Frontiers in Oncology最新文献

Background: Neoadjuvant therapy (NAT) has been increasingly promoted for treating early-stage breast cancer (BC), which significantly improves the adoption of breast-conserving surgery (BCS). However, concerns related to the oncological safety of BCS versus mastectomy remain unelucidated. The present study compared survival outcomes between patients treated with BCS and those treated with mastectomy after NAT through stratified analyses.

Methods: The study included female BC patients who underwent radical surgery after NAT at the Peking University First Hospital and Cancer Hospital of Chinese Academy of Medical Sciences from January 2013 to December 2021. Propensity score matching (PSM) was used to minimize the selection bias. Overall survival (OS) and disease-free survival (DFS) were compared between patients receiving BCS and mastectomy.

Results: A total of 994 patients were enrolled, including 285 patients treated with BCS and 709 patients treated with mastectomy. Following PSM, patients were assigned to the BCS (n = 258) and mastectomy (n = 258) groups; these two groups were well balanced regarding clinical and pathological characteristics. The 5-year OS rate (90.5% vs. 95.8%, P = 0.535) and DFS rate (86.3% vs. 86.9%, P = 0.648) of the mastectomy group were identical to those of the BCS group in the matched cohort. Stratified analysis revealed that mastectomy was an independent adverse prognostic factor for OS (hazard ratio [HR]: 2.158, 95% CI: 1.254-4.954, P = 0.034) and DFS (HR: 2.914, 95% CI: 1.713-5.422, P = 0.010) in patients with positive lymph nodes. Additionally, age-based stratification showed that mastectomy was an independent prognostic factor for DFS in BC patients aged > 40 years (HR: 2.471, 95% CI: 1.082-5.643, P = 0.022).

Conclusion: BCS does not affect OS and DFS in BC patients treated with NAT. However, it should be noted that BCS provides a substantial survival benefit as compared to mastectomy in patients with clinically positive lymph nodes and those aged > 40 years.

Tailgut cysts often present asymptomatically or with nonspecific symptoms. While commonly benign, they may in rare cases be malignant, often transforming into adenocarcinoma. We present a 68-year-old female who presented with a sacral mass and abscess. Upon Emergency Department presentation, her inflammatory markers were elevated as well as her lactate. Initially, the patient was treated for possible infectious etiology with parenteral antibiotics. However, an MRI was obtained that showed concerns for myxoid neoplasm or chordoma. A biopsy was subsequently performed that revealed mucinous adenocarcinoma. Additionally, on imaging there was an enhancing pelvic lymph node concerning for metastatic spread. Tailgut cysts with malignant transformation to adenocarcinoma are rare and are typically treated surgically to obtain clear margins. However, neoadjuvant chemotherapy may be used in patients who have metastatic disease, which was pursued in the course of our patient's care. This case presentation emphasizes the importance of a wide differential for presacral masses with atypical presentations raising concerns for underlying malignancy. Prompt recognition and intervention is imperative in cases of malignant transformation of tailgut cysts.

Pulmonary enteric adenocarcinoma (PEAC) is a rare subtype of lung adenocarcinoma characterized by intestinal differentiation. We report a case of synchronous bilateral PEAC in an elderly male patient, a presentation that is rarely documented in the literature. Histopathological examination revealed glandular structures resembling colorectal adenocarcinoma, with immunohistochemical positivity for CDX2, CK20, and SATB2, and negativity for TTF-1 and CK7. Molecular testing identified concurrent KRAS, TP53, and APC mutations, suggesting the activation of a colorectal-like oncogenic pathway. Following surgical resection and adjuvant chemoradiotherapy, the patient achieved short-term disease stability. This case highlights the diagnostic dilemma between primary PEAC and metastatic colorectal cancer and underscores the importance of integrated molecular and immunophenotypic profiling for accurate classification and potential targeted therapy.

Background: Metastatic castration-resistant prostate cancer (mCRPC) frequently involves the skeleton. While Radium-223 (Ra-223) alleviates symptomatic bone lesions, its effect on overall survival (OS) and fracture risk is debated. Bone-protective agents (BPAs) may play a critical modulatory role. This study systematically examined how Ra-223 influences OS and fracture risk and the effect of concomitant BPA use.

Methods: As per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, Embase, the Cochrane Library, and Web of Science were retrieved for randomized controlled trials (RCTs) and cohort studies through July 14, 2025. The primary outcomes were OS and fracture incidence in this PROSPERO-registered review (Registration No.: CRD420251102769). Hazard ratios (HRs) with 95% confidence intervals (CIs) were preferentially extracted; relative risks (RRs) were used when necessary. Heterogeneity was assessed using the I² statistic to guide the choice of random-effects versus random-effects models. Leave-one-out sensitivity analyses were conducted, and study quality was appraised using the NIH tool for RCTs and the Newcastle-Ottawa Scale (NOS) for cohort studies.

Results: Nine studies were included, including six RCTs and three cohort studies. The pooled OS analysis (five studies, n=3,671) showed no significant benefit (HR = 0.82, 95% CI: 0.60-1.11; I²=79.8%). Excluding one study on an abiraterone background revealed a survival advantage (HR = 0.71, 95% CI: 0.61-0.81; I²=43.5%). For fracture risk, pooled analysis (five studies, n=3,671) showed no significant increase (HR = 1.32, 95% CI: 0.68-2.58; I²=89.1%). Concomitant BPA use (3 studies, n=279) was associated with a substantial fracture risk reduction (RR = 0.23, 95% CI: 0.11-0.45; I²=0.0%).

Conclusions: Current evidence suggests that Ra-223 administered alongside standard therapy is not associated with statistically significant differences in OS or fracture risk among patients with mCRPC. Concomitant BPA therapy significantly reduces fracture incidence. Therapeutic context, including concurrent therapies and sequencing, may influence survival. Routine evaluation and consideration of BPA use during Ra-223-based regimens, together with strengthened bone health monitoring protocols, are advisable. Given the limited number of eligible studies and substantial heterogeneity, additional high-quality RCTs and individual patient data meta-analyses are needed to clarify these associations.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD420251102769.

Neoadjuvant immunotherapy for mismatch repair-deficient/microsatellite instability-high (dMMR/MSI-H) colorectal cancer continues to accumulate compelling clinical evidence. This report presents the case of a 37-year-old female who presented with moderate anemia (hemoglobin: 69 g/L) and was subsequently diagnosed with dMMR/MSI-H descending colon cancer. Following nine cycles of cadonilimab, a novel PD-1/CTLA-4 bispecific antibody, the patient achieved significant tumor regression and subsequent pathological complete response (pCR) after surgery, with a favorable safety profile observed throughout the treatment course. This case provides valuable clinical evidence supporting the efficacy and safety of cadonilimab in the neoadjuvant setting for dMMR/MSI-H colorectal cancer.

Background: Familial adenomatous polyposis (FAP) is characterized by the early development of colorectal and duodenal adenomas. Although colectomy reduces the risk of colorectal cancer, duodenal neoplasia remains a leading cause of mortality.

Aims: To assess the long-term efficacy of a nutraceutical blend containing phytoestrogens and insoluble fibers (Adipol) in reducing duodenal polyp burden in FAP patients.

Methods: This prospective cohort study followed 56 FAP patients for 10 years after completion of a randomised trial on Adipol. Importantly, post-trial treatment allocation was not randomised but based on patient choice. Patients freely choose one of four regimes: no therapy (Group 0), 3 months on/off (Group 1), 6 months on/off (Group 2), or continuous treatment (Group 3). Annual upper endoscopies evaluated duodenal polyp number and size.

Results: At 120 months, the mean polyp count was significantly reduced in Group 3 vs Group 0 (8.2 ± 3.4 vs 25.1 ± 5.8; p<0.001). Similarly, maximum polyp size decreased more in Group 3 (3.9 ± 1.1 mm) compared to Group 0 (7.8 ± 1.9 mm; p<0.01). Groups 1-2 showed intermediate reductions proportional to exposure.

Conclusion: Continuous Adipol supplementation is associated with sustained reduction in duodenal polyp burden in FAP patients. Although the non-randomised, single-center design limits generalizability, these findings support nutritional chemoprevention as a valuable adjunct strategy in FAP. Multicenter randomised trials and biomarker studies are warranted.

Objectives: This study aims to develop a CT radiomics-based predictive model integrating clinical characteristics to distinguish benign and malignant vertebral compression fractures (VCFs).

Methods: We retrospectively analyzed 208 patients with VCFs treated at our institution between January 2020 and November 2024. Patients were randomly divided into a training cohort (n = 145) and a validation cohort (n = 63). CT images were obtained, and three-dimensional lesion regions were manually segmented. A total of 1,316 radiomics features were extracted. Dimensionality reduction was performed using least absolute shrinkage and selection operator (LASSO) regression analysis and 5-fold cross-validation to identify key features. Univariate and multivariate analyses were used for identifying independent clinical predictors. Three models were constructed: a clinical model, a radiomics model, and a combined clinical-radiomics model. Model performance was evaluated using area under the receiver operating characteristic (ROC) curve (AUC), accuracy (ACC), sensitivity (SEN), specificity (SPE), positive predictive value (PPV), and negative predictive value (NPV). Predictive efficacy and clinical utility were further assessed via ROC curves, calibration plots, and decision curve analysis (DCA), along with clinical impact curves (CIC) and net reduction curves. The Delong test was used for statistical comparisons among different models, and a nomogram was developed to facilitate the visualization of the optimal model.

Results: Carbohydrate antigen 125 (CA125) and posterior vertebral involvement were identified as independent clinical predictors. The combined model achieved the highest AUC value of 0.846 in the validation cohort, followed by the radiomics model (0.842), and the clinical model (0.640). Calibration curves and DCA confirmed its superior predictive accuracy and clinical benefit.

Conclusions: The CT-based clinical-radiomics model demonstrated robust performance in differentiating benign from malignant VCFs and holds promise for guiding individualized patient management.

Objective: To systematically assess the clinical efficacy and safety of Kanglaite Injection in combination with chemotherapy for cancer pain. Using PICO framework: Population (adult cancer patients with pain), Intervention (Kanglaite Injection + chemotherapy), Comparator (chemotherapy alone), Outcomes (pain scores, relief rates, KPS, adverse events).

Methods: The CNKI, WanFang, VIP, Chinese Biomedical Database, PubMed, Embase and Cochrane Library databases were systematically searched. Randomized controlled trials specifically investigating the combined use of Kanglaite Injection and chemotherapy for cancer pain were included from the inception of the database until October 14, 2025. Literature screening and quality assessment were independently conducted by two researchers, with cross-verification. The extracted data were meta-analyzed using Rev Man 5.3 software.

Results: A total of 18 randomized controlled trials involving 1197 patients were included. The combined analysis demonstrated that Kanglaite Injection in conjunction with chemotherapy showed significant advantages over chemotherapy alone in terms of pain intensity score [SMD=-1.24, 95% CI (-1.68, -0.80), P<0.001], pain relief rate [RR = 1.72, 95% CI (1.52, 1.95), P<0.001], and enhancement in the Karnofsky Performance Status (KPS) score improvement rate [RR = 1.64, 95% CI (1.39, 1.93), P<0.001]. Furthermore, Kanglaite Injection combined with chemotherapy exhibited advantages in reducing post-chemotherapy gastrointestinal reactions [RR = 0.68, 95% CI (0.57, 0.81), P<0.001], white blood cell reduction [RR = 0.73, 95% CI (0.57, 0.93), P<0.001], and liver function damage [RR = 0.45, 95% CI (0.27, 0.75), P<0.001]. Evidence certainty was moderate for most outcomes per GRADE assessment.

Conclusion: The combination of Kanglaite Injection with chemotherapy appears effective and safe in treating cancer pain based on moderate-certainty evidence, pending further high-quality trials.

Male breast cancer (MBC) is rare, and visceral crisis is an exceptionally uncommon yet life-threatening presentation in this population. Although current guidelines recommend combination chemotherapy as first-line therapy for visceral crisis, responses are often inadequate, and evidence for alternative approaches in men is scarce. We report a case of HR+/HER2- metastatic MBC complicated by visceral crisis. Despite first-line chemotherapy, the patient showed swift clinical worsening accompanied by radiographic progression. In view of the lack of treatment response, a CDK4/6 inhibitor-based endocrine regimen was initiated, achieving substantial tumor regression and prolonged disease control. This case suggests that CDK4/6 inhibitor-based endocrine therapy can induce meaningful disease reversal even in visceral crisis and may be a feasible option for selected HR+/HER2- MBC patients after chemotherapy failure. Our case suggests that CDK4/6 inhibitor-based endocrine therapy may offer clinical benefit even in the setting of visceral crisis after chemotherapy failure, indicating that treatment sequencing in such scenarios may merit further consideration.

Background: Microsatellite instability (MSI) is an important molecular biomarker in colorectal cancer (CRC), associated with favorable prognosis and response to immune checkpoint inhibitors. Conventional MSI testing, including immunohistochemistry (IHC) and polymerase chain reaction (PCR), is invasive, time-consuming, and resource-dependent, underscoring the need for non-invasive and automated alternatives. This study aimed to develop and evaluate an ensemble learning framework integrating pretreatment colonoscopy images and routine clinical data for non-invasive MSI prediction in CRC.

Methods: In this retrospective study, patients with pathologically confirmed CRC and IHC-determined MSI status were included. Pretreatment colonoscopy images and routine clinical variables were collected. Five deep learning architectures (ResNet-50, EfficientNet, DenseNet, VGG-16, and Vision Transformer) were trained on image data, while four machine learning algorithms (Logistic Regression, Random Forest, Support Vector Machine, and Gradient Boosting) were trained on clinical data. The best-performing models from each modality were combined using a majority-voting ensemble. Model performance was assessed using accuracy, precision, recall, and area under the receiver operating characteristic curve (AUROC). Interpretability was evaluated using Gradient-weighted Class Activation Mapping (Grad-CAM) for image models and SHapley Additive exPlanations (SHAP) for clinical models.

Results: Among 1,844 patients, VGG-16 achieved the best image-based performance (AUROC = 0.896, accuracy = 0.832, recall = 0.708). Logistic Regression outperformed other clinical models (AUROC = 0.898, accuracy = 0.825, recall = 0.828). The ensemble model integrating both modalities achieved AUROC = 0.886, precision = 0.920, and recall = 0.845, outperforming single-modality approaches.

Conclusion: The proposed ensemble learning framework provides a non-invasive, interpretable, and accurate method for MSI prediction, offering potential to improve preoperative precision diagnostics and clinical decision-making in colorectal cancer.