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The Lancet Oncology
Journal Prestige (SJR): 16.085
Citation Impact (citeScore): 10
Number of Followers: 219  
 
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ISSN (Print) 1470-2045 - ISSN (Online) 1474-5488
Published by Elsevier Homepage  [3161 journals]
  • Stop-smoking services in the UK
    • Abstract: Publication date: Available online 16 January 2020Source: The Lancet OncologyAuthor(s): Talha Khan Burki
       
  • Olaparib plus bevacizumab improves progression-free survival in ovarian
           cancer
    • Abstract: Publication date: Available online 9 January 2020Source: The Lancet OncologyAuthor(s): Elizabeth Gourd
       
  • Deep-learning approaches for Gleason grading of prostate biopsies
    • Abstract: Publication date: Available online 8 January 2020Source: The Lancet OncologyAuthor(s): Anant Madabhushi, Michael D Feldman, Patrick Leo
       
  • Artificial intelligence for diagnosis and grading of prostate cancer in
           biopsies: a population-based, diagnostic study
    • Abstract: Publication date: Available online 8 January 2020Source: The Lancet OncologyAuthor(s): Peter Ström, Kimmo Kartasalo, Henrik Olsson, Leslie Solorzano, Brett Delahunt, Daniel M Berney, David G Bostwick, Andrew J Evans, David J Grignon, Peter A Humphrey, Kenneth A Iczkowski, James G Kench, Glen Kristiansen, Theodorus H van der Kwast, Katia R M Leite, Jesse K McKenney, Jon Oxley, Chin-Chen Pan, Hemamali Samaratunga, John R SrigleySummaryBackgroundAn increasing volume of prostate biopsies and a worldwide shortage of urological pathologists puts a strain on pathology departments. Additionally, the high intra-observer and inter-observer variability in grading can result in overtreatment and undertreatment of prostate cancer. To alleviate these problems, we aimed to develop an artificial intelligence (AI) system with clinically acceptable accuracy for prostate cancer detection, localisation, and Gleason grading.MethodsWe digitised 6682 slides from needle core biopsies from 976 randomly selected participants aged 50–69 in the Swedish prospective and population-based STHLM3 diagnostic study done between May 28, 2012, and Dec 30, 2014 (ISRCTN84445406), and another 271 from 93 men from outside the study. The resulting images were used to train deep neural networks for assessment of prostate biopsies. The networks were evaluated by predicting the presence, extent, and Gleason grade of malignant tissue for an independent test dataset comprising 1631 biopsies from 246 men from STHLM3 and an external validation dataset of 330 biopsies from 73 men. We also evaluated grading performance on 87 biopsies individually graded by 23 experienced urological pathologists from the International Society of Urological Pathology. We assessed discriminatory performance by receiver operating characteristics and tumour extent predictions by correlating predicted cancer length against measurements by the reporting pathologist. We quantified the concordance between grades assigned by the AI system and the expert urological pathologists using Cohen's kappa.FindingsThe AI achieved an area under the receiver operating characteristics curve of 0·997 (95% CI 0·994–0·999) for distinguishing between benign (n=910) and malignant (n=721) biopsy cores on the independent test dataset and 0·986 (0·972–0·996) on the external validation dataset (benign n=108, malignant n=222). The correlation between cancer length predicted by the AI and assigned by the reporting pathologist was 0·96 (95% CI 0·95–0·97) for the independent test dataset and 0·87 (0·84–0·90) for the external validation dataset. For assigning Gleason grades, the AI achieved a mean pairwise kappa of 0·62, which was within the range of the corresponding values for the expert pathologists (0·60–0·73).InterpretationAn AI system can be trained to detect and grade cancer in prostate needle biopsy samples at a ranking comparable to that of international experts in prostate pathology. Clinical application could reduce pathology workload by reducing the assessment of benign biopsies and by automating the task of measuring cancer length in positive biopsy cores. An AI system with expert-level grading performance might contribute a second opinion, aid in standardising grading, and provide pathology expertise in parts of the world where it does not exist.FundingSwedish Research Council, Swedish Cancer Society, Swedish eScience Research Center, EIT Health.
       
  • Immunoglobulin replacement and quality of life after CAR T-cell therapy
           – Authors' reply
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Theodore W Laetsch, Andrew C Harris
       
  • Cardiac metastasis from non-visceral sarcoma
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Wei-Jun Wang, Chien-Yi Hsu, Jeng-Fong Chiou, Yaoru Huang
       
  • Second-line therapies in advanced biliary tract cancers
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Sri Harsha Tella, Anuhya Kommalapati, Mitesh J Borad, Amit MahipalSummaryBiliary tract cancers constitute approximately 3% of gastrointestinal malignancies with poor prognosis. Surgical therapy is the main form of treatment in localised disease; however, for patients with advanced stage or unresectable disease, locoregional and systemic chemotherapeutics are primary treatment options. Although the combination of gemcitabine and cisplatin is a standard regimen of choice, there are no consensus guidelines that help in choosing an appropriate second-line therapy. Substantial progress has been made in the past decade to understand the tumorigenesis and genetic landscape of each biliary tract cancer subtype, which facilitates precision medicine for this cancer. Common genes implicated in biliary tract cancer tumorigenesis include IDH1, IDH2, FGFR1, FGFR2, FGFR3, EPHA2, BAP1, ARID1B, ELF3, PBRM1, PRKACA, PRKACB, HER2, and BRAF. With the advancements in molecular pathogenesis of biliary tract cancer, especially in an era of personalised medicine, many questions are yet to be answered in advanced stages of the cancer: what subset of patients might benefit from second-line drugs, how to choose an optimal second-line regimen, and their effects on quality of life. This Review seeks to summarise available literature and discuss the potential second-line systemic therapy options for advanced biliary tract cancer on the basis of advancements of our knowledge on molecular pathogenesis and tumorigenesis.
       
  • Characterisation and classification of oligometastatic disease: a European
           Society for Radiotherapy and Oncology and European Organisation for
           Research and Treatment of Cancer consensus recommendation
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Matthias Guckenberger, Yolande Lievens, Angelique B Bouma, Laurence Collette, Andre Dekker, Nandita M deSouza, Anne-Marie C Dingemans, Beatrice Fournier, Coen Hurkmans, Frédéric E Lecouvet, Icro Meattini, Alejandra Méndez Romero, Umberto Ricardi, Nicola S Russell, Daniel H Schanne, Marta Scorsetti, Bertrand Tombal, Dirk Verellen, Christine Verfaillie, Piet OstSummaryOligometastatic disease has been proposed as an intermediate state between localised and systemically metastasised disease. In the absence of randomised phase 3 trials, early clinical studies show improved survival when radical local therapy is added to standard systemic therapy for oligometastatic disease. However, since no biomarker for the identification of patients with true oligometastatic disease is clinically available, the diagnosis of oligometastatic disease is based solely on imaging findings. A small number of metastases on imaging could represent different clinical scenarios, which are associated with different prognoses and might require different treatment strategies. 20 international experts including 19 members of the European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer OligoCare project developed a comprehensive system for characterisation and classification of oligometastatic disease. We first did a systematic review of the literature to identify inclusion and exclusion criteria of prospective interventional oligometastatic disease clinical trials. Next, we used a Delphi consensus process to select a total of 17 oligometastatic disease characterisation factors that should be assessed in all patients treated with radical local therapy for oligometastatic disease, both within and outside of clinical trials. Using a second round of the Delphi method, we established a decision tree for oligometastatic disease classification together with a nomenclature. We agreed oligometastatic disease as the overall umbrella term. A history of polymetastatic disease before diagnosis of oligometastatic disease was used as the criterion to differentiate between induced oligometastatic disease (previous history of polymetastatic disease) and genuine oligometastatic disease (no history of polymetastatic disease). We further subclassified genuine oligometastatic disease into repeat oligometastatic disease (previous history of oligometastatic disease) and de-novo oligometastatic disease (first time diagnosis of oligometastatic disease). In de-novo oligometastatic disease, we differentiated between synchronous and metachronous oligometastatic disease. We did a final subclassification into oligorecurrence, oligoprogression, and oligopersistence, considering whether oligometastatic disease is diagnosed during a treatment-free interval or during active systemic therapy and whether or not an oligometastatic lesion is progressing on current imaging. This oligometastatic disease classification and nomenclature needs to be prospectively evaluated by the OligoCare study.
       
  • Osimertinib for leptomeningeal metastases in NSCLC
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Elizabeth Gourd
       
  • Intelligence outcomes after proton versus photon therapy
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Manjulika Das
       
  • San Antonio Breast Cancer Symposium 2019
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Katherine Gourd
       
  • 2019 ASH Annual Meeting
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Farhat Yaqub
       
  • Correction to Lancet Oncol 2019; 20: 1432–43
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s):
       
  • Androgen deprivation therapy plus salvage radiotherapy after prostatectomy
           – Authors' reply
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Christian Carrie, Sylvie Chabaud
       
  • Androgen deprivation therapy plus salvage radiotherapy after prostatectomy
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Samuel Birer, Daniel E Spratt
       
  • Androgen deprivation therapy plus salvage radiotherapy after prostatectomy
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Pirus Ghadjar, Thomas Wiegel
       
  • Tumour Treating Fields for mesothelioma – Authors' reply
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Giovanni L Ceresoli, Letizia Gianoncelli, Federica Grosso, STELLAR investigators
       
  • Tumour Treating Fields for mesothelioma
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Cornedine Jannette de Gooijer, Jacobus A Burgers
       
  • Tumour Treating Fields for mesothelioma
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Marcella Barbarino, Maria Bottaro, Luca Luzzi, Antonio Giordano, Luciano Mutti
       
  • How public health services pay for radiotherapy in Europe: an ESTRO–HERO
           analysis of reimbursement
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Yolande Lievens, Noémie Defourny, Julieta Corral, Chiara Gasparotto, Cai Grau, Josep Maria Borras, Elvisa Kozma, Felix Sedlmayer, Elena Slobina, Jean-François Daisne, Tatiana Hadjieva, Jiri Petera, Brian H Kristensen, Margit Valgma, Heikki Minn, Bruno Chauvet, Esther GC Troost, Antonio Lopez Medina, Vassilis Kouloulias, Zoltan Takácsi-NagySummaryReimbursement is a key factor in defining which resources are made available to ensure quality, efficiency, availability, and access to specific health-care interventions. This Policy Review assesses publicly funded radiotherapy reimbursement systems in Europe. We did a survey of the national societies of radiation oncology in Europe, focusing on the general features and global structure of the reimbursement system, the coverage scope, and level for typical indications. The annual expenditure covering radiotherapy in each country was also collected. Most countries have a predominantly budgetary-based system. Variability was the major finding, both in the components of the treatment considered for reimbursement, and in the fees paid for specific treatment techniques, fractionations, and indications. Annual expenses for radiotherapy, including capital investment, available in 12 countries, represented between 4·3% and 12·3% (average 7·8%) of the cancer care budget. Although an essential pillar in multidisciplinary oncology, radiotherapy is an inexpensive modality with a modest contribution to total cancer care costs. Scientific societies and policy makers across Europe need to discuss new strategies for reimbursement, combining flexibility with incentives to improve productivity and quality, allowing radiation oncology services to follow evolving evidence.
       
  • Immunoglobulin replacement and quality of life after CAR T-cell therapy
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Siraj A Misbah, Praveen Weeratunga
       
  • Artificial intelligence applications in upper gastrointestinal cancers
           – Authors' reply
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Huiyan Luo, Chaofeng Li, Longjun He, Zixian Wang, Rui-hua Xu
       
  • Artificial intelligence applications in upper gastrointestinal cancers
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Jialin Li, Ping Li, Wenquan Niu
       
  • A new standard of care for patients with high-risk rhabdomyosarcoma'
           – Authors' reply
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Gianni Bisogno, Andrea Ferrari, Soledad Gallego Melcon, Gian Luca De Salvo, Christophe Bergeron, Meriel Jenney
       
  • A new standard of care for patients with high-risk rhabdomyosarcoma'
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Antoine Italiano
       
  • A new standard of care for patients with high-risk rhabdomyosarcoma'
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Ewa Koscielniak, Thomas Klingebiel
       
  • Attrition in metastatic breast cancer: a metric to be reported in
           randomised clinical trials'
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Imperia Nuzzolese, Filippo Montemurro
       
  • Cancer and five chemicals: why we still don't know whether there is a risk
           to humans
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Kevin McConway
       
  • A promising start for checkpoint inhibitors in childhood malignancies
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Hussein Tawbi
       
  • Sequencing therapy for advanced renal cancer
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Axel Bex
       
  • The role of self-management in cancer survivorship care
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Afaf Girgis
       
  • Time for a shift in molecular down staging in luminal breast cancer
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Massimo Cristofanilli
       
  • Hong Kong: long civil unrest with long-term consequences
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): The Lancet Oncology
       
  • Immune checkpoint inhibitors and tuberculosis: an old disease in a new
           context
    • Abstract: Publication date: January 2020Source: The Lancet Oncology, Volume 21, Issue 1Author(s): Ewan A Langan, Victoria Graetz, Judith Allerheiligen, Detlef Zillikens, Jan Rupp, Patrick TerheydenSummaryTuberculosis, the leading cause of infection-related death in developing regions, is a leading cause of morbidity and mortality worldwide. Screening for, and treatment of, latent Mycobacterium tuberculosis infection is routine before initiation of anti-tumour necrosis factor α (anti-TNFα) agents in the management of psoriasis, Crohn's disease, and rheumatoid arthritis. By contrast, screening for latent tuberculosis before immune checkpoint inhibitor treatment in cancer is not routine, despite the increasing number of reports of primary infection with M tuberculosis or reactivation of latent M tuberculosis infection during such treatment. We present our experience with M tuberculosis screening in 70 patients who underwent immune checkpoint inhibitor therapy for metastatic skin cancer. Based on our understanding of the interaction between M tuberculosis and the immune system, we present the argument for tuberculosis screening before immune checkpoint inhibitor therapy and its use when considering anti-TNFα treatment for severe immune-related adverse events. We call for increased vigilance during immune checkpoint inhibition until its effects on tuberculosis pathophysiology are fully ascertained.
       
  • Genetic susceptibility to natural killer T-cell lymphoma
    • Abstract: Publication date: Available online 23 December 2019Source: The Lancet OncologyAuthor(s): Can Küçük
       
  • Genetic risk of extranodal natural killer T-cell lymphoma: a genome-wide
           association study in multiple populations
    • Abstract: Publication date: Available online 23 December 2019Source: The Lancet OncologyAuthor(s): Guo-Wang Lin, Caigang Xu, Kexin Chen, Hui-Qiang Huang, Jieping Chen, Bao Song, John K C Chan, Wenyu Li, Weiping Liu, Lee-Yung Shih, Wen-Yu Chuang, Won Seog Kim, Wen Tan, Rou-Jun Peng, Yurike Laurensia, Daryl Ming Zhe Cheah, DaChuan Huang, Chee Leong Cheng, Yi-Jiun Su, Soo-Yong TanSummaryBackgroundExtranodal natural killer T-cell lymphoma (NKTCL; nasal type) is an aggressive malignancy with a particularly high prevalence in Asian and Latin American populations. Epstein-Barr virus infection has a role in the pathogenesis of NKTCL, and HLA-DPB1 variants are risk factors for the disease. We aimed to identify additional novel genetic variants affecting risk of NKTCL.MethodsWe did a genome-wide association study of NKTCL in multiple populations from east Asia. We recruited a discovery cohort of 700 cases with NKTCL and 7752 controls without NKTCL of Han Chinese ancestry from 19 centres in southern, central, and northern regions of China, and four independent replication samples including 717 cases and 12 650 controls. Three of these independent samples (451 cases and 5301 controls) were from eight centres in the same regions of southern, central, and northern China, and the fourth (266 cases and 7349 controls) was from 11 centres in Hong Kong, Taiwan, Singapore, and South Korea. All cases had primary NKTCL that was confirmed histopathologically, and matching with controls was based on geographical region and self-reported ancestry. Logistic regression analysis was done independently by geographical regions, followed by fixed-effect meta-analyses, to identify susceptibility loci. Bioinformatic approaches, including expression quantitative trait loci, binding motif and transcriptome analyses, and biological experiments were done to fine-map and explore the functional relevance of genome-wide association loci to the development of NKTCL.FindingsGenetic data were gathered between Jan 1, 2008, and Jan 23, 2019. Meta-analysis of all samples (a total of 1417 cases and 20 402 controls) identified two novel loci significantly associated with NKTCL: IL18RAP on 2q12.1 (rs13015714; p=2·83 × 10−16; odds ratio 1·39 [95% CI 1·28–1·50]) and HLA-DRB1 on 6p21.3 (rs9271588; 9·35 × 10−26 1·53 [1·41–1·65]). Fine-mapping and experimental analyses showed that rs1420106 at the promoter of IL18RAP was highly correlated with rs13015714, and the rs1420106-A risk variant had an upregulatory effect on IL18RAP expression. Cell growth assays in two NKTCL cell lines (YT and SNK-6 cells) showed that knockdown of IL18RAP inhibited cell proliferation by cell cycle arrest in NKTCL cells. Haplotype association analysis showed that haplotype 47F-67I was associated with reduced risk of NKTCL, whereas 47Y-67L was associated with increased risk of NKTCL. These two positions are component parts of the peptide-binding pocket 7 (P7) of the HLA-DR heterodimer, suggesting that these alterations might account for the association at HLA-DRB1, independent of the previously reported HLA-DPB1 variants.InterpretationOur findings provide new insights into the development of NKTCL by showing the importance of inflammation and immune regulation through the IL18–IL18RAP axis and antigen presentation involving HLA-DRB1, which might help to identify potential therapeutic targets. Taken in combination with additional genetic and other risk factors, our results could potentially be used to stratify people at high risk of NKTCL for targeted prevention.FundingGuangdong Innovative and Entrepreneurial Research Team Program, National Natural Science Foundation of China, National Program for Support of Top-Notch Young Professionals, Chang Jiang Scholars Program, Singapore Ministry of Health's National Medical Research Council, Tanoto Foundation, National Research Foundation Singapore, Chang Gung Memorial Hospital, Recruitment Program for Young Professionals of China, First Affiliated Hospital and Army Medical University, US National Institutes of Health, and US National Cancer Institute.
       
  • Unlocking the secret of the obesity paradox in renal tumours
    • Abstract: Publication date: Available online 20 December 2019Source: The Lancet OncologyAuthor(s): Matteo Santoni, Alessio Cortellini, Sebastiano Buti
       
  • Transcriptomic signatures related to the obesity paradox in patients with
           clear cell renal cell carcinoma: a cohort study
    • Abstract: Publication date: Available online 20 December 2019Source: The Lancet OncologyAuthor(s): Alejandro Sanchez, Helena Furberg, Fengshen Kuo, Lynda Vuong, Yasser Ged, Sujata Patil, Irina Ostrovnaya, Stacey Petruzella, Albert Reising, Parul Patel, Roy Mano, Jonathan Coleman, Paul Russo, Catherine H Liu, Andrew J Dannenberg, Timothy A Chan, Robert Motzer, Martin H Voss, A Ari HakimiSummaryBackgroundObesity is associated with an increased risk of developing clear cell renal cell carcinoma (RCC) but, paradoxically, obesity is also associated with improved oncological outcomes in this cancer. Because the biological mechanisms underlying this paradoxical association are poorly understood, we aimed to identify transcriptomic differences in primary tumour and peritumoral adipose tissue between obese patients and those at a normal weight.MethodsIn this cohort study, we assessed data from five independent clinical cohorts of patients with clear cell RCC aged 18 years and older. Overweight patients were excluded from each cohort for our analysis. We assessed patients from the COMPARZ phase 3 clinical trial, a cohort from the Cancer Genome Atlas (TCGA), and a Memorial Sloan Kettering (MSK) observational immunotherapy cohort for their inclusion into our study. We assessed overall survival in obese patients (those with a body-mass index [BMI] ≥30 kg/m2) and in patients with a normal weight (BMI 18·5–24·9 kg/m2, as per WHO's BMI categories), defined as the time from treatment initiation (in the COMPARZ and MSK immunotherapy cohorts) or surgery (in the TCGA cohort) to the date of any-cause death or of censoring on the day of the last follow-up. We also evaluated and validated transcriptomic differences in the primary tumours of obese patients compared with those of a normal weight. We compared gene-expression differences in peritumoral adipose tissue and tumour tissue in an additional, prospectively collected cohort of patients with non-metastatic clear cell RCC (the MSK peritumoral adipose tissue cohort). We analysed differences in gene expression between obese patients and those at a normal weight in the COMPARZ, TCGA, and peritumoral adipose tissue cohorts. We also assessed the tumour immune microenvironment in a prospective cohort of patients who had nephrectomy for localised RCC at MSK.FindingsOf the 453 patients in the COMPARZ trial, 375 (83%) patients had available microarray data, pretreatment BMI measurements, and overall survival data for analyses, and we excluded 119 (26%) overweight patients, leaving a final cohort of 256 (68%) patients from this study for our analyses. From 332 patients in the TCGA cohort, we evaluated clinical and demographic data from 152 (46%) patients with advanced (ie, stages III and IV) clear cell RCC treated by nephrectomy; after exclusion of 59 (39%) overweight patients, our final cohort consisted of 93 (61%) patients. After exclusion of 74 (36%) overweight patients from the initial MSK immunotherapy study population of 203 participants, our final cohort for overall survival analysis comprised 129 (64%) participants. We found that overall survival was longer in obese patients than in those with normal weight in the TCGA cohort, after adjustment for stage or grade (adjusted HR 0·41, 95% CI 0·22–0·75), and in the COMPARZ clinical trial after adjustment for International Metastatic RCC Database (IMDC) risk score (0·68, 0·48–0·96). In the MSK immunotherapy cohort, the inverse association of BMI with mortality (HR 0·54, 95% CI 0·31–0·95) was not significant after adjustment for IMDC risk score (adjusted HR 0·72, 95% CI 0·40–1·30). Tumours of obese patients showed higher angiogenic scores on gene-set enrichment analysis-derived hallmark gene set angiogenesis signatures than did those of patients at a normal weight, but the degree of immune cell infiltration did not differ by BMI. We found increased peritumoral adipose tissue inflammation in obese patients relative to those at a normal weight, especially in peritumoral fat near the tumour.InterpretationWe found aspects of the tumour microenvironment that vary by BMI in the tumour and peritumoral adipose tissue, which might contribute to the apparent survival advantage in obese patients with clear cell RCC compared with patients at a normal weight. The complex interplay between the clear cell RCC tumour and peritumoral adipose tissue microenvironment might have clinical relevance and warrants further investigation.FundingRuth L Kirschstein Research Service Award, American Society of Clinical Oncology Young Investigator Award, MSK's Ludwig Center, Weiss Family Kidney Research Fund, Novartis, The Sidney Kimmel Center for Prostate and Urologic Cancers, and the National Institutes of Health (National Cancer Institute) Cancer Center Support Grant.
       
  • CDK4/6 inhibitors in breast cancer: one more step towards reduced
           mortality
    • Abstract: Publication date: Available online 16 December 2019Source: The Lancet OncologyAuthor(s): Giuseppe Curigliano, Sibylle Loibl
       
  • Time to re-think the olanzapine dose
    • Abstract: Publication date: Available online 11 December 2019Source: The Lancet OncologyAuthor(s): Alex Molassiotis
       
  • Entrectinib for ROS1 fusion-positive NSCLC and NTRK fusion-positive solid
           tumours
    • Abstract: Publication date: Available online 11 December 2019Source: The Lancet OncologyAuthor(s): Ulrik Lassen
       
  • Denosumab in early breast cancer: negative data and a call to action
    • Abstract: Publication date: Available online 2 December 2019Source: The Lancet OncologyAuthor(s): Francesco Perrone, Adriano Gravina
       
  • The tip of the iceberg: predicting PARP inhibitor efficacy in prostate
           cancer
    • Abstract: Publication date: Available online 2 December 2019Source: The Lancet OncologyAuthor(s): Silke Gillessen, Robert G Bristow
       
  • Real-time artificial intelligence for detection of upper gastrointestinal
           cancer by endoscopy: a multicentre, case-control, diagnostic study
    • Abstract: Publication date: December 2019Source: The Lancet Oncology, Volume 20, Issue 12Author(s): Huiyan Luo, Guoliang Xu, Chaofeng Li, Longjun He, Linna Luo, Zixian Wang, Bingzhong Jing, Yishu Deng, Ying Jin, Yin Li, Bin Li, Wencheng Tan, Caisheng He, Sharvesh Raj Seeruttun, Qiubao Wu, Jun Huang, De-wang Huang, Bin Chen, Shao-bin Lin, Qin-ming ChenSummaryBackgroundUpper gastrointestinal cancers (including oesophageal cancer and gastric cancer) are the most common cancers worldwide. Artificial intelligence platforms using deep learning algorithms have made remarkable progress in medical imaging but their application in upper gastrointestinal cancers has been limited. We aimed to develop and validate the Gastrointestinal Artificial Intelligence Diagnostic System (GRAIDS) for the diagnosis of upper gastrointestinal cancers through analysis of imaging data from clinical endoscopies.MethodsThis multicentre, case-control, diagnostic study was done in six hospitals of different tiers (ie, municipal, provincial, and national) in China. The images of consecutive participants, aged 18 years or older, who had not had a previous endoscopy were retrieved from all participating hospitals. All patients with upper gastrointestinal cancer lesions (including oesophageal cancer and gastric cancer) that were histologically proven malignancies were eligible for this study. Only images with standard white light were deemed eligible. The images from Sun Yat-sen University Cancer Center were randomly assigned (8:1:1) to the training and intrinsic verification datasets for developing GRAIDS, and the internal validation dataset for evaluating the performance of GRAIDS. Its diagnostic performance was evaluated using an internal and prospective validation set from Sun Yat-sen University Cancer Center (a national hospital) and additional external validation sets from five primary care hospitals. The performance of GRAIDS was also compared with endoscopists with three degrees of expertise: expert, competent, and trainee. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of GRAIDS and endoscopists for the identification of cancerous lesions were evaluated by calculating the 95% CIs using the Clopper-Pearson method.Findings1 036 496 endoscopy images from 84 424 individuals were used to develop and test GRAIDS. The diagnostic accuracy in identifying upper gastrointestinal cancers was 0·955 (95% CI 0·952–0·957) in the internal validation set, 0·927 (0·925–0·929) in the prospective set, and ranged from 0·915 (0·913–0·917) to 0·977 (0·977–0·978) in the five external validation sets. GRAIDS achieved diagnostic sensitivity similar to that of the expert endoscopist (0·942 [95% CI 0·924–0·957] vs 0·945 [0·927–0·959]; p=0·692) and superior sensitivity compared with competent (0·858 [0·832–0·880], p
       
  • Correction to Lancet Oncol 2019; 20: e645–52
    • Abstract: Publication date: December 2019Source: The Lancet Oncology, Volume 20, Issue 12Author(s):
       
  • Correction to Lancet Oncol 2019; 20: 1544–55
    • Abstract: Publication date: December 2019Source: The Lancet Oncology, Volume 20, Issue 12Author(s):
       
  • Correction to Lancet Oncol 2019; 20: 1349–59
    • Abstract: Publication date: December 2019Source: The Lancet Oncology, Volume 20, Issue 12Author(s):
       
  • Correction to Lancet Oncol 2019; 20: 1342–44
    • Abstract: Publication date: December 2019Source: The Lancet Oncology, Volume 20, Issue 12Author(s):
       
  • Correction to Lancet Oncol 2019; 20: 383–93
    • Abstract: Publication date: December 2019Source: The Lancet Oncology, Volume 20, Issue 12Author(s):
       
  • Optimal patient selection for stereotactic body radiotherapy –
           Authors' reply
    • Abstract: Publication date: December 2019Source: The Lancet Oncology, Volume 20, Issue 12Author(s): Douglas H Brand, Alison C Tree, Emma Hall, Nicholas van As, PACE Trial Investigators
       
  • Optimal patient selection for stereotactic body radiotherapy
    • Abstract: Publication date: December 2019Source: The Lancet Oncology, Volume 20, Issue 12Author(s): Amar U Kishan, Sean P Collins, Nicholas G Nickols
       
  • Radiation-induced cystitis and hyperbaric oxygen therapy
    • Abstract: Publication date: December 2019Source: The Lancet Oncology, Volume 20, Issue 12Author(s): Richard Clarke
       
  • The incomplete story of complete mesocolic excision – Authors' reply
    • Abstract: Publication date: December 2019Source: The Lancet Oncology, Volume 20, Issue 12Author(s): Claus A Bertelsen, Anders U Neuenschwander, Jakob Kleif
       
  • The incomplete story of complete mesocolic excision
    • Abstract: Publication date: December 2019Source: The Lancet Oncology, Volume 20, Issue 12Author(s): Fahima Dossa, Trevor Wood, Nancy N Baxter
       
  • Are health-care policies restricting further progress in cancer survival
           outcomes'
    • Abstract: Publication date: December 2019Source: The Lancet Oncology, Volume 20, Issue 12Author(s): Reena Patel, Wing K Liu, Hiten RH Patel, Lisa Pickering, Mehran Afshar
       
  • 2019 international clinical practice guidelines for the treatment of
           venous thromboembolism
    • Abstract: Publication date: December 2019Source: The Lancet Oncology, Volume 20, Issue 12Author(s): Kyaw Zin Thein, Thein Hlaing Oo
       
  • Chemotherapy-free strategy for platinum-sensitive recurrent ovarian cancer
    • Abstract: Publication date: December 2019Source: The Lancet Oncology, Volume 20, Issue 12Author(s): Qi Zhou, Dongling Zou, Xingtao Long
       
  • Multiplicity in oncology randomised controlled trials: a threat to medical
           evidence'
    • Abstract: Publication date: December 2019Source: The Lancet Oncology, Volume 20, Issue 12Author(s): Vinay Prasad, Christopher M Booth
       
  • Shedding light on dabrafenib-induced fevers in patients with melanoma
    • Abstract: Publication date: December 2019Source: The Lancet Oncology, Volume 20, Issue 12Author(s): Peter Hersey, Jessamy C Tiffen, Stuart J Gallagher
       
  • Cancer prevention and treatment in humanitarian settings: an urgent and
           unmet need
    • Abstract: Publication date: December 2019Source: The Lancet Oncology, Volume 20, Issue 12Author(s): Jude Alawa, Cosette Maiky, Kaveh Khoshnood, Fouad M Fouad
       
  • Reducing infection-related morbidity and mortality in patients with
           myeloma
    • Abstract: Publication date: December 2019Source: The Lancet Oncology, Volume 20, Issue 12Author(s): Karthik Ramasamy
       
  • 2019 international clinical practice guidelines for the treatment of
           venous thromboembolism – Authors' reply
    • Abstract: Publication date: December 2019Source: The Lancet Oncology, Volume 20, Issue 12Author(s): James D Douketis, Corinne Frere, Dominique Farge, International Thrombosis and Cancer Initiative members
       
  • Overall survival with osimertinib in untreated NSCLC
    • Abstract: Publication date: Available online 29 November 2019Source: The Lancet OncologyAuthor(s): Elizabeth Gourd
       
  • Carcinogenicity of some industrial chemical intermediates and solvents
    • Abstract: Publication date: Available online 29 November 2019Source: The Lancet OncologyAuthor(s): Ivan Rusyn, Fiorella Belpoggi, Luisa Camacho, Heiko U. Käfferlein, Russell Cattley, Cherie F Estill, Jun Kanno, Frank Le Curieux, Jaroslav Mráz, Georgia K. Roberts, William A. Stubbings, Takashi Umemura, Jelle Vlaanderen, Veronique Bouvard, Yann Grosse, Lamia Benbrahim-Tallaa, Jennifer Girschik, Fatiha El Ghissassi, Elaine G. Rowan, Felicia Chung
       
  • Risk-based treatment of non-rhabdomyosarcoma soft-tissue sarcoma in
           children
    • Abstract: Publication date: Available online 27 November 2019Source: The Lancet OncologyAuthor(s): Javier Martin-Broto
       
  • Building momentum for subsets of patients with advanced triple-negative
           breast cancer
    • Abstract: Publication date: Available online 27 November 2019Source: The Lancet OncologyAuthor(s): Wendy A Woodward
       
  • A risk-based treatment strategy for non-rhabdomyosarcoma soft-tissue
           sarcomas in patients younger than 30 years (ARST0332): a Children's
           Oncology Group prospective study
    • Abstract: Publication date: Available online 27 November 2019Source: The Lancet OncologyAuthor(s): Sheri L Spunt, Lynn Million, Yueh-Yun Chi, James Anderson, Jing Tian, Emily Hibbitts, Cheryl Coffin, M Beth McCarville, R Lor Randall, David M Parham, Jennifer O Black, Simon C Kao, Andrea Hayes-Jordan, Suzanne Wolden, Fran Laurie, Roseanne Speights, Ellen Kawashima, Stephen X Skapek, William Meyer, Alberto S PappoSummaryBackgroundTumour grade, tumour size, resection potential, and extent of disease affect outcome in paediatric non-rhabdomyosarcoma soft-tissue sarcoma (NRSTS), but no risk stratification systems exist and the standard of care is poorly defined. We developed a risk stratification system from known prognostic factors and assessed it in the context of risk-adapted therapy for young patients with NRSTS.MethodsIn this prospective study, eligible patients enrolled in 159 hospitals in three countries were younger than 30 years, had a Lansky (patients ≤16 years) or Karnofsky (patients>16 years) performance status score of at least 50, and a new diagnosis of a WHO (2002 criteria) intermediate (rarely metastasising) or malignant soft-tissue tumour (apart from tumour types eligible for other Children's Oncology Group studies and tumours for which the therapy in this trial was deemed inappropriate), malignant peripheral nerve sheath tumour, non-metastatic and grossly resected dermatofibrosarcoma protuberans, undifferentiated embryonal sarcoma of the liver, or unclassified malignant soft-tissue sarcoma. Each patient was assigned to one of three risk groups and one of four treatment groups. Risk groups were: low (non-metastatic R0 or R1 low-grade, or ≤5 cm R1 high-grade tumour); intermediate (non-metastatic R0 or R1>5 cm high-grade, or unresected tumour of any size or grade); or high (metastatic tumour). The treatment groups were surgery alone, radiotherapy (55·8 Gy), chemoradiotherapy (chemotherapy and 55·8 Gy radiotherapy), and neoadjuvant chemoradiotherapy (chemotherapy and 45 Gy radiotherapy, then surgery and radiotherapy boost based on margins with continued chemotherapy). Chemotherapy included six cycles of ifosfamide 3 g/m2 per dose intravenously on days 1–3 and five cycles of doxorubicin 37·5 mg/m2 per dose intravenously on days 1–2 every 3 weeks with sequence adjusted on the basis of timing of surgery or radiotherapy. The primary outcomes were event-free survival, overall survival, and the pattern of treatment failure. Analysis was done per protocol. This study has been completed and is registered with ClinicalTrials.gov, NCT00346164.FindingsBetween Feb 5, 2007, and Feb 10, 2012, 550 eligible patients were enrolled, of whom 21 were treated in the incorrect group and excluded from this analysis. 529 evaluable patients were included in the analysis: low-risk (n=222), intermediate-risk (n=227), high-risk (n=80); surgery alone (n=205), radiotherapy (n=17), chemoradiotherapy (n=111), and neoadjuvant chemoradiotherapy (n=196). At a median follow-up of 6·5 years (IQR 4·9–7·9), 5-year event-free survival and overall survival were: 88·9% (95% CI 84·0–93·8) and 96·2% (93·2–99·2) in the low-risk group; 65·0% (58·2–71·8) and 79·2% (73·4–85·0) in the intermediate-risk group; and 21·2% (11·4–31·1) and 35·5% (23·6–47·4) in the high-risk group, respectively. Risk group predicted event-free survival and overall survival (p
       
  • Immune checkpoint inhibitors for refractory childhood cancers
    • Abstract: Publication date: Available online 25 November 2019Source: The Lancet OncologyAuthor(s): Brigitte C Widemann
       
  • A promising therapeutic vaccine for cervical precancer
    • Abstract: Publication date: Available online 21 November 2019Source: The Lancet OncologyAuthor(s): Manjulika Das
       
  • Critical treatment choices for patients with platinum-refractory
           urothelial carcinoma
    • Abstract: Publication date: Available online 18 November 2019Source: The Lancet OncologyAuthor(s): Yair Lotan, Xiaosong Meng
       
  • New treatment option for relapsed or refractory DLBCL
    • Abstract: Publication date: Available online 14 November 2019Source: The Lancet OncologyAuthor(s): Elizabeth Gourd
       
  • Is thermal ablation a new standard for cervical pre-cancer treatment in
           low-income and middle-income countries'
    • Abstract: Publication date: Available online 14 November 2019Source: The Lancet OncologyAuthor(s): Patrick Petignat, Bruno Kenfack
       
  • CAR T-cell cocktail therapy for B-cell malignancies
    • Abstract: Publication date: Available online 7 November 2019Source: The Lancet OncologyAuthor(s): Elizabeth Gourd
       
  • New smoking ban for restaurants and bars in Austria
    • Abstract: Publication date: Available online 7 November 2019Source: The Lancet OncologyAuthor(s): Talha Khan Burki
       
  • Presenting symptoms of cancer and stage at diagnosis: evidence from a
           cross-sectional, population-based study
    • Abstract: Publication date: Available online 6 November 2019Source: The Lancet OncologyAuthor(s): Minjoung Monica Koo, Ruth Swann, Sean McPhail, Gary A Abel, Lucy Elliss-Brookes, Greg P Rubin, Georgios LyratzopoulosSummaryBackgroundEarly diagnosis interventions such as symptom awareness campaigns increasingly form part of global cancer control strategies. However, these strategies will have little impact in improving cancer outcomes if the targeted symptoms represent advanced stage of disease. Therefore, we aimed to examine associations between common presenting symptoms of cancer and stage at diagnosis.MethodsIn this cross-sectional study, we analysed population-level data from the English National Cancer Diagnosis Audit 2014 for patients aged 25 years and older with one of 12 types of solid tumours (bladder, breast, colon, endometrial, laryngeal, lung, melanoma, oral or oropharyngeal, ovarian, prostate, rectal, and renal cancer). We considered 20 common presenting symptoms and examined their associations with stage at diagnosis (TNM stage IV vs stage I–III) using logistic regression. For each symptom, we estimated these associations when reported as a single presenting symptom and when reported together with other symptoms.FindingsWe analysed data for 7997 patients. The proportion of patients diagnosed with stage IV cancer varied substantially by presenting symptom, from 1% (95% CI 1–3; eight of 584 patients) for abnormal mole to 80% (71–87; 84 of 105 patients) for neck lump. Three of the examined symptoms (neck lump, chest pain, and back pain) were consistently associated with increased odds of stage IV cancer, whether reported alone or with other symptoms, whereas the opposite was true for abnormal mole, breast lump, postmenopausal bleeding, and rectal bleeding. For 13 of the 20 symptoms (abnormal mole, breast lump, post-menopausal bleeding, rectal bleeding, lower urinary tract symptoms, haematuria, change in bowel habit, hoarseness, fatigue, abdominal pain, lower abdominal pain, weight loss, and the “any other symptom” category), more than 50% of patients were diagnosed at stages other than stage IV; for 19 of the 20 studied symptoms (all except for neck lump), more than a third of patients were diagnosed at stages other than stage IV.InterpretationDespite specific presenting symptoms being more strongly associated with advanced stage at diagnosis than others, for most symptoms, large proportions of patients are diagnosed at stages other than stage IV. These findings provide support for early diagnosis interventions targeting common cancer symptoms, countering concerns that they might be simply expediting the detection of advanced stage disease.FundingUK Department of Health's Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis; and Cancer Research UK.
       
  • Earlier diagnosis: the importance of cancer symptoms
    • Abstract: Publication date: Available online 6 November 2019Source: The Lancet OncologyAuthor(s): Katriina Whitaker
       
  • Early intervention effective in smouldering multiple myeloma
    • Abstract: Publication date: Available online 1 November 2019Source: The Lancet OncologyAuthor(s): Elizabeth Gourd
       
  • LEEP for cervical neoplasia recurrence in HIV-positive patients
    • Abstract: Publication date: Available online 1 November 2019Source: The Lancet OncologyAuthor(s): Manjulika Das
       
  • Promising radiotherapy classifier for early breast cancer
    • Abstract: Publication date: Available online 24 October 2019Source: The Lancet OncologyAuthor(s): Manjulika Das
       
  • Alleviation of radiotherapy-induced oral mucositis
    • Abstract: Publication date: Available online 24 October 2019Source: The Lancet OncologyAuthor(s): Elizabeth Gourd
       
 
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