Current oncology最新文献

(1) Background: Hepatoblastoma and medulloblastoma are two types of pediatric tumors with embryonic origins. Both tumor types can exhibit genetic alterations that affect the β-catenin and Wnt pathways; (2) Materials and Methods: This study used bioinformatics and integrative analysis of multi-omics data at both the tumor and single-cell levels to investigate two distinct pediatric tumors: medulloblastoma and hepatoblastoma; (3) Results: The cross-transcriptome analysis revealed a commonly regulated expression signature between hepatoblastoma and medulloblastoma tumors. Among the commonly upregulated genes, the transcription factor LEF1 was significantly expressed in both tumor types. In medulloblastoma, LEF1 upregulation is associated with the WNT-subtype. The analysis of LEF1 genome binding occupancy in H1 embryonic stem cells identified 141 LEF1 proximal targets activated in WNT medulloblastoma, 13 of which are involved in Wnt pathway regulation: RNF43, LEF1, NKD1, AXIN2, DKK4, DKK1, LGR6, FGFR2, NXN, TCF7L1, STK3, YAP1, and NFATC4. The ROC curve analysis of the combined expression of these 13 WNT-related LEF1 targets yielded an area under the curve (AUC) of 1.00, indicating 100% specificity and sensitivity for predicting the WNT subtype in the PBTA medulloblastoma cohort. An expression score based on these 13 WNT-LEF1 targets accurately predicted the WNT subtype in two independent medulloblastoma transcriptome cohorts. At the single-cell level, the WNT-LEF1 expression score was exclusively positive in WNT-medulloblastoma tumor cells. This WNT-LEF1-dependent signature was also confirmed as activated in the hepatoblastoma tumor transcriptome. At the single-cell level, the WNT-LEF1 expression score was higher in tumor cells from both human hepatoblastoma samples and a hepatoblastoma patient-derived xenotransplant model; (4) Discussion: This study uncovered a shared transcriptional activation of a LEF1-dependent embryonic program, which orchestrates the regulation of the Wnt signaling pathway in tumor cells from both hepatoblastoma and medulloblastoma.

Pediatric brain tumor survivors (PBTS) are at risk for late effects related to their diagnosis and treatment. Long-term medical follow-ups are deemed essential, implying a transition from pediatric to adult healthcare settings. This pilot study aims to assess the feasibility, acceptability, and preliminary effects of a targeted transition readiness intervention for PBTS. The program consisted of three hybrid workshops that targeted disease-related self-management skills, social skills, and cognitive functioning, as well as parallel workshops for their caregivers. The feasibility and acceptability were assessed through recruitment, retention, and satisfaction rates. Preliminary effects were primarily assessed via a pre/post assessment of transition readiness skills using the Transition Readiness Assessment (TRAQ) questionnaire. Among the eligible dyads, 12 (38%) consented to participate. Ten dyads participated in at least two workshops, and six dyads participated in all workshops. Overall, the participants were satisfied with the intervention (parents = 86%; PBTS = 73%). Although not statistically significant, a clinically relevant post-workshop increase in transition readiness skills was observed for PBTS (d = 0.36) and their caregivers (d = 0.25). The results suggest the relevance of the intervention and encourage further developments. Adjustments are needed to optimize reach and efficacy. The workshops have the potential to be adapted to be more accessible and shorter.

Few evidence-based trainings exist on how to equip healthcare providers, particularly nurses, with the skills to engage in cost of care conversations with patients/caregivers to mitigate the impact of cancer-related financial toxicity. This study evaluated a pilot training developed in collaboration with Triage Cancer^® to prepare oncology nurses to identify and assist patients/caregivers facing financial and/or legal barriers to care. Ten pediatric oncology nurses completed the training and pre/post-surveys on behaviors related to financial and legal need screening, frequency and comfort level of answering questions, knowledge, and behavior changes, along with training evaluation questions. At baseline, six nurses reported never screening for financial needs and nine for legal needs. Following the training, seven nurses stated they were likely to screen for financial/legal needs. At six months post-training, nurses had referred 85 patients/caregivers to financial/legal navigation services. Comfort levels in answering financial/legal questions increased by 6.5 points and knowledge scores increased by 1.7 points post-training. Most nurses recommended this training to other healthcare providers who work with patients with cancer and their caregivers. This study highlights the importance of providing oncology nurses with resources to engage in cost of care conversations and oncology financial legal navigation programs to mitigate the impact of cancer-related financial toxicity.

Treatment for lung cancer continues to rapidly evolve. Here, we describe trends in the initial treatment of adults with newly diagnosed primary non-small-cell lung cancer in Japan. This retrospective cohort study used data from JMDC Inc. Claims Database from 2015 to 2023. Adults with lung cancer, confirmed using a combination of diagnosis, treatment, or procedure codes, were enrolled. A total of 9373 patients were included, with a mean age of approximately 59 years. The median time from diagnosis to treatment initiation ranged from 38 days in patients treated surgically to 25 days in patients with distant metastases. The observed trends were a decrease in the percentage of newly diagnosed patients with distant metastases, a decline in chemotherapy use in patients with early-stage disease, and in advanced disease, a more than doubling in the use of targeted therapy, including checkpoint inhibitors, while radiotherapy and chemotherapy tended to decrease. The observed changes in treatment were driven mainly by the increased use of targeted therapies including checkpoint inhibitors and are aligned with current treatment guidelines in Japan. The observation of fewer patients with distant metastases over time possibly indicates earlier detection. Additional research is needed to understand if new therapies are being extended to older and frail patients with lung cancer in Japan.

Background: Lymphadenectomy is considered a key part of the radical treatment of resectable lung cancer, although its appropriate extension in early stages is a debated topic due to the great heterogeneity of studies in the literature. This study aims to evaluate the impact of lymphadenectomy extent on survival and recurrence in the treatment of early-stage NSCLC patients undergoing lobectomy and lymph node dissection.

Methods: Data from clinical stage I NSCLC patients undergoing lobectomy and hilar-mediastinal lymphadenectomy at two thoracic surgery centers from 2016 to 2019 were retrospectively evaluated. Information regarding perioperative outcomes and lymphadenectomy details was collected and analyzed, and their impact on OS, CSS, and DFS was assessed.

Results: During the period under review, 323 patients with stage cI lung cancer underwent lobectomy with lymphadenectomy. Statistical analysis showed that the evaluated lymph nodal factors (mean number of lymph nodes removed and number and type of lymph node station explored) did not statistically significantly impact OS, CSS, and DFS at a median follow-up of 59 months (IQR 45-71).

Conclusions: The results of this study suggest that a less invasive procedure than systematic lymphadenectomy could be performed in early-stage cases with adequate preoperative staging.

Purpose: To evaluate the diagnostic value of ultrasound radiomics in distinguishing between benign and malignant breast nodules in women who have undergone silicone breast augmentation.

Methods: A retrospective study was conducted of 99 breast nodules detected by ultrasound in 93 women who had undergone silicone breast augmentation. The ultrasound data were collected between 1 January 2006 and 1 September 2023. The nodules were allocated into a training set (n = 69) and a validation set (n = 30). Regions of interest (ROIs) were manually delineated using 3D Slicer software, and radiomic features were extracted and selected using Python programming. Eight machine learning algorithms were applied to build predictive models, and their performance was assessed using sensitivity, specificity, area under the ROC curve (AUC), accuracy, Brier score, and log loss. Model performance was further evaluated using ROC curves and calibration curves, while clinical utility was assessed via decision curve analysis (DCA).

Results: The random forest model exhibited superior performance in differentiating benign from malignant nodules in the validation set, achieving sensitivity of 0.765, specificity of 0.838, and an AUC of 0.787 (95% CI: 0.561-0.960). The model's accuracy, Brier score, and log loss were 0.796, 0.197, and 0.599, respectively. DCA suggested potential clinical utility of the model.

Conclusion: Ultrasound radiomics demonstrates promising diagnostic accuracy in differentiating benign from malignant breast nodules in women with silicone breast prostheses. This approach has the potential to serve as an additional diagnostic tool for patients following silicone breast augmentation.

Purpose: Breath-hold T2-weighted half-Fourier acquisition single-shot turbo spin echo (HASTE) magnetic resonance imaging (MRI) of the upper abdomen with a slice thickness below 5 mm suffers from high image noise and blurring. The purpose of this prospective study was to improve image quality and accelerate imaging acquisition by using single-breath-hold T2-weighted HASTE with deep learning (DL) reconstruction (DL-HASTE) with a 3 mm slice thickness. Method: MRI of the upper abdomen with DL-HASTE was performed in 35 participants (5 healthy volunteers and 30 patients) at 3 Tesla. In a subgroup of five healthy participants, signal-to-noise ratio (SNR) analysis was used after DL reconstruction to identify the smallest possible layer thickness (1, 2, 3, 4, 5 mm). DL-HASTE was acquired with a 3 mm slice thickness (DL-HASTE-3 mm) in 30 patients and compared with 5 mm DL-HASTE (DL-HASTE-5 mm) and with standard HASTE (standard-HASTE-5 mm). Image quality and motion artifacts were assessed quantitatively using Laplacian variance and semi-quantitatively by two radiologists using five-point Likert scales. Results: In the five healthy participants, DL-HASTE-3 mm was identified as the optimal slice (SNR 23.227 ± 3.901). Both DL-HASTE-3 mm and DL-HASTE-5 mm were assigned significantly higher overall image quality scores than standard-HASTE-5 mm (Laplacian variance, both p < 0.001; Likert scale, p < 0.001). Compared with DL-HASTE-5 mm (1.10 × 10^-5 ± 6.93 × 10^-6), DL-HASTE-3 mm (1.56 × 10^-5 ± 8.69 × 10^-6) provided a significantly higher SNR Laplacian variance (p < 0.001) and sharpness sub-scores for the intestinal tract, adrenal glands, and small anatomic structures (bile ducts, pancreatic ducts, and vessels; p < 0.05). Lesion detectability was rated excellent for both DL-HASTE-3 mm and DL-HASTE-5 mm (both: 5 [IQR4-5]) and was assigned higher scores than standard-HASTE-5 mm (4 [IQR4-5]; p < 0.001). DL-HASTE reduced the acquisition time by 63-69% compared with standard-HASTE-5 mm (p < 0.001). Conclusions: DL-HASTE is a robust abdominal MRI technique that improves image quality while at the same time reducing acquisition time compared with the routine clinical HASTE sequence. Using ultra-thin DL-HASTE-3 mm results in an even greater improvement with a similar SNR.

Background: The aim of this study was to compare microwave ablation (MWA) with and without prior placement of an intra-arterial catheter for the purpose of application of contrast medium (CM).

Methods: 148 patients (45 female, 65.1 ± 14.9 years) with liver tumors who underwent CT-guided MWA were included. Of these, 25 patients had an IA catheter placed in the hepatic artery.

Results: 37 patients underwent planning imaging for MWA without CM. A total of 86 patients received a standard dose of 80 mL intravenous (IV) CM for the planning scans. The patients with an IA catheter (n = 25) received an IA application of 10 mL CM. A total of 29 patients received contrast-enhanced scans in the PV phase for control of needle positioning after IV application of a standard dose of 80 mL CM. In patients with an IA catheter, control of the needle position was performed by single-slice scans. IA CM application during the ablation enabled monitoring of the ablation zone. Over the entire intervention, patients with IA catheters received less CM as compared to patients without an IA catheter (39.1 ± 10.4 mL vs. 141 ± 39.69 mL; p < 0.001).

Conclusions: IA catheter placement was associated with a significant decrease of the amount of CM during MWA and enabled monitoring of the ablation zone.

(1) Background: Volumetric modulated arc therapy (VMAT) can deliver more accurate dose distribution and reduce radiotherapy-induced toxicities for postoperative cervical and endometrial cancer. This study aims to retrospectively analyze the relationship between dosimetric parameters of organs at risk (OARs) and acute toxicities and provide suggestions for the dose constraints. (2) Methods: A total of 164 postoperative cervical and endometrial cancer patients were retrospectively analyzed, and the endpoints were grade ≥ 2 acute urinary toxicity (AUT) and acute lower gastrointestinal toxicity (ALGIT). The normal tissue complication probability (NTCP) model was established using the logistic regression model. Restricted cubic spline (RCS) curves were used to explore the association between dosimetric parameters and toxicities. The receiver operating characteristic (ROC) curve, calibration curve, Akaike's corrected information criterion (AICc), decision curve analysis (DCA), and clinical impact curve (CIC) were analyzed to evaluate the performance of NTCP models. (3) Results: Bladder V_40Gy was identified to develop the NTCP model of AUT, and the mean AUC was 0.69 (CI: 0.58-0.80). Three candidate predictors, namely the small intestine V_30Gy, colon D_45%, and rectum D_55%, were identified to develop the NTCP model of ALGIT, and the mean AUC was 0.71 (CI: 0.61-0.80). Both models were considered to have relatively good discriminative accuracy and could provide a high net benefit in clinical applications. (4) Conclusions: We developed NTCP models to predict the probability for grade ≥ 2 AUT and ALGIT. We recommend that bladder V_40Gy, the small intestine V_30Gy, colon D_45%, and rectum D_55% be controlled below 42%, 20.4%, 16.9 Gy, and 32.0 Gy, respectively.

(1) Background: This pilot study evaluates the feasibility and preliminary effects of acupuncture for cancer-related cognitive dysfunction (CRCD) in cancer survivors. (2) Methods: A randomized trial comparing real acupuncture (RA) to sham acupuncture (SA) and waitlist control (WLC) among cancer survivors reporting cognitive difficulties. Interventions were delivered weekly over 10 weeks. Feasibility was evaluated by recruitment, treatment adherence, and assessment completion. Subjective CRCD was assessed by the Functional Assessment of Cancer Therapy-Cognitive Function-Perceived Cognitive Impairment subscale (FACT-Cog PCI) and objective CRCD was assessed by the Hopkins Verbal Learning Test-Revised (HVLT-R). (3) Results: 32 participants (57.1% of eligible patients) were enrolled. All participants in acupuncture groups completed ≥8 of 10 treatments. Assessment completion rate was 100% for all participants. From baseline to week 10, the RA group (n = 19) reported a clinically meaningful 17.3-point increase in FACT-Cog PCI (95% confidence interval [CI] 12.5 to 22.1), compared to 9.7 points (95% CI 2.8 to 16.7) in the SA group (n = 9), and 6.8 points (95% CI -3.7 to 17.2) in the WLC group (n = 4). In the subgroup analysis among patients with a below-average baseline HVLT-R (T-score < 50), the RA group (n = 8) increased FACT-Cog PCI scores by 20.4 (95% CI 13.6 to 27.3), compared to 11.1 points (95% CI 0.6 to 21.5) in the SA group (n = 5). The improvements from RA persisted through week 16 in both the total sample and the sub-group. Eleven mild adverse events were reported, with pain and bleeding at the needling sites being the most common. (4) Conclusions: The findings support the feasibility and safety of conducting a randomized, placebo-controlled trial to evaluate acupuncture for cognitive dysfunction in cancer survivors.