Background.
Challenges in the diagnosis and classification of cholangiocarcinoma have made it difficult to quantify the true incidence of this highly aggressive malignancy.
Methods.
We analyzed the ...Surveillance, Epidemiology, and End Results data to assess long‐term trends in the age‐standardized incidence of intrahepatic and extrahepatic cholangiocarcinoma between 1973 and 2012, correcting for systematic coding errors. Because intrahepatic cholangiocarcinoma (ICC) may frequently be misdiagnosed as cancer of unknown primary (CUP), we also analyzed trends in the incidence of CUP.
Results.
Between 1973 and 2012, the reported U.S. incidence of ICC increased from 0.44 to 1.18 cases per 100,000, representing an annual percentage change (APC) of 2.30%; this trend has accelerated during the past decade to an APC of 4.36%. The incidence of extrahepatic cholangiocarcinoma increased modestly from 0.95 to 1.02 per 100,000 during the 40‐year period (APC, 0.14%). The incidence of CUP with histologic features potentially consistent with cholangiocarcinoma decreased by 51% between 1973 and 2012 (APC, −1.87%), whereas the incidence of CUP with squamous or nonepithelial histologic features increased modestly (APC, 0.42%).
Conclusion.
The recognized incidence of ICC in the U.S. continues to rise, whereas the incidence of ECC is stable. The incidence of CUP has fallen dramatically during the same time period.
Implications for Practice:
Clinical distinctions between cholangiocarcinoma (particularly intrahepatic cholangiocarcinoma ICC) and cancer of unknown primary (CUP) can be challenging. Recent discoveries have identified recurrent and potentially targetable genomic abnormalities in ICC, highlighting the importance of improving diagnosis. This study demonstrates that the incidence of ICC is increasing in the U.S., whereas the incidence of extrahepatic cholangiocarcinoma is stable. Concomitantly, the incidence of CUP has declined dramatically, suggesting that improved distinction between ICC and CUP may be a major driver of the increasing recognized incidence of ICC. The increasing incidence of ICC warrants further study of prevention and treatment approaches.
摘要
背景. 在胆管癌诊断和分类中存在的挑战使得这种高度侵袭性恶性肿瘤的真实发病率难以量化。
方法. 我们对监测、流行病学及预后 (SEER) 项目中的数据进行了分析, 评估1973‐2012年间肝内和肝外胆管癌年龄标化发病率的长期变化趋势 (根据系统编码误差校正) 。由于肝内胆管癌 (ICC) 常可能被误诊为原发部位不明的癌症 (CUP), 我们还对 CUP 发病率的变化趋势进行了分析。
结果. 1973‐2012 年间, 美国 ICC 发病率从 0.44/10 万人增长到 1.18/10 万人, 相当于年变化率 (APC) 为 2.30%。这一趋势在过去十年间进一步加剧, APC 提高至 4.36%。肝外胆管癌在 40 年间从 0.95/10 万人略增加到 1.02/10 万人 (APC: 0.14%)。 1973‐2012 年间, 组织学特征可能与胆管癌一致的 CUP 发病率下降了 51% (APC: ‐1.87%), 而鳞癌或非上皮性组织学特征的 CUP 的发病率则略有升高 (APC: 0.42%)。
结论. 在美国, 确诊的ICC发病率持续升高, 而ECC发病率保持稳定。而相同时期的CUP发病率则呈现大幅下降。The Oncologist 2016;21:594–599
对临床实践的提示: 对胆管癌尤其是肝内胆管癌 (ICC) 与原发部位不明的癌症 (CUP) 进行临床鉴别富有挑战性。 ICC 中近期识别出来的的复发和潜在靶位基因组异常强调了改进诊断的重要性。本研究证实美国的 ICC 发病率在持续升高, 而肝外胆管癌的发病率保持稳定。同一时期, CUP 的发病率则大幅下降, 提示 ICC 与 CUP 鉴别的进步可能是确诊的 ICC 发病率升高的主要驱动因素。 ICC 持续升高的发病率提示有必要针对其预防和治疗手段开展进一步的研究。
The recognized incidence of intrahepatic cholangiocarcinoma in the U.S. continues to rise, whereas the incidence of extrahepatic cholangiocarcinoma is stable. The incidence of carcinoma of unknown primary has fallen dramatically during the same time period.
Large-scale genomic characterization of tumors from prospective cohort studies may yield new insights into cancer pathogenesis. We performed whole-exome sequencing of 619 incident colorectal cancers ...(CRCs) and integrated the results with tumor immunity, pathology, and survival data. We identified recurrently mutated genes in CRC, such as BCL9L, RBM10, CTCF, and KLF5, that were not previously appreciated in this disease. Furthermore, we investigated the genomic correlates of immune-cell infiltration and found that higher neoantigen load was positively associated with overall lymphocytic infiltration, tumor-infiltrating lymphocytes (TILs), memory T cells, and CRC-specific survival. The association with TILs was evident even within microsatellite-stable tumors. We also found positive selection of mutations in HLA genes and other components of the antigen-processing machinery in TIL-rich tumors. These results may inform immunotherapeutic approaches in CRC. More generally, this study demonstrates a framework for future integrative molecular epidemiology research in colorectal and other malignancies.
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•Whole-exome sequencing of 619 colorectal cancers with clinicopathologic annotations•Discovery of significantly mutated genes in colorectal cancer•Neoantigen load correlation with infiltrating lymphocytes and memory T cells•Positive selection for HLA mutations in immune-cell-infiltrated tumors
Through whole-exome sequencing of annotated colorectal tumors, Giannakis et al. identify additional colorectal cancer driver genes and correlate high neoantigen load with increased lymphocytic infiltration and improved survival. They also find positive selection for HLA mutations in immune-cell-infiltrated tumors. These results may inform immunotherapeutic approaches in colorectal cancer.
Although abundant myeloid cell populations in the pancreatic ductal adenocarcinoma (PDAC) microenvironment have been postulated to suppress antitumor immunity, the composition of these populations, ...their spatial locations, and how they relate to patient outcomes are poorly understood.
To generate spatially resolved tumor and immune cell data at single-cell resolution, we developed two quantitative multiplex immunofluorescence assays to interrogate myeloid cells (CD15, CD14, ARG1, CD33, HLA-DR) and macrophages CD68, CD163, CD86, IFN regulatory factor 5, MRC1 (CD206) in the PDAC tumor microenvironment. Spatial point pattern analyses were conducted to assess the degree of colocalization between tumor cells and immune cells. Multivariable-adjusted Cox proportional hazards regression was used to assess associations with patient outcomes.
In a multi-institutional cohort of 305 primary PDAC resection specimens, myeloid cells were abundant, enriched within stromal regions, highly heterogeneous across tumors, and differed by somatic genotype. High densities of CD15
ARG1
immunosuppressive granulocytic cells and M2-polarized macrophages were associated with worse patient survival. Moreover, beyond cell density, closer proximity of M2-polarized macrophages to tumor cells was strongly associated with disease-free survival, revealing the clinical significance and biologic importance of immune cell localization within tumor areas.
A diverse set of myeloid cells are present within the PDAC tumor microenvironment and are distributed heterogeneously across patient tumors. Not only the densities but also the spatial locations of myeloid immune cells are associated with patient outcomes, highlighting the potential role of spatially resolved myeloid cell subtypes as quantitative biomarkers for PDAC prognosis and therapy.
Immune cells in the tumor microenvironment have an important role in regulating tumor progression. Therefore, stimulating immune reactions to tumors can be an attractive therapeutic and prevention ...strategy. Cancer cells and host cells constantly interact with each other in the tumor microenvironment; thus, cancer immunology is an interdisciplinary area where integrated analysis of both host and tumor factors is needed. Cancer represents a heterogeneous group of diseases with different genetic and epigenetic alterations; therefore, molecular classification of cancer (for example lung, prostate and breast cancers) is an important component in clinical decision making. However, most studies on antitumor immunity and clinical outcome lack analysis of tumor molecular biomarkers. In this Review, we discuss colorectal cancer as a prototypical example of cancer. Common molecular classifiers of colon cancer include KRAS, BRAF and PIK3CA mutations, microsatellite instability, LINE-1 methylation, and CpG island methylator phenotype. Since tumor molecular features and immune reactions are inter-related, a comprehensive assessment of these factors is critical. Examining the effects of tumor-host interactions on clinical outcome and prognosis represents an evolving interdisciplinary field of molecular pathological epidemiology. Pathological immunity evaluation may provide information on prognosis and help identify patients who are more likely to benefit from immunotherapy.
BRAF mutation in colorectal cancer is associated with microsatellite instability (MSI) through its relationship with high-level CpG island methylator phenotype (CIMP) and MLH1 promoter methylation. ...MSI and BRAF mutation analyses are routinely used for familial cancer risk assessment. To clarify clinical outcome associations of combined MSI/BRAF subgroups, we investigated survival in 1253 rectal and colon cancer patients within the Nurses' Health Study and Health Professionals Follow-up Study with available data on clinical and other molecular features, including CIMP, LINE-1 hypomethylation, and KRAS and PIK3CA mutations. Compared with the majority subtype of microsatellite stable (MSS)/BRAF-wild-type, MSS/BRAF-mutant, MSI-high/BRAF-mutant, and MSI-high/BRAF-wild-type subtypes showed multivariable colorectal cancer-specific mortality hazard ratios of 1.60 (95% confidence interval CI =1.12 to 2.28; P = .009), 0.48 (95% CI = 0.27 to 0.87; P = .02), and 0.25 (95% CI = 0.12 to 0.52; P < .001), respectively. No evidence existed for a differential prognostic role of BRAF mutation by MSI status (P(interaction) > .50). Combined BRAF/MSI status in colorectal cancer is a tumor molecular biomarker for prognosic risk stratification.
Among 88,902 participants followed over a period of 22 years in the Nurses' Health Study and the Health Professionals Follow-up Study, colon cancer mortality was reduced after screening sigmoidoscopy ...(hazard ratio, 0.59) and screening colonoscopy (hazard ratio, 0.32).
Randomized, controlled trials have shown that screening with flexible sigmoidoscopy reduces the incidence of colorectal cancer and associated mortality, albeit with diminished effectiveness for cancers of the proximal colon.
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Although comparable data from randomized, controlled trials of screening colonoscopy are not yet available,
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colonoscopy is also widely endorsed by expert bodies for population-based screening, largely on the basis of case–control studies that show associations with reduced colorectal-cancer incidence and mortality.
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However, as with flexible sigmoidoscopy, there is uncertainty about the effectiveness of colonoscopy in reducing the incidence of and mortality associated with proximal colon cancer
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and about . . .
Increasing evidence links the gut microbiota with colorectal cancer. Metagenomic analyses indicate that symbiotic Fusobacterium spp. are associated with human colorectal carcinoma, but whether this ...is an indirect or causal link remains unclear. We find that Fusobacterium spp. are enriched in human colonic adenomas relative to surrounding tissues and in stool samples from colorectal adenoma and carcinoma patients compared to healthy subjects. Additionally, in the ApcMin/+ mouse model of intestinal tumorigenesis, Fusobacterium nucleatum increases tumor multiplicity and selectively recruits tumor-infiltrating myeloid cells, which can promote tumor progression. Tumors from ApcMin/+ mice exposed to F. nucleatum exhibit a proinflammatory expression signature that is shared with human fusobacteria-positive colorectal carcinomas. However, unlike other bacteria linked to colorectal carcinoma, F. nucleatum does not exacerbate colitis, enteritis, or inflammation-associated intestinal carcinogenesis. Collectively, these data suggest that, through recruitment of tumor-infiltrating immune cells, fusobacteria generate a proinflammatory microenvironment that is conducive for colorectal neoplasia progression.
•Fusobacterium is enriched in human adenomas, suggesting an early role in tumorigenesis•Fusobacterium nucleatum accelerates tumorigenesis in ApcMin/+ mice•F. nucleatum drives myeloid cell infiltration in intestinal tumors•Fusobacterium is associated with a proinflammatory signature in mouse and human tumors
Background & Aims Increased intake of dietary fiber has been proposed to reduce the risk of inflammatory bowel disease (Crohn's disease CD and ulcerative colitis UC). However, few prospective studies ...have examined associations between long-term intake of dietary fiber and risk of incident CD or UC. Methods We collected and analyzed data from 170,776 women, followed up over 26 years, who participated in the Nurses' Health Study, followed up for 3,317,425 person-years. Dietary information was prospectively ascertained via administration of a validated semiquantitative food frequency questionnaire every 4 years. Self-reported CD and UC were confirmed through review of medical records. Cox proportional hazards models, adjusting for potential confounders, were used to calculate hazard ratios (HRs). Results We confirmed 269 incident cases of CD (incidence, 8/100,000 person-years) and 338 cases of UC (incidence, 10/100,000 person-years). Compared with the lowest quintile of energy-adjusted cumulative average intake of dietary fiber, intake of the highest quintile (median of 24.3 g/day) was associated with a 40% reduction in risk of CD (multivariate HR for CD, 0.59; 95% confidence interval, 0.39–0.90). This apparent reduction appeared to be greatest for fiber derived from fruits; fiber from cereals, whole grains, or legumes did not modify risk. In contrast, neither total intake of dietary fiber (multivariate HR, 0.82; 95% confidence interval, 0.58–1.17) nor intake of fiber from specific sources appeared to be significantly associated with risk of UC. Conclusions Based on data from the Nurses' Health Study, long-term intake of dietary fiber, particularly from fruit, is associated with lower risk of CD but not UC. Further studies are needed to determine the mechanisms that mediate this association.
This study of 636 cases of colorectal cancer culled from two large cohorts of participants who reported data on aspirin use showed that regular use of aspirin reduced the risk of having a colorectal ...cancer that expressed high amounts of COX-2, an enzyme affected by aspirin.
Regular use of aspirin reduced the risk of having a colorectal cancer that expressed high amounts of COX-2, an enzyme affected by aspirin.
Observational studies and randomized intervention trials have found that regular use of aspirin reduces the risk of colorectal neoplasms.
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The mechanism by which aspirin influences the risk of colorectal cancer is not well understood. Aspirin inhibits cyclooxygenase, which catalyzes the rate-limiting step in the metabolic conversion of arachidonic acid to prostaglandins and related eicosanoids.
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One form of cyclooxygenase, termed cyclooxygenase-2 (COX-2), promotes inflammation and cell proliferation, and colorectal cancers often overexpress this enzyme.
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Randomized trials have demonstrated that selective inhibitors of COX-2 reduce the risk of recurrent adenoma in participants at high risk.
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However, aspirin and nonsteroidal . . .
Dietary fats influence intestinal inflammation and regulate mucosal immunity. Data on the association between dietary fat and risk of Crohn's disease (CD) and ulcerative colitis (UC) are limited and ...conflicting.
We conducted a prospective study of women enrolled in the Nurses' Health Study cohorts. Diet was prospectively ascertained every 4 years using a validated semi-quantitative food frequency questionnaire. Self-reported CD and UC were confirmed through medical record review. We examined the effect of energy-adjusted cumulative average total fat intake and specific types of fat and fatty acids on the risk of CD and UC using Cox proportional hazards models adjusting for potential confounders.
Among 170,805 women, we confirmed 269 incident cases of CD (incidence 8/100,000 person-years) and 338 incident cases of UC (incidence 10/100,000 person-years) over 26 years and 3,317,338 person-years of follow-up. Cumulative energy-adjusted intake of total fat, saturated fats, unsaturated fats, n-6 and n-3 polyunsaturated fatty acids (PUFAs) were not associated with risk of CD or UC. However, greater intake of long-chain n-3 PUFAs was associated with a trend towards lower risk of UC (HR 0.72, 95% CI 0.51 to 1.01). In contrast, high long-term intake of trans-unsaturated fatty acids was associated with a trend towards an increased incidence of UC (HR 1.34, 95% CI 0.94 to 1.92).
A high intake of dietary long-chain n-3 PUFAs may be associated with a reduced risk of UC. In contrast, high intake of trans-unsaturated fats may be associated with an increased risk of UC.
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