Current oncology最新文献

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced malignancies, but they may cause a wide range of immune-related adverse events (irAEs). Hepatic toxicity occurs in approximately 1-6% of patients treated with nivolumab and usually presents with a hepatocellular pattern responsive to corticosteroids. The cholestatic-predominant immune-mediated hepatitis seems to respond poorly to immunosuppression. We describe an 87-year-old man with metastatic melanoma treated with nivolumab who developed steroid-refractory, cholestatic-predominant immune-mediated hepatitis after 18 cycles of therapy. Laboratory tests revealed a mixed but predominantly cholestatic pattern (ALT 585 U/L, GGT 2261 U/L, total bilirubin 2.0 mg/dL). Imaging excluded biliary obstruction or hepatic metastases. Liver biopsy showed acute lobular hepatitis with intracanalicular cholestasis and mild bile duct injury, consistent with immune-mediated, drug-induced injury (Ishak score 5). Mycophenolate mofetil produced only partial biochemical improvement. The patient died one month later from influenza A pneumonia in the context of combined immunosuppressive therapy. This case illustrates a cholestatic-predominant phenotype of nivolumab-induced hepatitis, characterized by poor corticosteroid response and incomplete recovery despite second-line immunosuppression. Recognition of this entity is essential, as early introduction of agents such as mycophenolate may improve outcomes. In elderly and frail patients, however, the risks of intensified immunosuppression must be carefully balanced against infection risk, highlighting the need for individualized management and vigilant monitoring.

Background: Myasthenia gravis (MG) is frequently associated with thymic abnormalities, including thymomas and hyperplasia. This study aims to analyze the clinical and pathological characteristics of thymectomized patients over a 20-year period, focusing on the relationship between thymoma subtype and MG incidence, as well as post-thymectomy remission outcomes. Methods: We retrospectively analyzed 420 patients who underwent thymectomy (open or VATS), with a mean age of 54.4 years and 59% female. Thymic pathology included thymomas (56.2%), thymic cysts (14.3%), and other lesions. 39.5% of patients had MG, of which 48.8% were thymomatous MG. Multivariate regression was used to identify predictors of MG and remission outcomes. Results: MG was significantly associated with younger age (p < 0.005), germinal hyperplasia (p < 0.001), and thymoma, especially WHO B2 subtype (p = 0.016). Six-month complete remission rates did not differ between thymomatous and non-thymomatous MG. In the subgroup undergoing VATS, median length of stay decreased to 3 days compared to 5 days in the overall cohort. The intraoperative complication rate for VATS was 1.5%, compared to 11.6% for open surgery. Conclusions: This is one of the largest single-center studies to evaluate the link between thymoma histology and MG. WHO type B2 thymoma and germinal hyperplasia were more commonly associated with MG. Comparable remission outcomes support the role of thymectomy in both thymomatous and non-thymomatous MG, emphasizing the need for individualized surgical strategies.

In colorectal carcinoma (CRC), 5-fluorouracil (5-FU) remains the cornerstone of adjuvant systemic therapy, with folic acid (FA) serving as an essential adjunct. Expression of genes related to the metabolism and action of 5-FU and FA can be influenced by patient- and tumor-specific biological factors. In this study, we explore differential gene expression profiles of 180 genes representing 14 different gene sets associated with different 5-FU and FA metabolism processes, at both gene and pathway levels across clinical and molecular subgroups. In 71 patients with CRC, paired tumors and normal colonic tissues were analyzed. In CRC tissue, several gene sets (including Cell Cycle Checkpoint, Oxidative Stress Response, and Signaling Pathway, etc.) were upregulated, while three gene sets (Apoptotic, Tumor Suppressor, and Endoplasmic Reticulum Stress) were downregulated. Kirsten rat sarcoma virus (KRAS), tumor protein p53 (TP53), and microsatellite instability (MSI) status impacted gene expression across molecular subgroups. At the individual gene level, among cell cycle genes, the BUB3 mitotic checkpoint protein (BUB3) was upregulated in MSI tumors compared to MSS, whereas SMAD family member 4 (SMAD4) was downregulated in MSS tumors compared to MSI. DNA fragmentation factor alpha (DFFA) was downregulated in MSI and upregulated in MSS. Notably, thymidylate synthetase (TYMS) was more upregulated in MSI tumors (1.65-fold; 95% CI: 1.27-2.13) compared to MSS (1.19-fold; 95% CI: 1.02-1.39). Dysregulation of these genes across these factors will broaden our understanding of 5-FU-based treatment in CRC. Furthermore, targeting dysregulated pathways could form the basis for improved precision therapies tailored to CRC subtypes.

Lymphedema is a common complication after breast cancer surgery, often causing functional limitations and reduced quality of life. Prophylactic compression sleeves have been suggested as a preventive strategy, but their effectiveness remains unclear. We conducted a systematic review of randomized controlled trials to evaluate whether early use of compression sleeves lowers the risk of lymphedema in this population. Comprehensive searches of major medical databases were performed, and eligible studies were analyzed. The findings showed that prophylactic compression sleeves did not significantly reduce the incidence of lymphedema compared with standard care. Some studies reported smaller increases in arm volume among sleeve users, but these results were inconsistent. Overall, compression sleeves appear to have limited value for lymphedema prevention, though they may provide modest benefit in reducing early swelling. Further high-quality research is needed to establish clear recommendations for clinical practice.

Over the past decade, the management of adult gliomas has been reshaped by profound scientific and clinical advances [...].

Background: Subcutaneous pertuzumab and trastuzumab with hyaluronidase (PHESGO^®) shorten chair time versus intravenous dual HER2 blockade, but real-world Asian data are scarce.

Methods: We retrospectively reviewed 47 Asian patients with HER2-positive breast cancer treated with PHESGO^® (January 2024-July 2025) across neoadjuvant, adjuvant, and metastatic settings. The primary endpoint was pathological complete response (pCR) in the neoadjuvant cohort; secondary endpoints included sequencing, safety, and metastatic activity.

Results: Median age was 65 years. In the neoadjuvant cohort (n = 26), pCR was 65% (17/26). PHESGO^®-first regimens achieved higher pCR than anthracycline-first regimens (85.7% vs. 41.7%; p = 0.038). Treatment was generally well tolerated: the most frequent events were dysgeusia (57%), diarrhea (38%), and rash (34%), mostly grade 1-2; one grade ≥3 event (thrombocytopenia) occurred, and no symptomatic cardiac dysfunction was observed. Adverse event profiles were broadly comparable in patients ≥ 70 versus <70 years. In metastatic disease (n = 10), objective response and disease control rates were 56% and 78%, respectively.

Conclusions: In routine practice, PHESGO^® showed substantial neoadjuvant activity, acceptable toxicity, and workflow advantages. Early use of subcutaneous dual HER2 blockade with taxane may enhance pCR and facilitate delivery; prospective validation is warranted.

Introduction: Pancreatico-duodenectomy (PD) remains one of the most complex abdominal surgeries, and pancreatico-jejunostomy (PJ) fistula is its most critical postoperative complication. In efforts to reduce the incidence of postoperative pancreatic fistula (POPF), several PJ techniques and adjuncts, including stents, have been recommended. This article presents data from an international survey regarding PJ methods, the use of pancreatic stents, and their correlation with POPF rates from surgical centers worldwide.

Methods: A nine-item online questionnaire was sent globally through social networks, individual mailing lists, and the ASHBPS mailing list. Data were analyzed through the Student's t-test (two-tailed, unequal variance). A p-value < 0.05 was considered to be statistically significant.

Results: A total of 122 units of pancreatic surgery from 26 countries distributed across five continents responded to the survey. Most centers performed less than 50 PDs a year, preferred a duct-to-mucosa PJ, and employed a stent routinely. Mean POPF grade B and C incidences were lower in high-volume (15.24% ± 7.29 and 3.95% ± 2.39) and in PJ stent-using centers (16.25% ± 8.7 and 5.37% ± 7.49).

Conclusions: Institutional case volume and stent usage are more crucial determinants of POPF incidence than the PJ technique itself. Centralization and standardization of PD procedures are related to reductions in major fistula rates.

Background: Stereotactic radiosurgery (SRS) was originally conceived as a noninvasive alternative to functional neurosurgery by the Swedish neurosurgeon Lars Leksell. This review traces the historical development of stereotactic methods from early mechanical frames to advanced image-guided systems and examines the pivotal innovations that enable precise intracranial targeting for SRS.

Methods: Using PubMed and Google Scholar, we reviewed the literature on the general history of functional stereotactic neurosurgery and radiosurgery, its indications, and how their treatment methods evolved, focusing mainly on the early period from the end of the 18th century to the 1990s.

Results: The origins of stereotaxy as a principle and technique were traced back to the early 20th century with animal studies by Horsley and Clarke, later adapted for human use by Spiegel and Wycis, and then Talairach in the 1940s. This enabled the precise targeting of deep brain structures for lesion-based interventions in movement, pain, and psychiatric disorders. Deep Brain Stimulation (DBS) emerged in the 1980s as a reversible treatment for tremor. Stereotactic radiosurgery was conceived in 1951 as a noninvasive alternative functional approach and saw limited use until the 1990s due to imaging constraints. With MRI-guided planning, its application has expanded mostly to the management of benign and malignant tumors and vascular disorders, as well as for functional approaches, particularly for trigeminal neuralgia, tremor, epilepsy, and OCD.

Conclusions: This review underscores how technological progress and shifting clinical priorities have transformed SRS from a niche neurosurgical technique into a cornerstone of modern clinical practice, with functional SRS representing its latest clinical field of expansion.

Postoperative venous thromboembolism (VTE) after minimally invasive surgery (MIS) for gynecologic malignancy is uncommon. Our objective was to characterize the rates and identify risk factors of postoperative VTE. A retrospective cohort study of patients undergoing MIS for gynecologic malignancy at three Canadian institutions from 2014 to 2020 was performed. The primary outcome was incidence of VTE within 90 days post-operatively. Descriptive statistics were used for clinicopathologic factors, and univariate analysis compared differences between groups. Rate and 95% confidence interval for VTE per 1000 surgeries were calculated. A total of 1786 patients met inclusion criteria, 85.3% uterine, 11.5% cervical, and 2.3% had ovarian cancer. Modes of surgery included robotic (49.4%), laparoscopic (20.7%), or combined laparoscopic/vaginal (29.9%). There were 15 VTE events at 90 days post-operatively (0.84%). Rates of VTE were lowest in patients who underwent robotic surgery, followed by combined laparoscopic/vaginal, and highest in a laparoscopic approach (p = 0.047). Pelvic lymphadenectomy (p = 0.038) and adjuvant chemotherapy (p = 0.022) were the only significant factors associated with risk of VTE. The incidence of VTE after MIS for gynecologic malignancy is low. Robotic surgery was associated with a lower incidence, although event rates are low, and further research is warranted.

Objective: The primary objective of this pilot randomized clinical trial was to determine the effect of adding a supervised resistance exercise programme to a home-based physical activity plan on health-related quality of life in patients with colorectal cancer undergoing active treatment. The secondary objectives were to evaluate its effects on anxiety, depression, sleep quality, and inflammatory parameters.

Methods: This is a pilot randomized clinical trial with parallel groups. Patients with CRC were recruited through the Oncology Department at the Salamanca University Health Care Complex in Spain. They were randomly allocated to receive either a home-based physical activity plus a supervised resistance training programme, or the home-based physical activity plan only. The primary outcome was health-related quality of life measures and the secondary outcomes included anxiety, depression and sleep quality evaluations. The supervised training lasted 8 weeks for each patient.

Results: A total of 40 patients were recruited, 20 for each group. Adding a supervised resistance exercise programme to the home-based activity plan improved symptoms related to quality of life, such as fatigue (p = 0.040) and constipation (p = 0.015). However, no significant effect was found with regard to other health-related quality of life, anxiety, depression or sleep variables.

Conclusions: Fatigue and constipation in patients with CRC receiving chemo- and/or immunotherapy may benefit from the introduction of supervised resistance exercise training programmes.