795549251414656","url":null,"abstract":"<p><strong>Background: </strong>Atezolizumab combined with bevacizumab (Atezo + Bev) has received regulatory approval as a first-line systemic therapy for unresectable hepatocellular carcinoma. This study aimed to evaluate the effectiveness and safety of atezolizumab combined with bevacizumab (Atezo + Bev) in treating unresectable hepatocellular carcinoma (uHCC) in a real-world Chinese population, focusing on both first-line and second-line treatment settings.</p><p><strong>Methods: </strong>In this multicenter, retrospective study, patients with uHCC treated with Atezo + Bev were included at 5 centers in China from Jan. 2021 to Jan. 2023. Treatment efficacy was assessed using RECIST 1.1 and mRECIST criteria. Overall response (ORR), disease control rates (DCRs), time to disease progression (TPP), progression-free survival (PFS), and overall survival (OS) were calculated.</p><p><strong>Results: </strong>The study included 48 patients, with a median age of 58 years, among which 35 and 13 patients received Atezo + Bev as first- and second-line treatment, respectively. The ORR and DCR were 39.6% and 70.8% according to RECIST 1.1, and 60.4% and 75.0% according to mRECIST, respectively. With a median follow-up of 14.5 months, the median PFS was 8.5 months (95% CI [4.4, 11.2]) in the first-line treatment group, while in the second-line group it was 5.1 months (95% CI [2.1, 7.9]). The median OS was not reached. Adverse events of any grade were observed in 75% of patients (n = 36), most commonly being thrombocytopenia (27.1%), lymphopenia (25%), and abnormal liver function (14.6%).</p><p><strong>Conclusion: </strong>This study confirmed the practical efficacy and safety of Atezo + Bev in real-world Chinese patients with uHCC, both as a first-line and second-line treatment. Further studies are warranted to validate these findings and optimize treatment strategies.</p>","PeriodicalId":48591,"journal":{"name":"Clinical Medicine Insights-Oncology","volume":"20 ","pages":"11795549251414656"},"PeriodicalIF":1.9,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12820020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Analysis of Peripheral Blood Indicators for Immune-Related Adverse Events (irAEs) in Patients With Advanced Lung Cancer.","authors":"Yin-Min Ji, Yu-Hui Qin, Ya-Hui Lv, Shu-Yan Xiao, Yi Dong, Zhi-Song Hu, Peng-Fei Cui, Tao Li, Xiao-Ran Cui, Yi Hu","doi":"10.1177/11795549251413304","DOIUrl":"10.1177/11795549251413304","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors (ICIs) have revolutionized advanced lung cancer treatment, but immune-related adverse events (irAEs) remain a significant challenge. This study aimed to identify peripheral blood indicators associated with Immune-Related Adverse Events (irAEs) to improve early prediction and management.</p><p><strong>Methods: </strong>A retrospective analysis of 1910 advanced lung cancer cases treated with ICIs (2015-2024) was conducted. Patients were categorized into 2 groups: irAEs (n = 323) and control (n = 323). Peripheral blood indicators were analyzed at baseline and during treatment. Statistical analyses included t-tests, Mann-Whitney U tests, logistic regression, and Cox proportional hazards models.</p><p><strong>Results: </strong>Age (odds ratio [OR] = 0.96, <i>P</i> < .001) and radiotherapy history (OR = 2.35, <i>P</i> = .004) were significant irAE risk factors. Hemoglobin, red blood cells, and lymphocyte ratios decreased, while neutrophil ratios, neutrophil-to-lymphocyte ratio (NLR), lactate dehydrogenase (LDH), and systemic inflammation markers increased in irAE patients. The NLR and LDH were independent predictors of irAEs and overall survival (<i>P</i> < .05).</p><p><strong>Conclusion: </strong>Peripheral blood indicators are valuable for irAE prediction. Specifically, elevated NLR (hazard ratio [HR] = 1.14, <i>P</i> = .002) and LDH (HR = 1.00, <i>P</i> = .03) were identified as independent risk factors for irAEs and were also significantly associated with poorer overall survival.</p>","PeriodicalId":48591,"journal":{"name":"Clinical Medicine Insights-Oncology","volume":"20 ","pages":"11795549251413304"},"PeriodicalIF":1.9,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12819973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of Nomogram for Predicting Postoperative Progression Risk in High-Risk Thymoma and Thymic Carcinoma Utilizing Clinical and Preoperative CT Features.","authors":"Qian Meng, Nan Jiang, Jun Chen, Chunjiao Weng, Huanmin Miao, Xiaoxia Ping, Chunhong Hu","doi":"10.1177/11795549251413298","DOIUrl":"10.1177/11795549251413298","url":null,"abstract":"<p><strong>Background: </strong>Computed tomography (CT) features and clinical characteristics have been shown in recent studies to be effective predictive indicators for risk stratification of thymic epithelial tumors. High-risk thymoma and thymic carcinoma (HRT-TC) are highly aggressive and are associated with poor prognoses. The aim of this study is to evaluate the predictive value of CT features and clinical characteristics to assess postoperative progression in patients with HRT-TC.</p><p><strong>Methods: </strong>Clinical and enhanced CT data were retrospectively collected from patients who underwent HRT-TC surgery between June 1, 2012, and June 1, 2022. A univariate Cox regression analysis was conducted to identify the risk factors associated with postoperative progression. A multivariate Cox regression analysis was then used to determine the independent risk factors. Three-year and 5-year single-factor models as well as multifactorial combined models were then constructed based on the results of these analyses to assess their efficacy, accuracy, and net benefit. The best-performing model was selected to create a nomogram for a consistency assessment.</p><p><strong>Results: </strong>A total of 215 patients were included in the study. The multivariate Cox regression analysis revealed that independent prognostic factors that influenced postoperative progression were the tumor length (hazard ratio [HR] = 1.027; 95% confidence interval [CI] = 1.004-1.049, <i>P</i> = .018), tumor resection (HR = 4.122; 95% CI = 2.054-8.274, <i>P</i> < .001), and the mediastinal vascular invasion (MVI; HR = 2.779; 95% CI = 1.140-6.775, <i>P</i> = .025). The 3-year and 5-year combined models demonstrated superior predictive efficacy, accuracy, and net benefits. The nomogram and calibration curves showed that the predicted risk probabilities from the nomogram aligned well with actual observations.</p><p><strong>Conclusions: </strong>A nomogram based on clinical and CT features provided effective predictions of progression following HRT-TC. This prognostic tool holds significant value for clinicians to guide therapeutic decisions and personalize survival assessments.</p>","PeriodicalId":48591,"journal":{"name":"Clinical Medicine Insights-Oncology","volume":"20 ","pages":"11795549251413298"},"PeriodicalIF":1.9,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12812200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146004482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction Model for Low Bone Mineral Density in Cancer Survivors and Age-Matched Controls Using a Causal Bayesian Network: A Nationwide Population-Based Study in Korea.","authors":"Sujeong Han, Sung-Bae Park, Sohee Oh, Bumjo Oh","doi":"10.1177/11795549251411101","DOIUrl":"10.1177/11795549251411101","url":null,"abstract":"<p><strong>Background: </strong>With advances in cancer treatment, the number of cancer survivors has increased, bringing attention to long-term complications such as alterations in bone mineral density (BMD). Although survivors are at elevated risk for low BMD, prior studies have focused on specific cancer types and relied on traditional regression models, which are limited in capturing complex inter-variable relationships. This study aimed to examine the causal relationships among factors affecting BMD in cancer survivors and age-matched controls using causal Bayesian network (CBN) modeling.</p><p><strong>Methods: </strong>Data from the 2010-2011 Korea National Health and Nutrition Examination Survey (KNHANES) V were analyzed. We included 227 cancer survivors and 681 age- and sex-matched controls. Associations between BMD and variables such as age, sex, body composition, smoking, fracture history, and vitamin D were assessed using linear regression. A CBN model was then applied to evaluate probabilistic dependencies and potential causal relationships between variables and femoral neck BMD.</p><p><strong>Results: </strong>Among all participants, age, sex, smoking, fracture history, body fat percentage, muscle mass, and cancer history were significantly associated with femoral neck BMD. In cancer survivors, age (β = -0.032, <i>P</i> < .001) and sex (β = -0.680, <i>P</i> < .001) showed negative associations with BMD, whereas higher muscle mass (β = 0.073, <i>P</i> < .001) was a strong positive predictor. Smoking (β = -0.779, <i>P</i> = .005) and previous fractures (β = -0.507, <i>P</i> = .003) were also linked to lower BMD. The CBN model identified direct effects of age and muscle mass on BMD, with indirect effects from sex, smoking, and fracture history. Among women aged >60 years, greater muscle mass appeared particularly protective.</p><p><strong>Conclusion: </strong>Causal Bayesian network modeling identified muscle mass as a key modifiable factor influencing BMD among cancer survivors. These findings highlight the importance of muscle-preserving lifestyle interventions, including resistance exercise and adequate protein intake, in survivorship care. The CBN approach provides a framework for identifying individualized risk pathways and can support personalized bone-health management strategies in clinical practice.</p>","PeriodicalId":48591,"journal":{"name":"Clinical Medicine Insights-Oncology","volume":"20 ","pages":"11795549251411101"},"PeriodicalIF":1.9,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12783566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beta-Blocker Use and Survival Outcomes in Pancreatic Cancer Patients: A Systematic Review and Meta-Analysis.","authors":"Rui Li, Jie Chen, Yingkai Chen, Kai Jin, Yong Chen, Changyu Deng, Xuefen Liu, Yue Li","doi":"10.1177/11795549251411762","DOIUrl":"10.1177/11795549251411762","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic cancers (PCs)-especially pancreatic ductal adenocarcinoma (PDAC)-are among the deadliest digestive system cancers, with a 5 year survival of approximately 13%. Beta blockers (BBs), which inhibit beta-adrenergic receptor-mediated angiogenesis and immunosuppression, are potential candidates for oncological drug repurposing. However, the clinical evidence is inconsistent, and robust subgroup analyses are lacking. This study systematically evaluated the association between BB use and survival in PC patients. Furthermore, subgroup analyses were conducted to clarify differential clinical effects.</p><p><strong>Methods: </strong>This study was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD420251106076). The PubMed, Embase, Cochrane Library, and Web of Science databases were searched to identify observational studies on all-cause mortality (ACM) and cancer-specific mortality (CSM). Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using RevMan 5.3 and R, and the results were presented in forest plots.</p><p><strong>Results: </strong>This analysis included nine retrospective cohort studies involving over 30 000 patients. There were no significant associations between BB use and ACM (HR = 1.07; 95% CI [0.95-1.20]) or CSM (HR = 0.89; 95% CI [0.70-1.14]). However, subgroup analysis revealed that BB use was significantly associated with increased ACM risk in surgical patients (HR = 1.18; 95% CI [1.05-1.31]). Moreover, non-selective BB (NSBB) use significantly reduced CSM risk (HR = 0.81; 95% CI [0.68-0.97]). Both sensitivity and trim-and-fill analyses confirmed the robustness and consistency of these results.</p><p><strong>Conclusions: </strong>This meta-analysis presents the first systematic evidence regarding the potential role of NSBBs in mitigating CSM, thus providing support for their potential repurposing. In addition, these findings indicate that perioperative BB use may be associated with increased ACM risk, highlighting the need for careful perioperative risk assessment. To further substantiate these findings, future prospective studies should explore combined approaches, particularly those integrating immune or anti-angiogenic therapies.</p>","PeriodicalId":48591,"journal":{"name":"Clinical Medicine Insights-Oncology","volume":"20 ","pages":"11795549251411762"},"PeriodicalIF":1.9,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12775345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}