Frontiers in Oncology最新文献

{"title":"Rapid detection of liver metastasis risk in colorectal cancer patients through blood test indicators","authors":"Zhou Yu, Gang Li, Wanxiu Xu","doi":"10.3389/fonc.2024.1460136","DOIUrl":"https://doi.org/10.3389/fonc.2024.1460136","url":null,"abstract":"IntroductionColorectal cancer (CRC) is one of the most common malignancies, with liver metastasis being its most common form of metastasis. The diagnosis of colorectal cancer liver metastasis (CRCLM) mainly relies on imaging techniques and puncture biopsy techniques, but there is no simple and quick early diagnosisof CRCLM.MethodsThis study aims to develop a method for rapidly detecting the risk of liver metastasis in CRC patients through blood test indicators based on machine learning (ML) techniques, thereby improving treatment outcomes. To achieve this, blood test indicators from 246 CRC patients and 256 CRCLM patients were collected and analyzed, including routine blood tests, liver function tests, electrolyte tests, renal function tests, glucose determination, cardiac enzyme profiles, blood lipids, and tumor markers. Six commonly used ML models were used for CRC and CRCLM classification and optimized by using a feature selection strategy.ResultsThe results showed that AdaBoost algorithm can achieve the highest accuracy of 89.3% among the six models, which improved to 91.1% after feature selection strategy, resulting with 20 key markers.ConclusionsThe results demonstrate that the combination of machine learning techniques with blood markers is feasible and effective for the rapid diagnosis of CRCLM, significantly im-proving diagnostic ac-curacy and patient prognosis.","PeriodicalId":12482,"journal":{"name":"Frontiers in Oncology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The potential of retinoic acid receptors as prognostic biomarkers and therapeutic targets in gastric cancer","authors":"Silvio Ken Garattini, Debora Basile, Valli’ De Re, Giulia Brisotto, Gianmaria Miolo, Vincenzo Canzonieri, Giuseppe Aprile, Carla Corvaja, Silvia Buriolla, Enrico Garattini, Fabio Puglisi","doi":"10.3389/fonc.2024.1453934","DOIUrl":"https://doi.org/10.3389/fonc.2024.1453934","url":null,"abstract":"BackgroundGastric cancer is a heterogeneous collection of tumors characterized by low survival rates. All-trans retinoic acid (retinoic-acid) is a clinically useful therapeutic agent belonging to the chemical family of retinoids, which consists of both natural and synthetic derivatives of vitamin-A. Retinoids are essential components of the normal diet and they regulate different physiological processes. From a therapeutic point of view, retinoic-acid is the first example of clinically useful differentiating agent. Indeed, the differentiating properties of this compound have promoted the use of retinoic-acid as a standard of care in Acute-Promyelocytic-Leukemia, a rare form of acute myeloid leukemia. In this study, we determine the RNA expression of the six isoforms of <jats:italic>Retinoic</jats:italic>-<jats:italic>Acid</jats:italic>-<jats:italic>Receptors</jats:italic> (<jats:italic>RARα</jats:italic>/<jats:italic>RARβ</jats:italic>/<jats:italic>RARγ</jats:italic>/<jats:italic>RXRα</jats:italic>/<jats:italic>RXRβ</jats:italic>/<jats:italic>RXRγ</jats:italic>) in view of their potential use as gastric cancer progression markers and/or therapeutic targets. In addition, we evaluate associations between the expression of these receptors and a simplified molecular classification of stomach tumors as well as the clinical characteristics of the cohort of patients analyzed. Finally, we define the prognostic value of the various <jats:italic>Retinoic</jats:italic>-<jats:italic>Acid</jats:italic>-<jats:italic>Receptors</jats:italic> in gastric cancer.MethodsIn this single institution and retrospective <jats:italic>RAR-GASTRIC</jats:italic> study, we consider 55 consecutive gastric cancer patients. We extract total RNA from the pathological specimens and we perform a <jats:italic>NanoString Assay</jats:italic> using a customized panel of genes. This allows us to determine the expression levels of the <jats:italic>RAR</jats:italic> and <jats:italic>RXR</jats:italic> mRNAs as well as other transcripts of interest.ResultsOur data demonstrate ubiquitous expression of the <jats:italic>RAR</jats:italic> and <jats:italic>RXR</jats:italic> mRNAs in gastric cancers. High levels of <jats:italic>RARα</jats:italic>, <jats:italic>RARβ</jats:italic>, <jats:italic>RXRα</jats:italic> and <jats:italic>RXRβ</jats:italic> show a significant association with stage IV tumors, “<jats:italic>de novo</jats:italic>” metastatic disease, microsatellite-stable-status, epithelial-to-mesenchymal-transition, as well as <jats:italic>PIK3CA</jats:italic> and <jats:italic>TP53</jats:italic> expression. Finally, we observe a worse <jats:italic>overall</jats:italic>-<jats:italic>survival</jats:italic> in gastric cancer patients characterized by high <jats:italic>RARα</jats:italic>/<jats:italic>RARβ</jats:italic>/<jats:italic>RARγ</jats:italic>/<jats:italic>RXRβ</jats:italic> mRNA levels.ConclusionsIn gastric cancer, high expression levels of <jats:italic>RARα</jats:italic>/<jats:italic>RAR","PeriodicalId":12482,"journal":{"name":"Frontiers in Oncology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genomic alterations in the stepwise progression from normal mucosa to metastasizing oral squamous cell carcinoma","authors":"Jakob Myllerup Jensen, Sannia Mia Svenningsen Sjöstedt, Javiera Laing Carmona, Lise Barlebo Ahlborn, Filipe Garrett Vieira, Finn Cilius Nielsen, Katalin Kiss, Christian Grønhøj, Christian von Buchwald","doi":"10.3389/fonc.2024.1450361","DOIUrl":"https://doi.org/10.3389/fonc.2024.1450361","url":null,"abstract":"IntroductionThe aim of this study was to investigate the genomic changes that occur in the development from dysplasia, cancer and to regional metastases in patients with oral cavity squamous cell carcinoma (OSCC).Material and methodsWe included OSCC patients with lymph node metastases at diagnosis, treated with primary surgery at Rigshospitalet, University of Copenhagen in the period 2007-2014. The resected tumor specimens were evaluated by a pathologist, who marked areas of morphologically normal tissue and dysplasia surrounding the cancer, two areas from the cancer tissue, and one area within the lymph node metastases. From these areas a punch biopsy was taken, and DNA from each sample was extracted and sequenced using Illumina’s TSO500 HT cancer panel.ResultsFrom 51 OSCC patients, 255 samples were included, comprising a wide variety of genomic alterations. Substantial intratumor heterogeneity was found. The most commonly mutated gene was <jats:italic>TP53</jats:italic>, mutated in 65% of all samples. Only two patients had no <jats:italic>TP53</jats:italic> mutation in any samples. We found that morphologically normal appearing mucosa as well as surrounding dysplasia also contained malignant mutations, supporting the theory of field cancerization. There was a significant lower average tumor mutational burden (TMB) in the lymph node metastases compared to the primary tumors, supporting the theory of clonal selection.ConclusionSubstantial inter- and intratumor genomic heterogeneity was found. Mutation of <jats:italic>TP53</jats:italic> was the most common and was present in all but two patients. Our data strongly supports the theory of clonal selection and the theory of field cancerization.","PeriodicalId":12482,"journal":{"name":"Frontiers in Oncology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142224658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review effects of radiation treatment on HPV-related vulvar cancer: a meta-analysis and systematic review","authors":"Wei Li, Lijun Zhai, Yinju Zhu, Fengjun Lou, Shiyu Liu, Ke Li, Liang Chen, Huankun Wang","doi":"10.3389/fonc.2024.1400047","DOIUrl":"https://doi.org/10.3389/fonc.2024.1400047","url":null,"abstract":"ObjectiveVulvar carcinoma exhibits a robust correlation alongside HPV infection; however, the impact of HPV rank on the prognostic outcomes of radiation therapy within vulvar malignancies stays ambiguous. In the present study, we performed a comprehensive examination as well as meta-analysis to assess the influence of infection with HPV upon the long-term outlook as well as sensitivity of individuals with vulvar cancer undergoing radiation therapy.MethodsA meticulous examination of the existing research was conducted in accordance with the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A thorough search was conducted in the PubMed, Embase, Web of Science, as well as Cochrane Library databases, covering the entire available literature till April 1, 2023. The studies that met the inclusion criteria contained data about HPV infection and oncological outcomes in patients with vulvar cancer who received radiation therapy. This study was registered in PROSPERO (CRD42023417957).ResultsWe identified 12 retrospective studies meeting our inclusion criteria, which included a total of 3967 patients. Patients with HPV-associated vulvar cancer achieved a better overall survival rate after radiotherapy (HR=0.71, 95%CI: 0.54-0.93, P=0.01), and showed a significant improvement in disease-free survival (HR=0.75, 95%CI: 0.58-0.97, P=0.09) and progression-free survival (HR=0.31, 95%CI: 0.22-0.45, P,&amp;lt;0.01). Meanwhile, the complete remission rate after radiotherapy was higher for HPV-associated vulvar cancer patients (M-H=4.02, 95% CI: 1.87-8.61, P=0.0003), and the local control rate was better (HR=1.90, 95% CI: 1.15-3.15, P=0.01), exhibiting a reduced incidence of relapse within the field of study (HR=0.21, 95% CI: 0.10-0.42, P&amp;lt;0.001).ConclusionIn comparison to HPV-independent vulvar squamous cell carcinoma, patients with HPV-associated vulvar cancer exhibit higher sensitivity to radiotherapy, with a significant difference in prognosis. Further research should investigate the mechanisms underlying this high sensitivity to radiotherapy caused by HPV, and should be evaluated using high-quality randomized controlled trials.","PeriodicalId":12482,"journal":{"name":"Frontiers in Oncology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting non-coding RNAs to overcome osimertinib resistance in EGFR-mutated non-small cell lung cancer","authors":"Beilei Zeng, Kelun Gan, Yuanhang Yu, Jianping Hu, Qiao Deng, Chong Yin, Xi Gao","doi":"10.3389/fonc.2024.1442237","DOIUrl":"https://doi.org/10.3389/fonc.2024.1442237","url":null,"abstract":"Osimertinib, a third-generation inhibitor of epidermal growth factor receptor (EGFR) tyrosine kinase, exhibits remarkable efficacy in prolonging the survival of patients with non-small cell lung cancer (NSCLC) carrying <jats:italic>EGFR</jats:italic> mutations, surpassing the efficacy of first- and second-generation EGFR tyrosine kinases. Nevertheless, the emergence of osimertinib resistance is inevitable, necessitating an investigation into the underlying mechanisms. Increasing evidence has revealed that non-coding RNAs (ncRNAs), including microRNAs, long ncRNAs, and circular RNAs, play a significant role in the development and progression of lung cancer. These ncRNAs regulate essential signaling pathways, offering a novel avenue for understanding the fundamental mechanisms of osimertinib resistance. Recent studies have reported the significant impact of ncRNAs on osimertinib resistance, achieved through various mechanisms that modulate treatment sensitivity. We provide a concise overview of the functions and underlying mechanisms of extensively researched ncRNAs in the development of osimertinib resistance and emphasize their potential clinical application in <jats:italic>EGFR</jats:italic>-mutated NSCLC resistant to osimertinib. Finally, we discuss the obstacles that must be addressed to effectively translate ncRNA-based approaches into clinical practice.","PeriodicalId":12482,"journal":{"name":"Frontiers in Oncology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functions of patient- and family-centered pediatric cancer communication in Pakistan","authors":"Dylan E. Graetz, Alia Ahmad, Muhammad Rafie Raza, Ambreen Hameed, Asma Naheed, Atoofa Najmi, Afia tul Quanita, Shabnam Munir, Safwan Ahmad, Gia Ferrara, Courtney Staples, Carlos Rodriguez Galindo, Syed Ahmer Hamid, Sima Jeha, Jennifer W. Mack","doi":"10.3389/fonc.2024.1393908","DOIUrl":"https://doi.org/10.3389/fonc.2024.1393908","url":null,"abstract":"BackgroundCommunication is an essential aspect of high-quality patient- and family-centered care. A model for pediatric cancer communication developed in the United States defined eight communication functions. The purpose of this study was to explore the relevance of these functions in Pakistan as part of an effort to understand the role of culture in communication.Materials and methodsSemi-structured interviews were conducted with 20 clinicians and 18 caregivers of children with cancer at two major cancer centers. Interviews were conducted in Urdu or English and transcribed and translated as necessary. Two independent coders used <jats:italic>a priori</jats:italic> codes related to the communication model as well as novel codes derived inductively. Thematic analysis focused on operationalization of the functional communication model.ResultsClinicians and caregivers in Pakistan discussed the importance of all eight communication functions previously identified including: <jats:italic>information exchange, decision-making, managing uncertainty, enabling family self-management, responding to emotions, supporting hope, providing validation</jats:italic>, and <jats:italic>building relationships.</jats:italic> The operationalization of these functions was influenced by Pakistani cultural context. For example, <jats:italic>information-exchange</jats:italic> included the importance of addressing preconceptions and community myths, while <jats:italic>managing uncertainty</jats:italic> included strong references to religion and faith-based coping. Essential to all eight functions was <jats:italic>trust</jats:italic> between the family and the medical team.DiscussionThese findings support the use of this functional communication model in diverse pediatric oncology settings and emphasize the importance of trust. Culturally sensitive operationalization of these functions could inform the adaptation of tools to measure communication and interventions aimed at supporting the needs of parents of children with cancer.","PeriodicalId":12482,"journal":{"name":"Frontiers in Oncology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prognostic value of Th17/Treg cell in cervical cancer: a systematic review and meta-analysis","authors":"Jingwei Zhang, Jijie Zhan, Ziting Guan, Xinmei Lin, Tian Li, Miao Li, Changlin Zhang, Li Zhong","doi":"10.3389/fonc.2024.1442103","DOIUrl":"https://doi.org/10.3389/fonc.2024.1442103","url":null,"abstract":"BackgroundThe prognostic significance of Treg and Th17 cells, as well as their ratio (Th17/Treg), in cervical cancer remains a topic of debate. Our study aimed to clarify their association with patient survival and clinical outcomes in cervical cancer through a comprehensive meta-analysis.Materials and methodsWe conducted a comprehensive search in PubMed, Embase, and Web of Science to identify eligible studies. Studies related to cervical cancer and involving Treg cells or Th17 cells were included. For prognostic analysis, we collected Hazard Ratio values of patient survival. For studies focusing on clinical characteristics, we selected mean and standard deviation values for further analysis. This study was registered at PROSPERO (ID:CRD42024546507).ResultsOut of the 2949 records initially retrieved, we ultimately included 21 studies in our analysis. High levels of Treg cells were found to be correlated with shorter survival in patients with cervical cancer. Subgroup analysis revealed that the prognostic effect of Treg cells on cervical cancer was not influenced by their source or definition. However, analyses of different survival measures indicated that only Overall Survival showed a correlation with Treg cell levels. Additionally, Treg cells were associated with clinical staging. High-grade Th17 cells were associated with lymphatic metastases and advanced clinical stage. The Th17/Treg ratio was found to be elevated in both cervical intraepithelial neoplasia and cervical cancer patients compared to controls.DiscussionDespite limitations such as heterogeneity among selected studies and inadequate subgroup analyses, our study contributes to a deeper understanding of the significance of Treg cells in the onset and progression of cervical cancer. It also provides valuable insights for future research in immunotherapy.Systematic review registration<jats:uri>https://www.crd.york.ac.uk/prospero/</jats:uri>, identifier CRD42024546507.","PeriodicalId":12482,"journal":{"name":"Frontiers in Oncology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative study of CAD/CAM reconstruction and miniplates for patient-specific fixation in LCL-type mandibular reconstruction","authors":"Philipp Lampert, Jakob Fenske, Jonas Wüster, Steffen Koerdt, Kilian Kreutzer, Philipp Ruf, Sara Checa, Max Heiland, Claudius Steffen, Carsten Rendenbach","doi":"10.3389/fonc.2024.1438269","DOIUrl":"https://doi.org/10.3389/fonc.2024.1438269","url":null,"abstract":"ObjectiveMiniplates offer superior clinical handling and facilitate postoperative removal after mandibular reconstruction but unfavorable load distribution under high stress has been shown. This study aimed to compare the clinical outcome of patient-specific 3D-printed (PS-3D) titanium miniplate with reconstruction plate fixation in three-segmental LCL-type reconstructions for the first time.MethodsPatients undergoing three-segmental LCL-type mandibular reconstruction after malignant tumor resection between April 2017 and July 2023 were analyzed in a retrospective single-center study. Inclusion criteria were primary reconstruction using a fibula free flap and PS-3D titanium mini- or reconstruction plate fixation. Complication rates were recorded and analyzed within 6 months after surgery using the N – 1 Chi<jats:sup>2</jats:sup>- and unequal variance t-test.Results38 patients (10 females, 28 males; mean age 61.4 ± 7.6 years) met the inclusion criteria. In 14 patients (36.8%) miniplates were used in the anterior region. Rates of fixation failure, plate exposure, incomplete osseous union, wound infection, soft tissue, and overall complications did not differ significantly between the two plate systems.ConclusionComplication rates did not differ significantly between PS-3D mini- and reconstruction plates in three-segmental LCL-type mandibular reconstructions. Given their advantages in clinical handling and postoperative removal, PS-3D miniplates can be a viable alternative also in larger mandibular reconstructions.","PeriodicalId":12482,"journal":{"name":"Frontiers in Oncology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of PD-L1 expression and molecular alterations in primary versus metastatic lung adenocarcinoma: a real-world study in China","authors":"Gang Chen, Yang Yu, Youchao Qi, Guangxu Li, Ning Li, Fande Meng, Wujie Wang, Rong Shen","doi":"10.3389/fonc.2024.1393686","DOIUrl":"https://doi.org/10.3389/fonc.2024.1393686","url":null,"abstract":"ObjectivesProgrammed death-ligand 1 (PD-L1) is the only Food and Drug Administration-approved biomarker for monitoring response to immune checkpoint inhibitor (ICI) therapy in patients with lung adenocarcinoma. Understanding the nuances of molecular phenotypes, clinical attributes, and PD-L1 expression levels in primary and metastatic lung adenocarcinoma may help predict response to therapy and assist in the clinical management of lung adenocarcinoma.MethodsA total of 235 primary and metastatic lesion specimens from patients with non-small cell lung cancer (NSCLC) an institution in Shandong, China were analyzed. PD-L1 expression was assessed by immunohistochemistry using the 22C3 antibody, and the molecular phenotype was determined by next-generation sequencing of 450 genes. The molecular phenotypes of the primary and metastatic lesions were compared.ResultsElevated PD-L1 expression was significantly associated with advanced and metastatic disease (P = 0.001). The distribution of PD-L1 expression varied based on the anatomical location, showing a higher frequency of elevated PD-L1 expression in distal metastases than in the primary tumor. Metastatic lesions exhibited a higher proportion of carcinogenic pathway gene alterations and a greater number of DNA damage-repair pathway gene alterations than the primary lesions. Notably, <jats:italic>CDKN2A</jats:italic> copy number deletions were more prevalent in metastatic lesions than in primary lesions. Clinical data stemming from research conducted at the Memorial Sloan Kettering Cancer Center revealed an association between the absence of CDKN2A expression and a poorer prognosis in stage I lung adenocarcinoma.ConclusionSamples of metastatic tumors exhibited a higher proportion of elevated PD-L1 expression, a greater number of pathway alterations, and a higher occurrence of <jats:italic>CDKN2A</jats:italic> copy number deletions than primary samples. This highlights the importance of reinforcing the clinical management and follow-up of patients with <jats:italic>CDKN2A</jats:italic> deficiency, particularly within the subset of stage I lung adenocarcinoma.","PeriodicalId":12482,"journal":{"name":"Frontiers in Oncology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and toxicities in patients with diffuse-large B cell lymphoma involving the gastrointestinal tract and digestive organs","authors":"Gohar S. Manzar, Elaine E. Cha, Kelsey L. Corrigan, Alison K. Yoder, Benjamin R. Schrank, Lewis F. Nasr, Dai Chihara, Luis Malpica Castillo, Ranjit Nair, Preetesh Jain, Sattva S. Neelapu, Maria A. Rodriguez, Paolo Strati, Loretta J. Nastoupil, Jillian R. Gunther, Bouthaina S. Dabaja, Chelsea C. Pinnix, Susan Y. Wu, Penny Q. Fang","doi":"10.3389/fonc.2024.1447020","DOIUrl":"https://doi.org/10.3389/fonc.2024.1447020","url":null,"abstract":"BackgroundDiffuse large B-cell lymphoma (DLBCL) involving the gastrointestinal (GI) organs is rare, and real-world outcomes after combined modality therapy (CMT) with systemic therapy (ST) and radiotherapy (RT) are not well-characterized, particularly in the contemporary era. We characterized outcomes in a large cohort of GI-DLBCL patients treated with ST alone or CMT.MethodsPatients with GI-DLBCL treated at a single institution were retrospectively reviewed. Kaplan-Meier and Cox regression models estimated survival. Multivariable analyses were conducted using the Cox proportional hazards model.ResultsOf 204 patients, gastric involvement was most common (63%). Most presented with early-stage disease (61%). All patients received ST and 65 patients (32%) received RT, 88% as part of first-line CMT. Median dose was 36 Gy (IQR 30.6–39.6) in 18 fractions (IQR 17–22). Median follow-up was 46 months. Five-year overall survival (OS) and progression-free survival (PFS) was 88% and 84%, respectively; complete response (CR) rate was 82%. Improved OS associated with low IPI (<jats:italic>p</jats:italic>=0.001), fewer chemotherapy lines (<jats:italic>p</jats:italic>&amp;lt;0.001), early stage (<jats:italic>p</jats:italic>&amp;lt;0.006), and CR (<jats:italic>p</jats:italic>&amp;lt;0.001). Survival did not differ by RT receipt (<jats:italic>p</jats:italic>&amp;gt;0.25). Only early stage and CR correlated with improved OS on multivariable analysis. Stomach-directed RT vs. RT to other sites correlated with improved PFS and OS (<jats:italic>p</jats:italic>&amp;lt;0.04). Patients with early stage DLBCL treated with CMT in the post-rituximab era had equivalent OS vs. ST alone, even with fewer chemotherapy cycles (<jats:italic>p</jats:italic>&amp;lt;0.02; median of 4 with RT vs. 6 cycles without). Fifty patients had bulky disease (≥7.5 cm), of whom 18 (36%) had early stage disease. Among patients with bulky disease, 5 (10%) developed relapse at the initial site of disease bulk. Four of the 5 patients did not receive consolidative radiation. Among these 4 patients, 3 relapsed only in their initial site of bulky disease. Of 191 patients with luminal GI-DLBCL, <jats:italic>n</jats:italic>=4 (2.1%) developed perforation; only one received RT. Acute Grade 3 toxicities were reported in 41.2% of patients, and 12 (5.8%) patients had late Grade 3 toxicities, 99% attributed to chemotherapy.ConclusionGI-DLBCL patients have favorable outcomes after CMT with minimal late toxicity. CMT may be offered with abridged systemic regimens with equivalent outcomes. Stomach directed-RT may mitigate relapse risk associated with incomplete disease response or bulky disease.","PeriodicalId":12482,"journal":{"name":"Frontiers in Oncology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}