Lin Yang

Trend and Cancer-Specific Prevalence of Kidney Stones Among US Cancer Survivors, 2007–2020

Purpose: To evaluate the prevalence and cancer-specific patterns of kidney stones among U.S. cancer survivors compared to non-cancer adults. Methods: This was a serial cross-sectional, descriptive epidemiologic analysis of a US nationally representative sample from the National Health and Nutrition Examination Survey from 2007 to 2020. Weighted prevalence of kidney stones was estimated for both non-cancer adults and cancer survivors by study cycle. Multivariable logistic regression was conducted to examine factors associated with higher probability of kidney stones in both non-cancer adults and cancer survivors. Results: From 2007–2008 to 2017–2020, kidney stone prevalence rose in both non-cancer adults (8.5% to 9.2%, p for trend = 0.013) and cancer survivors (13.1% to 17.3%, p for trend = 0.033). Throughout the study period, prevalence was consistently higher in cancer survivors. The overall prevalence from 2007 to 2020 was 15.8% (95% CI: 14.0–17.5%) in cancer survivors and 9.2% (95% CI: 8.8–9.6%) in non-cancer adults. After adjusting for sociodemographic, lifestyle, and health factors, cancer survivors had higher odds of kidney stones (OR = 1.28, 95% CI: 1.10–1.49). Compared with non-cancer adults, survivors of ovarian (OR = 3.71, 95% CI: 1.77–7.78), kidney (OR = 2.88, 95% CI: 1.46–5.68), bone and soft tissue (OR = 2.86, 95% CI: 1.12–7.30), uterine (OR = 1.94, 95% CI: 1.17–3.22), cervix (OR = 1.68, 95% CI: 1.08–2.61) and prostate (OR = 1.41, 95% CI: 1.06–1.87) cancers were statistically more likely to report kidney stones. The prevalence was numerically highest among survivors of kidney cancer (34.7%), followed by bone and soft tissue (29.9%), ovarian (29.8%), and testicular (26.3%) cancers. Conclusions: The higher prevalence of kidney stones in cancer survivors, with substantial variation by cancer type, highlights the urgent need for effective clinical management of kidney stones in oncology settings and mechanistic research.

Comprehensive Genomic and Immunohistochemical Profiling to Predict Prognosis and Recurrence in Fertility-Sparing Therapy Based on Progesterone for Endometrial Carcinoma

Background Endometrial carcinoma (EC) represents a unique clinical challenge. Fertility-sparing treatments rely on achieving complete response (CR) through progesterone-based therapy. We sought to investigate the prognostic value of molecular subtyping and immunohistochemical (IHC) markers in predicting three-month treatment outcomes and recurrence in EC patients undergoing fertility-sparing therapy. Methods A retrospective cohort of 68 patients diagnosed with early-stage EC received hysteroscopic surgery and conservative treatment whose paraffin-embedded tissue blocks preserved in our hospital between Jan. 2010 and Oct. 2022 was evaluated. Molecular subtyping based on TCGA classification identified low copy-number (CNL), microsatellite instability-high (MSI-H), and copy-number high (CNH) subtypes. IHC markers, including PTEN, PIK3CA, β-catenin, ARID1A, estrogen receptor (ER), and progesterone receptor (PR) were analyzed for their association with CR and recurrence. Transcriptome sequencing gene chips were used to study patients who achieved or did not achieve CR after three months, those who experienced recurrence within one year, and those who did not recur within two years. Differential genes were then mapped to KEGG pathways to explore the underlying mechanisms of progesterone therapy efficacy. Results Among the 68 patients classified through TCGA molecular typing, 65 cases (95.6%) were CNL subtype, two (2.9%) were MSI-H subtype, and one (1.5%) was CNH subtype. Following a three-month treatment, the CR rate for the CNL subtype was 75.4% (49/65), the MSI-H subtype was 50.0% (1/2), and the CNH subtype was 0% (0/1). In CNL subtype endometrial carcinoma, individuals with high PTEN and PR expression were more likely to achieve CR after three months ( P  < .05). Conversely, those with elevated CA199 levels and increased PIK3CA expression were more prone to recurrence after CR. Conclusion MSI-H and p53-mutant subtypes of endometrial carcinoma are not suitable for fertility preservation therapy. PTEN/PI3K-AKT-mTOR pathway activation contributes to reduced progesterone sensitivity, underscoring the need for targeted therapeutic strategies to improve patient outcomes.