Frontiers in Oncology最新文献

Objective: Dinutuximab beta (dB) immunotherapy is used as maintenance treatment for relapsed/refractory neuroblastoma (NBL); however, comparative studies directly comparing dB with no dB therapy in this setting are lacking. This study aimed to indirectly compare dB (with or without interleukin-2) with no immunotherapy in patients with relapsed NBL.

Methods: Three studies of dB (APN311-202, APN311-304, and APN311-303) with individual patient data, along with two historical control cohorts (INBR and R1) were included. Both unadjusted (naïve) and population-adjusted comparisons of overall survival (OS) were performed, with adjustment conducted using inverse probability or odds weighting. Harmonized inclusion criteria were applied across all study populations. The adjusted comparison used the propensity score reweighting to balance the cohorts based on key baseline prognostic factors.

Results: The base-case unadjusted indirect comparison revealed that dB (with or without IL-2) significantly prolonged OS compared to historical controls not treated with dB (hazard ratio [HR], 0.43; 95% confidence interval [CI], 0.31- 0.79; p<0.001). Similarly, in the adjusted comparison, dB significantly prolonged OS compared to historical controls (HR, 0.53; 95% CI, 0.35; 0.79, p=0.002). All sensitivity unadjusted and adjusted comparisons supported the results of the base-case analysis.

Conclusion: Dinutuximab beta significantly prolonged OS compared to historical control cohorts not treated with dB in both unadjusted and adjusted indirect comparisons.

Background: Gastric cancer (GC) remains a leading cause of cancer mortality globally, with a multifactorial etiology involving infectious, behavioral, and dietary risk factors. However, age-specific variations in these factors are not well understood.

Methods: We conducted a hospital-based retrospective study of 903 pathologically confirmed GC cases recruited from several tertiary medical centers in south China. Participants were stratified into three age groups (≤30, 31-55, and >55 years). Key variables-including Helicobacter pylori infection, smoking, obesity, dietary habits, and medical history-were analyzed using chi-square tests and multivariable logistic regression to assess age-related differences in risk factor prevalence and associations.

Results: The prevalence of H. pylori infection and smoking significantly increased with age (p < 0.05), and both factors are known contributors to gastric cancer risk in prior studies. Smoked/grilled food consumption showed a significant association with GC, particularly among older adults (OR = 2.05, 95% CI: 1.29-3.27, p = 0.002). Obesity and low fruit/vegetable intake were not statistically significant. Socioeconomic indicators, including urban employee basic medical insurance (UEBMI) coverage, also exhibited age-related patterns but showed mixed associations with GC risk.

Conclusion: This study highlights age-specific disparities in GC risk profiles and underscores the cumulative exposure patterns of H. pylori infection, smoking, and dietary carcinogens. However, given the retrospective and hospital-based design, causal relationships cannot be established, and selection bias may exist. Despite these limitations, the findings provide an epidemiological basis for age-tailored prevention strategies, emphasizing early eradication of H. pylori, smoking cessation, and dietary interventions for high-risk populations.

Background: The hospital spending of patients with esophageal squamous cell carcinoma (ESCC) have been increasing over years, imposing a heavy economic burden on these patients. However, little is known about the association between spending and their overall survival (OS).

Methods: We recruited 11,037 ESCC patients who were admitted between August, 2009 and December, 2018 at the Southern Center (Cancer Hospital of Shantou University Medical College), and between January, 2012 to December, 2017 at the Northern Center (Anyang Cancer Hospital). Spending terciles were the exposure measure, and OS was the outcome. OS in terciles 2 and 3 was compared with OS in tercile 1 (the lowest spending tercile) using Cox regression models. Analyses were stratified by TNM stage and study center.

Results: Monthly hospital spending followed an "L-shaped" trend. After a maximum follow-up of 12.52 years, the median survival time was 4.70 years. Higher spending was associated with worse OS in stage 0-II patients (adjusted HR_{tercile 3 vs 1} = 1.55, 95% CI: 1.27-1.89), but with better OS in stage III-IV patients (adjusted HR_{tercile 2 vs 1} = 0.82, 95% CI: 0.74-0.90; adjusted HR_{tercile 3 vs 1} = 0.73, 95% CI: 0.64-0.83). These associations were consistent across both the Southern and Northern Centers.

Conclusions: The findings suggest that early-stage ESCC patients may benefit from more conservative treatment approaches, whereas advanced-stage patients require comprehensive and sufficient treatment.

This paper reports a rare case of a 4-year-old male child with acute lymphoblastic leukemia (ALL) presenting initially with bone marrow necrosis (BMN) as the chief clinical manifestation. The child sought medical attention due to fever, bone pain, and fatigue. Laboratory tests indicated pancytopenia. Initial bone marrow cytomorphology examination revealed disrupted cellular architecture, suggesting possible BMN, and single-site flow cytometry detected no definitive abnormalities, highlighting the diagnostic complexity caused by BMN. Through multi-site bone marrow aspiration and biopsy, the diagnosis was ultimately confirmed as common B-cell ALL (common-B-ALL). Treatment followed the South China Children's Cancer Collaborative Group SCCCG-ALL-2023 protocol, incorporating blinatumomab immunotherapy based on risk stratification. The child responded well to treatment and is currently in the maintenance chemotherapy phase, with minimal residual disease (MRD) monitoring consistently indicating complete remission. This case emphasizes the importance of early recognition of rare presentations like BMN-onset in pediatric ALL, the necessity of multi-site bone marrow examination, and the crucial role of individualized treatment strategies.

Purpose: The aim of this study was to evaluate the feasibility of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) contrast-enhanced magnetic resonance imaging (CE-MRI) for determining the gross tumor volume (GTV) of hepatocellular carcinoma (HCC).

Methods: A retrospective analysis was conducted on 12 patients diagnosed with HCC (18 lesions) who received radiotherapy and underwent magnetic resonance (MR) simulation. Six series images, including MR T₁-weighted image (T₁WI) and contrast-enhanced T₁WI (CE-T₁WI) at 15 s, 45 s, 75 s, 150 s, and >20 min after Gd-EOB-DTPA injection, were obtained, and the GTV was determined in the different temporal images. The differences in mean signal intensity (SI), SI contrast between the HCC and liver tissue, volume and shape of HCC GTV among different phases were compared.

Results: (1) The mean SI of liver tissue reached its peak enhancement at >20 min, showing a 140.90 ± 64.69% increase, compared with T₁WI (p < 0.05). (2) Compared with CE-T₁WI_-20min, the mean SI of the HCC increased by -41.19~18.09% from T₁WI, CE-T₁WI_-15s to CE-T₁WI_-150s. Conversely, the mean SI of liver tissue decreased by 5.27~55.87% over the same period. Consequently, the SI contrast between HCC and liver tissue decreased by 53.30~89.37%. (3) The maximum GTV volume determined by CE-T₁WI_-20min was (22.80 ± 18.57) cm³, coinciding with the highest value of SI contrast (0.29 ± 0.16). (4) Compared with GTV_-20min, GTV_-T1WI and GTV_-15s~GTV_-150s had volume reductions of 6.73~19.35%. (5) Compared with GTV_-20min, the Dice similarity coefficients (DSC) of GTV_-T1WI and GTV_-15s~GTV_-150s ranged from 0.745 to 0.819. Additionally, the shape change trend of GTV in the CE-T₁WI images was generally consistent with the volume change trend.

Conclusion: CE-T₁WI MR images acquired more than 20 min post-injection of Gd-EOB-DTPA exhibited significant advantages in determining the GTV boundaries and enhancing the contrast of SI between HCC and liver tissue. The CE-T₁WI_-20min sequence is recommended for determining HCC GTV.

Background: Up to 80% of patients with resected pancreatic cancer experience recurrence within 2 years. We evaluated the feasibility and accuracy of a personalized, tumor-informed circulating tumor DNA (ctDNA) test for the early detection of recurrence risk during long-term postoperative surveillance.

Methods: We recruited 43 patients with pancreatic cancer who underwent curative surgical resections. A personalized panel was developed to detect ctDNA in plasma based on whole-exome mutation information derived from tumor tissues. A total of 139 plasma samples were analyzed to assess recurrence risk and the efficacy of adjuvant therapy.

Results: A personalized ctDNA monitoring panel was successfully customized in 35 of 43 cases. Sixteen patients relapsed within a median of 15.7 months (range: 5.4-30.0 months) postsurgery. For the 11 patients with positive ctDNA, the median lead time from initial ctDNA positivity to radiological relapse was 4.59 months (range: 0.88-15.61). After completion of adjuvant chemotherapy (ACT), 94.3% (33/35) of patients contributed 52.5% (73/139) of the ctDNA testing samples. These samples exhibited an elevated rate of ctDNA detection (48.5%, 16/33) compared to samples obtained prior to and during the commencement of ACT, with a negative predictive value of 82.4% (14/17) and a positive predictive value of 75.0% (12/16). The presence of ctDNA was significantly correlated with shorter disease-free survival and overall survival.

Conclusions: Long-term dynamic ctDNA monitoring after pancreatic cancer resection, particularly following the completion of ACT, is predictive of recurrence risk. The proactive implementation of ctDNA monitoring after ACT in patients with resectable pancreatic cancer has important implications for clinical practice.

Objective: To systematically evaluate the efficacy and safety of traditional Chinese medicine (TCM) for postoperative adjuvant chemotherapy for colorectal cancer.

Methods: CNKI, VIP, Wanfang, CBM, PubMed, and Web of Science were searched for the randomized controlled trials (RCT) of TCM participating in postoperative adjuvant chemotherapy for colorectal cancer. The search period was from January 1, 2018 to December 31, 2024. Cochrane bias risk assessment tool was used to evaluate the quality of included studies, and RevMan5.4 was used for meta-analysis.

Results: A total of 41 randomized controlled trials involving 2918 patients with colorectal cancer was ultimately included. The results demonstrated that the combination of TCM with chemotherapy was superior to chemotherapy alone in several aspects. These included the objective response rate (ORR), improvement of TCM-related symptoms, levels of tumor markers CEA and CA199, immune function indicators (CD3⁺, CD4⁺, CD4⁺/CD8⁺, NK cells), and quality of life as measured by the KPS score. Additionally, the combination therapy reduced CD8⁺ levels and mitigated abnormal laboratory indicators caused by chemotherapy, such as leukopenia, thrombocytopenia, decreased hemoglobin, and abnormal liver and kidney function. Furthermore, it alleviated chemotherapy-related adverse effects (AEs), including nausea, vomiting, and peripheral nerve toxicity.

Conclusions: TCM may be associated with improvements in quality of life and reduce chemotherapy side effects in postoperative colorectal cancer patients, though large-scale rigorous trials are needed to confirm efficacy and safety.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42025635900.

Background: Mammary Paget's Disease (MPD) is a rare subtype of breast cancer, accounting for 1%-4% of all breast cancers. Controversy remains regarding whether sentinel lymph node biopsy (SLNB) is necessary for MPD patients undergoing breast-conserving surgery (BCS) when imaging studies fail to detect deep invasive carcinoma, and this controversy lacks support from specific case evidence.

Case summary: A patient presented with "recurrent left nipple fissure for 3 years and eczematous changes for 3 months." Preoperative biopsy at another hospital confirmed MPD; imaging showed no deep mass. Postoperative pathology revealed left breast MPD associated with multifocal microinvasive carcinoma, accompanied by metastases to left axillary lymph nodes (6/8), left subclavian lymph nodes (2/3), and left supraclavicular lymph nodes (1/3). The pathological stage was pT1mic pN3c cM0. No recurrence was observed 6 months after adjuvant therapy with the TCbHP regimen plus capecitabine consolidation therapy.

Conclusion: Although no definite mass was identified on breast magnetic resonance imaging (MRI) in this case, SLNB and subsequent pathology confirmed extensive lymph node metastasis (pN3c). Omission of SLNB could have led to understaging and compromised treatment decision-making. This single case may suggest that SLNB holds significant staging value for MPD patients with no obvious breast mass on imaging. It provides hypothesis-generating, practical evidence for addressing this controversial clinical issue, warranting further investigation in larger cohorts.

Background: The modified Glasgow Prognostic Score (mGPS), which reflects the degree of systemic inflammation and nutritional status, is associated with prognosis in various common malignancies. However, its association with 30-day unplanned readmission and 1-year mortality in stage III-IV lung cancer (LC) patients remains unvalidated. This study aimed to evaluate the prognostic value of mGPS in stage III-IV LC patients receiving immune checkpoint inhibitors (ICIs).

Methods: In this retrospective study, 209 patients diagnosed with stage III-IV LC who underwent ICI therapy between January 2023 and May 2024 were included. Patients were stratified based on mGPS scores into three risk categories: low-risk (0 points), intermediate-risk (1 point), and high-risk (2 points). Kaplan-Meier analyses, multivariate Cox proportional hazard regression, and subgroup analyses were employed to assess primary outcomes.

Results: Among the enrolled patients, the rates of 30-day unplanned readmission and 1-year mortality were 35.4% (74/209) and 11.0% (23/209), respectively. Kaplan-Meier analysis indicated significantly elevated cumulative incidences of 30-day unplanned readmission and 1-year mortality in the high-risk group relative to intermediate- and low-risk groups (log-rank p < 0.001). Adjusted multivariable Cox regression revealed that each 1-point increase in mGPS conferred a 72% higher risk of 30-day unplanned readmission (HR 1.72, 95%CI 1.25-2.38, p = 0.001) and a 117% higher risk of 1-year mortality (HR 2.17, 95%CI 1.15-4.10, p = 0.017). Additionally, compared with low-risk patients, those in the high-risk group experienced a 198% increase in the risk of 30-day unplanned readmission (HR 2.98, 95% CI 1.56-5.69, p = 0.001) and a 366% increase in 1-year mortality risk (HR 4.66, 95% CI 1.33-16.35, p = 0.017). Trend tests confirmed that the risk of adverse outcomes rose steadily with increasing mGPS risk category. Subgroup analyses demonstrated that the prognostic effect of mGPS was consistent across age, TNM stage, metastatic status, and nutritional condition (p for interaction > 0.05).

Conclusion: Higher mGPS scores significantly correlate with elevated risks of both 30-day unplanned readmission and 1-year mortality among LC patients receiving ICI therapy. Routine mGPS monitoring may warrants further evaluation in prospective multicenter validation studies to inform prophylactic interventions.