International Journal of Clinical Oncology最新文献

Background: Uncertainties persist regarding the allocation of apical lymph nodes in colorectal cancer, the approaches to lymph node dissection and mesocolic excision, which may contribute to inconsistent surgical practices. The aim of this study is to assess surgeons' practices in lymph node dissection and mesocolic excision approaches and to identify areas lacking standardization.

Methods: A multinational pilot survey of 22 colorectal surgeons from 6 countries was conducted during the FICARE colorectal meeting. The survey consisted of 21 Likert-scale questions on surgical practices and lymph node allocation in colorectal cancer surgery.

Results: Majority of the respondents (90.9%) recognized conceptual differences in apical lymph node stratification between right- and left-sided colon cancers, whereas D3 LND for left-sided cancer should include mesocolic tissue along the inferior mesenteric artery from its origin to the last sigmoid artery. Complete lymph node dissection requires excision of mesocolic tissue along inferior mesenteric artery for left colon cancer and superior mesenteric artery for right colon cancer according to 81.8% of respondents. At the same time, 95.5% agreed that intermediate and paracolic lymph nodes are located within a 10-cm resection margin proximally and distally from tumor, while 81.9% of respondents supported the concept of tumor-specific mesocolic excision to be sufficient enough for adequate paracolic and intermediate lymph node dissection.

Conclusions: A multinational snapshot showed an existing contraindication in surgeons' perception of lymph node stratification and the variability in mesocolic excision and LND. Further Delphi consensus is needed to prove the suggested concepts.

Background: This study aimed to assess the ability of FoundationOne Liquid CDx (F1 Liquid), a blood-based comprehensive genomic profiling test introduced in Japan in 2021, to detect the H3K27M mutation in patients with diffuse midline glioma using a nationwide real-world database in Japan.

Methods: We identified patients with IDH-wildtype diffuse gliomas in midline locations registered in the Center for Cancer Genomics and Advanced Therapeutics database from June 2019 to April 2024. Detection rates of the H3K27M mutation and other major variants were compared across two blood-based comprehensive genomic profiling tests, F1 Liquid and Guardant360 CDx, and three tissue-based, FoundationOne CDx (F1 CDx), NCC Oncopanel, and GenMine TOP. Predictors of H3K27M mutation detection were analyzed using logistic regression.

Results: We identified 114 patients with diffuse gliomas located in the midline. Among these, 31.6% underwent F1 Liquid testing, which had only a 2.8% detection rate for the H3K27M mutation. In contrast, F1 CDx testing had a significantly higher detection rate of 92.2% (p < 0.01). Not undergoing F1 Liquid testing was the only independent predictor of H3K27M detection (odds ratio, 267; 95% confidence interval, 44.4-5250; p < 0.01). F1 Liquid also showed low detection rates for TP53 (2.8%), PDGFRA (0%), and NF1 (2.8%).

Conclusion: Our findings indicate a critical limitation of F1 Liquid in detecting the H3K27M and other significant mutations in diffuse midline glioma.

Background: While computed tomography (CT)-based body composition has been studied for prognostic prediction in colorectal cancer, specific analyses for rectal cancer patients remain limited. This study aimed to investigate the relationship between CT-derived body composition indices and long-term postoperative outcomes in rectal cancer patients and to develop corresponding predictive models.

Methods: In this multicenter retrospective study, 696 patients who underwent radical surgery for rectal cancer between 2018 and 2021 were enrolled. Skeletal muscle index (SMI) and subcutaneous adipose tissue index (SATI) were calculated from preoperative CT scans at the third lumbar vertebra. Univariate and multivariate Cox regression analyses were performed to identify independent prognostic factors for recurrence-free survival (RFS) and overall survival (OS). Nomogram prediction models were constructed based on significant factors and validated internally using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).

Results: A total of 96 (13.8%) patients experienced recurrence and 89 (12.8%) died during follow-up. Multivariate analysis identified low SMI and high SATI as independent predictors of both poorer RFS (SMI: HR = 0.329, 95% CI 0.182-0.595; SATI: HR = 2.717, 95% CI 1.505-4.905) and OS (SMI: HR = 0.132, 95% CI 0.053-0.330; SATI: HR = 3.542, 95% CI 1.739-7.211), along with advanced T and N stages.Query The developed nomograms demonstrated good predictive accuracy. For RFS prediction, the area under the curve (AUC) values were 0.862, 0.846, and 0.824 for 3-, 4-, and 5-year predictions in the training set, and 0.825, 0.866, and 0.838 in the validation set. For OS prediction, the AUCs were 0.886, 0.898, and 0.875 (training set), and 0.876, 0.912, and 0.877 (validation set). Calibration curves and DCA indicated favorable model performance and clinical utility.

Conclusion: CT-derived body composition, specifically SMI and SATI, is associated with postoperative RFS and OS in rectal cancer patients. The established nomograms, integrating these indices with tumor stage, provide a valuable and individualized tool for prognostic assessment.

Background: Mucinous borderline ovarian tumors (MBOTs) are rare neoplasms with excellent prognosis, yet the optimal surgical extent remains controversial. No large-scale study in Japan has evaluated treatment trends and prognostic factors for MBOTs. This study aimed to clarify their clinicopathological features, management patterns, and survival outcomes using a nationwide registry.

Methods: Data were obtained from the Japan Society of Obstetrics and Gynecology Gynecologic Tumor Registry, including 96,476 ovarian tumors treated between 2004 and 2018. Among them, 12,766 MBOT cases were identified. Surgical procedures-hysterectomy, omentectomy, lymphadenectomy, and adjuvant chemotherapy-were analyzed. Survival analyses of 8564 cases with complete prognostic data were performed using Kaplan-Meier and Cox proportional hazards models.

Results: Over 90% of MBOTs were stage I, and the median age was 52 years. Hysterectomy was performed in 50.8%, omentectomy in 57.9% (2015-2018 subset), and lymphadenectomy in 7.6%. Only 2.6% received adjuvant chemotherapy. The 5-year overall survival exceeded 95%. Multivariate analysis identified age ≥ 50 years (HR 2.5, 95% CI 1.8-3.6) and stage IC (HR 2.7, 95% CI 1.9-3.6) as independent adverse factors. Omentectomy showed a marginal survival benefit (HR 0.6, p = 0.05), whereas hysterectomy, lymphadenectomy, and chemotherapy conferred no advantage. Chemotherapy correlated with poorer outcomes, likely due to confounding by indication.

Conclusions: This nationwide cohort-the largest MBOT series reported to date-demonstrates conservative management with excellent prognosis in Japan. Radical surgery and chemotherapy provide no survival benefit, whereas fertility-sparing surgery appears appropriate for younger patients.

Background: Some head and neck cancers are metastatic tumors of unknown primary origin, but their epidemiology has seldom been studied. This study aimed to address this knowledge gap using a nationwide database in Japan. Furthermore, we examined the nationwide implementation of human papillomavirus (HPV) and Epstein-Barr virus (EBV) testing, assessed their inter-facility and temporal variations, and compared these findings with oropharyngeal cancer cases.

Methods: Head and neck squamous cell carcinoma of unknown primary origin and oropharyngeal squamous cell carcinoma diagnosed between 2018 and 2022 were identified from the Hospital-based Cancer Registries of Japan. Data on sex, age, TNM classification, HPV and EBV test results, and treatment facilities were collected. Temporal changes in viral diagnostic practices were analyzed.

Results: We identified 1636 new cases of head and neck cancers of unknown primary. The disease was more common in males and patients aged 70-74 years. HPV positivity was more frequent in patients aged 45-59 years, whereas EBV positivity was less frequent in all age groups. Of the patients, 67.6% were treated at certified head and neck cancer facilities, which had higher viral testing rates than non-certified facilities. Case numbers remained stable over time, whereas viral testing and HPV positivity increased; however, both remained lower than in oropharyngeal cancer cases.

Conclusions: This study visualized real-world virus testing for patients with head and neck cancers of unknown primary, providing insights into diagnostic equity, institutional capacity, and the need for standardized cancer care. Continued surveillance is essential to improve outcomes in this rare condition.

Background: Advances in image-enhanced endoscopy have improved early detection of superficial squamous cell carcinomas in the oropharynx, hypopharynx, and larynx. As a minimally invasive treatment, transoral endoscopic surgery offers advantages over (chemo)radiotherapy and open surgery, including preservation of voice and swallowing function and the option of future radiotherapy. However, some lesions remain undetected during preoperative examinations of conscious patients and are identified only intraoperatively under general anesthesia. In this study, we sought to clarify the clinical characteristics of lesions newly detected during surgery.

Methods: We retrospectively reviewed 193 patients with 284 superficial squamous cell carcinoma lesions of the oro-hypopharynx or larynx who underwent transoral endoscopic surgery between January 2016 and December 2024. To identify factors associated with intraoperative detection, newly identified lesions were compared with preoperatively detected lesions in terms of location, tumor size, histopathology, and preoperative endoscopic examination conditions.

Results: Among the 284 lesions, 24 (8.5%) were newly detected intraoperatively, which were significantly smaller than those detected preoperatively (median: 7.5 vs. 17 mm) and were mainly located on the posterior walls of the oropharynx and hypopharynx. Sixteen lesions were identified using narrow-band imaging (NBI) alone, whereas eight required additional Lugol staining. Lesions requiring Lugol staining were significantly more likely to be carcinoma in situ than invasive carcinoma.

Conclusions: Intraoperatively detected lesions were generally smaller and more frequently located on the posterior pharyngeal wall. Given the limitations of conscious endoscopic examinations, meticulous intraoperative inspection using NBI and Lugol staining is essential to avoid overlooking indistinct lesions.

Background: Talc slurry pleurodesis is widely used for malignant pleural effusion (MPE); however, its success rate ranges from 50 to 75%, and reliable predictors are lacking. This study aimed to identify predictors of pleural effusion control failure following pleurodesis and develop a short-term predictive scoring system.

Methods: We retrospectively analyzed 170 patients with MPE who underwent talc pleurodesis at a single center between 2014 and 2024. The cohort was divided into training (n = 136) and validation (n = 34) cohorts. Logistic regression was used to identify independent predictors of pleural effusion control failure within 30-90 days.

Results: The most common primary tumors were lung, breast, and ovarian cancers. Pleural effusion was controlled in 70.6% of cases. Univariate analysis identified low body mass index, supportive care alone, Grade 2 collapse of the lower lung field post-drainage, extensive pulmonary consolidation, large tumor (≥ 7 cm), hypoalbuminemia, and positive pleural fluid cytology (Class III or higher) to be associated with pleural effusion control failure. Multivariate analysis revealed that massive pleural effusion (P = 0.048), supportive care alone (P < 0.001), and Grade 2 lung collapse (P = 0.003) were independent predictors of pleural effusion control failure. A scoring system incorporating these factors was validated in a validation cohort, demonstrating a control rate of approximately 90%, 60% and 30% in patients scoring ≤ 1, 2 and ≥ 3 points, respectively.

Conclusions: The scoring system may support early decision-making regarding talc pleurodesis and palliative strategies, potentially improving quality of life in patients with MPE.

Hereditary colorectal cancer (HCRC), arising from pathogenic germline variants, accounts for 5-10% of all CRCs. The widespread clinical adoption of next-generation sequencing (NGS) and multigene panel testing (MGPT) has fundamentally transformed the diagnostic paradigm for this genetic predisposition. This review summarizes the latest epidemiological data on genetic predisposition to CRC and examines the essential practical changes required for genomics-based precision medicine. Recent large-scale genomic cohort studies have consistently revealed a higher prevalence of pathogenic/likely pathogenic germline variants (PGVs) in unselected CRC populations than previously recognized, ranging from 3.3 to 15.5%. This proportion is dramatically elevated in patients with early onset CRC (EOCRC), defined as a diagnosis before age 50, where prevalence consistently exceeds 15%. Notably, MGPT has expanded the etiological spectrum far beyond Lynch syndrome (LS)-related genes, demonstrating a significant contribution from non-LS and high- and moderate-penetrance genes, particularly those associated with homologous recombination deficiency (HRD). Consequently, the management of genetic predisposition to CRC is rapidly shifting from single syndrome-based diagnoses to individualized precision medicine guided by gene-specific lifetime cancer risks. To realize clinical benefits, two imperatives must be addressed: (1) the implementation of universal genomic screening for all patients with EOCRC and (2) the development of proactive medical-contact approach models in cascade screening for at-risk relatives. Nevertheless, the viability of this proposal varies considerably between Europe, America, and Asia. Considerable uncertainty surrounds implementation in Asia, where a plethora of challenges must be overcome to facilitate the integration of genomic medicine within the Asian context.

Background: Early diagnosis of oral squamous cell carcinoma (OSCC) remains challenging, with survival largely stage-dependent at presentation. Artificial intelligence (AI) promises to enhance detection and clinical decision-making across clinical photographs, radiology, optical imaging, and digital pathology.

Methods: This narrative review synthesizes peer-reviewed PubMed-indexed English-language studies up to October 2025, prioritizing prospective designs, external validation, and clinically interpretable models. We focus on tasks relevant to clinicians: lesion triage from clinical images, prediction of nodal metastasis on CT/MRI/PET, margin assessment with optical modalities, and histopathology-based diagnosis/grading. We also discuss implementation issues: dataset shift, bias, and reporting standards.

Results: In clinical photographs, deep learning achieves high diagnostic accuracy for OSCC and oral potentially malignant disorders (OPMD) classification in single-center studies and shows promising generalization with multi-site external testing, yet performance still degrades on out-of-distribution images and under real-world artifacts. In radiology, radiomics and deep learning models improve risk stratification and prediction of cervical nodal metastasis beyond conventional imaging, particularly with multimodal feature fusion. Optical methods such as hyperspectral spatial frequency domain imaging and OCT combined with AI show feasibility for intraoperative margin assessment and in-clinic triage. Digital pathology models on whole-slide images approach expert-level classification for OSCC diagnosis and are beginning to predict malignant transformation risk in oral epithelial dysplasia; however, rigorous prospective validation remains scarce.

Conclusion: AI systems for OSCC are maturing and clinically oriented. Before routine adoption, studies must demonstrate external validity, clinician-in-the-loop performance, calibration, and impact on time-to-diagnosis and patient outcomes. Pragmatic trials and transparent reporting are essential to move beyond proof-of-concept into equitable clinical benefit.

Pancreatic ductal adenocarcinoma (PDAC) is a global lethal malignancy, with increasing incidence and dismal survival rates. Inflammation plays a central role in shaping PDAC biology, and interleukin-1 receptor type 1 (IL-1R1) is a key mediator linking oncogenic signaling, stromal activation, and immune suppression. This review summarizes current insights into IL-1R1 signaling in PDAC, focusing on its role in tumor microenvironment remodeling, tumor progression, and metastasis. IL-1R1 activation by IL-1α or IL-1β triggers MyD88-dependent pathways, including NF-κB, MAPK, and STAT3, which induce pro-inflammatory cytokines, angiogenic factors, and immune checkpoints. These events contribute to the desmoplastic and immunosuppressive tumor microenvironment characteristic of PDAC. IL-1R1 orchestrates crosstalk between cancer cells, cancer-associated fibroblasts, and tumor-associated macrophages, promoting epithelial-mesenchymal transition, extracellular matrix remodeling, and immune evasion. Moreover, IL-1R1 promotes metastatic dissemination by enhancing the survival of circulating tumor cells through platelet shielding and neutrophil extracellular traps, while fostering angiogenesis and lymphangiogenesis to establish niches in the liver and peritoneum. Clinically, high IL-1R1 expression correlates with advanced disease, metastasis, and poor prognosis. Therapeutic blockade of the IL-1 pathway with agents, such as anakinra, canakinumab, or rilonacept, reduces tumor growth, metastasis, and immune suppression in preclinical PDAC models. Combination strategies with chemotherapy, radiotherapy, or immune checkpoint inhibitors further enhance anti-tumor efficacy. However, major challenges remain, including limited clinical trial data, infection risk, and the absence of predictive biomarkers. Summarily, IL-1R1 is a central driver of PDAC aggressiveness and a therapeutic target. Targeting this pathway may enable biomarker-guided strategies to improve outcomes in this disease.