Current oncology最新文献

Cutaneous squamous cell carcinoma (CSCC) is the second most common skin cancer after basal cell carcinoma. When squamous cell carcinomas in situ are included, nonmelanoma skin cancer incidence is nearly equal between CSCC and basal cell carcinoma. The incidence of CSCC has been increasing worldwide in recent decades, and despite the effectiveness of office-based therapies, patients with high-risk lesions associated with advanced CSCC face high rates of recurrence and mortality. This underscores the importance of accurate diagnoses and clear criteria to define high-risk lesions for prognosis and better treatment strategies. However, variability exists in CSCC registration practices internationally, and differences in pathology reporting likely contribute to an underestimate of the true burden of disease. Thus, there is a need to refine elements included in skin biopsy reports to provide a precise representation of the high-risk features of CSCC to improve patient care. In this review, a multidisciplinary group of Canadian experts discuss clinical considerations and provide key guidance and practical strategies surrounding skin biopsy techniques, completion of requisition forms, and dermatopathology reports for CSCC. This article summarizes the expert panel's recommendations with the goal of improving diagnosis and pathological reporting of biopsy specimens to achieve better patient outcomes for CSCC.

Soft-tissue sarcomas (STSs) are rare malignancies predominantly found in the extremities. Surgery and radiation are standard treatments, but post-operative pulmonary surveillance, involving clinical visits and thoracic imaging, is crucial due to a high recurrence rate, most commonly to the lungs. Current pulmonary surveillance guidelines lack robust evidence. The Surveillance AFter Extremity Tumor SurgerY (SAFETY) randomized controlled trial is designed to determine the impact of pulmonary surveillance frequency (every three versus six months) and chest imaging modality (CXR versus CT) on patient-important outcomes. The pilot phase assessed feasibility of patient enrolment, protocol adherence, and data quality, as well as aggregate outcomes at two years of follow-up. 100 patients were enrolled from 300 screened patients across 17 international sites. Minor protocol deviations were common. Follow-up, data completeness and data quality met the progression criteria of 85%. Of the 100 patients, 15 died, 21 had metastases, seven had local recurrence and 30 experienced at least one serious adverse event. This SAFETY trial study established feasibility of enrolment and data quality, and confirmed the need to emphasize protocol adherence in sarcoma care. The results of this trial are expected to provide crucial evidence to standardize STS pulmonary surveillance practices, ultimately improving patient management and expectations.

The study aimed to understand how patients with liver cancer experience and adapt to the fear of cancer recurrence, providing insights into psychological processes and strategies that can inform psycho-oncology research and interventions. In-depth interviews were conducted with 13 patients with liver cancer from December 2019 to February 2020 and analyzed using Colaizzi's phenomenological method. Four theme clusters emerged: (1) "Inevitable reality of recurrence," which highlighted the acceptance of recurrence; (2) "Amplified fears," which reflected heightened emotional distress; (3) "Changes in daily life driven by fear," which illustrated lifestyle changes driven by uncertainty; and (4) "Living with fear," which described adaptive strategies and resilience. The findings highlight the need for targeted psycho-oncological approaches to address the fear of cancer recurrence in patients with liver cancer, supporting the development of resilience and enhancing their overall quality of life. Further research is essential to design tailored strategies that reduce psychological distress and promote long-term survivorship.

The aim of this study was to explore the longitudinal relationship between death anxiety (DA) and fear of cancer recurrence (FCR) in women newly diagnosed with breast cancer at baseline and 3 months post-discharge. A total of 426 women with breast cancer completed the Templer's Death Anxiety Scale and the Fear of Cancer Recurrence Inventory at hospital discharge and 3 months later. Cross-lagged panel analysis (CLPA) was used to describe the relationship of the two variables (DA and FCR) over time and identify the optimal intervention symptom nodes for breast cancer patients in different stages. The findings suggest that the specific symptoms of DA, known as "cognition", predict the subsequent symptom development for a variety of mental health problems in the network structure. The "Psychological distress" symptom in FCR is the most susceptible to other symptoms. In addition, death-related cognition may be a bridge symptom that connects the co-occurrence of DA and FCR. Death-related "time awareness" is the optimal symptom node for intervention in early-stage breast cancer patients, while it is "cognition" in advanced patients. The death-related cognition and emotional regulation of death may be the best target for interventions among breast cancer patients, considering their DA coincides with FCR. The best intervention for patients with early-stage breast cancer may be the time awareness of death, while it may be more effective for patients with advanced cancer to be educated about disease and death, as well as to enhance correct perception.

Primary urethral cancer is an extremely rare malignancy, accounting for less than 1% of all cancers. Due to its rarity, evidence-based treatment recommendations are lacking. We report the case of a 44-year-old woman with metastatic squamous cell urethral carcinoma and paraneoplastic Sweet syndrome. The tumor was p16-positive with strong PD-L1 expression (CPS > 50%). Following surgery and adjuvant chemoradiotherapy, the patient developed hepatic and lymph node metastases. Pembrolizumab was initiated as first-line systemic therapy because of prior hematologic toxicity with cisplatin. After four cycles, complete radiologic remission of metastases and full resolution of the Sweet syndrome were achieved. This case highlights the potential benefit of immune checkpoint inhibitors in metastatic urethral SCC, particularly in p16-positive and PD-L1-high tumors, suggesting an inflamed and immunogenic microenvironment. To our knowledge, this is the first reported case of paraneoplastic Sweet syndrome successfully treated with pembrolizumab. These findings underscore the need for further investigation of immunotherapy in this rare and challenging malignancy.

Tumor suppressor p53 is essential for maintaining DNA stability and preventing cancer. Under normal conditions, the p53 protein is either degraded or bound to a negative regulator, rendering it inactive, but when DNA damage occurs, p53 is activated, causing cell cycle arrest and allowing time for cellular repair. If, however, DNA damage is too severe, the cell undergoes apoptosis and is eliminated. Mutations in the p53 gene are linked to various types of cancer and are present in 30-40% of human breast cancers, leading to loss of tumor suppressor function and uncontrolled tumor growth. Moreover, in triple-negative breast cancer (TNBC), a particularly deadly form of the disease, the incidence of p53 mutations increases to 70-80%. Many p53 mutations occur in the DNA binding domain of the p53 gene, leading to accumulation of mutant p53 (mtp53) within the cell, and tumor development. Converting mtp53 back to its functional wild-type form (wtp53) is consequently a rational approach to preventing or even reversing tumor growth. Mechanisms of action of tumor suppressor p53 are widely discussed elsewhere; hence, we will focus on our own studies, using small molecule activators of mtp53 to combat breast cancer. We will show that specific small molecules, such as PRIMA-1 (p53 reactivation and induction of mass apoptosis), reactivate mtp53 in hormone-dependent human breast cancer cells. Furthermore, we will demonstrate the effectiveness of PRIMA-1 at arresting xenograft growth in an animal model and go on to show that the PRIMA-1 analog APR-246 effectively restores wtp53 tumor suppressor activity in TNBC cells. A brief overview of current clinical trials aimed at reactivating p53 to treat certain cancers is provided. Finally, we discuss the possible use of naturally occurring compounds, which are generally non-toxic, to reactivate mutant p53 and control TNBC progression.

Purpose: As cancer treatments and survival rates continue to improve, integrating supportive complementary therapies into oncology practice is increasingly important. Identifying patient- and clinic-level considerations can guide the selection and integration of evidence-based and effective therapies. Using the Behavioural Design Space (BDS), this study illustrates how a design framework can facilitate the identification of patient needs, clinic requirements, and system-level constraints prior to implementing a digital meditation tool (DMT). Methods: A cross-sectional survey of cancer patients in active treatment to assess distress, attitudes, barriers, and knowledge of meditation. Descriptive statistics and binary multivariate logistic regressions examined associations between patient characteristics and interest in meditation or using a DMT. Findings were mapped onto the six elements of the BDS framework in consultation with clinic staff. Results: Among 148 patients surveyed, 65% had never meditated, yet 42% expressed interest in using a DMT. Greater engagement in stress-coping activities was the strongest predictor of interest in both learning meditation and using a DMT. Female sex increased, while age decreased, the odds of interest in using a DMT. Conclusions: Integrating complementary therapies into oncology care requires attention to patient, clinic, and system-level factors. The BDS framework can guide the therapy/tool selection process by highlighting patient needs, potential barriers, and implementation challenges. Future work should focus on operationalizing the BDS into a practical decision-making tool for healthcare providers.

Background/objectives: Introduction: Breast cancer remains a leading cause of cancer morbidity and mortality among women, and timely diagnosis is critical for improving outcomes. Organized screening programs strive to function efficiently, with minimal delays; however, evidence indicates that longer waiting times may be present at different stages of the diagnostic process. Few studies have evaluated how socio-demographic, reproductive, lifestyle, and clinical characteristics may influence diagnostic timeliness in a regional screening context.

Materials and methods: We retrospectively analyzed data from 240 women who underwent breast biopsy following abnormal screening assessment, out of 24,000 patients enrolled in a regional breast cancer screening program conducted in Northeastern and Southeastern Romania. Diagnostic timeliness was observed across three consecutive intervals of the screening pathway: mammography to biopsy (T1), biopsy to histopathological confirmation (T2), and cumulative presentation-to-diagnosis time (T3). Baseline population characteristics were described, subgroup comparisons performed, and multivariable regression models applied to identify independent predictors of diagnostic delay and to explore interaction effects at different stages of the screening process.

Results: The interval between mammography and biopsy accounted for the most substantial waiting times (T1 median 24 days). The cumulative time to diagnosis (T3) reached a median of 32 days. Territorial inequalities were the strongest determinant of delay: rural patients experienced approximately five additional days before histopathological confirmation compared with urban patients (p = 0.003). Social vulnerability further contributed to prolonged T1 and T3 intervals, while lifestyle, reproductive, and anthropometric factors showed only minor or inconsistent associations. Interaction analyses revealed that delays linked to rural residence were most pronounced among younger women, an age group at higher risk for aggressive subtypes such as triple-negative breast cancer.

Conclusions: In our findings, regional background and social vulnerability outweighed individual risk factors in shaping total diagnostic time. These results support the careful monitoring of interval-specific performance to strengthen equitable access to biopsy among vulnerable populations, where the effectiveness of early breast cancer detection is often challenged.

Background: Endometriosis affects an estimated 10% of reproductive-aged women and is associated with increased ovarian cancer risk. While BRCA1/2 mutations are established risk factors for ovarian cancer, their association with endometriosis remains unclear. This study aimed to characterize the prevalence and clinical features of endometriosis within a large cohort of BRCA mutation carriers. Methods: A descriptive analysis was conducted using data from a multi-center longitudinal cohort of women with pathogenic BRCA variants. Reproductive history and related factors were collected through self-reported questionnaires and compared. Results: Among 16,950 BRCA carriers, the prevalence of endometriosis was 2.4%. Compared to BRCA carriers without endometriosis, those with endometriosis were more likely to carry a BRCA2 mutation, have post-secondary education, and experience earlier menarche. BRCA carriers with endometriosis had a lower ovarian cancer prevalence than those without (10% vs. 15%, p < 0.001). Conclusions: This is the first study of this scale to report the prevalence of endometriosis among BRCA mutation carriers, which was lower than previously reported in the general population. The association between endometriosis and ovarian cancer does not appear to be generalizable to this population. Further prospective studies are warranted to clarify this association among BRCA mutation carriers.

Systemic therapy is the mainstay of treatment in inoperable cholangiocarcinoma (CCA). The aim of this study was to evaluate the overall survival (OS), progression-free survival (PFS), recurrence patterns, and the association between biliary complications and OS in patients with inoperable, localized cholangiocarcinoma treated with radiotherapy (RT) alone. Records of patients treated between 2004 and 2022 who received a minimum of 32.5 Gy BED10 were retrospectively reviewed. Survival was estimated using the Kaplan-Meier method, and prognostic factors were assessed using univariate and multivariable analyses. A total of 56 patients (median age 67.5) were included, most of whom had intrahepatic (78.6%) CCA, and most of whom received SBRT (76.8%). The median dose was 36 Gy (BED 55 Gy), and the median OS and PFS were 20 months and 10 months, respectively. One-year local control was 92.1% and the primary site of progression was intrahepatic (64.9%). On univariate analyses, pre-radiation biliary obstruction, elevated baseline CA 19-9, larger tumor size, and age were associated with worse outcomes; on multivariable analysis, only lesion size was prognostic. Biliary complications were associated with inferior OS. These findings highlight the high intrahepatic out-of-field failure rates and suggest the incorporation of biliary-event-free survival as a clinically relevant endpoint.