Frontiers in Oncology最新文献

Objective: This study aimed to evaluate the oncologic safety of sentinel lymph node biopsy (SLNB) compared with systematic lymph node dissection (LND) in patients with early-stage cervical cancer and to determine whether SLNB alone yields comparable survival outcomes.

Data sources: Studies published up to October 2025 were systematically searched in PubMed, Embase, and Web of Science using relevant keywords, including "sentinel lymph node", "cervical cancer", "cervical carcinoma" and "lymphadenectomy."

Study eligibility criteria: Comparative cohort studies and single-arm studies involving patients with early-stage cervical cancer undergoing SLNB, with or without LND, and reporting survival outcomes- including cancer-specific survival (CSS), disease-specific survival (DSS), overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS) -were included.

Study appraisal and synthesis methods: The quality of the included studies was assessed using appropriate tools: the Cochrane Risk of Bias 2.0 (RoB 2) tool for randomized controlled trials, the Newcastle-Ottawa Scale (NOS) for observational studies, and the Methodological Index for Non-Randomized Studies (MINORS) for single-arm or non-randomized studies. All meta-analyses were performed using the meta package in R. Hazard ratios (HRs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using fixed- or random-effects models depending on heterogeneity. Sensitivity analyses were conducted via leave-one-out analysis.

Results: The pooled analysis of six comparative studies revealed no significant difference in cancer-specific survival (HR = 0.93, 95% CI: 0.27-3.20), overall survival (HR = 0.92 (95% CI: 0.65-1.31), disease-free survival (HR = 0.99, 95%CI: 0.00-855.48), or progression-free survival (HR = 0.71, 95% CI: 0.29-1.05) between the SLNB and LND groups. SLNB was associated with a significantly lower risk of postoperative complications (RR = 0.70, P = 0.0406), and did not increase the recurrence rate (RR = 0.96, 95% CI: 0.36-2.53) compared with LND. Six single-arm studies reported 5-year OS and DFS rates of 97% and 94%, respectively, following SLNB alone. The pooled SLNB positivity rate across 13 studies was 8% (95% CI: 5%-12%). Sensitivity analysis confirmed the robustness of the CSS results.

Conclusion: This study suggests that SLNB provides oncologic outcomes comparable to LND while reducing surgical morbidity in early-stage cervical cancer. The inclusion of CSS as a validated endpoint reinforces the cancer-specific safety of SLNB, with no significant compromise observed in either OS or PFS. While current evidence is promising, further large-scale prospective trials are needed to refine indications and standardize implementation of SLNB in routine clinical practice.

Background: The purpose of this study is to explore the molecular mechanism of SIRT1 regulating chemotherapy resistance.

Methods: Expression level of SIRT1 in ovarian cancer cell lines SKOV3, SKOV3/DDP (cisplatin-resistant cell line) and normal ovarian epithelial cell line IOSE80 was detected. Through the intervention of β-catenin agonist BML-284, the mechanism of SIRT1 regulating glycolysis and angiogenesis through β-catenin/c-myc/PKM2 pathway was discussed. Finally, the nude mice transplanted tumor model was constructed to verify the role of SIRT1 in vivo.

Results: The expression of SIRT1 increased in ovarian cancer cell line, especially in cisplatin-resistant cell line SKOV3/DDP. Knocking down SIRT1 can inhibit the proliferation, invasion and migration of ovarian cancer cells, promote cell apoptosis, and reduce the drug resistance of cells to cisplatin. SIRT1 enhances the malignant biological behavior of ovarian cancer cells by promoting glycolysis and angiogenesis. SIRT1 up-regulates the expression of key glycolytic enzymes and angiogenic factors by activating β-catenin/c-myc/PKM2 pathway. In vivo experiments, knocking down SIRT1 can reduce the glycolysis level and angiogenesis ability of tumor tissue.

Conclusion: SIRT1 promotes glycolysis and angiogenesis of ovarian cancer cells by activating β-catenin/c-myc/PKM2 pathway, thus enhancing chemotherapy resistance. SIRT1 is expected to be a new target for ovarian cancer treatment.

Objectives: To investigate the potential of intratumoral and peritumoral radiomics derived from CT to preoperatively predict tumor deposits (TDs) in patients with advanced gastric cancer (AGC).

Methods: In this retrospective investigation, a total of 374 patients from two medical centers were recruited and divided into training (n = 186), validation (n = 80), and test (n = 108) cohorts. Intratumoral and peritumoral radiomics models were developed utilizing radiomics features derived from the corresponding 3D regions of interest (ROIs). A combined radiomics model integrating intratumoral and peritumoral features was further constructed through feature-level concatenation. Additionally, an ensemble model was established via the integration of this combined radiomics model with selected independent clinical prognostic factors. All models were evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). Finally, the Shapley Additive Explanations (SHAP) method and nomogram were employed to elucidate the predictive mechanisms of the three radiomics models (intratumoral, peritumoral, and combined) and the ensemble model.

Results: The combined intratumoral-peritumoral radiomics model showed higher AUC than the standalone intratumoral and peritumoral models across all cohorts (training: 0.874 vs. 0.751 vs. 0.830; validation: 0.846 vs. 0.720 vs. 0.713; test: 0.842 vs. 0.701 vs. 0.675). Moreover, the ensemble model yielded the highest AUCs across all cohorts (0.925, 0.865, 0.878 for training, validation, and test cohorts, respectively).

Conclusion: Both intratumoral and peritumoral radiomics offer meaningful information regarding TDs, while the CT-based ensemble model holds the capacity to preoperatively predict TDs in AGC patients.

Gastric glomus tumor (GGT) is a rare mesenchymal neoplasm of the stomach that accounts for only 1% of gastrointestinal tumors and originates from glomus cells within the gastric wall. The exact etiology remains unclear, and due to nonspecific clinical manifestations, definitive diagnosis relies on imaging, pathology, and immunohistochemistry. We report a case of a 60-year-old female with a two-year history of unexplained upper abdominal burning pain. After undergoing abdominal CT, gastroscopy, pathology, and immunohistochemistry analyses, she was diagnosed with gastric glomus tumor complicated by hepatic metastasis. The patient subsequently received chemotherapy, transcatheter arterial embolization(TAE) for hemostasis, anti-infection treatment, blood transfusion, and symptomatic and supportive care at our hospital. Ultimately, the patient's overall survival was 21 months. This article presents the case and reviews the clinical presentation, pathological features, diagnosis, and treatment strategies for GGT to provide reference for clinical practice.

Purpose: To compare the differences in dosimetry and toxicities between Magnetic Resonance Imaging (MRI) and Computed Tomography (CT)-guided intracavitary and interstitial implantation for locally advanced cervical cancer, respectively.

Methods: We analyzed 40 cases of locally advanced cervical cancer admitted to our hospital from January 2023 to September 2024. Patients underwent CT-guided intracavitary and interstitial implantation followed by MRI scanning. We compared the volume of HR-CTV and IR-CTV, the dosimetric differences of HR-CTV D₉₀ and IR-CTV D₉₀, and the dosimetric differences of D_2cc for the bladder, rectum, and small intestine under the two localization methods.

Results: The mean HR-CTV and IR-CTV volumes were larger using CT guidance compared with MRI guidance (P<0.05), the differences were statistically significant. The HR-CTV D₉₀ and IR-CTV D₉₀ were smaller using CT than MRI guidance. The difference was statistically significant (P<0.05). There was a statistically significant difference in the rectum D_2cc between CT and MRI guidance (P<0.05), while there was no statistically significant difference for the D_2cc of the bladder and small intestine between the two methods (P>0.05).

Conclusion: Intracavitary and interstitial implantation under MRI guidance can significantly improve HR-CTV and IR-CTV D₉₀ with reduced target volume and good protection of the rectum, and there is no significant difference for the bladder and small intestine.

Rationale: Cutaneous metastatic carcinoma is a malignant tumor that originates outside the skin. Studies have found that the most common primary tumor in female patients with cutaneous metastatic carcinoma is breast cancer. Cutaneous metastatic carcinoma spreads to the adjacent skin through blood vessels, lymphatics, or interstitial spaces. It forms ulcerative or nodular lesions. Carcinoma en cuirasse is characterized by extensive induration and sclerosis of the skin, resembling armor, and is a rare form of cutaneous metastatic carcinoma.

Patient concerns: We report a rare case of a 59-year-old patient who developed dark red nodules on the skin of the breast in 2013. These nodules gradually enlarged, ultimately causing the breast to lose its normal shape. Subsequently, the skin on the chest and back thickened, accompanied by local erosion and ulceration that gave the skin a hardened, armor-like appearance.

Diagnoses: Ultrasound and chest CT suggest diffuse infiltration in the subcutaneous fat of the neck and thorax. Core-needle biopsy pathology reveals infiltrating micropapillary carcinoma, with tumor invasion of the dermis, the tumor clearly originates from the breast.

Interventions: The first-line treatment for advanced-stage breast cancer is the combination of cyclin-dependent kinase 4/6 inhibitors (CDK4/6 inhibitors) and aromatase inhibitors (AIs), specifically Abemaciclib and Anastrozole.

Outcomes: The patient has been treated for 44 months, and the disease has significantly improved. This is evidenced by the absence of tumor tissue in the biopsy of the affected skin.

Lessons: Breast cancer cutaneous metastasis, although rare, requires high vigilance, especially in the HER2-negative Luminal B subtype. The efficacy data on CDK4/6 inhibitors combined with endocrine therapy as a standard regimen for cutaneous metastasis is still lacking. It is necessary to enhance mechanistic studies and clinical observations, taking molecular characteristics into account.

Background: Image-guided radiotherapy (IGRT) is key to making sure the radiation dose is accurate when treating kids with multi-isocenter total body irradiation (TBI). Ensuring dose accuracy in pediatric multi-isocenter TBI. Shanghai Children's Medical Center employed low-dose fan-beam CT (FBCT) for integrated multi-isocenter calibration, whereas Fujian Children's Hospital used cone-beam CT (CBCT) for sequential isocenter alignment.

Objective: To evaluate FBCT versus CBCT guidance effects on target coverage and organ doses across two regimens: 12 Gy in 6 fractions and 3 Gy in 1 fraction.

Methods: Retrospective analysis of 34 pediatric TBI patients (21 FBCT, 13 CBCT) treated with identical field setups (three upper-body isocenters; two/three lower-body isocenters; junction at upper femur third). Pre-treatment FBCT/CBCT images were registered to planning CTs; doses recalculated using original plans. Metrics: PTV V90%, V100%, V110%, mean doses; homogeneity index (HI); conformity index (CI); mean lung and kidney doses.

Results: In the 12 Gy group, FBCT guidance improved PTV coverage: V_90% increased from 96.11% to 97.14%, V_100% from 90.40% to 92.81%, and V_110% decreased from 20.73% to 16.67% (all P < 0.01). HI decreased from 0.25 to 0.16, CI increased from 0.77 to 0.89, and mean PTV dose rose from 12.33 to 12.57 Gy (all P < 0.01). Mean lung dose fell from 8.61 to 8.47 Gy, and mean kidney dose from 8.24 to 8.10 Gy (both P < 0.01). In the 3 Gy group, FBCT guidance also improved PTV coverage: V_90% increased from 96.32% to 97.82%, V_100% from 91.44% to 93.97%, and V_110% decreased from 17.43% to 13.72% (all P < 0.01). HI decreased from 0.21 to 0.13, CI increased from 0.77 to 0.87, and mean PTV dose rose from 3.08 to 3.12 Gy (all P < 0.01). Mean lung dose decreased from 2.34 to 2.25 Gy, and mean kidney dose from 2.09 to 2.06 Gy (both P < 0.01).

Conclusion: FBCT guidance gave better target dose conformity and homogeneity, and lower lung doses, than CBCT guidance-both for the 12 Gy myeloablative regimen and the 3 Gy low-dose regimen. These results suggest that FBCT guidance is a better option for image-guided total body irradiation in children.

Primary pulmonary adenoid cystic carcinoma (PACC) is an exceedingly rare malignant lung tumor. We report an extremely rare case of a 38-year-old female. In 2013, a computed tomography (CT) scan suggested lung cancer in the left upper lobe, and a percutaneous biopsy confirmed PACC pathologically. She underwent surgical resection followed by postoperative adjuvant chemotherapy in the same year, with no recurrence during the 5-year post-operative follow-up. In December 2019, follow-up CT revealed bilateral renal metastases. Subsequently, in 2021, chest wall metastases developed. After sequential radiotherapy, chemotherapy, and combined immunotherapy, the chest wall mass was significantly reduced. During this period, multiple immune-related adverse events (irAEs) occurred. Upon progression of the renal metastases in 2024, ultrasound-guided ablation was performed. Subsequent re-evaluations showed essentially no viability in the bilateral renal tumors, and the chest wall mass remained stable. This patient was diagnosed with PACC in 2013. As of September 2025, her overall survival (OS) has exceeded 11 years. The successful management of this case is attributed to multimodal therapy. To date, no cases of PACC with concurrent bilateral renal and chest wall metastases have been reported, thus providing a valuable reference for the diagnosis and treatment of PACC.

Objective: This study aimed to critically review the current evidence on the anticancer potential of the cell-derived secretome, with emphasis on mesenchymal stem/stromal cell (MSC) products, and to provide a realistic translational roadmap.

Methods: This narrative review analyzes preclinical studies (in vitro) published from 2000 until September 30, 2025, identified through PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar. We focused on the secretome composition, its source-dependent variability, the reported antitumor mechanisms, and the factors responsible for the conflicting pro- versus anti-tumorigenic outcomes. This narrative review covers the literature from January 2000 up to December 1, 2025 (final search: PubMed/MEDLINE, Scopus, Web of Science, ClinicalTrials.gov; terms: "secretome" OR "exosome" AND "cancer" AND "clinical trial").

Key findings: Numerous preclinical studies demonstrate that certain MSC-derived secretomes-particularly inflammatory-primed, serum-free preparations from perinatal tissues (Wharton's jelly or umbilical cord) and extracellular vesicle (EV)-depleted or genetically/drug-loaded variants-consistently reduce the cancer cell viability, migration, angiogenesis, and tumor growth (55%-85% inhibition in rodent models) across breast, prostate, lung, glioma, and melanoma models. Conversely, unprimed adult tissue MSC secretomes and intact exosome fractions frequently exert neutral or tumor-promoting effects. Engineered platforms (e.g., TRAIL- or azurin-expressing MSCs and paclitaxel-primed amniotic cells) achieve the largest potency gains (from 10- to 100-fold) and favorable safety profiles in vivo. To date, no clinical trial has reported on the anticancer efficacy of any cell-free secretome product in humans.

Translational implications: Clinical advancement requires immediate consensus on an optimal perinatal-sourced candidate, mandatory priming/EV depletion, validated quantitative potency assays, and Good Manufacturing Practice (GMP)-compliant manufacturing. With coordinated effort, first-in-human phase I trials could commence by 2028-2029, offering a novel, off-the-shelf paracrine therapy for solid tumors.

Objective: This study compared surgical complication, quality of life (QoL), functional recovery, and oncologic outcomes between mandibular preservation (MP) and mandibular sacrificing (MS) procedures in patients with locally advanced oral squamous cell carcinoma (OSCC) abutting the mandible who achieved a radiologic complete response (rCR) following neoadjuvant immunotherapy (NAT).

Methods: A retrospective cohort study was conducted on 78 patients who achieved a primary site rCR post-NAT. Patients were allocated to an MP cohort (n=42) or an MS cohort (n=36) based on the definitive surgery performed. Primary outcomes were major complications (Clavien-Dindo ≥ III) and longitudinal QoL (EORTC QLQ-C30/H&N35). Secondary outcomes included functional recovery and 3-year oncologic survival.

Results: The MP cohort experienced significantly fewer major complications than the MS cohort (2.4% vs. 19.4%, p=0.013), a finding that held in multivariable analysis (aOR: 3.85, p=0.008). The MP cohort also demonstrated a significantly shorter median hospital stay (9 vs. 16 days, p<0.001), lower rates of gastrostomy dependence at discharge (28.6% vs. 63.9%, p=0.002) and at 3 months (0% vs. 11.1%, p=0.037), and superior QoL scores across multiple domains from 6 months onwards. With a median follow-up of 3 years, there were no significant differences in local (p=0.534), regional (p=0.305), or disease-free survival (p=0.332) between the cohorts.

Conclusion: For select patients with OSCC achieving rCR after NAT, a mandibular preservation strategy is associated with significantly less postoperative complication, improved functional recovery and quality of life, while not compromising short-term oncologic control in this cohort. These findings suggest the feasibility of challenging the paradigm of mandatory mandibular sacrifice in exceptional responders, pending further prospective validation.