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.

Background: The optimal treatment strategy for advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) remains undefined. Although combinations of locoregional therapies-such as transarterial chemoembolization (TACE) and hepatic arterial infusion chemotherapy (HAIC)-with systemic agents (tyrosine kinase inhibitors [TKIs] and PD-1 inhibitors) show promise, direct comparative evidence among different regimens remains limited.

Methods: In this single-center retrospective study, we included 347 patients with unresectable HCC and PVTT treated between January 2020 and December 2022. Patients were categorized into four groups based on initial therapy: TACE-HAIC-TP (n = 79), TACE-TP (n = 90), HAIC-TP (n = 98), and TACE alone (n = 80). The primary endpoints were overall survival (OS) and progression-free survival (PFS).

Results: All combination regimens significantly improved OS and PFS compared with TACE alone (median OS: 11.4 months; median PFS: 5.8 months; all p < 0.001). The TACE-HAIC-TP group had the longest median OS (21.0 months) and PFS (15.3 months). However, after propensity score matching, no significant difference in survival outcomes was observed between the TACE-HAIC-TP and HAIC-TP groups. The HAIC-TP and TACE-TP regimens demonstrated comparable efficacy. Regarding safety, TACE-HAIC-TP was associated with the highest incidence of adverse events, including appetite loss, fatigue, nausea/vomiting, bleeding, and immune-related pneumonia. HAIC-TP carried a higher risk of gastrointestinal reactions and bleeding, whereas hand-foot syndrome was more frequent with TACE-TP.

Conclusion: In patients with unresectable HCC and PVTT, combining TKIs and PD-1 inhibitors with locoregional therapy (TACE or HAIC) confers superior survival benefits over TACE monotherapy. The HAIC-TP regimen was associated with a more favorable balance of efficacy and tolerability compared with the more intensive TACE-HAIC-TP strategy, suggesting it may represent a promising therapeutic option pending prospective validation. Treatment selection should be individualized based on efficacy-safety trade-offs.

Biliary tract tumours represent a serious medical problem due to their high mortality rate. In early stages, patients are indicated for postoperative therapy after potentially curative surgery in order to reduce the risk of recurrence and prolong survival. Most patients with bile duct tumours are diagnosed at a locoregionally advanced and/or metastatic stage. The standard treatment for these patients is systemic therapy, now in combination with immunotherapy. Deepening knowledge of the molecular biology of this disease allows for the selection of treatment tailored to the individual patient based on the presence of specific targetable alterations in some patients. The article provides an overview of current treatment options for this disease across all stages.

Background: Tumor lysis syndrome (TLS) is a major metabolic emergency in pediatric oncology and a leading cause of acute kidney injury (AKI) in children with hematological malignancies. Early identification of children at risk for severe AKI remains challenging.

Methods: This retrospective study included 50 children with laboratory or clinical TLS diagnosed according to the Howard-Pui classification. Serial biochemical parameters were analyzed over a 10-day period. AKI severity was classified using the pediatric Risk, Injury, Failure, Loss, End-stage renal disease (pRIFLE) criteria based on changes in estimated glomerular filtration rate (eGFR). Clinical characteristics, biochemical trends (especially phosphate and uric acid), and outcomes were compared between children with mild (pRIFLE 0 [no AKI]/R/I) and severe (pRIFLE-F) AKI.

Results: Twenty-seven patients had acute lymphoblastic leukemia (ALL), and 23 had lymphoma, mainly Burkitt's lymphoma. Clinical TLS accounted for 86% of cases, and 60% of children developed severe AKI. Severe AKI was significantly associated with spontaneous TLS onset, prolonged TLS duration, increased need for kidney therapy, intensive care admission, and higher mortality. Static demographic characteristics, malignancy type, tumor burden, and radiological findings did not differ between AKI severity groups. While hyperphosphatemia and hyperuricemia were common, dynamic phosphate changes showed the strongest association with AKI severity. The daily rise in serum phosphate before AKI onset demonstrated good discriminatory performance for predicting severe AKI (AUC 0.839), outperforming changes in uric acid.

Conclusion: In pediatric TLS, AKI severity is the main determinant of clinical outcome. Dynamic phosphate kinetics (Delta phosphorus), rather than static biochemical thresholds, represent a robust early biomarker for identifying children at risk of severe AKI and may improve risk stratification, particularly in resource-limited settings.

Background: Cachexia is a frequent, specific metabolic syndrome that severely compromises survival in gastric cancer (GC). While early diagnosis is paramount, existing screening methods are limited by complexity and suboptimal accuracy. There is an urgent need for an efficient, data-driven tool derived from routine clinical parameters.

Methods: In this multicenter retrospective study, we analyzed data from three independent hospitals. Variable selection was performed using univariable and multivariable analyses. We constructed and compared multiple machine learning (ML) models to predict cachexia risk. The models' discriminative ability, calibration, and clinical net benefit were comprehensively evaluated via AUC, calibration plots, and Decision Curve Analysis (DCA).

Results: The study included 1,570 GC patients (cachexia prevalence: 30.3%). Patients were divided into training (n=920), internal testing (n=350), and external validation (n=300) cohorts. Cachexia was significantly associated with poor nutritional status, elevated inflammation, and inferior overall survival (P < 0.01). The Random Forest (RF) model yielded the best performance, maintaining excellent stability across the internal test set (AUC = 0.898) and external validation set (AUC = 0.913). To enhance clinical utility, we further derived a simplified decision tree model based on three accessible markers: CA19-9, CEA, and albumin. This simplified tool retained high diagnostic accuracy (AUC > 0.783) and demonstrated significant positive net benefits in DCA.

Conclusion: We successfully established and externally validated a high-performance ML model for predicting GC-associated cachexia. Crucially, the derived simplified decision tree offers a convenient, highly generalizable tool for clinicians to identify high-risk patients using routine laboratory tests, enabling earlier precision nutritional management.

This case report describes a 51-year-old female with HER2-positive breast cancer who developed recurrent, severe thrombocytopenia during treatment with trastuzumab and pertuzumab. Through a retrospective analysis of her entire treatment course-encompassing neoadjuvant, adjuvant, and radiotherapy phases-we dynamically observed the temporal correlation between anti-HER2 therapy administration and acute drops in platelet count (nadir: 8×10⁹/L), accompanied by bleeding symptoms. The thrombocytopenia responded well to thrombopoietin-stimulating agents and immunomodulatory therapy but recurred persistently, even after switching to trastuzumab monotherapy or its subcutaneous formulation. Laboratory workup was notable for revealing a predisposition to undifferentiated connective tissue disease (UCTD) with positive antinuclear antibody (ANA) and positive anti-SSA/Ro52 antibodies. Ultimately, all targeted therapies were discontinued due to intolerability. This case highlights that both trastuzumab and pertuzumab (including subcutaneous forms) can induce rare immune-mediated thrombocytopenia, a risk significantly heightened by underlying autoimmune serology. The mechanisms appear multifactorial, involving the patient's immune status, treatment phase, and route of administration. It underscores the need for heightened clinical vigilance, prompt drug suspension, supportive care, and individualized, multidisciplinary management in such scenarios.

Background: The prognostic significance of the pan-immune-inflammation value (PIV) in head and neck squamous cell carcinoma has been comprehensively documented. Nevertheless, its exact role remains ambiguous. The objective of this study is to perform a systematic exploration of the correlation between the pretreatment PIV and survival outcomes in this population.

Methods: An extensive and systematic search of the literature was conducted through electronic databases, including Web of Science, PubMed, and Embase. The search period covered from inception to October 1, 2025. The primary endpoint was survival outcomes. Hazard ratios (HRs) and their 95% confidence intervals (CIs) for survival outcomes were retrieved. A random-effects model was employed to integrate the pooled findings. This meta-analysis was prospectively registered with PROSPERO (CRD420251170558).

Results: A total of twelve studies, encompassing 5,056 patients, were included. The pooled results revealed that patients in the high PIV group exhibited significantly inferior overall survival (12 studies; HR = 2.62; 95% CI: 2.00 - 3.44; I² = 74%) and disease-free survival (9 studies; HR = 2.34; 95% CI: 1.69 - 3.26; I² = 79%) when compared to those in the low PIV group. Subgroup analyses buttressed the prognostic significance of PIV for overall survival and disease-free survival across diverse geographical regions, tumor stages, and treatment strategies. Moreover, evidence aggregated from limited studies indicated that a higher PIV was associated with a worse distal metastasis-free survival (3 studies; HR = 2.04; 95% CI: 1.13 - 3.67; P = 0.02; I² = 94%) and a marginally poorer local recurrence-free survival (3 studies; HR = 1.20; 95% CI: 1.00 - 1.44; P = 0.05; I² = 0%).

Conclusions: Our findings indicate that the pretreatment PIV has the potential to serve as a valuable biomarker for predicting the survival outcomes of patients with head and neck squamous cell carcinoma.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD420251170558.

Background: For intermediate- and high-risk prostate cancer, dose escalation is essential to optimize oncological control. While external beam radiotherapy (EBRT) alone can be limited by dose constraints to adjacent organs-at-risk, high-dose-rate (HDR) brachytherapy provides a highly conformal boost option.

Methods: This retrospective single-institution study analyzed 250 patients with localized intermediate- and high-risk prostate cancer treated between 06/2004 and 03/2024 with EBRT plus HDR brachytherapy boost. The EBRT dose averaged 50.4 Gy (range: 45-64 Gy), followed by HDR boost in nearly all patients (98.8%) with two fractions of 9 Gy. Androgen deprivation therapy (ADT) was administered to 39.2% of patients (98/250). Primary outcomes included local control (LC), progression-free survival (PFS), and overall survival (OS).

Results: After a median follow-up of 63.5 months (mean 70.4, range 3-231), oncological outcomes were excellent. LC rates were 99.6% at 3 years, 98.8% at 5 years, and 98.4% at 10 years. PFS was 98%, 96.8%, and 96% at 3, 5, and 10 years, respectively. OS reached 98.4% at 5 years and 96% at 10 years. During the 231-month follow-up, 8.4% of patients developed biochemical recurrence, whereas in-field progression was observed in only 1.6%. Patients receiving ADT achieved 100% LC across all timepoints. Patterns of failure were predominantly distant (lymph nodes and bone). Acute and late toxicity was predominantly mild. No acute Grade ≥3 genitourinary (GU) or gastrointestinal (GI) toxicity was observed. Late Grade ≥3 toxicity was rare (0.8%, limited to GU events), and no late Grade ≥3 GI toxicity occurred.

Conclusions: The combination of EBRT and HDR brachytherapy boost yields outstanding long-term LC, PFS, and OS for intermediate- and high-risk prostate cancer, confirming this regimen as a highly effective treatment strategy. The dominant pattern of failure was distant, underscoring the need for optimized systemic therapy integration in high-risk patients.

This case report describes the innovative integration of Cone-beam CT (CBCT) - derived parenchymal blood volume (PBV) mapping with embolization guidance technology to successfully direct the combined treatment of transarterial chemoembolization (TACE) and cryoablation of in a 70-year-old female with recurrent, hypovascular gallbladder liver metastases. By utilizing PBV software to quantitatively analyze tumor perfusion patterns through cone-beam CT acquisitions, the interventional team overcame the diagnostic limitations of conventional angiography in visualizing these typically occult lesions, identifying a characteristic peripheral hyperperfusion signature. Subsequently, the embolization guidance software automatically detected the tumor-feeding arteries and projected this information onto real-time fluoroscopy, enabling precise superselective catheterization. Post-TACE lipiodol deposition served as a radiopaque marker for accurate cryoablation probe placement under CT guidance. The procedural endpoint was objectively confirmed by a quantifiable change in PBV values, transitioning from pre-operative hypoperfusion to a post-operative "black cavity" pattern, indicative of complete treatment response. This novel multi-modal image-guided approach establishes a new paradigm for managing complex hepatic metastases, providing a comprehensive single-session solution for lesion identification, targeted embolization, and verified ablation.

Primary extramedullary plasmacytoma (EMP) of the kidney is a rare indolent lymphoma characterized by the monoclonal proliferation of plasma cells outside the bone marrow. Owing to its special site of origin, it is highly prone to misdiagnosis in clinical practice. Herein, we report a case of primary extramedullary plasmacytoma of the kidney. Abdominal computed tomography (CT) of the patient revealed a left renal mass, and renal carcinoma was considered. After adequate preoperative preparation, the patient underwent a radical nephrectomy for renal carcinoma. Pathological and immunohistochemical results strongly suggested the diagnosis of renal plasmacytoma. Subsequently, the patient underwent various examinations; however, no evidence of systemic plasma cell disease was found. After the surgery, the patient refused further radiotherapy or chemotherapy. Abdominal CT was performed three months postoperatively, and no recurrence was detected. We reviewed the current case, together with previous similar reports, to further understand the characteristics, diagnosis, and treatment of this disease. Although the prognosis of EMP is relatively favorable, regular follow-up examinations are necessary because of the potential risk of recurrence or progression to plasma cell neoplasms.