Frontiers in Oncology最新文献

Objective: This study seeks to create and assess a combined radiomics model that combines intratumoral habitat features with peritumoral characteristics from CT imaging to predict spread through air spaces (STAS) in ≤ 2 cm solid lung adenocarcinomas.

Materials and methods: A total of 401 patients with solid invasive lung adenocarcinomas ≤ 2 cm from two centers were retrospectively enrolled (training cohort: 217 cases, validation cohort: 93 cases, test cohort: 91 cases). Univariate and multivariate logistic regression analyses were employed to assess both CT features and clinical data, aiming to determine independent predictors of STAS. Regions of interest (ROI) for tumors were delineated on CT images, with peritumoral regions expanded by 1 mm, 3 mm, and 5 mm. Tumors were further segmented into three habitat subregions using K-means clustering. Radiomic features were extracted from the intratumoral, peritumoral, and habitat regions, and five machine learning algorithms were applied to construct predictive models. The best-performing predictive model was selected and further integrated into a combined model. Performance was assessed by receiver operating characteristic (ROC) curve's area under the curve (AUC), calibration curves, and decision curve analysis (DCA).

Results: The habitat model outperformed the Intra model, and the Peri3mm model surpassed Peri1mm and Peri5mm models. The integration of habitat, Peri3mm, and clinical models yielded a substantial improvement in predictive performance, with AUCs reaching 0.948, 0.897, and 0.930 in the training, validation, and test sets, respectively. Calibration curves and DCA confirmed favorable fit and higher clinical net benefit.

Conclusion: The combined model provides high accuracy for predicting STAS in solid lung adenocarcinomas with a diameter of ≤ 2 cm, offering valuable support for treatment decision-making.

Introduction: Given the high disparities present in cancer care worldwide and even more challenging infrastructure and access for low- and middle-income countries, adhering precisely to international guidelines has become a challenging and complex task. Recommendations from an independent multidisciplinary panel of experts from 13 countries, including medical oncologists, pathologists, surgeons, and radiation oncologists, who met during IGCS to address some of these challenges.

Methods: The panel met in New York City in September of 2022 during the International Gynecological Cancer Society Congress and was composed of specialists from developing countries in Africa, Asia, Eastern Europe, Latin America, and the Middle East. The panel addressed 103 questions and provided recommendations for the management of early, locally advanced, recurrent, and/or metastatic endometrial cancer. The questions were carefully developed by the group and specifically directed to, and answered by, specialists according to their respective areas of expertise. Consensus was defined as at least 75% of the voting members selecting a particular recommendation, whereas a majority vote was considered when one option garnered between 50.0% and 74.9% of votes. Resource limitation was defined as any issues limiting access to qualified surgeons, contemporary imaging or radiation-oncology techniques, antineoplastic drugs, or funding for providing modern medical care.

Results: Eighteen of the 109 (16.5%) questions presented to the panel reached consensus, whereas a majority vote was reached for 43 (39.4%) additional questions. The recommendations for the remaining questions were considerably heterogeneous and were considered experts opinion only.

Conclusion: Establishing guidelines with recommendations in areas with resource limitations may help healthcare providers and improve patient care around the world.

Background: Multiple Myeloma (MM) predominantly affects older adults, with a median diagnosis age of 70 years, posing challenges in management due to frailty, comorbidities, and age-related physiological changes. As the aging population grows, the prevalence of MM in older patients is expected to rise, requiring improved clinical strategies.

Methods: This consensus report outlines a multidisciplinary framework for the identification, geriatric assessment (GA), and management of older adults with MM, emphasizing the role of frailty assessments, such as the IMWG frailty score, in tailoring treatments. The objective is to develop a working model tailored to the Quebec context. A meeting on May 7, 2024 brought together experts to discuss improving access to GA and developing strategies for implementing geriatric management tools. Unmet needs include the lack of standardized screening tools, limited access to specialized geriatric oncology services, and inconsistent treatment approaches. Personalized care is critical in addressing frailty, comorbidities, patient preference, and functional status.

Results: This report proposes a structured referral pathway involving age-based triaging and criteria for geriatric consultation. Multidisciplinary teams, including geriatricians, are essential for optimizing care and improving outcomes, with a focus on quality of life and effective therapies. Standardized practices and collaborative approaches are vital for addressing the complexities of MM in this vulnerable population.

Background: Survival remains heterogeneous in locally advancednasopharyngeal carcinoma (NPC) despite immunotherapy, highlighting the need for explainable artificial intelligence (AI) for risk-adapted care.

Methods: We retrospectively analyzed 249 patients with locally advanced NPC between 2018 and 2025. Patients were randomly split into a training cohort (70%) and a validation cohort (30%). A Cox-XGBoost survival modeling framework was developed using routinely available clinical variables to generate individualized risk scores and classify patients into low- and high-risk groups. Model discrimination was assessed using time-dependent ROC analysis. SHAP (SHapley Additive exPlanations) was applied to provide transparent, feature-level and patient-level interpretations of predicted risk.

Results: Univariable Cox regression identified age, tumor grade, and N stage as significant prognostic factors. In the training cohort, the XGBoost-derived risk score robustly separated low- and high-risk groups, with significantly prolonged survival in the low-risk group (P < 0.001). In the validation cohort, the AUCs for predicting 1-, 2-, and 3-year OS were 0.784, 0.765, and 0.725, respectively. SHAP analyses consistently highlighted age as the strongest driver of predicted risk, followed by N stage and tumor grade; older age and advanced nodal disease were associated with higher predicted mortality risk.

Conclusion: An interpretable XGBoost-based survival model built from routine clinical variables provides clinically meaningful risk stratification for locally advanced NPC patients.

Background: Hepatitis B virus-associated hepatocellular carcinoma (HBV-HCC) is characterized by high postoperative recurrence rates. Although numerous recurrence prediction models exist, their performance and clinical utility remain uncertain.

Objective: To systematically evaluate the performance and methodological quality of existing recurrence risk prediction models for HBV-HCC patients.

Methods: We searched PubMed, Web of Science, Embase, Scopus, and OVID databases. Data were extracted following the CHARMS checklist, and the PROBAST tool was used to assess the risk of bias. A meta-analysis of the C-index from validation cohorts was performed using a random-effects model.

Results: A total of 22 studies, encompassing 22 models, were included. Regarding the modeling methodology, 20 models were developed using the Cox proportional hazards regression model, one used a logistic regression model, and one utilized machine learning (ML). All 22 studies exhibited a high risk of bias, predominantly originating from the analysis domain. The meta-analysis revealed a pooled C-index of 0.73 (95% CI: 0.70-0.75) in the validation cohorts. The most frequently used predictors were MVI, AFP, tumor size, tumor number, and HBV-DNA.

Conclusion: Existing recurrence prediction models for HBV-HCC demonstrate moderate predictive accuracy but are universally affected by a high risk of bias. This limits their reliability and applicability in current clinical practice. Future research should emphasize methodological rigor and conduct multicenter external validation before applying models in clinical practice.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42025629973.

Introduction: Sorafenib remains the first-line targeted therapy for advanced hepatocellular carcinoma (HCC), but its clinical efficacy is severely limited by intrinsic and acquired drug resistance. Dysregulation of the BAX/Bcl-2/PUMA apoptotic pathway and XPO1/p27 cell cycle pathway is closely associated with sorafenib resistance. This study aimed to explore whether selinexor, a selective nuclear export inhibitor, could enhance the sensitivity of HCC cells to sorafenib and to clarify the underlying molecular mechanism.

Methods: A series of in vitro cell experiments (Huh7, SK-HEP-1, HepG2) and in vivo Huh7 xenograft nude mouse models were conducted. CCK-8 assay, flow cytometry, Western blot and immunohistochemistry were used to detect cell proliferation, cell cycle distribution, apoptosis, and the expression levels of key proteins related to apoptosis and cell cycle pathways. The additive effect of the drug combination was verified by comparing the experimental inhibitory rate with the theoretical additive effect.

Results: Selinexor combined with sorafenib significantly inhibited tumor growth in nude mice, with a stronger inhibitory effect than monotherapy. In vitro, the two drugs exerted an additive effect on suppressing the proliferation of Huh7, SK-HEP-1 and HepG2 cells. Meanwhile, the combination treatment induced obvious G1 phase arrest in Huh7 cells and markedly increased the apoptosis rate of Huh7 and HepG2 cells. Mechanistically, the combined therapy upregulated the expression of pro-apoptotic proteins BAX and PUMA as well as cell cycle regulator p27, while downregulating anti-apoptotic protein Bcl-2 and nuclear export protein XPO1.

Discussion: This study confirms that selinexor enhances the sensitivity of HCC cells to sorafenib by regulating the BAX/Bcl-2/PUMA apoptotic pathway and the XPO1/p27 cell cycle pathway. The combination strategy provides a novel potential approach for improving the therapeutic efficacy of sorafenib and overcoming both intrinsic and acquired sorafenib resistance in HCC. The main limitations of this study are the lack of RT-PCR verification and further detection of downstream apoptotic effector molecules, which need to be explored in future research.

Background: Although the soft hook-wire has been designed to be less traumatic than rigid devices, localization-related complications are still at risk to perioperative safety. This study aimed to find out independent risk factors for these complications in solitary pulmonary nodules patients (SPNs) and create a new nomogram for exact risk stratification.

Methods: Retrospectively analyzed 244 consecutive patients who underwent CT-guided soft hook-wire localization and subsequently had video-assisted thoracoscopic surgery for SPNs in our department from January 2025 to November 2025. Univariate and multivariate logistic regression analysis was done to find out independent predictors for complications. According to these factors, we developed and evaluated a prognosis nomogram.

Results: Technical success rate of localization was 100%. Post-procedural complications occurred in 71 (29.1%) patients. Complications were restricted to pneumothorax and pulmonary hemorrhage. After multivariate analysis, it was found that the presence of emphysema (OR: 15.45, P < 0.001), nodule location in the right upper lobe (OR: 6.08, P < 0.001), and lower platelet count (OR: 0.99, P = 0.012) were all independent risk factors. The well-calibrated model achieved a C-index of 0.80 (95% CI: 0.74-0.86) and demonstrated net clinical benefits across threshold probabilities of 0-0.85.

Conclusion: The prediction nomogram developed in this study exhibits good accuracy in predicting complications following CT-guided soft hook-wire localization of SPNs and provides an objective tool for clinical staff to assess preoperative risk.

Purpose: This study aimed to evaluate the diagnostic performance and safety of core needle biopsy (CNB) as a first-line diagnostic tool for selected thyroid nodules with suspicious imaging features or other high-risk characteristics in a real-world setting.

Methods: The protocol for this observational study was approved by the Review Board of Tianjin Medical University Cancer Institute and Hospital. All the medical records of patients who underwent ultrasound (US)-guided CNB of thyroid nodules were searched between 1 January 2022 and 30 April 2023. US-guided CNB was performed using a disposable 18-gauge needle, and the pathological results of CNB were divided into six categories: nondiagnostic, benign, indeterminate, follicular neoplasms (FN) or suspected follicular neoplasms (SFN), suspicion of malignancy, and malignancy. The diagnostic performance and complications of CNB and the risk factors associated with inconclusive results were also assessed.

Results: A total of 286 patients with 316 nodules were included. Of the 199 cases of malignant nodules, 72 were confirmed by surgery after CNB, and 127 were managed as malignant based on definitive CNB findings in conjunction with clinical and imaging correlation, without surgical confirmation. Among the 78 benign nodules, eight were confirmed by surgery, 50 cases were confirmed by CNB plus contrast-enhanced ultrasound (CEUS), and 20 cases were confirmed by CNB with no change in follow-up for more than 1 year. The non-diagnostic and inconclusive rates were 1.9% and 10.4%, respectively. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CNB were 98.2%, 100.0%, 93.6%, 97.5%, and 100.0%, respectively. The rate of unnecessary surgeries was 6.3%.

Conclusion: CNB is an effective diagnostic tool for thyroid nodules, demonstrating high diagnostic accuracy and a low rate of non-diagnostic results. It may serve as a viable alternative or complementary first-line diagnostic option for selected nodules, particularly those with suspicious ultrasound features or larger sizes, by providing reliable histological architectural assessment.

Background: Surgical resection for pancreatic cancer is associated with high rates of locoregional recurrence and peritoneal metastasis, leading to poor prognosis. This study aimed to evaluate the safety and efficacy of laparoscopic pancreaticoduodenectomy (LPD) combined with a modified perioperative hyperthermic intraperitoneal chemotherapy (HIPEC) regimen for resectable pancreatic head cancer.

Methods: This dual-center retrospective cohort study included patients with resectable pancreatic head cancer who underwent LPD between May 2018 and July 2024. Patients were allocated to either the LPD-alone group (n=54) or the LPD plus HIPEC (LPD+HIPEC) group (n=55). The HIPEC protocol consisted of intraoperative hyperthermic saline perfusion, followed by intraperitoneal gemcitabine on postoperative day 2 and saline perfusion on day 4. The primary endpoint was overall survival (OS). Secondary endpoints included postoperative complications and patterns of recurrence. A multivariate Cox proportional hazards model was used to identify independent predictors of survival.

Results: A total of 109 patients were analyzed. Baseline demographic, clinical, and key oncologic characteristics were comparable between the two groups. The incidence of major postoperative complications (Clavien-Dindo grade ≥III) was not significantly different between the LPD+HIPEC and LPD groups (5.5% vs. 5.6%, P = 1.000). The LPD+HIPEC group had a significantly longer median OS (27 months; 95% CI, 24.1-29.9) compared to the LPD group (23 months; 95% CI, 20.5-25.5; P = 0.045). The 1-, 2-, and 3-year OS rates were 84.9%, 58.2%, and 26.3% in the LPD+HIPEC group, versus 74.6%, 40.0%, and 15.0% in the LPD group, respectively. Locoregional recurrence was significantly lower in the LPD+HIPEC group (14.6% vs. 31.5%, P = 0.035). On multivariate analysis, treatment with LPD+HIPEC was an independent predictor of improved OS (Hazard Ratio: 0.58; 95% CI: 0.35-0.97; P = 0.038).

Conclusion: In this retrospective analysis, LPD combined with a modified perioperative HIPEC regimen was associated with improved overall survival and reduced locoregional recurrence rates for resectable pancreatic head cancer, without a significant increase in severe postoperative morbidity. These findings suggest a potential therapeutic role for this strategy, warranting further investigation in prospective randomized trials.