Frontiers in Oncology最新文献

Objective: This study aims to describe trends in bone cancer-related mortality from 1999 to 2020 and analyze disparities across various demographic subgroups.

Methods: Data were obtained from the CDC WONDER multiple cause of death database (1999-2020). Deaths of individuals aged 25 years or older with primary malignant bone cancer (ICD-10 codes C40-C41) as the underlying cause were included. AAMRs were calculated. Joinpoint regression analysis was employed to evaluate temporal trends and estimate the APC and AAPC.

Results: From 1999 to 2020, a total of 25,859 bone cancer deaths were reported among US adults. The overall ASMR increased from 0.528 per 100,000 (95% CI: 0.495-0.562) in 1999 to 0.599 per 100,000 (95% CI: 0.569-0.682) in 2020, with an AAPC of 0.509 (95% CI: 0.196 to 0.931; p = 0.002) over the 22-year period. Joinpoint analysis identified three distinct segments: a non-significant decrease from 1999 to 2014 (APC = -0.218, p = 0.288), a significant increase from 2014 to 2018 (APC = 4.479, p = 0.157), and a non-significant decrease from 2018 to 2020 (APC = -1.779, p = 0.424). Mortality rates were higher in males (0.712 per 100,000) than in females (0.446 per 100,000). Adults aged 85 years and older had the highest mortality rate (3.430 per 100,000). Black or African American individuals experienced a higher mortality rate (0.584 per 100,000) compared to White (0.561 per 100,000) and Hispanic or Latino (0.335 per 100,000) individuals. Geographically, the South had the highest mortality rate (0.614 per 100,000), while the Northeast had the lowest (0.444 per 100,000).

Conclusion: Bone cancer mortality among US adults showed an overall increasing trend from 1999 to 2020, with significant disparities by age, sex, race, and geographic region. The triphasic mortality trend may reflect evolving diagnostic technologies, treatment approaches, and healthcare accessibility. These findings provide valuable insights for public health planning and resource allocation aimed at reducing the burden of bone malignancies.

Introduction: Skin cancer is one of the most common malignancies worldwide, and early-stage diagnosis remains challenging due to its morphological similarity to benign lesions. Most existing computer-aided diagnostic systems rely on single static images, overlooking temporal information that is critical for distinguishing progressive malignancy.

Methods: We propose a novel multi-agent spatiotemporal fusion framework to enhance diagnostic accuracy. The framework consists of three key components: (1) a spatial agent based on a convolutional neural network for high-fidelity static feature extraction; (2) a temporal agent employing gated recurrent units to model longitudinal lesion evolution; and (3) a collaboration agent that dynamically fuses spatial and temporal representations via an attention-based weighting strategy.

Results: Experiments on large-scale public dermoscopic datasets showed that our method achieved an accuracy of 94.5%, an F1-score of 93.8%, and an AUC of 0.97-outperforming traditional machine learning models, CNN classifiers, and 3D-CNN baselines. Ablation studies further confirmed the critical contribution of temporal modeling and adaptive fusion, particularly in differentiating early melanoma from atypical nevi.

Discussion: This work highlights the potential of spatiotemporal modeling to improve early skin cancer detection and provides a promising direction for AI-assisted diagnosis of other chronic diseases requiring longitudinal monitoring.

Cardiac intimal sarcomas (CIS) are rare, aggressive primary cardiac malignancies with limited data guiding adjuvant treatment. We report a case of a 40-year-old woman with bi-atrial CIS who underwent bi-atrial resection and mitral valve replacement, with pathology confirming an MDM2-amplified intimal sarcoma and positive margins (R1). She received four cycles of adjuvant chemotherapy followed by adjuvant radiation therapy (RT) delivered using volumetric modulated arc therapy (VMAT), planned with four-dimensional computed tomography to account for respiratory motion, to a total dose of 60 Gy with a 6-Gy sequential boost. Treatment was well tolerated, with only grade 1-2 acute toxicities that resolved by completion of therapy. At 33 months following completion of RT and 41 months from diagnosis, the patient remains alive and disease-free without evidence of recurrence or significant late toxicity. This case supports the feasibility of incorporating adjuvant RT into a multimodal treatment approach for CIS and suggests that advanced radiation planning techniques may allow safe delivery of curative-intent doses to the heart, although further studies are needed to define its role in this rare malignancy.

The proliferation, migration, and invasion of tumor cells require a large amount of nutrients. Among them, the uptake of amino acids is crucial for most cellular functions, such as protein synthesis and cell growth. Tumor cells obtain a large number of essential amino acids from the environment through unique metabolic pathways and accelerate the synthesis of non-essential amino acids to meet their own needs. This review summarizes the uptake and utilization of amino acids by tumors and their inhibitory effects on immune cells, providing a basis for targeted metabolism in cancer treatment.

Background: This study examined the association between pre-treatment inflammation, immune cell- and nutrition/metabolism-related scores, and prognosis of patients with hepatocellular carcinoma (HCC) post-treatment.

Methods: This study collected clinical data on demographics, pretreatment blood tests, pathology, and follow-up. Key markers included C-reactive protein, albumin, neutrophil and lymphocyte counts, creatinine, bilirubin, international normalized ratio, tumor size and number, alpha-fetoprotein, platelet count, and CD4+/CD8+ T-cell levels. Disease-free survival (DFS) was calculated from treatment to recurrence. Twelve scores were derived. Kaplan-Meier and univariate Cox analyses identified significant predictors, followed by multivariate Cox models to determine independent risk factors. Logistic regression and receiver operating characteristic (ROC) analyses assessed predictive performance. Scores were grouped as inflammation-, metabolism-, or immune-related to construct nomograms and evaluate C-index values using R software.

Results: Except for Gender (p = 0.019), all other clinical characteristics showed no statistically significant differences between the training and validation sets (p > 0.05).Univariate Cox regression showed that pre-albumin (P = 0.01), PNI (P < 0.001), TBS (P = 0.01), ALBI (P < 0.001), PALBI (P < 0.001), and CRAFITY (P < 0.001) were significantly associated with DFS. Multivariate analysis identified PALBI (P = 0.03) and CRAFITY (P = 0.04) as independent predictors. A prognostic model was constructed: Risk score = 0.03903 × TBS + 0.79809 × PALBI + 0.40881 × CRAFITY, stratifying patients into high- and low-risk groups. Kaplan-Meier analysis showed significantly better DFS in the low-risk group (P = 0.001). ROC analysis for 1- and 2-year DFS yielded AUCs of 0.69 and 0.75. Logistic regression confirmed the risk score as a predictor of mortality (P = 0.002, AUC = 0.644). Excluding TBS, the remaining scores were grouped into inflammation-related, nutrition/metabolism-related, and immune-related categories. Corresponding nomograms showed good calibration, with C-index values of 0.610, 0.581, and 0.575, respectively.

Conclusion: Pre-treatment PALBI and CRAFITY scores are independent prognostic factors for post-treatment survival among patients with HCC, with inflammation-related scores providing superior predictive value for DFS compared to metabolism- and immune-related scores.

Reports of secondary mutations in mutual exclusive driver genes after resistance to targeted therapy are rare. We present a patient with Anaplastic lymphoma kinase (ALK) fusion lung adenocarcinoma who received sequential treatment with ALK tyrosine kinase inhibitor (TKI) (crizotinib, PFS:32.3 months and then conteltinib, PFS: 29 months). Upon further disease progression, a lung biopsy and next-generation sequencing (NGS) revealed acquired secondary driver mutations including Epidermal Growth Factor Receptor (EGFR) L858R and ALK mutation of F1174L. Subsequently, the patient switched to third generation EGFR-TKI treatment with almonertinib. This case suggests EGFR mutation is one of the mechanisms of ALK-TKI resistance, highlights the value of re-biopsy in identifying potentially targetable resistance mechanisms and underscores the spatiotemporal heterogeneity of tumors under the selective pressure of ALK-TKI.

Background: Cardiac metastasis from cervical cancer is rare and often presents with nonspecific symptoms, leading to diagnostic delays. This case highlights the role of myocardial contrast echocardiography (MCE) in detecting such metastases in long-term cervical cancer survivors.

Case presentation: A 63-year-old female with a history of cervical cancer treated 11 years ago presented with thrombocytopenia and respiratory symptoms. Imaging revealed a mobile mass in the right ventricle extending into the pulmonary artery. MCE showed peripheral rim enhancement, indicative of a necrotic malignant tumor, confirmed as metastatic squamous cell carcinoma.

Therapeutic intervention: The patient underwent surgical resection of the right ventricular mass and tricuspid valvuloplasty. Her thrombocytopenia resolved post-surgery, and no further oncological treatment was needed.

Conclusion: MCE is a valuable tool for diagnosing cardiac metastases, especially in cervical cancer survivors. This case underscores the need for long-term follow-up and imaging surveillance due to the risk of delayed and atypical metastasis.

Mucosa-associated lymphoid tissue (MALT) lymphoma is a relatively uncommon subtype of non-Hodgkin lymphoma which occurs anywhere but lymph nodes. We present a case of MALT lymphoma with plasmacytic differentiation and amyloid deposition. Although plasmacytic differentiation is shown in some cases, amyloid deposition is the rare one in the current cases we collected. Amyloidosis is often associated with some malignant diseases, but MALT is known as an indolent lymphoma. We want to report this case to raise pathologists' cognizance on this disease.

Background: NTRK fusions are relatively rare in papillary thyroid carcinoma (PTC), and their clinicopathological characteristics, particularly in unselected populations and in comparison with BRAF^V600E PTC, have not been systematically elucidated.

Methods: In this retrospective study, we analyzed PTC patients who underwent surgery between October 2022 and May 2025. All patients underwent preoperative fine-needle aspiration biopsy and multigene molecular testing. Ultimately, 38 patients with NTRK-fusion PTC and 1196 patients with BRAF^V600E PTC were included. A comprehensive analysis of the clinical, ultrasonographic, and pathological features of NTRK-fusion PTC was conducted, with comparison to BRAF^V600E PTC.

Results: Among the 38 identified NTRK-fusion PTC patients, NTRK3 (81.6%) was the predominant fusion type. Histologically, classical PTC and mixed growth patterns with follicular architecture (34.2% each) were most frequent, followed by the follicular variant (18.4%). NTRK-fusion PTC demonstrated a high rate of lymph node metastasis (LNM) (78.9%). Among preoperative parameters, a tumor diameter >12 mm on ultrasound was associated with increased risk of lateral LNM (OR = 5.00, 95% CI: 1.10-22.82; P = 0.038). Besides, NTRK1-fusion PTCs demonstrated a significantly higher frequency of bilateral lobe involvement compared to NTRK3-fusion PTCs (57.1% vs. 12.9%, P = 0.025). Compared to patients with BRAF^V600E PTC, those with isolated NTRK-fusion (n=34) were significantly younger (median age: 35.0 vs 43.0 years), had larger tumors (median diameter: 10.5 vs 7.0 mm), higher rates of LNM (76.5% vs 50.7%), and greater prevalence of co-existing Hashimoto's thyroiditis (61.8% vs 28.3%) and follicular nodular disease (26.5% vs 10.6%) (all P < 0.01). Cytopathologically, NTRK-fusion PTC demonstrates a higher proportion of atypia of undetermined significance/follicular neoplasm compared to BRAF^V600E PTC (41.2% vs. 16.1%). Sonographically, isoechogenicity (20.6% vs. 7.9%), microcalcifications (79.4% vs. 58.0%), and a wider-than-tall shape (91.2% vs. 52.5%) were more frequently observed in the NTRK-fusion group (all P < 0.05).

Conclusions: NTRK-fusion defines a distinct PTC molecular subtype characterized by a high burden of LNM and a spectrum of features linked to follicular growth patterns. These findings facilitate the preoperative identification of this tumor subtype and provide a foundation for individualized risk stratification and tailored management strategies.

Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm that may present with non-islet cell tumor hypoglycemia (NICTH), also referred to as Doege-Potter syndrome, primarily due to aberrant secretion of big-IGF2. However, not all big-IGF2-producing SFTs result in hypoglycemia, implying the involvement of additional pathogenic factors. This article reports a case of a 60-year-old male who presented with hypoglycemic syncope secondary to Doege-Potter syndrome. Preoperative imaging identified a large, highly vascularized SFT, approximately 20 cm in diameter, located in the right thoracic cavity. Intraoperative continuous glucose monitoring (CGM) recorded a gradual normalization of blood glucose levels following sequential ligation of three dominant tumor vessels originated from veins- prior to tumor resection - underscoring the essential role of tumor vascular in facilitating big-IGF2 release. Our findings provide the first direct evidence that tumor vasculature is critical for manifesting clinically significant hypoglycemia, thereby complementing established molecular mechanisms such as IGF2 overexpression and impaired pro-IGF2 processing. These insights advance the understanding of NICTH pathogenesis and hold meaningful implications for refining surgical management strategies.