Frontiers in Oncology最新文献

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.

Background: Testicular cancer (TC) is the most common malignancy in young men, with incidence increasing globally, especially in high-income countries. Although survival has improved due to advances in diagnosis and treatment, disparities in TC burden remain. This study analyzes global, regional, and national trends in TC incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021, and projects future trends to 2035.

Methods: Data were obtained from the Global Burden of Disease (GBD) 2021 database. Incidence, mortality, and DALY rates per 100,000 population were calculated with 95% uncertainty intervals (UIs). Trend analysis used Joinpoint regression and estimated annual percentage change (EAPC). Decomposition analysis identified drivers of burden changes. A Bayesian age-period-cohort (BAPC) model projected future burden.

Results: In 2021, there were 91,507 TC cases, 11,388 deaths, and 560,921 DALYs globally. From 1990 to 2021, cases rose by 136%, deaths by 49%, and DALYs by 44%. Incidence increased from 1.45 to 2.31 per 100,000. The middle socio-demographic index (SDI) region showed the highest EAPCs for incidence (4.34%), mortality (1.07%), and DALYs (0.92%). The Caribbean had the fastest-growing incidence (EAPC = 5.71%). Nationally, the U.S. had the most cases (11,845), Monaco the highest incidence (32.89/100,000), and Qatar the steepest rise (EAPC = 10.25%). By 2035, incidence is projected to rise further, while mortality and DALY rates may decline.

Conclusion: The global burden of TC has increased markedly since 1990, especially in middle-SDI regions and the Caribbean. Although some areas have seen improvements, rising incidence highlights the need for targeted prevention and optimized care strategies.

N⁶-methyladenosine (m⁶A), as the most abundant RNA epitranscriptional modification in eukaryotes, its key component of the methyltransferase complex, METTL14, not only cooperates in catalyzing m⁶A deposition but also has functions independent of methyltransferase activity. This article systematically reviews the dual regulatory role of METTL14 in tumors and its molecular mechanisms, mainly organizing the relevant research in a logical sequence of "tumor suppressive effect - tumor promoting effect - controversial or context-dependent". Studies have shown that METTL14 often plays a tumor suppressive role in tumors such as hepatocellular carcinoma and colorectal cancer, while in pancreatic cancer and nasopharyngeal carcinoma, it mostly promotes malignant progression, showing a high degree of context dependence. This article focuses on two key mechanisms: on the one hand, METTL14 precisely regulates the processing, stability, and function of non-coding RNAs (including miRNAs, lncRNAs, and circRNAs) through m⁶A modification, reshaping the competitive endogenous RNA (ceRNA) network; on the other hand, it shapes an immunosuppressive tumor microenvironment by directly upregulating immune checkpoints such as PD-L1, mediating metabolism-immune interactions, and regulating the function of immune cells. Its functional duality also stems from the selective regulation of key pathways such as PI3K/AKT, as well as the differential interpretation by different m⁶A readers (such as YTHDF2 and IGF2BPs). Given the close association of these mechanisms with clinical prognosis, the expression level of METTL14 shows significant potential as a prognostic marker and therapeutic target; in the future, it is necessary to combine single-cell multi-omics and other technologies to analyze its dynamic regulatory network in specific tumor contexts and explore precise treatment strategies based on synthetic lethality or targeting downstream effector molecules.

Langerhans Cell Sarcoma (LCS) is an extremely rare and aggressive neoplasm with limited consensus on optimal treatment. We report the case of a 56-year-old woman with refractory Langerhans Cell Histiocytosis (LCH) that transformed into Langerhans Cell Sarcoma (LCS) who achieved complete remission following chemotherapy with cladribine, high-dose cytarabine, G-CSF, and mitoxantrone (CLAG-M), and subsequent allogeneic hematopoietic stem cell transplantation (HSCT). This case highlights the potential role of allogeneic HSCT as an effective therapeutic option for refractory LCS and underscores the importance of reporting additional cases to guide future management strategies in this rare malignancy.