Frontiers in Oncology最新文献

Introduction: Bone is the second most common site of metastasis for renal malignancies after the lung, with approximately 30% of metastatic renal cell carcinomas involving bone. Current research indicates that the common sites of bone metastasis from renal malignancies are mainly the axial skeleton. About 71% of patients with bone metastasis have multiple bone metastases. Cases of distal ulna metastasis of renal malignancies are rarely reported. At present, there are no standardized guidelines for the surgical treatment of distal ulna metastasis of renal malignancies. We report a case of distal ulna metastasis from renal malignancy. Additionally, we review the surgical techniques of distal ulna resection and their impact on wrist function over the past 20 years.

Case presentation: A 61-year-old male patient came to the hospital due to pain and swelling in the left forearm for one month. The patient had undergone surgery for clear cell renal cell carcinoma of the left kidney, and biopsy confirmed metastatic clear cell renal cell carcinoma. He required surgical resection. In this case, the patient underwent wide segmental resection of a 10 cm tumor in the distal ulna without soft tissue reconstruction. Eleven months after surgery, the patient was able to achieve complete wrist joint mobility following active rehabilitation. The patient was discharged without complications and is now undergoing regular follow-ups every three months, as well as receiving monthly doses of the bone protective agent denosumab for the treatment of bone metastasis.

Conclusion: In this case, the distal ulna tumor segment was extensively resected without reconstruction or prosthetic implantation. The patient had good wrist joint function in the short term. Different surgical methods for distal ulna resection impact the recovery of wrist joint function in patients. However, as all the literature reviews involved short- to medium-term follow-ups, longer-term follow-up may be needed to observe the recovery of wrist joint function at different time points in patients.

Hypothesis: The primary objective of this study is to develop an end-to-end deep learning framework based on multi-task learning to predict pulmonary nodule growth by jointly modeling nodule segmentation and visual follow-up image synthesis. By decoupling nodule growth into deformation and texture evolution, the model aims to enhance predictive accuracy and clinical applicability through improved regional focus and deep supervision strategies.

Methods: We present MT-NoGNet, a dual-task network for pulmonary nodule growth prediction via simultaneous deformation-texture modeling. The framework employs a shared encoder with two decoders: a spatial transformer for volume change estimation and a texture predictor with adaptive normalization. A cross-task attention mechanism enforces consistency between morphological expansion and internal density evolution.

Results: Evaluated on longitudinal CT scans from 246 patients at Shanghai Chest Hospital, the framework achieved that the predicted peak signal to noise ratio (PSNR) was 44.30, structural similarity index (SSIM) was 0.7776, and dice similarity coefficient (DSC) was 0.7823.

Conclusions: This study establishes that multi-task learning model of deformation-texture features significantly enhances pulmonary nodule growth prediction accuracy while providing radiologists with interpretable visualizations of progression patterns, demonstrating substantial potential for optimizing clinical surveillance protocols.

Surgical operation is the most commonly used treatment for colorectal cancer, and the treatment of synchronous multiple primary colorectal cancer is also mainly based on surgical operation. Retroperitoneal Approach for total colectomy in minimally invasive treatment of synchronous multiple colon cancer has reported. But concurrent multi-segmental resection for multiple primary colorectal cancers via a single-incision laparoscopic surgery with transabdominal postperitoneal approach has not previously been reported. We would like to share a case of radical resection of ileocecal cancer and sigmoid colon cancer via transabdominal postperitoneal approach under single-incision laparoscopy. A 72-year-old female presented to the clinic with a progressive alteration in bowel habits and stool consistency over the past year, accompanied by fatigue during the preceding month. The diagnoses included ileocecal cancer, sigmoid colon cancer, severe anemia, coronary atherosclerosis and incomplete intestinal obstruction. Blood transfusion was administered to correct the anemic condition. Given the patient's comorbidities, including severe anemia and coronary atherosclerosis, along with a body mass index of 20.8 kg/m², a single-incision laparoscopic surgery with transabdominal postperitoneal approach was selected.

The paradigm of the Hallmarks of Cancer, updated by Douglas Hanahan in 2022, represents one of the most influential syntheses for understanding the functional capabilities that sustain neoplastic transformation. However, its traditional interpretation, often reductionist and fragmentary, does not capture the non-linear, emergent, and adaptive dynamics of tumor behavior. This review proposes a reinterpretation of the hallmarks through the lens of complexity theory, conceptualizing colorectal cancer (CRC) as a self-organizing, open system operating far from equilibrium. Using an integrative conceptual approach, we map the ten classical hallmarks and the new dimensions proposed in 2022 (phenotypic plasticity, non-mutational epigenetic reprogramming, polymorphic microbiomes, and senescence) onto the fundamental properties of complex systems: nonlinearity, emergence, feedback, openness, and historical dependence. We argue that CRC should not be understood as a simple sum of molecular alterations but as a dynamic network of interactions among cells, tissues, and microenvironments where global organization emerges from local rules. This systems-based perspective provides a conceptual foundation for translational models and integrative methodologies in oncology.

Introduction: Liver cancer remains a leading cause of cancer-related mortality in China. Analyses based solely on crude mortality rates may obscure temporal trends and inequalities in the context of rapid population aging. This study examined recent trends and socio-demographic disparities in liver cancer mortality in China using age-standardized analyses.

Methods: We conducted a population-based analysis using data from the China National Mortality Surveillance System covering all 31 provincial-level regions of mainland China from 2015 to 2021. Liver cancer deaths were identified using ICD-10 code C22. Mortality rates were calculated for adults aged ≥20 years. Age-standardized mortality rates (ASMRs) were estimated by direct standardization to the 2010 China standard population. Temporal trends were assessed using joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Disparities by sex, urban-rural residence, and geographic region were quantified using rate differences (RD), rate ratios (RR), and an index of disparity. Decomposition analysis was applied to assess the contributions of population aging and changes in age-specific mortality rates to crude mortality trends.

Results: Between 2015 and 2021, a total of approximately 470,000 liver cancer deaths were recorded. The crude mortality rate changed modestly, whereas the ASMR declined steadily from 30.16 per 100,000 in 2015 to 23.60 per 100,000 in 2021. Joinpoint regression showed a significant overall decline in ASMRs (AAPC -4.0%, 95% CI -5.2% to -2.8%), with no statistically significant joinpoints detected. Throughout the study period, males had substantially higher ASMRs than females (2021: 36.9 vs. 13.8 per 100,000; RR = 2.67). Rural areas consistently exhibited higher ASMRs than urban areas, with the rural-urban RD widening from 6.4 per 100,000 in 2015 to 8.5 per 100,000 in 2021. Regionally, ASMRs declined more rapidly in Eastern China (29.7 to 22.6 per 100,000) than in Central (31.1 to 29.8 per 100,000) and Western China (30.4 to 28.7 per 100,000), resulting in increasing regional disparity. Age-specific mortality increased sharply with advancing age. Decomposition analysis indicated that population aging increased crude mortality, partially offset by reductions in age-specific mortality rates.

Conclusions: Liver cancer mortality in China declined from 2015 to 2021 after age standardization; however, substantial and widening disparities by sex, urban-rural residence, age, and region persist. These findings highlight the importance of age-standardized and equity-focused approaches to liver cancer prevention and control.

Colonic leiomyosarcoma (LMS) is a highly aggressive tumor arising from smooth muscle cells and is generally associated with a poor prognosis. This report presents a case of colonic LMS originating from the submucosal layer of the ascending colon. A 76-year-old woman was admitted with intermittent hematochezia persisting for over a month. Imaging studies revealed a tumor in the ascending colon accompanied by intussusception. The patient underwent a right hemicolectomy with systematic lymphadenectomy involving the middle colic root and right branch regions. Postoperative histopathological analysis confirmed colonic LMS arising from the submucosa, with no evidence of lymph node metastasis. Colonic intussusception secondary to LMS is extremely rare, and, to our knowledge, no previous cases of colonic intussusception caused by metastatic sarcoma have been reported. It remains uncertain whether the tumor originated primarily in the colon or resulted from hematogenous metastasis to the colonic mucosa.

Objective: This study investigates the value of Pan-Immune-Inflammatory Value (PIV) and Prognostic Nutritional Index (PNI) in predicting the recurrence of triple-negative breast cancer (TNBC) patients within 2 years after radical surgery.

Methods: This study retrospectively selected the medical records of 130 TNBC patients who underwent radical surgery at Shidong Hospital of Yangpu District in Shanghai from January 2020 to March 2023. The preoperative PIV and PNI values and clinical data of the patients were collected, and the patients were divided into a recurrence group (47 cases) and a non-recurrence group (83 cases) based on the follow-up results within 2 years after surgery. The optimal cutoff values of PIV and PNI were determined through receiver operating characteristic (ROC) curves, and their predictive values for recurrence within 2 years after surgery were analyzed. Binary logistic regression models were used to analyze the independent predictive effects of PIV and PNI on recurrence within 2 years after surgery, and nomogram models were constructed to evaluate their clinical application value.

Results: Tumor diameter (OR: 1.754, 95% CI: 1.156-2.663), SII (OR: 1.560, 95% CI: 1.053-2.312), PIV (OR: 1.891, 95% CI: 1.217-2.938), and PNI (OR: 0.676, 95% CI: 0.473-0.966) are factors affecting recurrence within 2 years after surgery in TNBC patients. Multivariate Cox regression analysis showed that low PNI (HR = 2.25, 95% CI: 1.40-3.62, P = 0.001) and high PIV (HR = 1.83, 95% CI: 1.17-2.86, P = 0.008) are independent risk factors for tumor recurrence within 2 years after surgery in TNBC patients. Patients with high PIV and low PNI (n=28) had the poorest RFS, while those with low PIV and high PNI (n=35) had the best outcomes. The calibration curve of the nomogram model constructed based on PIV and PNI showed a high consistency between the predicted and actual values.

Conclusion: PIV and PNI can serve as effective indicators for predicting recurrence within 2 years after radical surgery in TNBC patients, providing a more scientific reference for clinicians.

Introduction: Chordoma is a rare malignant tumor originating in the notochord characterized by slow progression but frequent recurrences. Systemic treatment for this condition is not well defined. This study aimed to describe real-world clinical practice patterns of systemic therapy and its outcomes in patients with advanced chordoma treated at a sarcoma referral center member of the European Reference Network on Rare Adult Solid Cancers (EURACAN).

Methods: Consecutive adult patients with histologically confirmed chordoma, diagnosed between 2005 and 2024, who received tyrosine kinase inhibitors (TKI) or immune checkpoint inhibitors (ICI), were retrospectively reviewed. Demographic, clinicopathological, and treatment data were collected from institutional databases. Responses were radiologically assessed according to RECIST criteria by sarcoma radiologists as part of routine clinical care. Data were collected up to December 31, 2024.

Results: A total of 13 patients (median age 62 years) were identified. All had undergone surgery, and more than half received adjuvant radiation therapy. Most patients (n=10, 76.9%) received systemic therapy with imatinib as first-line treatment, while a minority (n=2, 15.4%) received ICIs as first-line therapy. Several patients received multiple lines of treatment, including sequential exposure to TKI and ICI. Objective responses were observed in 2 of 5 patients in the TKI-only subgroup (40.0%) and 4 of 8 patients in the ICI-exposed subgroup (50.0%), all of which were partial responses, with prolonged disease stabilization being the a common outcome. The median progression-free survival (PFS) for the entire cohort was 12.3 months, and the median overall survival (OS) was 149.8 months. The median PFS and median OS in the TKI-only subgroup were 7.4 and 113.5 months, respectively, whereas they were 12.7 and 151.6 months in the ICI-exposed subgroup, respectively. Subgroup results are descriptive, exploratory, and hypothesis-generating due to the small sample size.

Conclusion: Our results indicate that systemic therapy can provide durable disease control in selected patients with chordoma. TKI are commonly used and may provide good responses while ICIs show potential activity in selected patients but await confirmation in robust clinical trials. These real-world data reinforce the need for prospective, multicenter studies to optimize treatment sequencing and patient selection in this rare malignancy.

Immune checkpoint inhibitors (ICIs) have revolutionized the practice of oncology, becoming a cornerstone treatment for many cancers. Nivolumab, an antibody-targeting programmed cell death protein-1 (PD-1), and ipilimumab, an antibody-targeting cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), are two ICIs that, when combined, lead to improved treatment responses and enhanced survival rates. However, dual immunotherapy can come at the expense of increased incidence of autoimmune-related adverse events. The mortality rate of ICI-induced myocarditis can be high, and therapy rechallenge can pose a significant risk of recurrence and severe complications. There is no consensus regarding therapy rechallenge after myocarditis, and this decision should be made in a multidisciplinary discussion following a patient-centered approach. In our paper, we report the case of an adult patient with metastatic renal cell carcinoma who developed multiorgan toxicity, including severe myocarditis that required pacemaker implantation, after a single cycle of ipilimumab and nivolumab. Importantly, we also report the consequences on her cardiac and safety profile following ICI rechallenge.

Introduction: Gastric cancer incidence and characteristics vary due to environmental factors, and technical advances facilitate early detection of the disease. This study aimed to assess whether significant socio-economic changes and technological advancements in Poland - one of the most rapidly developing countries worldwide - affected the molecular characteristics and detection rates of early gastric cancer sub-types in Western Poland.

Methods: Ninety-two patients undergoing gastrectomy for gastric cancer in 1998-2002 and 2016-2020 were studied. Surgical specimens were re-analyzed for histopathological features, including tumor type, grade, and stage (up-dated World Health Organization [WHO] classification). Immunohistochemical markers (Ki-67, p53, E-cadherin, CD10, CD31, bcl-2) and antigens for Helicobacter pylori (H. pylori) and Epstein-Barr virus (EBV) were evaluated. Microsatellite instability (MSI) was assessed via PMS2/MSH2 protein expression.

Results: The groups were comparable in age and gender, with male predominance. Histological features, H. pylori and EBV colonization, and most molecular markers showed no significant differences. However, Ki-67 proliferation index significantly increased in cancers diagnosed in 2016-2020, correlating with intestinal-type tumors and p53 expression. In this group, higher Ki-67 levels were also linked to H. pylori infection, microsatellite stability, and increased angiogenesis.

Conclusions: Despite advancements in H. pylori research and technology over 20 years, no improvement was observed in H. pylori-positive tumor rates or early gastric cancer detection in Western Poland. Although molecular characteristics remained largely unchanged, the increased proliferation index in recently diagnosed cancers merits further study.