Tag: statistics

Cancer Causes Control. 2026 Jan 21;37(2):33. doi: 10.1007/s10552-025-02099-9.

ABSTRACT

PURPOSE: To examine the relationship between guideline-concordant breast cancer care and hazard of cancer death by patient race and ethnicity.

METHODS: We used SEER-Medicare data to identify 212,555 older women diagnosed with invasive breast cancer between 2000 and 2017. Guideline-concordant diagnostic workup, locoregional treatment, and initiation of systemic therapy were defined using NCCN guidelines. Hazards of breast cancer death 2 and 5 years from diagnosis by each guideline-concordance outcome overall and stratified by race and ethnicity were estimated using Cox proportional hazards models.

RESULTS: Non-concordant diagnostic workup, locoregional treatment, and systemic therapy initiation were each associated with increased hazards of 2- and 5-year breast cancer mortality (diagnostics HR_2-year (95% CI) 1.33 (1.25-1.41), HR_5-year 1.29 (1.23-1.35); locoregional HR_2-year 2.10 (1.98-2.23), HR_5-year 1.83 (1.76-1.90); systemics HR_2-year 1.67 (1.51-1.84), HR_5-year 1.56 (1.45-1.68)). Non-concordant diagnostic workup and systemic therapy initiation were associated with greater hazard of 2- and 5-year breast cancer death among Black, Asian/Pacific Islander, Hispanic White, and non-Hispanic White patients; there was no consistent association among American Indian/Alaska Native patients for either outcome. Locoregional treatment was strongly associated with hazards of cancer death for all groups.

CONCLUSION: Equitable delivery of guideline-recommended breast cancer care from diagnosis through treatment across racial and ethnic groups may mitigate survival disparities. Efforts to improve access to high-quality care must be informed by and responsive to the social and structural root causes of health inequities.

PMID:41563590 | DOI:10.1007/s10552-025-02099-9

Support Care Cancer. 2026 Jan 21;34(2):112. doi: 10.1007/s00520-026-10343-4.

ABSTRACT

BACKGROUND: Early phase clinical trials (EP-CTs) investigate novel therapeutic approaches for patients with cancer, but little is known about patterns of supportive care service utilization and advance care planning (ACP) in this population. We sought to characterize these features in an EP-CT population and evaluate associations among receipt of supportive care services and ACP documentation.

METHODS: We retrospectively reviewed the electronic health record (EHR) of consecutive patients enrolled in EP-CTs at Massachusetts General Hospital from 01/01/17-12/30/19. We abstracted sociodemographics, performance status (Eastern Cooperative Oncology Group [ECOG] score), oncology history, trial details, as well as receipt and timing of six supportive care services (palliative care [PC], social work [SW], spiritual services [SS], parental support [PS], physical therapy [PT], and nutrition). We additionally abstracted receipt and timing of ACP documentation (defined as any EHR-documented conversation addressing illness understanding or values, preferences, or goals for future medical care, as identified using a structured keyword search). We then separately examined associations between receipt of any supportive care service and ACP documentation, number of supportive care services received and ACP documentation, and subtype of supportive care received and ACP documentation. These analyses used logistic regression models adjusted for age, sex, cancer type, and performance status.

RESULTS: During our study period, 376 patients participated in EP-CTs (median age 63.0 years, 55.9% female, 97.3% stage 4, median ECOG 1, median follow-up: 223 days, median time from diagnosis to EP-CT: 844 days). Nearly all received at least one type of supportive care across their illness trajectory (88.0%), with varied rates by service type (PC: 54.8%, SW: 64.1%, SS: 39.1%, PS: 8.0%, PT: 54.0%, nutrition: 61.2%). Most also had some form of ACP (73.9%) documented between diagnosis and death. Multivariable regression models demonstrated that receipt of any of the six forms of supportive care was associated with higher likelihood of ACP documentation (odds ratio [OR]: 9.18, 95% confidence interval (CI): 4.49-18.78, p < 0.001). Similarly, we observed associations between number of supportive care services received when considered as a continuous covariate and ACP documentation (OR_{1 service}:1.89, 95%CI:0.90-4.03, p = 0.090; OR_{2 services}: 15.36, 95%CI 5.78-40.78, p < 0.001, OR_{3+ services}: 35.78, 95%CI: 14.35-89.24, p < 0.001). These associations also persisted when considering PC independently (OR_PC = 11.17, 95%CI_PC = 5.76-21.67, p < 0.001) from other supportive care services (OR_other = 5.41, 95%CI_other: 2.64-11.09, p < 0.001).

CONCLUSIONS: In this large cohort of EP-CT participants, most patients received supportive care services and had documented ACP, suggesting trial-related engagement does not impede care delivery. Notably, receipt of supportive care services correlated with ACP documentation. These findings underscore the importance of addressing individual supportive care needs among EP-CT participants.

PMID:41563588 | DOI:10.1007/s00520-026-10343-4

Infect Dis Ther. 2026 Jan 21. doi: 10.1007/s40121-026-01302-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Aging in people with HIV (PWH) is accompanied by an increased burden of multimorbidity and persistent inflammation. Identifying biomarkers that reflect comorbidity risk can help improve long-term care. This study evaluated the association of multimorbidity with GDF-15, sICAM-1, sVCAM-1, and sP-selectin in PWH.

METHODS: A cross-sectional study was performed in two cohorts of adults receiving antiretroviral therapy: a discovery cohort (n = 74) and a validation cohort (Spanish CoRIS network) (n = 150). Median age was 53 years in both cohorts (IQR 44-60 and 45-58), and women represented 19 (25.7%) and 75 (50.0%), respectively. Multimorbidity was defined as ≥ 2 comorbidities, including but not limited to cardiovascular, metabolic, renal, and non-AIDS-defining cancers. Plasma GDF-15, sICAM-1, sVCAM-1, and sP-selectin were quantified by multiplex immunoassay. Associations with log-transformed GDF-15 were assessed using multivariable linear regression including age-multimorbidity ordinal categories, tobacco smoking, and CD4+ nadir.

RESULTS: Multimorbidity prevalence was 48.6% (36) in the hospital cohort and 54.7% (82) in CoRIS. In both cohorts, participants with multimorbidity had significantly higher GDF-15 levels (hospital: 771.5 vs. 390.0 pg/ml; CoRIS: 485.2 vs. 360.1 pg/ml; both p < 0.001). In the hospital cohort, smoking and age-multimorbidity were independently associated with elevated GDF-15, with 26.1% and 16.0% increases per category, respectively (p < 0.05). These associations were confirmed in CoRIS, with 5.44% and 19.0% increases (p < 0.01). CD4+ nadir showed no significant association with GDF-15. No significant associations were observed between multimorbidity and sICAM-1, sVCAM-1, or sP-selectin (all p > 0.05).

CONCLUSIONS: Elevated GDF-15 was consistently associated with multimorbidity in PWH, primarily driven by aging and tobacco smoking. GDF-15 appears to reflect a broader state of multisystem physiological stress than traditional endothelial activation markers, supporting its utility as a biomarker to identify PWH at higher risk of age-related comorbidities and to monitor the impact of modifiable risk factors in clinical care.

PMID:41563586 | DOI:10.1007/s40121-026-01302-x

Cancer Causes Control. 2026 Jan 21;37(2):34. doi: 10.1007/s10552-025-02091-3.

ABSTRACT

PURPOSE: The diet-induced gut microbiota (DI-GM) score captures diet quality relevant to microbial health. However, its association with gynecological cancer (GC) remains unclear. The aim of this study was to investigate the association between DI-GM scores and gynecological cancer risk in U.S. women.

METHODS: We analyzed data from 8,512 adult women aged ≥ 20 years from The U.S. National Health and Nutrition Examination Survey (NHANES) 2011-2018. DI-GM scores reflected intake of 14 food groups classified as beneficial or harmful to gut microbial health. Multivariable survey-weighted logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for covariates.

RESULTS: Women with GC had significantly lower DI-GM scores than those without (mean 4.7 vs. 5.0; p = 0.031). Higher DI-GM scores were associated with reduced GC risk (adjusted OR per unit increase: 0.92; 95% CI 0.87-0.98; p = 0.011). Participants with DI-GM ≥ 6 had 27% lower odds of GC compared to those with scores 0-3 (p = 0.037). The beneficial component of DI-GM was independently associated with lower GC risk. No significant effect modification was observed in stratified analyses.

CONCLUSION: Greater adherence to a microbiota-friendly diet may lower gynecological cancer risk in women.

PMID:41563582 | DOI:10.1007/s10552-025-02091-3

Environ Monit Assess. 2026 Jan 21;198(2):155. doi: 10.1007/s10661-026-14999-7.

ABSTRACT

This article aims to predict the concentration of air pollutants at any unmonitored location based on sparse monitoring points in the monitoring area, thereby achieving the goal of fine-grained air pollution mapping. To learn the spatial distribution characteristics of air pollutants from sparse monitoring data, this article proposes a novel Graph Neural Network (GNN) model called Graph Convolutional Neural Networks on K Neighbors (KN-GCN). Additionally, a data augmentation method is employed to enhance the sparse monitoring data and prevent overfitting of the KN-GCN model during the training process. Moreover, since the ground truth concentration value is unavailable at unmonitored locations, the accuracy of the prediction cannot be measured. Therefore, a training strategy is designed to reflect the unmeasurable accuracy on the metrics of the KN-GCN model. To evaluate the proposed method, a Computational Fluid Dynamics (CFD) simulation experiment and a public dataset experiment are conducted. The results reveal that the proposed method outperforms the baseline methods by an average of 65% and 17.8% in the CFD experiment and public dataset experiment, respectively.

PMID:41563526 | DOI:10.1007/s10661-026-14999-7

Genet Epidemiol. 2026 Feb;50(1):e70031. doi: 10.1002/gepi.70031.

ABSTRACT

A longstanding aim of developmental psychology and epidemiology is to understand the causal effects of parental phenotypes on offspring outcomes. Traditional approaches often fail to account for confounding and reverse causation. We evaluate the use of Mendelian randomisation with non-inherited variants (MR-NIV) to address these limitations. MR-NIV leverages non-inherited genetic variants to instrument the parental phenotype independent of the offspring’s genotype. We used Directed Acyclic Graphs and simulations to validate MR-NIV and explore robustness to assortative mating. In contrast to an alternative MR method which adjusts the parental genotype for offspring genotype, MR-NIV can be robust to assortative mating when used without trio data. In settings without trio data, MR-NIV outperformed the adjustment method. The adjustment method outperformed MR-NIV in settings with trio data. Applying MR-NIV to the Avon Longitudinal Study of Parents and Children, we assessed the causal effect of parental smoking on offspring smoking initiation at age 16. Results were consistent with observational studies, suggesting a meaningful increase in the risk of offspring smoking due to parental smoking. However, larger sample sizes will be necessary to provide a precise answer. MR-NIV offers a promising extension of Mendelian randomisation for studying the developmental environment.

PMID:41562185 | DOI:10.1002/gepi.70031

Ann Saudi Med. 2026 Jan-Feb;46(1):32-41. doi: 10.5144/0256-4947.2026.32. Epub 2026 Jan 22.

ABSTRACT

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) has become the preferred minimally invasive approach for thoracic surgical procedures, with potential advantages over traditional thoracotomy. Perioperative and long-term outcomes between uni-port (U-VATS) versus multi-port (M-VATS) techniques remains under investigation.

OBJECTIVES: To compare U-VATS and M-VATS in terms of operative outcomes, complications, and oncological parameters.

DESIGN: Retrospective cohort study.

SETTING: Single tertiary referral center, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia.

PATIENTS AND METHODS: Adult patients aged 18-75 years who underwent VATS lung resection between January 2015 and September 2024 were included. Pediatric patients and those undergoing open techniques were excluded. Collected data included sociodemographic, preoperative, intraoperative, and postoperative variables. Statistical analysis used t-test, Mann-Whitney U, Chi-square, and multivariate logistic regression.

MAIN OUTCOME MEASURES: Operative time, blood loss, lymph node dissection, postoperative complications, hospital stay, mortality, and recurrence.

SAMPLE SIZE: 194 patients (103 U-VATS, 91 M-VATS).

RESULTS: Baseline characteristics were similar between groups. U-VATS was associated with longer operative time, [mean (SD) 210.0 (110.4) vs. 154.2 (69.9) min, P<.001] and greater blood loss [416.7 (392.2) vs. 150.0 (76.4) ml, P=.034]. Malignant lymph node involvement was higher in U-VATS (39.8% vs. 19.8%, P=.021), with more lymph node stations sampled. Anatomical resections were more common in U-VATS (31.1% vs. 13.2%, P=.005). Complication rates were low, with pneumonia (4.4%) as the most frequent in M-VATS and prolonged air leak (2.9%) in U-VATS. Thirty-day mortality was comparable (17.5% vs. 15.4%). Multivariate analysis showed M-VATS was associated with dissecting more lymph nodes (odds ratio, OR: 1.223; 95% confidence interval, CI: 1.019-1.468; P=.030), while anatomical resections were more likely with U-VATS (OR: 0.40; 95% CI: 0.180-0.740; P=.006).

CONCLUSIONS: Both U-VATS and M-VATS are safe for lung resections. U-VATS is more commonly used for anatomical resections and allows broader lymph node station sampling, supporting its expanding role in thoracic surgery.

LIMITATIONS: Single-center retrospective design, relatively small sample, and incomplete lymph node documentation.

PMID:41562168 | DOI:10.5144/0256-4947.2026.32

Ann Saudi Med. 2026 Jan-Feb;46(1):54-60. doi: 10.5144/0256-4947.2026.54. Epub 2026 Jan 22.

ABSTRACT

BACKGROUND: Fiberoptic bronchoscopy is a crucial diagnostic tool in the evaluation of lung cancer, particularly in tumors with endobronchial involvement. While forceps biopsy, bronchial brushing, and bronchial washing are commonly used, the diagnostic value and optimal timing of bronchial washing remain debatable.

OBJECTIVES: To evaluate the effect of pre- and post-biopsy bronchial washing on cytological diagnostic yield in patients with visible endobronchial lesions.

DESIGN: Prospective diagnostic study.

SETTINGS: Single tertiary university hospital.

MATERIALS AND METHODS: Between April 2018 and April 2021, 55 patients with bronchoscopically visible endobronchial lesions underwent flexible bronchoscopy. Patients with invisible or submucosal tumors were excluded. Bronchial washings were obtained before and after 4-6 forceps biopsies. Cytological analyses were conducted blindly on all specimens. Statistical analysis included Chi-square and McNemar tests, with P<.05 considered significant.

MAIN OUTCOME MEASURES: Cytological diagnostic positivity rates in pre- and post-biopsy bronchial washings.

SAMPLE SIZE: Fifty-five patients.

RESULTS: Forceps biopsy alone achieved a diagnostic yield of 95%, which increased to 96% when combined with bronchial washing. Post-biopsy washing demonstrated a significantly higher cytological positivity rate (47%) than pre-biopsy washing (22%) (P=.002). No complications were observed.

CONCLUSIONS: Bronchial washing after forceps biopsy significantly improves cytological diagnostic yield in endobronchial lung lesions. Its simplicity, low cost, and additional diagnostic yield support its routine use in bronchoscopic evaluation.

LIMITATIONS: Single-center design and relatively small sample size; other cytologic methods such as brushing orendobronchial ultrasound (EBUS) were not evaluated.

PMID:41562167 | DOI:10.5144/0256-4947.2026.54

Ann Saudi Med. 2026 Jan-Feb;46(1):20-31. doi: 10.5144/0256-4947.2026.20. Epub 2026 Jan 22.

ABSTRACT

BACKGROUND: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare and severe autoimmune disease characterized by pauci-immune necrotizing vasculitis.

OBJECTIVES: The study aims to explore the frequency, clinical characteristics, and management of AAV patients in two tertiary centers in the United Arab Emirates (UAE) over 17 years.

DESIGN: A retrospective observational case series.

SETTING: Two tertiary centers in the UAE.

METHODS: Patients diagnosed with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), or eosinophilic granulomatosis with polyangiitis (EGPA) from 2008 to 2024 were included. Demographic, clinical, laboratory, histopathological information, treatment, complications, relapses, and mortality were collected. ANCA testing for anti-proteinase 3 (PR3) and anti-myeloperoxidase (MPO) antibodies was performed using enzyme-linked immunosorbent assays. Descriptive statistical analysis was performed to summarize the data.

MAIN OUTCOME MEASURES: Subtype distribution, organ involvement, ANCA positivity, relapse, and mortality rates.

SAMPLE SIZE: Twenty-six patients.

RESULTS: We identified 26 AAV patients with a median age of 52.5 years. The majority were females (58%, n=15), and half were locals. The most common AAV subtype was microscopic polyangiitis (50%, n=13), followed by granulomatosis with polyangiitis (38%, n=10) and eosinophilic granulomatosis with polyangiitis (12%, n=3). ANCAs tested positive in nearly all of these cases. The most common clinical manifestations of AAV were constitutional symptoms with renal and pulmonary involvement. The induction therapy included corticosteroids, rituximab, cyclophosphamide, mycophenolate mofetil, and plasma exchange. The most prescribed maintenance medications were corticosteroids and azathioprine. The overall relapse rate was 31%, and the overall mortality rate was 19% (n=5).

CONCLUSION: In our cohort, MPA was the most common subtype, being predominantly associated with P-ANCA/MPO-ANCA positivity. Notably, few studies from the Gulf region have addressed this topic. It’s unclear whether this finding reflects low occurrence or potential underdiagnosis and, thus, points to unmet needs and a significant gap in the understanding of AAV. Multicenter studies are needed to validate these results and improve AAV management in Middle Eastern populations.

LIMITATIONS: Retrospective design with small number of participants.

PMID:41562166 | DOI:10.5144/0256-4947.2026.20

Ann Saudi Med. 2026 Jan-Feb;46(1):1-8. doi: 10.5144/0256-4947.2026.1. Epub 2026 Jan 22.

ABSTRACT

BACKGROUND: In pediatric surgical practice, physicians may face malpractice claims leading to substantial compensations and even criminal liability.

OBJECTIVES: To examine the legal processes and responsibilities of physicians by reviewing Supreme Court decisions related to malpractice claims involving pediatric surgeons.

DESIGN AND SETTINGS: A retrospective study based on the online archive of Supreme Court decisions.

PATIENTS AND METHODS: A search was conducted using keywords from the Supreme Court decision search engine. Decisions were reached regarding malpractice claims involving pediatric surgery.

MAIN OUTCOMES MEASURES: The medical procedure that was the subject of the malpractice claim, the resulting damage, the expertise of the physicians, and the reasons for the Supreme Court’s reversal and approval were evaluated.

SAMPLE SIZE: 82 Supreme Court decisions.

RESULTS: Among 82 decisions, circumcision (46%; n=38) was the most common. Appendicitis and testicular torsion followed. Total/subtotal penile amputation was present in 40% (n=15) of circumcisions. Half of the appendicitis cases resulted in death, and all testicular torsion cases resulted in organ loss. General surgeons were the most frequent physicians involved in litigation, accounting for 16% of cases (n=13), followed by pediatric surgeons and general practitioners, each accounting for 15% of cases (n=12). Supreme Courts found physicians at fault in 35% of criminal cases and 38% of civil cases. Deficiencies in expert reports were the reason for reversals in 42% of the decisions.

CONCLUSION: Supreme Courts conduct comprehensive evaluations in malpractice cases, considering factors such as indication, authority, fault status, complication management, and causal link. Physicians’ understanding of these issues will significantly contribute to minimizing malpractice claims.

LIMITATIONS: Retrospective study.

PMID:41562164 | DOI:10.5144/0256-4947.2026.1