Clinical oncology最新文献_第6页

Long-Term Weight Loss After Head and Neck Radiotherapy: Especially Considering Survivorship and Quality of Life 头颈部放射治疗后的长期体重减轻：特别考虑生存和生活质量

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-10-10 DOI: 10.1016/j.clon.2025.103955

S. Haider

引用次数: 0

CODAK: Real-World Clinical Outcomes of Patients With Unresectable, Stage III Non–Small Cell Lung Cancer Treated With Durvalumab After Chemoradiotherapy in the United Kingdom CODAK：在英国化疗后使用Durvalumab治疗不可切除的III期非小细胞肺癌患者的真实世界临床结果

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-10-09 DOI: 10.1016/j.clon.2025.103949

K. Franks , D. Smith , P. Shaw , G.L. Banna , M. Cominos , T. Talbot , B.T. Blak , L. Lindqvist-Brown , M. Ahmed

Aims

The aim of this study was to describe the clinical outcomes, demographics, and clinical characteristics of patients with locally advanced, unresectable, stage III non–small cell lung cancer (NSCLC) treated with durvalumab as part of the UK early access programme or post reimbursement.

Materials and methods

CODAK (NCT04667312) was a multicentre, noninterventional, cohort study of patients (N = 114) with locally advanced, unresectable, stage III NSCLC initiated on durvalumab between 1 September 2017 and 31 December 2019 following concurrent or sequential chemoradiotherapy (CRT) in the UK, with retrospective data collection from 10 clinical centres. The primary outcome was the real-world overall survival (rwOS) rate at 12 and 24 months post durvalumab initiation.

Results

Of the 114 patients included, 47 (41.2%) were aged ≥70 years and 67 (58.7%) were male. Median follow-up time from durvalumab initiation was 22 months. The 12-month rwOS rate was 80.2% (95% confidence interval [CI]: 73.1-88.0), and the 24-month rate was 63.0% (54.1-73.4). Median rwOS was 35.9 months (95% CI: 35.9 to not reached [NR]) in the overall cohort. Before durvalumab initiation, 85.1% (97/114) received concurrent CRT and 13.2% (15/114) received sequential CRT (two unknown). In the overall cohort, median real-world progression-free survival was 28.5 months (95% CI: 16.4-NR). The median time to durvalumcab treatment discontinuation was 8.7 months (95% CI: 6.2-11.2). Thirty-three patients (28.9%) discontinued durvalumab treatment due to adverse events (AEs). Pneumonitis/interstitial lung disease (ILD) was the most common AE leading to discontinuation among all patients (19/114 [16.7%]). Eleven patients (9.6%) had at least one interruption due to pneumonitis/ILD.

Conclusion

CODAK provides data from the UK that add to real-world evidence showing that durvalumab following CRT is an effective standard of care for patients with unresectable, stage III NSCLC.

本研究的目的是描述局部晚期，不可切除的III期非小细胞肺癌（NSCLC）患者的临床结果，人口统计学和临床特征，作为英国早期准入计划或后报销计划的一部分，durvalumab治疗。scodak （NCT04667312）是一项多中心、非介入性队列研究，研究对象为2017年9月1日至2019年12月31日期间在英国接受同步或顺序放化疗（CRT）后开始使用durvalumab治疗的局部晚期、不可切除的III期NSCLC患者（N = 114），回顾性收集了来自10个临床中心的数据。主要终点是杜伐单抗开始治疗后12个月和24个月的真实总生存率（rwOS）。结果114例患者中，年龄≥70岁的47例（41.2%），男性67例（58.7%）。durvalumab起始的中位随访时间为22个月。12个月rwOS率为80.2%(95%可信区间[CI]: 73.1 ~ 88.0)， 24个月rwOS率为63.0%（54.1 ~ 73.4）。在整个队列中，中位生存期为35.9个月（95% CI: 35.9至未达到[NR]）。在durvalumab起始治疗前，85.1%（97/114）接受并行CRT， 13.2%（15/114）接受序贯CRT（2例未知）。在整个队列中，实际无进展生存期中位数为28.5个月（95% CI: 16.4-NR）。杜伐单抗停止治疗的中位时间为8.7个月（95% CI: 6.2-11.2）。33名患者（28.9%）因不良事件（ae）停止了杜伐单抗治疗。肺炎/间质性肺疾病（ILD）是导致所有患者停药的最常见AE（19/114[16.7%]）。11名患者（9.6%）因肺炎/ILD至少有一次中断。结论：codak提供的来自英国的数据增加了现实世界的证据，表明durvalumab在CRT后是不可切除的III期NSCLC患者的有效标准护理。

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引用次数: 0

Association Between Dose Reduction of Cyclin-dependent Kinase 4/6 Inhibitors and Survival in Advanced Breast Cancer: A Systematic Review and Meta-analysis 周期蛋白依赖性激酶4/6抑制剂剂量减少与晚期乳腺癌患者生存之间的关系：一项系统综述和荟萃分析

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-10-08 DOI: 10.1016/j.clon.2025.103950

F. Petrelli , A. Ghidini , L. Dottorini

Aims

The integration of cyclin-dependent kinase 4/6 (CDK4/6) inhibitors into the treatment regimen for advanced breast cancer (BC), specifically oestrogen receptor–positive (ER+) subtypes, marks a significant stride in oncological therapy. These inhibitors have demonstrated substantial clinical benefits and are generally well tolerated compared to other targeted therapies. Our study evaluated the effects of dosage reductions on progression-free survival (PFS) and overall survival (OS) in patients undergoing CDK4/6 inhibitor therapy.

Materials and Methods

We conducted an exhaustive literature review across several databases, including PubMed, Embase, and Cochrane, considering studies published up to September 30, 2023. The selection criteria were based on the Patients Interventions Comparisons Outcomes (PICOS) framework, focussing on studies involving ER+ BC patients treated with CDK4/6 inhibitors in combination with endocrine therapy. Both retrospective and prospective studies were included involving adult patients treated with standard doses of CDK4/6 inhibitors for approved indications.

Results

The systematic review included 33 retrospective studies and one phase 2 study, encompassing 7,767 patients. Analysis revealed significant improvements in both OS (hazard ratio [HR] = 0.75, 95% confidence interval [CI]: 0.61-0.93; P < .01) and PFS (HR = 0.87, 95% CI: 0.76-0.98; P = .02) among patients who underwent dosage reduction. The data exhibited low heterogeneity across studies, strengthening the reliability of our findings.

Conclusion

Our research provides valuable insights into the dosage optimisation of CDK4/6 inhibitors and its impact on patient outcomes. The findings suggest that when clinically indicated, dose reductions do not compromise treatment efficacy and may even improve survival outcomes. These results offer a promising direction for future clinical practices and research in oncology, particularly in personalising treatment approaches for patients with ER+ advanced BC.

目的：将细胞周期蛋白依赖性激酶4/6 （CDK4/6）抑制剂整合到晚期乳腺癌（BC）的治疗方案中，特别是雌激素受体阳性（ER+）亚型，标志着肿瘤治疗的重大进展。与其他靶向治疗相比，这些抑制剂已显示出实质性的临床益处，并且通常耐受性良好。我们的研究评估了剂量减少对接受CDK4/6抑制剂治疗的患者的无进展生存期（PFS）和总生存期（OS）的影响。材料和方法：我们对包括PubMed、Embase和Cochrane在内的多个数据库进行了详尽的文献综述，考虑了截至2023年9月30日发表的研究。选择标准基于患者干预比较结果（PICOS）框架，重点是涉及ER+ BC患者的CDK4/6抑制剂联合内分泌治疗的研究。回顾性和前瞻性研究纳入了使用标准剂量CDK4/6抑制剂治疗经批准适应症的成年患者。结果：系统评价纳入33项回顾性研究和1项2期研究，共纳入7767例患者。分析显示，减量组患者的OS（风险比[HR] = 0.75, 95%可信区间[CI]: 0.61-0.93; P < 0.01）和PFS （HR = 0.87, 95% CI: 0.76-0.98; P = 0.02）均有显著改善。各研究的数据异质性较低，增强了我们研究结果的可靠性。结论：我们的研究为CDK4/6抑制剂的剂量优化及其对患者预后的影响提供了有价值的见解。研究结果表明，当临床指征时，减少剂量不会影响治疗效果，甚至可能改善生存结果。这些结果为未来的临床实践和肿瘤学研究提供了一个有希望的方向，特别是在ER+晚期BC患者的个性化治疗方法方面。

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引用次数: 0

When to Hold and When to Fold: The Clinical Approach to Locoregional Recurrence After Curative Treatment of Solid Cancers. 什么时候握，什么时候折：实体癌根治后局部复发的临床方法。

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-10-08 DOI: 10.1016/j.clon.2025.103951

N Joseph, P J Hoskin

Although retreatment of locoregional recurrence offers a critical window of opportunity for curative intervention, it poses a significant clinical challenge due to its complex nature and the scarcity of high-level evidence to guide optimal treatment. This article provides a clinical perspective on approaches to salvage treatment, emphasising the need for personalised strategies. Key considerations include determining the intent of treatment (curative vs palliative), differentiating between true recurrence and de novo primary tumours, and understanding the impact of previous treatments on salvage options. The role of adjuvant and neoadjuvant systemic therapy is also discussed, highlighting the need for further research in this area.

虽然局部复发的再治疗为治疗性干预提供了一个关键的机会窗口，但由于其复杂性和缺乏指导最佳治疗的高水平证据，它构成了一个重大的临床挑战。这篇文章提供了抢救治疗方法的临床观点，强调个性化策略的必要性。关键考虑因素包括确定治疗意图（治愈性与姑息性），区分真正复发和新生原发性肿瘤，以及了解既往治疗对挽救选择的影响。本文还讨论了辅助和新辅助全身治疗的作用，强调了该领域进一步研究的必要性。

引用次数: 0

The Delivery of Stereotactic Radiosurgery for Intracranial Metastatic Disease: Insights from a Survey of UK Hospitals Through the Tessa Jowell Academy 立体定向放射手术治疗颅内转移性疾病：通过Tessa Jowell学院对英国医院的调查得出的见解

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-10-06 DOI: 10.1016/j.clon.2025.103947

J. King , C. Barker , A. Wright , B. Allen , N. Huskens , J. Cahill

Aims

The use of stereotactic radiosurgery (SRS) to treat patients with intracranial metastatic disease is increasing. Despite efforts to standardise practice across the centres delivering SRS in the UK, evidence suggests that patient selection, treatment volumes, and clinical practice vary significantly. This study aimed to understand the current SRS service provision and identify challenges to support more consistent, high-quality care.

Materials and methods

In 2023, the Tessa Jowell Academy SRS working group distributed a national survey to centres delivering SRS for brain metastases. The survey covered service configuration, treatment protocols, imaging practices, and challenges. Responses were collected from October 2023 to March 2024, with 20 centres participating (17 in England, two in Scotland, and one in Wales).

Results

Substantial variation was reported in service size and delivery. Weekly SRS multidisciplinary team caseloads ranged 3 to 25 patients, and referral rates (adjusted to catchment area) varied five-fold. Most centres used Linac systems (n = 15), followed by Gamma Knife (n = 4) and Cyberknife (n = 3); only two centres had multiple machine types. Six of the 20 centres (30%) referred patients externally, mainly for Gamma Knife treatment. Treatment criteria varied widely: centres treated from ≤5 to >50 lesions, with maximum treated volumes for a single fraction varying substantially. The time from imaging to treatment ranged from within the same day to within two weeks. Variation was also noted in approaches to radionecrosis imaging, treatment margins, and steroid use.

The key challenges reported included workforce capacity (reported by 50% of centres), imaging access (40%), and inappropriate referrals (15%). Encouragingly, five centres (25%) reported no major barriers to service delivery.

Conclusion

The findings highlight a significant variation in SRS practice across the UK. The Tessa Jowell Academy will use these insights to promote standardisation, support clinical teams, and reduce unwarranted variation—ensuring equitable access to high-quality SRS for patients with brain metastases.

目的立体定向放射外科（SRS）治疗颅内转移性疾病的应用越来越多。尽管在英国各个提供SRS的中心努力使实践标准化，但有证据表明，患者选择、治疗量和临床实践差异很大。本研究旨在了解当前SRS服务的提供，并确定支持更一致、高质量护理的挑战。材料和方法2023年，Tessa Jowell学院SRS工作组向提供脑转移SRS的中心分发了一项全国性调查。调查涵盖了服务配置、治疗方案、成像实践和挑战。从2023年10月到2024年3月，共有20个中心参与调查（17个在英格兰，2个在苏格兰，1个在威尔士）。结果在服务规模和交付方面报告了实质性的变化。每周SRS多学科小组病例量为3至25例，转诊率（根据集水区调整）变化了5倍。大多数中心使用直线系统（n = 15），其次是伽玛刀（n = 4）和射波刀（n = 3）；只有两个中心有多种机器类型。20个中心中有6个（30%）将患者转介到外部，主要是进行伽玛刀治疗。治疗标准差异很大：治疗中心从≤5到50个病变，单个部分的最大治疗体积差异很大。从成像到治疗的时间从同一天到两周不等。在放射性坏死成像方法、治疗范围和类固醇使用方面也存在差异。报告的主要挑战包括劳动力能力（50%的中心报告），成像访问（40%）和不适当的转诊（15%）。令人鼓舞的是，五个中心（25%）报告在提供服务方面没有重大障碍。结论：研究结果强调了英国各地SRS实践的显著差异。Tessa Jowell学院将利用这些见解来促进标准化，支持临床团队，减少不必要的变化，确保脑转移患者公平获得高质量的SRS。

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引用次数: 0

Oncoflash Oncoflash。

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-09-29 DOI: 10.1016/j.clon.2025.103946

F. Holt , R. Simoes

引用次数: 0

The BRAFV600E Mutation Enhances Age-Based Prognostic Stratification in Radioiodine-Treated Papillary Thyroid Cancer: A Retrospective Cohort Study BRAFV600E突变增强了放射性碘治疗的甲状腺乳头状癌基于年龄的预后分层：一项回顾性队列研究

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-09-24 DOI: 10.1016/j.clon.2025.103945

J. Cao , H. Liang , X. Li , X. Guan , Y.Z. Ma , J. Li

Aims

To evaluate whether BRAF^V600E mutation status enhances the value of age in predicting clinical outcomes for papillary thyroid carcinoma (PTC) patients receiving radioactive iodide (RAI) therapy.

Materials and methods

We conducted a retrospective analysis of 1160 PTC patients treated with RAI therapy. Patients were stratified by age (≤18, 18-55, and ≥55 years) and BRAF^V600E status. Clinicopathological characteristics, treatment responses, and risk factors for poor outcomes (biochemical/structural incomplete response biochemical incomplete response/structural incomplete response [BIR/SIR]) were analysed using logistic regression.

Results

BRAF^V600E-positive patients aged ≤18 years showed aggressive features, including larger tumour size, higher lymph node metastasis rates, elevated thyroglobulin levels (TgAb-negative), and worse 6-month/3-year outcomes (all P < .05). Multivariate analysis confirmed high-risk subtypes, distant metastasis, and elevated Tg levels as independent BIR/SIR predictors. BRAF^V600E-negative patients showed no significant age-related clinical characteristics and outcomes (P > .05).

Conclusion

BRAF^V600E mutation status significantly modifies the impact of age in PTC patients with RAI therapy. Patients aged ≤18 years with BRAF^V600E-positive exhibit distinct aggressive behaviours and poorer RAI therapy responses. These findings support integrating BRAF^V600E testing with age stratification to refine risk assessment and therapeutic strategies.

目的评价BRAFV600E突变状态是否增强了年龄在预测接受放射性碘化物（RAI）治疗的甲状腺乳头状癌（PTC）患者临床预后中的价值。材料与方法我们对1160例接受RAI治疗的PTC患者进行回顾性分析。患者按年龄（≤18岁、18-55岁和≥55岁）和BRAFV600E状态进行分层。采用logistic回归分析临床病理特征、治疗反应和不良结局的危险因素（生化/结构不完全缓解生化不完全缓解/结构不完全缓解[BIR/SIR]）。结果≤18岁brafv600e阳性患者表现为肿瘤体积较大、淋巴结转移率较高、甲状腺球蛋白水平升高（tgab阴性）、6个月/3年预后较差（P < 0.05）。多因素分析证实高危亚型、远处转移和Tg水平升高是独立的BIR/SIR预测因子。brafv600e阴性患者无明显的年龄相关临床特征和结局（P > 0.05）。结论brafv600e突变状态显著改变年龄对RAI治疗PTC患者的影响。年龄≤18岁的brafv600e阳性患者表现出明显的攻击行为和较差的RAI治疗反应。这些发现支持将BRAFV600E检测与年龄分层相结合，以完善风险评估和治疗策略。

{"title":"The BRAFV600E Mutation Enhances Age-Based Prognostic Stratification in Radioiodine-Treated Papillary Thyroid Cancer: A Retrospective Cohort Study","authors":"J. Cao , H. Liang , X. Li , X. Guan , Y.Z. Ma , J. Li","doi":"10.1016/j.clon.2025.103945","DOIUrl":"10.1016/j.clon.2025.103945","url":null,"abstract":"<div><h3>Aims</h3><div>To evaluate whether BRAF<sup>V600E</sup> mutation status enhances the value of age in predicting clinical outcomes for papillary thyroid carcinoma (PTC) patients receiving radioactive iodide (RAI) therapy.</div></div><div><h3>Materials and methods</h3><div>We conducted a retrospective analysis of 1160 PTC patients treated with RAI therapy. Patients were stratified by age (≤18, 18-55, and ≥55 years) and BRAF<sup>V600E</sup> status. Clinicopathological characteristics, treatment responses, and risk factors for poor outcomes (biochemical/structural incomplete response biochemical incomplete response/structural incomplete response [BIR/SIR]) were analysed using logistic regression.</div></div><div><h3>Results</h3><div>BRAF<sup>V600E</sup>-positive patients aged ≤18 years showed aggressive features, including larger tumour size, higher lymph node metastasis rates, elevated thyroglobulin levels (TgAb-negative), and worse 6-month/3-year outcomes (all <em>P</em> < .05). Multivariate analysis confirmed high-risk subtypes, distant metastasis, and elevated Tg levels as independent BIR/SIR predictors. BRAF<sup>V600E</sup>-negative patients showed no significant age-related clinical characteristics and outcomes (<em>P</em> > .05).</div></div><div><h3>Conclusion</h3><div>BRAF<sup>V600E</sup> mutation status significantly modifies the impact of age in PTC patients with RAI therapy. Patients aged ≤18 years with BRAF<sup>V600E</sup>-positive exhibit distinct aggressive behaviours and poorer RAI therapy responses. These findings support integrating BRAF<sup>V600E</sup> testing with age stratification to refine risk assessment and therapeutic strategies.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"48 ","pages":"Article 103945"},"PeriodicalIF":3.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145248008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical Impact of Next-Generation Sequencing–Guided Targeted Therapies in Advanced Cancer: A Systematic Review and Meta-Analysis 新一代测序引导的靶向治疗对晚期癌症的临床影响：系统回顾和荟萃分析。

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-09-23 DOI: 10.1016/j.clon.2025.103943

F. Kazmi , R. Katyal , T.F.D. Liu , P. Gkogkou , S.P. Blagden , S. Lord , D. Dodwell , N. Shrestha

Aims

Precision oncology, driven by next-generation sequencing (NGS), enables the use of matched targeted therapies (MTTs) tailored to tumour-specific genomic alterations. While benefits in early-stage cancer are well-established, the impact of MTTs in relapsed or metastatic settings remains unclear. This systematic review and meta-analysis (PROSPERO ID: CRD42023471466) evaluates the efficacy and safety of NGS-guided MTTs in patients with advanced solid and haematological tumours.

Materials and methods

Searches of CENTRAL, MEDLINE, EMBASE (to 30 October 2024), reference lists, and conference proceedings identified randomized controlled trials (RCTs) comparing NGS-guided MTTs (alone or combined with standard of care systemic treatment [SOC]) versus SOC alone in patients with advanced cancers that had progressed after at least one prior systemic therapy. Primary outcomes were progression-free survival (PFS), overall survival (OS), and grade ≥3 adverse events. Data extraction and bias assessment were conducted independently by two reviewers. Random-effects meta-analysis was performed using the DerSimonian-Laird method.

Results

Thirty RCTs (7393 patients) were included that collectively enrolled patients with eight different cancer types. With a median follow-up ranging from 12 months to 62.3 months, MTTs were associated with a 30–40% reduction in the risk of disease progression. No consistent OS benefit was observed with MTT monotherapy. However, combining MTTs with SOC resulted in improved OS, particularly in patients with prostate and urothelial cancer, but conferred PFS gain without OS improvement in those with breast and ovarian cancer. In terms of adverse events, we observed MTTs increased toxicity risk compared to SOC, specifically, in combination regimens. Most studies were at high risk of bias, with performance and detection bias being common limitations.

Conclusion

NGS-guided MTTs significantly enhance PFS, especially when combined with SOC, with OS benefits being more tumour-specific. Increased toxicity rates with MTTs underscore the need for careful in patient selection. Furthermore, genomic profiling should be routinely integrated into the management of patients with advanced or recurrent cancers.

目的：在下一代测序（NGS）的推动下，精确肿瘤学能够使用针对肿瘤特异性基因组改变的匹配靶向治疗（MTTs）。虽然对早期癌症的益处是公认的，但mtt对复发或转移性癌症的影响仍不清楚。这项系统综述和荟萃分析（PROSPERO ID: CRD42023471466）评估了ngs引导的mtt治疗晚期实体和血液肿瘤患者的疗效和安全性。材料和方法：检索CENTRAL， MEDLINE， EMBASE（至2024年10月30日），参考文献列表和会议记录，确定了随机对照试验（rct），比较ngs引导的MTTs（单独或联合标准护理系统治疗[SOC]）与单独SOC在至少一次既往系统治疗后进展的晚期癌症患者中的疗效。主要结局是无进展生存期（PFS）、总生存期（OS）和≥3级不良事件。数据提取和偏倚评估由两名审稿人独立进行。随机效应荟萃分析采用dersimonan - laird方法。结果：共纳入30项随机对照试验（7393例患者），共纳入8种不同癌症类型的患者。中位随访时间为12个月至62.3个月，mtt与疾病进展风险降低30-40%相关。MTT单药治疗未观察到一致的OS获益。然而，mtt联合SOC改善了OS，特别是前列腺癌和尿路上皮癌患者，但在乳腺癌和卵巢癌患者中，PFS增加而OS没有改善。在不良事件方面，我们观察到与SOC相比，mtt增加了毒性风险，特别是在联合方案中。大多数研究存在高偏倚风险，性能和检测偏倚是常见的局限性。结论：ngs引导的mtt可显著提高PFS，特别是与SOC联合使用时，OS获益更具肿瘤特异性。mtt的毒性增加强调了谨慎选择患者的必要性。此外，基因组分析应常规纳入晚期或复发癌症患者的管理。

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引用次数: 0

The Use of Molecular Tools for Identifying and Guiding Treatment of Cancers of Unknown Primary: A Systematic Review 使用分子工具识别和指导治疗未知原发癌症：系统综述

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-09-22 DOI: 10.1016/j.clon.2025.103944

S. Saibil , X. Yao , D. Sivajohanathan , M.D. Deodat , M. Vickers , P. Wheatley-Price , J.-Y. Yoon , H. Feilotter

Background

Cancer of unknown primary (CUP) represents a significant clinical challenge due to its heterogeneity and the poor prognosis often associated with the disease. Molecular profiling has emerged as a promising approach to address the challenges associated with CUP. This systematic review evaluates the existing evidence on the value of different types of molecular tools for CUP diagnosis and treatment.

Methods

MEDLINE, EMBASE and Cochrane Database of Systematic Reviews published between 2013 and 2024 were searched for shortlisting eligible studies, relating to the use of molecular profiling tests in clinical management of CUP patients. Eight studies are included in this review.

Results

Among 1556 publications from the literature search, four randomized controlled trials (RCTs), one comparative study, two single-arm studies reporting comparative data, and one diagnostic study were included.

The certainty of the aggregate evidence ranged from low to very low for the studies, as assessed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Studies using contemporary methods to determine tumour of origin or tumour agnostic actionable mutations demonstrated the positive impact on survival of CUP patients with access to targeted therapy and immunotherapy.

Conclusions

This systematic review highlights the complexities of the existing literature in patients with CUP. The published impact of molecular profiling tools on survival outcomes by guiding treatment has been limited due to study design; however, improved survival has been shown in patients who have received immunotherapy or targeted therapy. The results from future RCTs or high-quality comparative studies will clarify the role of molecular profiling tools in patients with CUP.

未知原发癌（CUP）由于其异质性和预后不良，是一个重大的临床挑战。分子谱分析已成为解决CUP相关挑战的一种有前途的方法。本系统综述评估了不同类型的分子工具对CUP诊断和治疗价值的现有证据。方法检索2013年至2024年间发表的medline、EMBASE和Cochrane系统评价数据库，筛选与在CUP患者临床管理中使用分子谱检测相关的合格研究。本综述纳入了8项研究。结果在文献检索的1556篇出版物中，包括4项随机对照试验（rct）、1项比较研究、2项报告比较数据的单臂研究和1项诊断研究。通过推荐、评估、发展和评价分级（GRADE）方法评估，这些研究的总证据的确定性从低到极低不等。使用现代方法确定肿瘤起源或肿瘤不可知的可操作突变的研究表明，获得靶向治疗和免疫治疗对CUP患者的生存有积极影响。结论本系统综述强调了CUP患者现有文献的复杂性。由于研究设计的原因，已发表的分子谱分析工具通过指导治疗对生存结果的影响有限；然而，接受免疫治疗或靶向治疗的患者生存率有所提高。未来的随机对照试验或高质量比较研究的结果将阐明分子谱分析工具在CUP患者中的作用。

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引用次数: 0

Quality of Decision-making at Oncology Multidisciplinary Team Meetings: A Structured Observational Study 肿瘤学多学科小组会议决策质量：一项结构化观察研究。

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-09-22 DOI: 10.1016/j.clon.2025.103942

Y. Koo , J. Shafiq , J. Yanga , S. Avery , S.K. Vinod

Aims

Multidisciplinary meetings (MDMs) are crucial in cancer care, with increasing attention on improving the quality of decision-making. Validated tools have been utilised to assess MDM performance internationally. However, no studies have been performed within the Australian context. This study evaluates the quality of decision-making at oncology MDMs across three affiliated academic institutions in Australia.

Materials and methods

This prospective observational study encompassed 14 different MDMs across three cancer centres in South Western Sydney Local Health District, NSW, Australia. Two trained observers observed four randomly chosen MDMs per tumour site, assessing the information quality and the team contributions, using the validated Metric for the Observation of Decision-Making (MDT-MODe) tool. Behaviours were scored on a Likert scale from 1 (behaviour contrary to the defined optimum) to 5 (evidence-based optimal behaviour).

Results

A total of 64 MDMs (N = 498 patients) were observed, with an average of seven cases per meeting (range: 2-15). Management decisions were made in 99% of the cases. Psychosocial factors (Mean (M) = 1.27, standard deviation [SD] = 0.70), comorbidities (M = 1.69, SD = 1.13) and patient's views (M = 1.12, SD = 0.51) were less comprehensively addressed compared to radiology (M = 4.10, SD = 1.52), pathology (M = 3.73, SD = 1.54) and patient history (M = 4.60, SD = 0.73) (P < 0.05). Regarding disciplinary contributions, cancer specialist nurses scored considerably lower (M = 1.04, SD = 0.38) compared to other team members (P < 0.05). The quality of information was consistent across MDMs, with mean scores of 2.5 to 2.99, however quality of team contributions varied more significantly.

Conclusion

Evaluating MDMs using a validated tool provides valuable insights into decision-making quality across MDMs. There was a consistent high standard of comprehensive medical information presented, but team contributions varied and psychosocial issues, comorbidities and patient preferences were less well considered. These findings provide an opportunity for offering feedback to MDMs, facilitating the identification of potential interventions to improve the quality of decision-making.

目的：多学科会议（MDMs）在癌症治疗中至关重要，越来越多的人关注提高决策质量。国际上已经使用了经过验证的工具来评估MDM性能。然而，没有在澳大利亚范围内进行研究。本研究评估了澳大利亚三个附属学术机构肿瘤学MDMs的决策质量。材料和方法：这项前瞻性观察性研究包括澳大利亚新南威尔士州西南悉尼地方卫生区三个癌症中心的14个不同的mdm。两名训练有素的观察员观察了每个肿瘤部位随机选择的四个mdm，使用经过验证的决策观察度量（MDT-MODe）工具评估信息质量和团队贡献。行为按照李克特量表评分，从1（与定义的最佳行为相反）到5（循证最佳行为）。结果：共观察MDMs 64例（N = 498例），平均每次会议7例（范围：2 ~ 15例）。在99%的案例中，管理层都做出了决定。与影像学（M = 4.10, SD = 1.52）、病理（M = 3.73, SD = 1.54）和病史（M = 4.60, SD = 0.73）相比，对心理社会因素（Mean (M) = 1.27，标准差[SD] = 0.70）、合并症（M = 1.69, SD = 1.13）和患者观点（M = 1.12, SD = 0.51）的研究不够全面（P < 0.05）。在学科贡献方面，癌症专科护士得分明显低于其他团队成员（M = 1.04, SD = 0.38）（P < 0.05）。信息的质量在mdm中是一致的，平均得分在2.5到2.99之间，但是团队贡献的质量变化更显著。结论：使用一种经过验证的工具来评估mdm，为mdm的决策质量提供了有价值的见解。提供的综合医疗信息始终是高标准的，但团队的贡献各不相同，心理社会问题、合并症和患者偏好没有得到很好的考虑。这些发现为向发展中国家提供反馈提供了机会，有助于确定潜在的干预措施，以提高决策质量。

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引用次数: 0