Anna Anttalainen

This study investigated the incidence, mortality, and causes of death in Finnish patients with mycosis fungoides (MF) or Sezary syndrome (SS). The study population consisted of 450 patients with MF and 23 with SS and their 1:1 matched controls. Data were collected from nationwide Finnish healthcare registries. The average incidence of MF was 0.38 and of SS 0.02 per 100,000 persons in 2007–2019 and was highest among older adults. Patients with SS had a low 5-year overall survival of 33.5% vs 64.5% in their controls (p = 0.0046), whereas 62.3% of patients with MF were alive 10 years after diagnosis vs 71.4% of their controls (p = 0.0011). SS diagnosis (hazard ratio [HR] 11.85 [5.08, 27.65]; p < 0.001) and higher age (HR 1.07 [1.01, 1.12]; p = 0.01) were risk factors of poorer disease-specific survival. Moreover, patients with MF had a 2.38-fold [1.07, 5.27] risk of thyroid diseases (p = 0.033) and over 1.5-fold [1.17, 2.07] risk of cardiovascular diseases (p = 0.002) compared with controls. In conclusion, in the Finnish population, patients with MF or SS had a higher incidence and mortality and more late comorbidities than controls. More awareness, earlier diagnostic tools, and more effective treat-ment for MF/SS are needed.

Background: Large B-cell lymphomas (LBCLs) form a notable subgroup of lymphomas; however, their associated long-term comorbidities and mortality rates remain under-researched in real-world settings. Material and methods: This nationwide Finnish population-based matched cohort study included virtually all LBCL patients (N = 7,019) diagnosed from 2008 to 2019, alongside age, sex, and region-matched controls (1:1 ratio) without lymphoma. Diagnoses of LBCLs were obtained from the Finnish Cancer Registry, with data linked to additional nationwide registries. Baseline characteristics were summarised using descriptive statistics. Overall survival (OS) was estimated using the Kaplan-Meier method, while Cox regression was used to analyse factors associated with OS and evaluate the risk and associated factors of comorbidities considering the competing risk of death. Results: The 5-year survival rate for LBCL patients, median age 70.7 years and 52.7% male, was 50.0% (95% Confidence Interval [CI] 48.7% – 51.3%), compared to 82.6% (95% CI 81.5% – 83.6%) for controls. Among LBCL patients, older age and a higher Charlson comorbidity index were associated with increased mortality. Conversely, female sex, later diagnosis year, and radiation therapy were associated with improved survival. Patients with LBCL exhibited an elevated risk of long-term comorbidities, including solid tumours, hematological and skin cancers, lung and thyroid diseases, mental and behavioral disorders, and cardiovascular diseases. After 12 years of follow-up, lymphoma accounted for the primary cause of death in approximately 43% of LBCL patients. Interpretation: Large B-cell lymphomas are linked with significant long-term comorbidities and elevated mortality rates.

While KRAS is the most frequently mutated oncogene in non-small cell lung cancer (NSCLC), KRAS-mutant tumors have long been considered difficult to treat and thus, an unmet need still remains. Partly due to the lack of targeted treatments, comprehensive real-world description of NSCLC patients with KRAS mutation is still largely missing in Finland. In this study, all adult patients diagnosed with locally advanced and unresectable or metastatic NSCLC from 1 January 2018 to 31 August 2020 at the Hospital District of Helsinki and Uusimaa were first identified in this retrospective registry-based real-world study. The final cohort included only patients tested with next generation sequencing (NGS) and was stratified by the KRAS mutation status. A total of 383 patients with locally advanced and unresectable or metastatic NSCLC and with NGS testing performed were identified. Patients with KRAS mutation (KRAS G12C n = 35, other KRAS n = 74) were younger than patients without KRAS mutations, were all previous or current smokers, and had more often metastatic disease at diagnosis. Also, these patients had poorer survival, with higher age, Charlson comorbidity index (CCI) being 5 or above, and KRAS G12C being the most significant risk factors associated with poorer survival. This suggests that the patients with KRAS mutation have a more aggressive disease and/or tumors with KRAS mutation are more difficult to treat, at least without effective targeted therapies.

Background: Novel receptor tyrosine kinase inhibitors and immune checkpoint inhibitors have been introduced to the treatment of advanced renal cell carcinoma (aRCC) during the past decade. However, the adoption of novel treatments into clinical practice has been unknown in Finland. Objectives: Our aim was to evaluate the use of systemic treatments and treatment outcomes of aRCC patients in Southwest Finland during 2010–2021. Design and Methods: Clinical characteristics, treatments for aRCC, healthcare resource utilization, and overall survival (OS) were retrospectively obtained from electronic medical records. Patients were stratified using the International Metastatic RCC Database Consortium (IMDC) risk classification. Results: In total, 1112 RCC patients were identified, 336 (30%) patients presented with aRCC, and 57% of them ( n = 191) had received systemic treatment. Pre-2018, sunitinib (79%) was the most common first-line treatment, and pazopanib (17%), axitinib (17%), and cabozantinib (5%) were frequently used in the second-line. Post-2018, sunitinib (52%), cabozantinib (31%), and the combination of ipilimumab and nivolumab (10%) were most commonly used in the first-line, and cabozantinib (23%) in the second-line. Median OS for patients with favorable, intermediate, and poor risk were 61.9, 28.6, and 8.1 months, respectively. A total of 73%, 74%, and 35% of the patients with favorable, intermediate, and poor risk had received second-line systemic treatment. In poor-risk patients, the number of hospital inpatient days was twofold higher compared to intermediate and fourfold higher compared to favorable-risk patients. Conclusion: New treatment options were readily adopted into routine clinical practice after becoming reimbursed in Finland. OS and the need for hospitalization depended significantly on the IMDC risk category. Upfront combination treatments are warranted for poor-risk patients as the proportion of patients receiving second-line treatment is low. Registration: Clinical trial identifier: ClinicalTrials.gov NCT05363072.

Current methods for intraoperative surgical margin assessment are inadequate in terms of diagnostic accuracy, ease-of-use, and speed of analysis. Molecular analysis of tissues could potentially overcome these issues. A system based on differential ion mobility spectrometry (DMS) analysis of surgical smoke has been proposed as one potential method, but to date, it has been able to function in a relatively slow and heavily controlled manner that is inadequate for clinical use. In this study, we present an integrated sensor system that can measure a surgical smoke sample in seconds and relay the information of the tissue type to the user in near real time in simulated surgical use. The system was validated by operating porcine adipose tissue and muscle tissue. The differentiation of these tissues based on their surgical smoke profile with a cross-validated linear discriminant analysis model produced a classification accuracy of 93.1% (N = 1059). The measurements were also classified with a convolutional neural network model, resulting in a classification accuracy of 93.2%. These results indicate that the DMS-based smoke analysis system is capable of rapid tissue identification from surgical smoke produced in freehand surgery.