Lancet Regional Health-Europe最新文献

{"title":"Comparative effectiveness of different therapies for Clostridioides difficile infection in adults: a systematic review and network meta-analysis of randomized controlled trials","authors":"Dániel Steve Bednárik ,&nbsp;Kincső Csepke Földvári-Nagy ,&nbsp;Viktor Simon ,&nbsp;Anett Rancz ,&nbsp;Noémi Gede ,&nbsp;Dániel Sándor Veres ,&nbsp;Panagiotis Paraskevopoulos ,&nbsp;Tamás Schnabel ,&nbsp;Bálint Erőss ,&nbsp;Péter Hegyi ,&nbsp;Katalin Lenti ,&nbsp;László Földvári-Nagy","doi":"10.1016/j.lanepe.2024.101151","DOIUrl":"10.1016/j.lanepe.2024.101151","url":null,"abstract":"<div><h3>Background</h3><div><em>Clostridioides difficile</em> infection (CDI) is a leading cause of healthcare-associated diarrhea, with substantial morbidity and mortality. CDI is a severe and growing problem with numerous treatment options. We evaluated the effectiveness of all therapies in recurrent and non-recurrent infections and their prevention.</div></div><div><h3>Methods</h3><div>This network meta-analysis and systematic review of randomized controlled trials (RCTs) compared all CDI therapies and preventions. We included RCTs published until 19 August 2024 and focused on adult population. We performed a systematic search in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials. Inclusion criteria were patients: adults (&gt;16) treated against CDI; study type: randomized controlled trial; outcome: cure rate, recurrence or effectiveness of prevention. Any publication not meeting all criteria was considered to be ineligible and excluded. We applied random-effects meta-analysis using frequentist methods. We reported our main results as odds ratios (as a symmetric effect size measure, OR) with 95% confidence interval (95% CI). We used the Cochrane risk-of-bias tool to assess the risk of bias. Our study protocol was preregistered in PROSPERO (CRD42022371210).</div></div><div><h3>Findings</h3><div>We assessed 73 RCTs with 28 interventions, involving 27,959 patients (49.2% female) in five networks. Fecal microbiota transplantation (FMT) was the most effective treatment in terms of the cure rate overall (P-score: 0.9952) and in recurrent cases (P-score: 0.9836). In recurrent cases, fidaxomicin (P-score: 0.6734) showed significantly greater effectiveness than vancomycin (P-score: 0.3677) and tolevamer (P-score: 0.0365). For non-recurrent CDI treatments ridinilazole, fidaxomicin, FMT and nitazoxanide were equally effective. Ridinilazole (P-score: 0.7671) and fidaxomicin (P-score: 0.7627) emerged as the most effective in preventing recurrence. Probiotics were not effective in preventing CDI, since network meta-analyses did not show significant differences between probiotics and placebo. In probiotics’ subgroups pairwise meta-analyses <em>Lactobacillaceae</em> proved to be significantly more effective in prevention than placebo. Oral and colonoscopic FMT administration methods were equally effective. The study-level aggregated risk of bias of the publications included ranged from low to high. We observed relevant heterogeneity among studies in therapeutic doses, treatment durations, and follow-up times.</div></div><div><h3>Interpretation</h3><div>The superiority of FMT in the treatment of CDI highlights the potential for increased use of FMT in clinical settings. Further research on optimizing FMT protocols and exploring its long-term safety and efficacy in larger samples is needed. Our findings suggest that the preventive use of probiotics might be questioned.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101151"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143163874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between cardiometabolic diseases and the risk and progression of motor neuron diseases in Sweden: a population-based case–control study","authors":"Charilaos Chourpiliadis ,&nbsp;Anikó Lovik ,&nbsp;Christina Seitz ,&nbsp;Yihan Hu ,&nbsp;Jing Wu ,&nbsp;Petter Ljungman ,&nbsp;Rayomand Press ,&nbsp;Kristin Samuelsson ,&nbsp;Caroline Ingre ,&nbsp;Fang Fang","doi":"10.1016/j.lanepe.2024.101173","DOIUrl":"10.1016/j.lanepe.2024.101173","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The evidence on the link between cardiometabolic diseases (CMDs) and motor neuron diseases (MNDs) remains inconsistent. We aimed to determine whether there is an association of CMDs, namely, any cardiovascular disease, cardiac arrhythmia, heart failure, thromboembolic disease, hypertension, cerebrovascular disease, ischemic heart disease, diabetes mellitus type 2, and hypercholesterolemia with the risk and progression of MNDs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We included 1463 MND patients (amyotrophic lateral sclerosis (ALS), primary lateral sclerosis (PLS), progressive spinal muscular atrophy (PSMA), and unspecified MND) diagnosed from January 1, 2015, to July 1, 2023, in Sweden according to the Swedish Motor Neuron Disease Quality Registry (i.e., cases), up to 5 MND-free population controls per case (N = 7311) who were individually matched to the cases on age and sex, and the full siblings (N = 2002) and spouses (N = 1220) of MND patients (i.e., relative controls). Conditional logistic regression models were used to estimate the risk of MND diagnosis in relation to previous CMDs, through comparing MND patients to population controls or relative controls. MND patients were followed from diagnosis to assess the role of pre-diagnostic CMDs on disease progression. A joint longitudinal-survival model was used to estimate risk of mortality (or use of invasive ventilation) in relation to CMDs after taking into account the longitudinal changes of ALS functional rating scale-revised (ALSFRS-R) in the time-to-event analysis. Hierarchical clustering with the Ward's linkage and a dissimilarity matrix created by Gower's method was used to identify clusters of MND patients with distinct phenotypes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Among the CMDs studied, a history of diabetes mellitus type 2 (OR 0.75; 95% CI 0.62, 0.93) or hypercholesterolemia (OR 0.82; 95% CI 0.71, 0.94) more than one year before diagnosis was associated with a lower risk for MNDs. The associations persisted for more than five years before MND diagnosis. MND patients with a history of any cardiovascular disease (HR 1.43; 95% CI 1.13, 1.81), arrhythmia (HR 1.42; 95% CI 1.04, 1.93), heart failure (HR 1.79; 95% CI 1.02, 3.14), hypertension (HR 1.41; 95% CI 1.12, 1.77), or hypercholesterolemia (HR 1.28; 95% CI 1.01, 1.62) had an increased mortality risk, compared to others, after taking into consideration the longitudinal changes in ALSFRS-R. Cluster analysis identified two clusters of MND patients, where one cluster demonstrated higher age, worse functional status, and higher prevalence of CMDs at the time of diagnosis as well as a higher mortality and faster functional decline during follow-up, compared to the ones included in the other cluster.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Diabetes mellitus type 2 and hypercholesterolemia were associated with a lower future risk of MND. On the other hand, most of the CMDs were indicative of a poor disease ","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101173"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Nordic model fails to protect vulnerable children","authors":"Věra Skalická ,&nbsp;Terje Andreas Eikemo","doi":"10.1016/j.lanepe.2025.101217","DOIUrl":"10.1016/j.lanepe.2025.101217","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101217"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do national cancer control plans address care and research for children, adolescents, and young adults? A review of status, priorities, and recommendations across 41 European countries","authors":"Joan Prades ,&nbsp;Olga Kozhaeva ,&nbsp;Maria Otth ,&nbsp;Pamela Kearns ,&nbsp;Ruth Ladenstein ,&nbsp;Carmelo Rizzari ,&nbsp;Delphine Heenen ,&nbsp;Uta Dirksen ,&nbsp;Cormac Owens ,&nbsp;Deyan Lazarov ,&nbsp;Ciara Sheehan ,&nbsp;Josep M. Borras ,&nbsp;Gilles Vassal","doi":"10.1016/j.lanepe.2024.101155","DOIUrl":"10.1016/j.lanepe.2024.101155","url":null,"abstract":"<div><div>Paediatric cancers, although rare, are the leading cause of disease-related mortality in European children above one year. A key pillar of the European Health Union, Europe's Beating Cancer Plan (EBCP) puts a spotlight on childhood cancer. National Cancer Control Plans (NCCPs) have a key role but did not address childhood cancers sufficiently previously. This study considered the NCCPs of 41 European countries in relation to children and adolescents and young adults (AYAs). Twenty two NCCPs informed a structured narrative analysis. Four NCCPs were categorised as having comprehensive paediatric oncology content. Findings emphasise access to care through centralisation combined with local delivery of low-risk interventions and the role of multidisciplinary teams. Survivorship, AYA care, registries, and voluntary associations were addressed to varying degrees. Supportive care was among the weakest areas in the 22 NCCPs. Recommendations were presented to strengthen paediatric oncology in NCCPs and enrich the EBCP vision towards improved survival and reduced inequalities across Europe.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101155"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival and quality of life after first-time diagnosis of brain metastases: a multicenter, prospective, observational study","authors":"Olav Erich Yri ,&nbsp;Guro Lindviksmoen Astrup ,&nbsp;Astrid Telhaug Karlsson ,&nbsp;Rene van Helvoirt ,&nbsp;Marianne Jensen Hjermstad ,&nbsp;Kristin Moksnes Husby ,&nbsp;Jon Håvard Loge ,&nbsp;Jo-Åsmund Lund ,&nbsp;Tonje Lundeby ,&nbsp;Ørnulf Paulsen ,&nbsp;Eva Skovlund ,&nbsp;Marius-Ioan Taran ,&nbsp;Rebecca Rootwelt Winther ,&nbsp;Nina Aass ,&nbsp;Stein Kaasa","doi":"10.1016/j.lanepe.2024.101181","DOIUrl":"10.1016/j.lanepe.2024.101181","url":null,"abstract":"<div><h3>Background</h3><div>A major concern in anticancer treatment (ACT) of brain metastases (BM) is exposing patients with short expected survival to treatments that negatively impact on quality of life (QoL). Such futile ACT at the end of life is time-consuming and burdensome for patients and their families and entails unnecessary healthcare costs. Refraining from ACT is challenging for both physicians and patients. This study aimed to provide real-life data on survival after BM diagnosis and patient reported outcomes (PROs) after ACT to identify risk factors for futile treatment and to support BM treatment decisions.</div></div><div><h3>Methods</h3><div>This multi-center, prospective, observational study recruited consecutive patients with first-time BM from November 2017 to March 2021. Patients were followed until death or study end (October 1st, 2023). Clinical factors associated with survival were analyzed by the Cox’ proportional hazards model. Changes in PROs after BM treatment were described according to Eastern Cooperative Oncology Group (ECOG) performance status, survival, and treatment groups.</div></div><div><h3>Findings</h3><div>For the total cohort (<em>N</em> = 912), median overall survival (mOS) after BM diagnosis was 5.9 months (95% confidence interval [CI] 5.2–6.7). ECOG 2–4, uncontrolled extracranial metastases, and ≥5 BM were associated with short survival. In patients treated with radiotherapy, survival for patients with ECOG 2 and those with ECOG 3–4 was similar and particularly short for the whole brain radiotherapy (WBRT) group (ECOG 2: 2.9 months [95% CI 2.3–3.5]; ECOG 3–4: 2.1 [1.5–2.7]). Patients surviving &lt;6 months after BM diagnosis reported worse QoL scores two months after ACT; patients surviving &gt;6 months reported stable scores over time.</div></div><div><h3>Interpretation</h3><div>Patients with ECOG 2–4, especially those with uncontrolled extracranial metastases and ≥5 BM, are at risk for futile ACT. BM treatment guidelines should strongly caution against ACT to patients with expected survival &lt;6 months and specifically advise against WBRT.</div></div><div><h3>Funding</h3><div>The <span>South-Eastern Norway Regional Health Authority</span>; The <span>Norwegian Cancer Society</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101181"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose-dense anthracycline- and taxane-based chemotherapy remains the preferred treatment for selected patients with high-risk early breast cancer","authors":"Matteo Lambertini ,&nbsp;Bo Nordenskjold","doi":"10.1016/j.lanepe.2025.101212","DOIUrl":"10.1016/j.lanepe.2025.101212","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101212"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143133957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of artificial intelligence models for early detection of postoperative infections (PERISCOPE): a multicentre study using electronic health record data","authors":"Siri L. van der Meijden ,&nbsp;Anna M. van Boekel ,&nbsp;Laurens J. Schinkelshoek ,&nbsp;Harry van Goor ,&nbsp;Ewout W. Steyerberg ,&nbsp;Rob G.H.H. Nelissen ,&nbsp;Dieter Mesotten ,&nbsp;Bart F. Geerts ,&nbsp;Mark G.J. de Boer ,&nbsp;M. Sesmu Arbous","doi":"10.1016/j.lanepe.2024.101163","DOIUrl":"10.1016/j.lanepe.2024.101163","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative infections significantly impact patient outcomes and costs, exacerbated by late diagnoses, yet early reliable predictors are scarce. Existing artificial intelligence (AI) models for postoperative infection prediction often lack external validation or perform poorly in local settings when validated. We aimed to develop locally valid models as part of the PERISCOPE AI system to enable early detection, safer discharge, and more timely treatment of patients.</div></div><div><h3>Methods</h3><div>We developed and validated XGBoost models to predict postoperative infections within 7 and 30 days of surgery. Using retrospective pre-operative and intra-operative electronic health record data from 2014 to 2023 across various surgical specialities, the models were developed at Hospital A and validated and updated at Hospitals B and C in the Netherlands and Belgium. Model performance was evaluated before and after updating using the two most recent years of data as temporal validation datasets. Main outcome measures were model discrimination (area under the receiver operating characteristic curve (AUROC)), calibration (slope, intercept, and plots), and clinical utility (decision curve analysis with net benefit).</div></div><div><h3>Findings</h3><div>The study included 253,010 surgical procedures with 23,903 infections within 30-days. Discriminative performance, calibration properties, and clinical utility significantly improved after updating. Final AUROCs after updating for Hospitals A, B, and C were 0.82 (95% confidence interval (CI) 0.81–0.83), 0.82 (95% CI 0.81–0.83), and 0.91 (95% CI 0.90–0.91) respectively for 30-day predictions on the temporal validation datasets (2022–2023). Calibration plots demonstrated adequate correspondence between observed outcomes and predicted risk. All local models were deemed clinically useful as the net benefit was higher than default strategies (treat all and treat none) over a wide range of clinically relevant decision thresholds.</div></div><div><h3>Interpretation</h3><div>PERISCOPE can accurately predict overall postoperative infections within 7- and 30-days post-surgery. The robust performance implies potential for improving clinical care in diverse clinical target populations. This study supports the need for approaches to local updating of AI models to account for domain shifts in patient populations and data distributions across different clinical settings.</div></div><div><h3>Funding</h3><div>This study was funded by a <span>REACT EU</span> grant from <span>European Regional Development Fund (ERDF)</span> and <span>Kansen voor West</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101163"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11667051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Internal mammary node irradiation in 4541 node-positive breast cancer patients treated with newer systemic therapies and 3D-based radiotherapy (DBCG IMN2): a prospective, nationwide, population-based cohort study","authors":"Anders W. Mølby Nielsen ,&nbsp;Lise B.J. Thorsen ,&nbsp;Demet Özcan ,&nbsp;Louise W. Matthiessen ,&nbsp;Else Maae ,&nbsp;Marie L.H. Milo ,&nbsp;Mette H. Nielsen ,&nbsp;Trine Tramm ,&nbsp;Jens Overgaard ,&nbsp;Birgitte V. Offersen ,&nbsp;DBCG RT Committee","doi":"10.1016/j.lanepe.2024.101160","DOIUrl":"10.1016/j.lanepe.2024.101160","url":null,"abstract":"<div><h3>Background</h3><div>Internal mammary node irradiation (IMNI) improves overall survival (OS) in node-positive breast cancer patients. However, the effect is not documented in breast cancer patients treated with newer systemic therapies and 3D-based radiotherapy (RT). Therefore, the Danish Breast Cancer Group (DBCG) IMN2 study aimed to investigate the effect of IMNI in node-positive breast cancer patients treated with newer systemic therapies and 3D-based RT.</div></div><div><h3>Methods</h3><div>DBCG IMN2 was a nationwide population-based cohort study prospectively allocating node-positive breast cancer patients with right-sided tumours to IMNI and patients with left-sided tumours to no IMNI in six RT centres. Exclusion criteria were prior malignancies, bilateral breast cancer, neoadjuvant systemic therapy, recurrence before RT, or non-standard RT. Systemic treatment included taxane-based chemotherapy, aromatase inhibitors, and trastuzumab. The primary end-point was OS. Secondary endpoints were breast cancer mortality and distant metastasis. Cox regression analyses were used for adjusted hazard ratios (HR). <span><span>Clinicaltrial.gov</span><svg><path></path></svg></span> ID: <span><span>NCT06549920</span><svg><path></path></svg></span>.</div></div><div><h3>Findings</h3><div>In the period January 2007–May 2014, a total of 4541 patients were included. Patient characteristics were distributed evenly between right- and left-sided patients. Median follow-up was 13.7 years for OS. Survival rates at 15 years were 65.0% in patients with IMNI and 60.8% without leading to an adjusted HR of 0.85 (95% CI, 0.76–0.94; p = 0.0016) for OS. Corresponding HRs were 0.84 (95% CI, 0.74–0.95; p = 0.0077) for breast cancer mortality and HR 0.87 (95% CI, 0.78–0.98; p = 0.026) for distant metastasis. No subgroups were identified for the omission of IMNI. The 15-year cumulative incidence of death from ischemic or valvular heart disease was 0.2% (95% CI, 0.0–0.5) in right-sided and 0.7% (95% CI, 0.4–1.2) in left-sided patients.</div></div><div><h3>Interpretation</h3><div>IMNI reduced distant metastasis and breast cancer mortality and improved OS in node-positive breast cancer patients, despite treatment with newer systemic therapies and 3D-based RT.</div></div><div><h3>Funding</h3><div>This work was supported by the <span>Danish Cancer Society</span> and Department <span>of Clinical Medicine</span>, <span>Aarhus University</span>, Denmark.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101160"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefit from dose-dense adjuvant chemotherapy for breast cancer: subgroup analyses from the randomised phase 3 PANTHER trial","authors":"Alexios Matikas ,&nbsp;Andri Papakonstantinou ,&nbsp;Sibylle Loibl ,&nbsp;Günther G. Steger ,&nbsp;Michael Untch ,&nbsp;Hemming Johansson ,&nbsp;Nikos Tsiknakis ,&nbsp;Mats Hellström ,&nbsp;Richard Greil ,&nbsp;Volker Möbus ,&nbsp;Michael Gnant ,&nbsp;Jonas Bergh ,&nbsp;Theodoros Foukakis","doi":"10.1016/j.lanepe.2024.101162","DOIUrl":"10.1016/j.lanepe.2024.101162","url":null,"abstract":"<div><h3>Background</h3><div>It is unclear whether some patients with high-risk breast cancer do not warrant adjuvant dose-dense chemotherapy due to small expected absolute benefit.</div></div><div><h3>Methods</h3><div>The phase 3 PANTHER trial (<span><span>NCT00798070</span><svg><path></path></svg></span>) compared adjuvant sequential epirubicin/cyclophosphamide (EC) and docetaxel (D) administered in either tailored dose-dense (tDD EC/D) or standard interval schedule (FEC/D) to patients with high-risk resected early breast cancer (n = 2003). We compared outcomes across key subgroups of interest, evaluated the performance of the online prognostication and treatment benefit estimation tool PREDICT and conducted a subpopulation treatment effect pattern plot (STEPP) analysis. Primary endpoint was breast cancer recurrence free survival (BCRFS).</div></div><div><h3>Findings</h3><div>Median follow-up was 10.3 years. Treatment with tDD EC/D improved 10-year BCRFS across all subgroups including according to menopausal status, with an absolute benefit of 2% or more, as well as in luminal (Hazard Ratio [HR] = 0.83, 95% Confidence Interval [CI] 0.65–1.05) and Human Epidermal Growth Factor Receptor 2 (HER2) positive (HR = 0.53, 95% CI 0.30–0.93), but not triple negative breast cancer patients (HR = 1.02, 95% CI 0.66–1.57). PREDICT underestimated overall survival in the entire population and across all subgroups. In STEPP analysis, absolute benefit from tDD EC/D in BCRFS was stable across risk-defined subpopulations, from 3.8% in the lowest risk patients to 3.6% in the highest risk ones. There was no differential treatment effect over time.</div></div><div><h3>Interpretation</h3><div>We could not reliably identify any subgroup not benefiting from dose-dense treatment, which should be considered for patients with primary resected high-risk breast cancer.</div></div><div><h3>Funding</h3><div><span>Cancerfonden</span>, <span>Bröstcancerförbundet</span>, <span>Radiumhemmets Forskningsfonder</span>, <span>Amgen</span>, <span>Roche</span>, <span>sanofi-aventis</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101162"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11652897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scurvy incidence trend among children hospitalised in France, 2015–2023: a population-based interrupted time-series analysis","authors":"Zein Assad ,&nbsp;Maelle Trad ,&nbsp;Zaba Valtuille ,&nbsp;Cécile Dumaine ,&nbsp;Albert Faye ,&nbsp;Tania Ikowsky ,&nbsp;Florentia Kaguelidou ,&nbsp;Lindsay Osei ,&nbsp;Naim Ouldali ,&nbsp;Ulrich Meinzer","doi":"10.1016/j.lanepe.2024.101159","DOIUrl":"10.1016/j.lanepe.2024.101159","url":null,"abstract":"<div><h3>Background</h3><div>Scurvy, historically rare in-high income countries, has re-emerged as an indicator of socioeconomic and dietary disparities. Limited data exist on scurvy trends among European children, particularly following socioeconomic changes since the COVID-19 pandemic. This study analysed scurvy incidence trends among French children over a nine-year period, examining potential post-pandemic increases.</div></div><div><h3>Methods</h3><div>This cohort study used an interrupted time-series analysis of patient records from a national hospital-based French surveillance system. All children aged &lt;18 years hospitalized with scurvy and malnutrition from January 2015 to November 2023 were included. The monthly incidence of hospitalized scurvy per 100,000 children was analysed using a segmented linear regression model with autoregressive error. Incidence of hospitalization for malnutrition was analysed as secondary outcome and for urinary tract infection and vitamin D deficiency as control outcomes.</div></div><div><h3>Findings</h3><div>A total of 888 children were hospitalized with scurvy (median age, 11 years; interquartile range [IQR], 4–15; 431 boys [48.5%]). The COVID-19 pandemic in March 2020 was associated with a significant increase in scurvy incidence (cumulative increase, 34.5%; 95% confidence interval [CI], 12.7–56.3; p = 0.002) and severe malnutrition (cumulative increase, 20.3%; 95% CI, 10.7–29.9; p &lt; 0.001). The increased incidence of scurvy was correlated with the rise in the consumer price index. In contrast, no change was found for the two control outcomes.</div></div><div><h3>Interpretation</h3><div>This study identifies a significant increase in scurvy and severe malnutrition post-COVID-19, associated with inflation and socioeconomic instability, emphasizing the urgent need for targeted nutritional support for at-risk paediatric populations.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"49 ","pages":"Article 101159"},"PeriodicalIF":13.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11667167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}