Cancer[JOURNAL]
Sun
200 papers
Developing a quality evaluation indicator system for lung cancer diagnosis and treatment: a modified Delphi method study.
Shi L, Fei K, Liu M … +6 more , Zhou C, Yang J, Yang J, Wang J, Wang Z, Yang W
BMC Cancer · 2026 Jun · PMID 42304262 · Full text
OBJECTIVE: To establish a quality evaluation index system for the diagnosis and treatment of lung cancer. METHOD: The Donabedian health assessment model and Delphi method were used to construct an indicator system, and t...
OBJECTIVE: To establish a quality evaluation index system for the diagnosis and treatment of lung cancer. METHOD: The Donabedian health assessment model and Delphi method were used to construct an indicator system, and the Analytic Hierarchy Process was used to determine the weights of each level of indicators. RESULT: The final indicator system constructed includes 3 primary indicators: structure, process and outcome, 15 secondary indicators, and 55 tertiary indicators. Structural indicators include staff, regulations, and facilities; Process indicators include diagnosis, multidisciplinary team (MDT), Neoadjuvant therapy, surgical treatment, adjuvant treatment, radiation therapy, systemic therapy, patient follow-up and patient-centered; Outcome indicators include effectiveness, safety and timeliness. Of the two rounds of Delphi experts consulting, the Expert Enthusiasm Coefficient were respectively 100.0% and 96.15%, the Expert Authority Coefficient were respectively 0.818 and 0.825, and Expert Coordination Coefficient was between 0.476 ~ 0.748. CONCLUSION: The quality evaluation indicator system of lung cancer has high credibility and can be used as a tool for evaluating the quality of lung cancer care.
MRI radiomics and Y PET dosimetry for predicting hepatocellular carcinoma response after radioembolization.
Huang W, Ding J, Yuan H … +3 more , Li Z, Li H, Zeng Y
BMC Cancer · 2026 Jun · PMID 42304258 · Full text
BACKGROUND: To evaluate treatment response in hepatocellular carcinoma (HCC) following Yttrium-90 (Y) radioembolization by integrating pre-treatment contrast-enhanced magnetic resonance imaging (CE-MRI) radiomics with po...
BACKGROUND: To evaluate treatment response in hepatocellular carcinoma (HCC) following Yttrium-90 (Y) radioembolization by integrating pre-treatment contrast-enhanced magnetic resonance imaging (CE-MRI) radiomics with post-treatment Y positron emission tomography (PET) dosimetry. MATERIALS AND METHODS: This retrospective study included 57 patients with pathologically confirmed HCC. All patients underwent CE-MRI within 4-6 weeks before Y transarterial radioembolization (TARE), followed by Y PET/CT within 24 h post-treatment. Tumor response was assessed at three months using the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Radiomic features extracted from CE-MRI and 24 h tumor absorbed dose parameters from Y PET/CT were analyzed to predict treatment response, classifying patients as responders or non-responders. RESULTS: Based on mRECIST criteria, 32 patients were classified as responders (all partial response), while 25 were non-responders (20 stable disease, 5 progressive disease). 24-hour average absorbed dose is independent predictive factors for treatment response (OR = 1.06, p = 0.006). The combined model, incorporating clinical characteristics and MRI-derived radiomic features, achieved a sensitivity of 88% (28/32) [95% CI, 71%-96%], specificity of 68% (17/25) [95% CI, 46%-85%], and accuracy of 79% (45/57) [95% CI, 66%-89%]. CONCLUSION: The integration of pre-treatment CE-MRI radiomics with post-treatment Y PET imaging provides complementary insights into tumor biology and therapeutic efficacy. Early tumor absorbed dose metrics derived from Y PET, together with specific CE-MRI radiomic features, show strong correlations with treatment response and may serve as valuable predictive biomarkers to guide patient stratification and optimize radioembolization strategies in HCC.
Clinical profiling of AML1::ETO and KIT exon 17 mutation in pediatric AML by high-throughput drug sensitivity.
Hu Z, Tang X, Chen F … +10 more , Li T, Liu Y, Zhou G, Li Q, Liu S, Wang Y, Wen F, Mai H, Wang L, Liu S
BMC Cancer · 2026 Jun · PMID 42298546 · Full text
BACKGROUND: The favorable prognosis of pediatric AML1::ETO acute myeloid leukemia (AML) is well-established, yet the impact of co-occurring KIT mutations-particularly in exon 17-on clinical outcomes and chemosensitivity...
BACKGROUND: The favorable prognosis of pediatric AML1::ETO acute myeloid leukemia (AML) is well-established, yet the impact of co-occurring KIT mutations-particularly in exon 17-on clinical outcomes and chemosensitivity remains incompletely defined. METHODS: We analyzed the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) database comprising 957 pediatric AML patients to assess the clinical characteristics and prognosis of pediatric patients harboring AML1::ETO and KIT mutation using Kaplan-Meier survival analysis and Cox proportional hazards models. Subsequently, we performed experimental validation using bone marrow samples from 16 pediatric AML patients at Shenzhen Children's Hospital by high-throughput drug sensitivity (HDS) screening against therapeutic agents and whole transcriptome sequencing analysis of significant genes. Functional enrichment analysis of these differential expression genes was carried out by Gene Ontology. RESULTS: Analysis from the TARGET database revealed that while AML1::ETO AML generally carries a favorable prognosis, concomitant KIT exon 17 mutations significantly attenuate this survival advantage. Exploratory experimental validation in a limited cohort of AML1::ETO and KIT exon 17 mutation patients suggested a potential trend of broad drug resistance such as cytarabine and daunorubicin. Preliminary transcriptomic analysis identified upregulation of SOCS1, a negative regulator of the JAK-STAT pathway, as a potential feature of this resistant phenotype. Furthermore, elevated SOCS1 expression was associated with poor prognosis. CONCLUSIONS: We conclude that KIT mutations, especially exon 17, confer a high-risk phenotype in otherwise favorable pediatric AML1::ETO AML. Our exploratory data suggest this may be associated with a chemoresistant profile, potentially driven by SOCS1-associated JAK-STAT dysregulation. These findings highlight the necessity of refined risk stratification based on KIT exon profiling and support targeting the SOCS1/JAK-STAT axis to overcome therapy resistance.
Bioinformatics mining and clinical validation of CD274 as a prognostic indicator in hepatocellular carcinoma.
Shi H, Zhang P, Wei Q … +5 more , He H, Wu H, Xiao T, Liu T, Zeng T
BMC Cancer · 2026 Jun · PMID 42298533 · Full text
BACKGROUND: Hepatocellular carcinoma (HCC) is a malignant tumour with high global incidence and mortality, featuring limited therapeutic options and poor prognosis, which necessitates novel prognostic biomarkers. The imm...
BACKGROUND: Hepatocellular carcinoma (HCC) is a malignant tumour with high global incidence and mortality, featuring limited therapeutic options and poor prognosis, which necessitates novel prognostic biomarkers. The immune checkpoint molecule CD274 (Programmed Death-Ligand 1, PD-L1) correlates with poor prognosis in most solid tumours, yet its prognostic value in HCC remains controversial, and circulating levels are unclear. This study aimed to multi-dimensionally investigate CD274's expression patterns and clinical significance in HCC. METHODS: Bioinformatics analyses were performed on The cancer genome atlas (TCGA) and Genotype-Tissue Expression (GTEx) databases to screen differentially expressed genes, with functional and pathway annotations via Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), Gene Set Enrichment Analysis (GSEA), and Single-Sample Gene Set Enrichment Analysis (ssGSEA). Survival analysis and univariate/multivariate Cox proportional hazards regression models were used to assess the prognostic value of CD274. PD-L1 protein expression was validated by immunohistochemistry (IHC) on HCC tissue microarrays. Serum PD-L1 concentrations were detected by ELISA in treatment-naive HCC patients and healthy controls. RESULTS: CD274 was lowly expressed in HCC tissues versus normal ones, and its expression correlated with TNF-α/NF-κB, complement, IFN-γ, adipogenesis and oxidative phosphorylation pathways, as well as lymphocyte-mediated immunity, immune globulin complexes and antigen binding. High CD274 expression negatively correlated with Th17 cells but positively with helper T cells, activated dendritic cells (aDCs), Th1 cells, T cells and macrophages via ssGSEA. Patients with high CD274 expression had longer overall survival (OS), disease-specific survival (DSS) and progression-free interval (PFI); multivariate Cox regression confirmed CD274 as an independent protective factor for DSS. PD-L1 protein expression showed no significant difference between HCC and normal liver tissues. Serum PD-L1 median was 349.6 pg/mL in HCC patients, significantly higher than 181.3 pg/mL in healthy controls. CONCLUSIONS: This study first identifies a unique "low tissue expression and elevated peripheral blood level" pattern of CD274 in HCC, with intratumoural high expression correlating with favourable prognosis. CD274 may exert distinct roles in local tumour and systemic immune regulation, and serum CD274 is a promising prognostic biomarker for HCC worthy of further research.
Clinicopathological features and immune checkpoint expression patterns in dMMR early gastric cancer: a retrospective pilot study.
Yokotani Y, Sakamoto N, Matsuo M … +8 more , Nakahata Y, Okuyama H, Mukai R, Nagano J, Obora A, Murakami Y, Kojima T, Yagi N
BMC Cancer · 2026 Jun · PMID 42298513 · Full text
BACKGROUND: Although mismatch repair-deficient (dMMR)/microsatellite and instability-high (MSI-H) status is recognized as a biomarker that predicts the efficiency of immune checkpoint inhibitors (ICIs), the efficacy of I...
BACKGROUND: Although mismatch repair-deficient (dMMR)/microsatellite and instability-high (MSI-H) status is recognized as a biomarker that predicts the efficiency of immune checkpoint inhibitors (ICIs), the efficacy of ICIs treatment is still insufficient. Accordingly, insights into the mechanisms of acquired resistance to ICIs in gastrointestinal cancers are necessary, and developing immunotherapeutic strategies to improve response rates is an urgent clinical priority. We investigated the clinical characteristics of dMMR/MSI-H early gastric cancer and analyzed the expression patterns of immune checkpoint molecules within the tumor microenvironment. METHOD: A total of 20 cases of early gastric cancer, treated between November 2019 and July 2024, were included. Immunohistochemistry was performed to assess the expression of mismatch repair (MMR) protein, and patient clinical characteristics were evaluated. Additionally, among the eight cases identified as dMMR early gastric cancer, they were further examined for the expression of immune checkpoint molecules in the tumor microenvironment using immunohistochemical staining. RESULT: The median age of patients diagnosed with dMMR early gastric cancer was 73 years. In 20 patients, female sex and severe atrophy were associated with dMMR status in univariate analysis (OR 7.67, 95% CI 1.04-94.53). The expression pattern of immune checkpoint molecules showed heterogeneity. CONCLUSION: These findings highlight the heterogeneity of immune checkpoint expression patterns and provide preliminary, hypothesis-generating insights into variability in response to PD-1/PD-L1 blockade.
In vitro functional analysis of lysyl oxidase family members in highly metastatic pancreatic cancer cells derived from a syngeneic orthotopic model.
Takahashi-Yamashiro K, Miyauchi K, Shimomura K … +7 more , Nishikawa M, Morishita Y, Nakanishi M, Hayami S, Kawai M, Miyazono K, Ehata S
BMC Cancer · 2026 Jun · PMID 42298507 · Full text
BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is one of the highly lethal malignancies, with no established and effective cure. Therefore, identifying novel molecular targets for this cancer remains an urgent prior...
BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is one of the highly lethal malignancies, with no established and effective cure. Therefore, identifying novel molecular targets for this cancer remains an urgent priority. METHODS AND RESULTS: We employed a syngeneic orthotopic inoculation model using murine pancreatic cancer Panc02 cells to better recapitulate the pancreatic tumor microenvironment. We established highly metastatic derivatives through three serial transplantation cycles, designated Panc02-3P cells. These cells exhibited enhanced tumorigenicity and metastatic potential both in vitro and in vivo. The RNA-sequence analysis revealed that Panc02-3P cells exhibited mesenchymal-like gene expression changes, compared with parental Panc02 cells, despite no significant changes in EMT-related transcription factor expression. In addition, we found that members of the lysyl oxidase (LOX) family, including LOX, LOXL1, and LOXL3, were markedly upregulated in Panc02-3P cells. The loss-of-function assays using siRNAs targeting LOX and LOXL1 demonstrated that the suppression of these genes significantly attenuated the migratory ability of Panc02-3P cells. CONCLUSION: Collectively, our findings suggest that the LOX family members are associated with the acquisition of a highly migratory and mesenchymal-like phenotype in metastatic pancreatic cancer cells and may contribute to tumor progression.
Feasibility of the effectiveness of a psychoeducational intervention on the physical and psychosexual functioning of women being treated for cervical cancer in a tertiary hospital in Southwest, Nigeria: a quasi-experimental study.
Adebisi TM, Oluwasola TAO, Ndikom CM … +1 more , Salako BL
BMC Cancer · 2026 Jun · PMID 42298499 · Full text
BACKGROUND: Cervical cancer is a global public health concern with significant morbidity and mortality even with advancement in treatment strategies. While efforts have been directed primarily to prevention and eliminati...
BACKGROUND: Cervical cancer is a global public health concern with significant morbidity and mortality even with advancement in treatment strategies. While efforts have been directed primarily to prevention and elimination, there is need to improve the health indices of those who have already been diagnosed. This study was designed to assess the feasibility of the effectiveness of a psycho-educational intervention on the physical and psychosexual functioning as well as health-related quality of life of women with cervical cancer. METHODS: A quasi-experimental single group pre- and post-test design was used to assess the effectiveness of a single-module psychoeducational intervention developed by the researcher through a guide developed for the design of psychoeducational interventions for women with gynaecological cancers. This was carried out among twenty (20) women (> 18years) attending the radiation and clinical oncology unit of Federal Medical Centre, Abeokuta, Nigeria. Women's functioning levels were assessed using two (2) standardized tools at baseline and four (4) weeks after the intervention. Data was analyzed with SPSS version 26 and hypotheses were tested using Wilcoxon Signed Rank test at a significance level of ≥ 0.05. RESULT: 60% were between 46 to 56years with a mean age of 51.7 ± 7.6; 70% were Yoruba, 45% were married and a higher percentage (35%) were traders. None of the respondents was ever vaccinated against Human Papilloma Virus and were on chemotherapy. Only 45% had partner support and 5 to 6 children with majority (55%) being post-menopausal. The intervention showed evidence of clinical relevance for all domains but did not yield a statistical significance for the physical (d=-0.016, p=0.954), psychological (d=-0.015, p=0.678) and sexual functioning (d=-0.098, p=0.678). However, HRQoL was significant (d=-0.702, p=0.011). Pain and partner support were the most significant socio-economic predictors of quality of life. CONCLUSIONS: Psychoeducational intervention can help improve the physical and psychosexual domains of functioning as well as the health-related quality of life of women with cervical carcinoma.
Identification and validation of programmed cell death-related genes in osteosarcoma: inhibiting CIB1 as a promising therapeutic strategy.
Hu B, Du L, Lu C … +6 more , Huang D, Pan M, Xue F, Shen Y, Ding L, Yin N
BMC Cancer · 2026 Jun · PMID 42298489 · Full text
BACKGROUND: This study explores programmed cell death (PCD)-related genes in osteosarcoma through bioinformatics and experimental validation. METHODS: Analysis of datasets from the GEO and TCGA databases identified 5,327...
BACKGROUND: This study explores programmed cell death (PCD)-related genes in osteosarcoma through bioinformatics and experimental validation. METHODS: Analysis of datasets from the GEO and TCGA databases identified 5,327 differentially expressed genes (DEGs), among which 294 overlapped with PCD-related genes. RESULTS: LASSO regression analysis identified six hub genes, and five of these (CIB1, CREB3L1, IL6R, TGFβ2, and TNFRSF10C) were further validated in osteosarcoma tissues. Notably, CIB1 exhibited significantly elevated expression and was selected for in-depth analysis. CIB1 downregulation inhibited osteosarcoma cell proliferation and invasion by inducing apoptosis and causing G2/M phase cell cycle arrest, and was associated with increased p53 expression, decreased phosphorylation of Akt and STAT3, and altered BCL2/BAX ratios, suggesting involvement of these pathways in the observed effects. CONCLUSIONS: In vitro experiments confirmed the tumor-suppressive role of CIB1 inhibition. These findings highlight CIB1 as a promising therapeutic target for osteosarcoma treatment.
Psychometric properties of patient-reported outcome measures for health-related quality of life in multiple myeloma: a systematic review based on COSMIN guidelines.
Xie L, Feng Q, Wang J … +3 more , Qin W, Ding Y, Wu Z
BMC Cancer · 2026 Jun · PMID 42298481 · Full text
PURPOSE: To systematically identify patient-reported outcome measures (PROMs) used to assess health-related quality of life (HRQoL), symptoms, and disease burden in patients with multiple myeloma (MM), and to appraise th...
PURPOSE: To systematically identify patient-reported outcome measures (PROMs) used to assess health-related quality of life (HRQoL), symptoms, and disease burden in patients with multiple myeloma (MM), and to appraise their measurement properties using the COSMIN methodology. METHODS: A systematic review was conducted in accordance with the COSMIN guideline for reviews of PROMs. Eligible studies reported PROM development, content validation, cross-cultural adaptation, or one or more measurement properties of PROMs used in adult patients with MM. Methodological quality was assessed using the COSMIN Risk of Bias checklist. The results for each measurement property were rated against the COSMIN criteria for good measurement properties, and the certainty of evidence was graded using the modified GRADE approach recommended by COSMIN. RESULTS: Twenty-six studies involving 14 PROMs were included. The EORTC QLQ-MY20 was the most frequently evaluated MM-specific module, followed by MyPOS, HM-PRO, MDASI-MM, FACT-MM, MySIm-Q, and QLICP-MM. Evidence was most often available for internal consistency, structural validity, and hypothesis testing for construct validity. By contrast, formal evidence on measurement error, criterion validity, and cross-cultural validity was seldom reported. No PROM demonstrated uniformly high-quality evidence across all key measurement properties. The EORTC QLQ-MY20 and MyPOS showed the broadest body of supportive evidence and appear to be the most defensible options for MM-specific HRQoL assessment, although additional high-quality content validity and longitudinal measurement studies remain necessary. CONCLUSION: Current evidence supports the use of several MM-specific PROMs, particularly the EORTC QLQ-MY20 and MyPOS, but the overall evidence base remains uneven. Future research should prioritize patient-centered content validation, measurement-error evidence, cross-cultural validity, responsiveness, and interpretability to strengthen PROM selection for MM clinical trials and practice.
Distinct epidemiologic patterns of mesothelioma: evidence from a 16-year provincial cohort in China.
Yin S, Hu T, Li X … +2 more , Xu D, Shu Y
BMC Cancer · 2026 Jun · PMID 42298472 · Full text
BACKGROUND: Epidemiologic data on mesothelioma in China remain limited, particularly with respect to long-term, province-level characterization of demographic features and survival outcomes. METHODS: We conducted a 16-ye...
BACKGROUND: Epidemiologic data on mesothelioma in China remain limited, particularly with respect to long-term, province-level characterization of demographic features and survival outcomes. METHODS: We conducted a 16-year retrospective cohort study of mesothelioma patients diagnosed at a major provincial tertiary referral center in China between 2009 and 2025. Among 128 identified cases, 93 met strict pathological criteria and were included for analysis. We evaluated sex distribution, anatomic site, age at diagnosis, and survival outcomes, and compared these features with representative cohorts from the United States, Europe, and Japan. RESULTS: Our 16-year provincial cohort showed a nearly equal male-to-female ratio that markedly distinct from the male predominance reported in Western populations. Peritoneal mesothelioma accounted for 33.3% of cases, a proportion higher than that typically reported in global cohorts. The higher proportion of female patients was observed across both pleural and peritoneal mesothelioma. The median age at diagnosis was significantly younger than that observed in the United States. The median progression-free survival (PFS) and overall survival (OS) were 10 months and 16 months, with a notable survival advantage for females with peritoneal mesothelioma. Notably, only 7.5% of patients had documented asbestos exposure, indicating additional environmental and/or genetic contributors maybe relevant in this setting. CONCLUSIONS: This long-term provincial cohort delineates mesothelioma epidemiology at the province level in China, marked by a near-equal sex distribution with substantial female representation across disease subtypes, a high proportion of peritoneal cases, younger age at diagnosis and a low prevalence of documented asbestos exposure. These findings show clear region-specific evidence, underscoring potential geographic heterogeneity in mesothelioma epidemiology.
3D multi-omics tumour atlases: from technology to biology and clinical translation.
Liu M, Villazon J, Forjaz A … +6 more , Tian X, Fan R, Wang S, Shi L, Wirtz D, Kiemen AL
Nat Rev Cancer · 2026 Jun · PMID 42298141 · Publisher ↗
Human tumours consist of highly heterogeneous and interacting cell types organized within a complex 3D space, forming a dynamic ecosystem that evolves through the development of pre-malignant lesions, tumour initiation,...
Human tumours consist of highly heterogeneous and interacting cell types organized within a complex 3D space, forming a dynamic ecosystem that evolves through the development of pre-malignant lesions, tumour initiation, progression, invasion and metastasis. Understanding the operational principles of tumour evolution at a holistic 3D level is critical for improving the ability to intercept and treat cancer early. Emerging technologies in spatial multi-omics and the generation of 3D tumour atlases are beginning to address this critical need. These efforts aim to capture the intricate interactions within precancerous lesions, tumours and their surrounding ecosystems over space and time. In this Review, we highlight emerging tools developed within and beyond the tumour atlas community and explore their potential in constructing comprehensive 3D tumour atlases. Such atlases have the potential to reveal novel biomarkers for risk stratification, early detection, preventive intervention, and transformative diagnostic and treatment strategies. Furthermore, a 3D tumour atlas can generate new insights into the molecular and cellular mechanisms driving human tumour evolution, paving the way for future research and innovation in cancer biology.
The Improving Opioid Use for Cancer Pain Framework: Addressing the needs of patients with cancer and pain in a new era of opioid prescribing.
Dy SM, Sharma R, Waldfogel JM … +2 more , Jones KF, Rieder TN
Cancer · 2026 Jun · PMID 42290390 · Publisher ↗
Opioids are essential for cancer pain management, but growing knowledge about their risks and limited effectiveness requires careful consideration in cancer pain guidelines and practice. To better address these issues, a...
Opioids are essential for cancer pain management, but growing knowledge about their risks and limited effectiveness requires careful consideration in cancer pain guidelines and practice. To better address these issues, an adult cancer pain and opioid framework was developed through structured literature analysis and expert input, focusing on the clinician-patient relationship and clinical practice. The framework was developed by compiling an initial list of concepts from guidelines and adaptation through crosswalking with key guidelines and a literature search and review. The concepts were organized into an initial draft framework before iterative refinement with input from the research team and content experts. The Improving Opioid Use for Cancer Pain Framework is centered on the whole-person approach to those with cancer, particularly the concepts of biopsychosocial cancer pain and person-centered care, including communication and shared decision-making. The goals of cancer pain management in the framework are enhancing comfort while minimizing adverse events, burden, and safety risks, with opioids considered as one tool in a comprehensive toolbox. Nonopioid strategies should be the first choice or the ultimate goal when possible and should always be used alongside opioids, with multimodal approaches often ideal. Clinicians should consider opioid effectiveness, burden, and risks, including adverse effects and risks for long-term use. Sufficient evidence now supports adoption of a more balanced approach to cancer pain management. Better use of multimodal nonopioid and nonpharmacologic pain management resources can improve cancer pain management without limiting opioid use for those who need it.
Comparing the association between out-of-pocket cost burden and cost-related care avoidance among individuals with and without a history of cancer.
Liang X, Tay D, Ke Y … +8 more , Ng DQ, Patikorn C, Asche C, Chaiyakunapruk N, Kirchhoff AC, Chan RJ, Chan A, Tan CJ
Cancer · 2026 Jun · PMID 42290381 · Full text
INTRODUCTION: Out-of-pocket (OOP) cost is routinely captured by payers and health systems and may help identify individuals at risk of cost-related care avoidance. This study aimed to evaluate the relationship between OO...
INTRODUCTION: Out-of-pocket (OOP) cost is routinely captured by payers and health systems and may help identify individuals at risk of cost-related care avoidance. This study aimed to evaluate the relationship between OOP cost burden relative to household income (OOP:HHI) and cost-related care avoidance and to assess whether this relationship differs by cancer history. METHODS: A retrospective cross-sectional study was conducted leveraging data from multiple survey waves of the Understanding America Study (2015-2024). Adults aged ≥18 years with data on OOP health care expenditure, household income, and cost-related care avoidance were included. Mixed-effects logistic models with random intercepts were used to assess associations between OOP:HHI and care avoidance, adjusting for respondent characteristics. Effect modification by cancer history was examined. Classification performance of OOP:HHI alone versus multivariable models was evaluated using receiver operating characteristic curves. RESULTS: The analysis included 21,299 responses from 10,811 respondents, of which 2180 responses were from 1052 respondents with cancer history. Higher OOP:HHI was independently associated with increased odds of cost-related care avoidance (adjusted odds ratio per 1% increase = 1.03; 95% CI, 1.02-1.04) with similar trends in both cancer and noncancer subgroups. OOP:HHI alone showed modest discrimination, whereas multivariable models demonstrated excellent performance in identifying respondents who indicated care avoidance. CONCLUSION: Higher OOP cost burden was associated with cost-related care avoidance regardless of cancer history, but cost burden alone was insufficient for risk identification. Integrating OOP costs with routinely available patient characteristics may better identify individuals at risk of care avoidance for targeted interventions to mitigate financial toxicity.
Sex differences in gastric cancer mutational burden reflect MLH1-associated epigenetic regulation.
Klein N, Shweiki D
BMC Cancer · 2026 Jun · PMID 42289660 · Full text
BACKGROUND: Tumor mutational burden (TMB) is widely used as a biomarker for predicting response to immune checkpoint inhibitors. Therefore, understanding its variability across patient groups, particularly between sexes,...
BACKGROUND: Tumor mutational burden (TMB) is widely used as a biomarker for predicting response to immune checkpoint inhibitors. Therefore, understanding its variability across patient groups, particularly between sexes, and its underlying biological determinants is of critical importance. METHODS: We analyzed autosomal TMB and its association with DNA repair-related regulatory mechanisms in gastric cancer across TCGA-STAD and independent targeted sequencing cohorts. Sex-stratified analyses were integrated with gene expression, promoter methylation, and regression modeling. RESULTS: Female tumors exhibited significantly higher autosomal TMB compared with male tumors, with differences most pronounced in older female patients. Across tumors, TMB was strongly associated with reduced MLH1 expression and increased MLH1 promoter methylation, while female tumors exhibited significantly higher MLH1 methylation levels. These relationships are consistent with mismatch repair deficiency as a major driver of mutation accumulation. In multivariable regression models adjusting for MLH1 methylation and expression, the association between sex and TMB was attenuated, suggesting that MLH1-related processes contribute to the observed sex differences. Subtype-aware analyses further suggested that the female-associated TMB elevation was partly related to increased representation of MSI/MMR-deficient tumors among females, while female and male MSI tumors showed comparable TMB. Independent targeted sequencing cohorts showed consistent directional trends, although these did not reach statistical significance. CONCLUSIONS: Together, our findings indicate that sex differences in mutation burden are linked to MLH1-associated epigenetic regulation, mismatch repair deficiency, and MSI/MMR-deficient tumor biology. These results highlight the importance of incorporating sex-specific molecular context into the interpretation of genomic biomarkers and support a more refined, biologically informed approach to precision oncology.
Strategies for enhancing participation of underrepresented patient populations in cancer clinical trials: learning from "bright spots".
Miller JE, Schwartz J, Ramachandran R … +2 more , Ross J, Suttiratana SC
BMC Cancer · 2026 Jun · PMID 42288829 · Full text
BACKGROUND: Adequate participation of women, older adults, racial and ethnic subgroups, and other groups, in pivotal trials for cancer therapies is critical for understanding and trusting the safety and efficacy of new m...
BACKGROUND: Adequate participation of women, older adults, racial and ethnic subgroups, and other groups, in pivotal trials for cancer therapies is critical for understanding and trusting the safety and efficacy of new medical products across populations. Despite consensus on the importance of representative research and extensive documentation of trial participation barriers, progress has been minimal for most groups, raising the question: What more can be done to enhance participation of underrepresented patient populations in cancer clinical trials, and in turn, improve medical evidence? METHODS: We used a "bright spot" approach to understand what drives successful representation of Black and LatinX patients in cancer clinical trials. We conducted 1-h interviews with "bright spot trial" teams, teams who conducted trials that adequately enrolled Black or LatinX patients relative to disease burden among pivotal trials supporting FDA approval of novel cancer therapeutics between 2012 and 2021, to identify organizational contexts and facilitators associated with success across multiple action levels. Transcripts were analyzed using constant comparative methods. RESULTS: Thirteen participants from 8 bright spot trial teams described a coherent set of strategies associated with representative enrollment, clustering across five levels: patient and community, clinician, trial and site, sponsor organization, and policy. Key practices included prospective budgeting for mitigating participant expenses; patient- and community co-developed educational programs; navigator use; early clinician engagement and referral training; protocol simplification, decentralization, and broadening of eligibility criteria; expansion into community and satellite hospitals affiliated with NCI Designated Cancer Center trial sites; and sustained, non-transactional community partnerships. At the organizational level, "bright spot trial" teams emphasized the importance of executive leadership commitment, real-time dashboarding on enrollment goals, performance-based incentives, employee training, and minimizing reliance on generic vendor solutions. CONCLUSIONS: Sponsors that achieved representative enrollment in oncology trials shared a common operational playbook: reduce patient and site burden, expand access to where care is delivered, widen trial eligibility, invest in trusted relationships, and embed accountability through leadership, data and incentives. Translating these strategies from bright spots into standard practice, supported by clearer regulatory guidance and evaluation, offers a concrete path toward more accessible and generalizable cancer clinical research.
The predictive role of tertiary lymphoid structures in the prognosis and response to immunotherapy of bladder cancer patients: a systematic review and meta-analysis.
Hu P, Wang C, Zeng X … +7 more , Jin S, Huang J, Wang Q, Li X, Du Y, Song Y, Xu T
BMC Cancer · 2026 Jun · PMID 42288780 · Full text
BACKGROUND: The association between tertiary lymphoid structures (TLS) and clinical outcomes in bladder cancer (BCa) patients, particularly their value in predicting immunotherapy response, remains inconsistent and has n...
BACKGROUND: The association between tertiary lymphoid structures (TLS) and clinical outcomes in bladder cancer (BCa) patients, particularly their value in predicting immunotherapy response, remains inconsistent and has not been systematically evaluated. OBJECTIVE: This systematic review and meta-analysis aimed to: (1) evaluate the association between TLS and survival outcomes in BCa; (2) examine the relationship between TLS and clinicopathological characteristics; and (3) summarize evidence on TLS and immunotherapy response. METHODS: We systematically searched PubMed, Embase, and Web of Science from inception to February 1, 2026. Hazard ratios (HRs) with 95% confidence intervals (CIs) for overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS) were extracted and pooled. The study protocol was registered with PROSPERO (CRD420261282595). RESULTS: Eight studies involving 1706 patients were included in the quantitative synthesis. Pooled analysis revealed that high TLS levels were significantly associated with improved OS (HR = 0.49, 95% CI: 0.33-0.74), PFS (HR = 0.51, 95% CI: 0.45-0.58), and DFS (HR = 0.42, 95% CI: 0.22-0.79). TLS showed a significant correlation only with tumor multiplicity among various clinicopathological features. Qualitative synthesis of six studies suggested that while baseline TLS had limited predictive value for immunotherapy response, therapy-induced increases in TLS number, density, and maturation were consistently associated with favorable treatment outcomes. CONCLUSION: High TLS levels are associated with favorable survival outcomes in bladder cancer patients, supporting their role as a prognostic biomarker. Therapy-induced TLS dynamics, rather than baseline status alone, may be a more relevant predictive biomarker for immunotherapy efficacy. These findings warrant validation in larger, prospective studies.
Correction: A Randomized clinical trial evaluating the impact on survival and quality of life of 177Lutetium[Lu]-edotreotide versus everolimus in patients with neuroendocrine tumors of the lung and thymus: the LEVEL study (GETNE T-2217).
Capdevila J, Pubul V, Anido U … +32 more , Walter T, Molina-Cerrillo J, Alonso-Gordoa T, Garcia-Carbonero R, San-Roman-Gil M, Llana B, Jimenez-Fonseca P, Viñuales MB, Ansquer C, Baudin E, Lepage C, Del Olmo-García M, Ruffinelli JC, Beron A, Haissaguerre M, Deshayes E, Taïeb D, Baldari S, Sansovini M, Cingarlini S, Filice A, Panzuto F, Álvarez-Álvarez R, Lousberg L, Nana FA, Hernando J, García-Álvarez A, García-Burillo A, Villacampa G, Vandamme T, Fazio N, Durand A
BMC Cancer · 2026 Jun · PMID 42288752 · Full text
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Toripalimab plus disitamab vedotin versus tislelizumab-based combination in advanced urothelial carcinoma: a real-world comparative study.
Wang T, Jiang X
BMC Cancer · 2026 Jun · PMID 42286571 · Full text
BACKGROUND: The optimal PD-1 inhibitor to combine with disitamab vedotin in advanced urothelial carcinoma remains unclear. This study aimed to compare the real-world efficacy and safety of toripalimab plus disitamab vedo...
BACKGROUND: The optimal PD-1 inhibitor to combine with disitamab vedotin in advanced urothelial carcinoma remains unclear. This study aimed to compare the real-world efficacy and safety of toripalimab plus disitamab vedotin versus tislelizumab plus disitamab vedotin in patients with locally advanced or metastatic urothelial carcinoma. METHODS: In this retrospective study, clinical data were collected from patients with locally advanced or metastatic urothelial carcinoma treated with a PD-1 inhibitor combined with disitamab vedotin between August 2021 and July 2025. Patients received either toripalimab-based (Group A) or tislelizumab-based therapy (Group B). Overall survival (OS) and progression-free survival (PFS) were evaluated using the Kaplan-Meier method. Tumor response was assessed according to RECIST criteria, including complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD), as well as objective response rate (ORR) and disease control rate (DCR). Treatment-related adverse events (TRAEs) were graded according to standard criteria. RESULTS: No significant differences were observed between the two groups in OS or PFS. The ORR and overall tumor response profiles were comparable between Group A and Group B. However, Group A demonstrated a lower rate of disease progression (9.30% vs. 28.95%) and a higher DCR (90.70% vs. 71.05%) compared with Group B. In terms of safety, the tislelizumab-based regimen was associated with significantly higher incidences of dermatitis, hypokalemia, anemia, and hypocalcemia. CONCLUSIONS: In this real-world study, toripalimab plus disitamab vedotin and tislelizumab plus disitamab vedotin demonstrated comparable efficacy in patients with locally advanced or metastatic urothelial carcinoma. Although no significant differences in survival outcomes were observed, the toripalimab-based regimen was associated with a lower rate of disease progression, a higher disease control rate, and a more favorable safety profile. Prospective multicenter studies are needed to further validate these findings.
Methylation-mediated regulation of tumor-suppressor function of the miR-379/656 (C14MC) cluster and its clinical utility in hepatocellular carcinoma.
Karunakara SH, Ramaswamy G, Kabekkodu SP … +4 more , Prashant A, Vishwanath P, Mehtani R, Santhekadur PK
BMC Cancer · 2026 Jun · PMID 42286554 · Full text
BACKGROUND: Hepatocellular carcinoma is a leading cause of cancer-related mortality. Several microRNAs play key roles in HCC development and progression. Epigenetic processes, such as DNA methylation, might regulate thes...
BACKGROUND: Hepatocellular carcinoma is a leading cause of cancer-related mortality. Several microRNAs play key roles in HCC development and progression. Epigenetic processes, such as DNA methylation, might regulate these RNAs during HCC pathogenesis. In this study, we show that the miR-379/656 cluster/C14MC acts as a tumor suppressor cluster and is epigenetically regulated by DNA methylation. METHODS: C14MC miRNA expression was determined in HCC cell lines using the nCounter assay and from the TCGA-LIHC clinical cohort. C14MC putative promoter was identified, characterized using cloning and luciferase assay, and the methylation status of promoter-bound CpGs was determined using bisulfite Sanger sequencing. The expressions of C14MC targets were experimentally validated by transcriptomic sequencing or transfecting mimics, followed by qRT-PCR. Furthermore, the diagnostic and prognostic significance of C14MC and its target interactome in HCC was assessed using clinical data from the TCGA-LIHC cohort. RESULTS: C14MC was downregulated in HCC cell lines and in TCGA-LIHC. The loss of C14MC tumor suppressor function was directly regulated by the hypermethylation of promoter-CpGs. Reactivating specific C14MC miRNAs, such as miR-299-5p and miR-376c-3p via mimics, abrogated the expression of several target oncogenes, including PARP1, SPP1, RAD21, and CENPA, which regulate critical molecular pathways such as the p53 signaling and NF-κB signaling pathways in HCC. Additionally, overexpressing these miRNAs inhibited HCC cell migration and invasion. Also, C14MC and its target interactome exhibited significant clinical correlation in terms of survival outcomes of HCC patients. CONCLUSIONS: This is the first study to show that C14MC is a methylation-dependent cluster in HCC. Several of these miRNAs and their targets can be used for early HCC diagnosis and prognosis. Thus, targeting C14MC can be useful in HCC management.
Preclinical evaluation of a fluorinated bifendate derivative in triple-negative breast cancer: integrated in vitro and in vivo evidence of antitumor activity.
Lin LZ, Huang HY, Peng Y … +3 more , Lin GQ, Hu J, Jiang Y
BMC Cancer · 2026 Jun · PMID 42286551 · Full text
BACKGROUND: Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer with limited therapeutic options and poor clinical outcomes. Bifendate (DDB), a clinically used hepatoprotective agent, has shown...
BACKGROUND: Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer with limited therapeutic options and poor clinical outcomes. Bifendate (DDB), a clinically used hepatoprotective agent, has shown modest antitumor activity. This study evaluated the antitumor activity of a fluorinated bifendate derivative (F-α-DDB-derivative) in TNBC models. METHODS: MDA-MB-468 cells were treated with DDB or F-α-DDB-derivative to assess cell viability, migration, apoptosis, and Ki-67 expression. Antitumor efficacy and preliminary safety were further evaluated in a nude mouse xenograft model. RESULTS: F-α-DDB-derivative reduced cell viability in a concentration-dependent manner and showed greater potency than DDB, with a 24 h IC₅₀ of 25.06 µg/mL versus 105.00 µg/mL for DDB. At 25 µg/mL, F-α-DDB-derivative significantly inhibited migration compared with the control group, reduced Ki-67 expression, increased apoptosis, and showed stronger antitumor activity than DDB in most evaluated assays. In vivo, intraperitoneal administration of F-α-DDB-derivative (20 mg/kg, every other day for 14 days) significantly suppressed tumor growth and reduced final tumor weight compared with both the control and DDB groups. No significant abnormalities in body weight or serum biochemical markers were observed under the tested conditions. CONCLUSIONS: Fluorination enhanced the antitumor activity of DDB in TNBC models. F-α-DDB-derivative represents a promising fluorinated lead compound for further preclinical investigation.
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