Current oncology最新文献

The study's aim was to compare the unplanned admission rates and nutrition outcomes in patients with head and neck squamous cell cancer (HNSCC) receiving chemoradiotherapy at two different hospitals with different nutrition support approaches. Hospital Site A used prophylactic tube feeding and Site B used reactive tube feeding. Consecutive HNSCC patients receiving chemoradiotherapy with curative intent over six months in 2015 were eligible for this prospective comparative cohort study. Only patients who were classified as at high nutrition risk using validated guidelines were included. Patients' weight was recorded at the start, end, and 4-6 weeks post treatment to determine percentage weight loss outcomes. Unplanned hospital admissions (for medical or nutrition related reasons) and associated length of stay (LOS) were collected throughout and up to 1-month post treatment. In total, 88 patients were included in the study (site A n = 58; site B n = 30). The mean age was 60 years, 86-90% were male, and predominantly had oropharyngeal cancer. There was no statistical difference between the groups for percentage weight loss at any timepoint, rates of unplanned nutrition related admissions, or LOS. Stepwise logistic analysis showed that being of an older age was predictive of having an unplanned nutrition-related admission. In summary, there was no difference in the rate of unplanned admissions or percentage weight loss for patients with HNSCC managed under the prophylactic versus reactive tube feeding approach. Decision making regarding the choice of feeding tube should be made in consultation with the patient and the multidisciplinary team.

As the proportion of people diagnosed with lung cancer who have never smoked rises, it is important to understand how their experiences differ from those of smokers. A better understanding of their experiences, views, and informational and supportive care needs is essential to ensuring an optimised patient-centred care pathway leading to improvements in patient satisfaction, quality of life, and treatment outcomes. This integrative review of the international literature identified 5866 articles by searching four academic databases, the grey literature, and hand-searching the reference lists of relevant systematic reviews. After screening, ten studies were selected for inclusion in the review. Thematic analysis identified five themes that spoke to the experiences of never smokers with lung cancer: stigma, awareness, diagnosis, the emotional response, and support. Stigma pervades, with potentially significant psychological and social consequences, negatively affecting patients emotionally and potentially delaying their diagnosis. Increasing awareness amongst healthcare professionals and the general public has the potential to reduce stigma and encourage earlier diagnosis. Support specifically tailored for never smokers with lung cancer can improve individuals' experiences of care. The experiences of never smokers with lung cancer are unique, and more research is required to better tailor support and guidance for this cohort.

Postoperative hemorrhage (POH) is a rare but serious complication of cranial neurosurgery, often resulting in neurological deterioration and necessitating urgent surgical intervention. Despite its clinical relevance, POH remains underreported and insufficiently understood. This study aimed to identify potential risk factors including perioperative variables and tumor-related characteristics associated with POH requiring surgical evacuation. A total of 1862 cranial tumor procedures were performed in our department over a 10-year period. Data on perioperative parameters and tumor characteristics were retrospectively collected and analyzed. Statistical analyses were conducted to assess associations of them to POH. Statistical analysis revealed several peri- and postoperative variables significantly associated with POH in univariate analyses. These included intraoperative blood loss (p = 0.012) and length of postoperative hospital stay (p = 0.016). Furthermore, the outcomes measured using the Glasgow Outcome Scale (p < 0.001) and the Karnofsky Performance Scale (p < 0.001) showed also statistical relevance as a result of postoperative bleeding in these patients. The findings suggest that specific perioperative factors particularly intraoperative blood loss are associated with an increased risk of POH after intracranial tumor surgery. Additionally, prolonged hospitalization and worsened functional outcomes were linked to the occurrence of postoperative hemorrhage. In contrast, tumor-specific characteristics and routine laboratory values showed no significant association with hemorrhagic complications in this cohort.

Objective: To evaluate the real-world efficacy and safety of disitamab vedotin (RC48-ADC) in patients with human epidermal growth factor receptor 2 (HER2) overexpression (immunohistochemistry [IHC] 2+ or 3+), advanced gastric/gastroesophageal junction cancer (GC/GEJC) with metastases who had received at least one line of prior systemic therapy.

Patients and methods: Patients with HER2-overexpressing advanced or metastatic GC/GEJC who had previously received the anti-HER2 antibody-drug conjugate disitamab vedotin between December 2022 and April 2024 were enrolled in this study. The patients' baseline characteristics, treatment procedures, and laboratory or imaging examinations were retrospectively collected and analyzed. The observation items included the objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and treatment-related adverse events (TRAEs).

Results: Of the 38 enrolled patients in the study, 27 were found to be HER2-positive. Most patients (29/38) received disitamab vedotin therapy as a third-line or subsequent treatment. A total of 68.4% of patients had previously received anti-HER2 therapy, and 13 patients underwent immunotherapy concurrently. The overall ORR and DCR were 31.6% and 65.8%, respectively. A higher ORR was observed in patients with a single metastatic site compared to those with multiple sites (53.3% vs. 17.4%, p = 0.022). In the general population, the median PFS was 6.5 months (95% confidence interval [CI] 3.3-9.8 months), and OS was 13.5 months (95% CI 9.0-17.9 months). The most common adverse event was anemia (89.5%), and eight patients suffered severe toxicities of grade ≥3.

Conclusions: Disitamab vedotin exhibited encouraging anti-tumor effectiveness with a tolerable safety profile for advanced GC/GEJC patients with HER2 overexpression who had failed at least one line of systemic therapy in a real-world setting.

Thyroid cancer survivors often experience worse quality of life than other cancer survivors, with fatigue and sleep disturbance being common contributors. In this prospective cohort from the ICaRe2 cancer registry, survivors completed the Brief Fatigue Inventory (BFI) and Pittsburgh Sleep Quality Index (PSQI) at enrollment and follow-up, with univariate and multivariable analyses identifying factors associated with fatigue and sleep quality. Among 249 survivors (83% female, median age 42), 205 completed the BFI and 224 the PSQI. Most were low (57%) or intermediate (34%) risk or recurrence at diagnosis, and 74% had no structural recurrence. Poor sleep and greater fatigue were significantly associated with female sex (p = 0.0003 and 0.001), younger age at diagnosis (p = 0.02 and 0.0006), and vocal cord paralysis (p = 0.01 and 0.046). Fatigue was also higher in those with hypoparathyroidism (p = 0.04). No associations were found with recurrence risk, therapy response, thyroid hormone type, or TSH levels. Younger female survivors, particularly those with vocal cord paralysis or hypoparathyroidism, are more prone to fatigue and poor sleep, highlighting potential targets for interventions to improve quality of life.

Surgical resection is recommended for operable stage I non-small-cell lung cancer (NSCLC), while radiotherapy reserved for inoperable patients. Very comorbid patients may receive no treatment at all. Social determinants of health (SDOHs) may influence access to these treatments. We examined how SDOHs affect treatment modality among these patients using a population-based retrospective cohort study using ICES data including adults with stage I NSCLC diagnosed between 2007 and 2023. Multivariable logistic regression assessed associations between SDOH and treatment received. Of 19,179 patients, 54.4% received only surgery, 15.8% received only radiotherapy, 27.5% received no treatment, and 2.3% received surgery and radiotherapy. Surgery was less likely in patients aged >80 versus <50 (OR 0.07, p < 0.001), patients with frailty (OR 0.38, p < 0.001), patients with ≥5 comorbidities (OR 0.21, p < 0.001), or those who were not rostered with a family physician (OR 0.59, p < 0.001). Recent immigrants were more likely to undergo surgery (OR 1.23, p = 0.035), as well as those in the highest neighbourhood income quintile (OR 1.45, p < 0.001). Surgery was less likely for those living 50-100 km from a cancer centre (OR 0.85, p = 0.004). Radiotherapy was more likely in patients aged >80 (OR 9.86, p < 0.001), those with ≥5 comorbidities (OR 2.23, p < 0.001), or those in the lowest household income quintile (OR 1.27, p = 0.009). Recent immigrants were less likely to receive radiotherapy (OR 0.69, p = 0.005). SDOHs independently influence treatment type for stage I NSCLC.

The increasing global incidence of thyroid cancer highlights the importance of accurately assessing risk factors, particularly those related to family history. Although having affected family members is widely recognized as a risk factor for thyroid cancer, the exact degree of risk and its variation across types of familial relationships, parental gender, and geographic regions remain unclear. This systematic review and meta-analysis aimed to clarify the association between family history and thyroid cancer risk. We conducted a comprehensive literature search of PubMed, Web of Science, and Embase following PRISMA guidelines, identifying 13 studies from 503 initially screened. Statistical analyses were performed using random-effects models to estimate pooled odds ratios and risk ratios, with subgroup analyses to assess variations across population and relationship types. Our findings showed an approximately 4.5-fold higher risk of thyroid cancer in individuals with affected family members. Individuals with affected siblings were more likely to develop thyroid cancer while the risks associated with maternal and paternal family history were comparable in magnitude, with no statistical difference between them. Socioeconomic, educational, and lifestyle differences did not significantly influence risk, and geographic variations in familial risk could not be statistically confirmed by the subgroup analysis, in the context of high between-study heterogeneity. These results suggest that family history is a substantial risk factor for thyroid cancer, reinforcing the need for enhanced surveillance and screening strategies for those with a familial predisposition.

Purpose: ATRIP (ATR-interacting protein) is a critical partner of ATR (ataxia telangiectasia and Rad3-related). The ATR-ATRIP heterodimer plays an essential role in initiating homologous recombination repair (HRR) during replication stress and inducing double-stranded DNA breaks following unresolved stalled replication forks. Our team recently identified ATRIP as a novel breast cancer susceptibility gene candidate through whole-exome sequencing (WES) of familial breast cancer patients and healthy controls from the Polish founder population, with subsequent validation in both Polish and British cohorts. In the present study, we report for the first time the detection of a novel deleterious mutation in ATRIP among several members of an Iranian family with clustering of breast cancer who were negative for mutations in the already known breast cancer risk genes. Methods: Six family members underwent germline DNA testing by WES, following initial negative results from multigene panel testing. Candidate variants were confirmed by Sanger sequencing and assessed according to ACMG guidelines. Results: We detected a novel ATRIP frameshift mutation (NM_130384.3:c.1033delC) in four of six family members that were tested, including two individuals affected with breast cancer. No pathogenic variants were found in other known cancer susceptibility genes. Conclusions: This is the first report of a deleterious ATRIP mutation in an Iranian family with familial breast cancer, suggesting a potential role of ATRIP in hereditary breast cancer. Further studies are required to confirm the role of ATRIP in breast cancer susceptibility, refine risk assessment, and evaluate potential personalized therapeutic strategies. In the interim, genetic counseling for ATRIP mutation carriers should proceed with caution, given current limitations in clinical interpretation.

The chest wall represents a complex musculoskeletal structure that provides protection to intrathoracic organs, mechanical support for respiration, and mobility for the upper limbs. Neoplastic diseases of the chest wall encompass a heterogeneous group of benign and malignant lesions, which may be classified as primary-originating from bone, cartilage, muscle, or soft tissue-or secondary, resulting from direct invasion or metastatic spread, most commonly from breast or lung carcinomas. Approximately half of all chest wall tumors are malignant, and their management remains a significant diagnostic and therapeutic challenge. Surgical resection continues to represent the mainstay of curative treatment, with complete en bloc excision and adequate oncologic margins being critical to minimize local recurrence. Advances in reconstructive techniques, including the use of prosthetic materials, biological meshes, and myocutaneous flaps, have markedly improved postoperative stability, respiratory function, and aesthetic outcomes. Optimal management requires a multidisciplinary approach involving thoracic and plastic surgeons, oncologists, and radiotherapists to ensure individualized and comprehensive care. This review summarizes current evidence on the classification, diagnostic evaluation, surgical strategies, and reconstructive options for chest wall tumors, emphasizing recent innovations that have contributed to improved long-term survival and quality of life in affected patients.

Objective: This study aims to assess the accuracy of pulmonary nodule detection via MRI compared to the gold standard, CT, in patients with extrathoracic cancer.

Materials and methods: MRI of the chest was performed on oncological patients for staging extrathoracic cancer and subsequently compared to their CT. Only the largest nodule was considered in patients with multiple nodules. Nodule size and malignancy were recorded for each modality, as well as the presence of interstitial lung disease (ILD), adenopathy, cardiomegaly, pleural effusion, pericardial effusion, and vertebral fracture. All cases were read by two thoracic radiologists and any discrepancies were resolved by discussion.

Results: A total of 154 patients with nodules were identified from 241 participants (mean age: 59 years [18-95]). Average nodule diameter was 11.5 mm (range: 3.9-29.1 mm; SD: 8.1 mm). MRI detected all nodules greater than 5 mm. Malignancy was detected in 37 nodules. The sensitivity, specificity, and accuracy values of MRI for all nodules were 93.51%, 100%, and 95.85%, respectively. For ground-glass nodules (n = 11), the values were 43.6%, 100%, and 65.0%, respectively. When compared to CT, long-axis diameter measured by MRI was underestimated by 9 ± 2.3% (p < 0.001). There was a strong correlation between measurements of CT and MRI (κ = 0.70-1.00). Furthermore, MRI accurately detected the presence of adenopathy (97.1%), cardiomegaly (99.17%), pleural effusion (98.34%), pericardial effusion (100%), and vertebral fracture (99.6%).

Conclusions: These findings suggest that lung MRI accurately detects pulmonary nodules and other thoracic pathologies commonly observed in oncological patients. Lung MRI may serve as a substitute to CT for oncological patients undergoing routine extrathoracic surveillance, thereby decreasing radiation exposure.