International Journal of Clinical Oncology最新文献

Background: Pelvic lymph-node dissection is performed across multiple surgical specialties. However, inconsistent terminology and unclear anatomical boundaries hinder standardization. This study established a multidisciplinary team with a shared anatomical understanding, with the aim to prospectively evaluate standardized pelvic lymph-node dissection, focusing on the dorsal region of the obturator nerve.

Methods: A prospective observational study was conducted at a single institution from November 2022 to 2025. A team of urology, gastrointestinal surgery, gynecology, and pathology specialists received standardized anatomical training. A total of 106 patients undergoing pelvic lymph-node dissection for pelvic cancers were enrolled. Pelvic regions were predefined into seven areas. Data on surgical outcomes, lymph-node yield, complications, operative time, and quality of life were collected. Central pathology review and photographic scoring were performed.

Results: Over 90% of surgeons rated the anatomical classification as clear. Planned lymphadenectomy was completed in over 95% of cases. The obturator region was consistently dissected. Dissection of the dorsal obturator nerve region did not increase the number of retrieved or positive lymph nodes but extended operative time by 15 min per side. No lymphadenectomy-related complications were observed in 96% of patients. Quality of life declined at 1 week postoperatively and stabilized by 1 month.

Conclusions: A multidisciplinary, standardized approach to pelvic lymph-node dissection is feasible and facilitates implementation across specialties. Dissection of the dorsal obturator nerve region increases operative time without demonstrating additional oncological advantage in this study. Standardized anatomical frameworks may facilitate safer and more consistent practice.

Pancreatic cancer remains one of the most lethal malignancies, with limited therapeutic options and poor responsiveness to immune checkpoint inhibitors (ICIs). This resistance is largely attributed to its profoundly immunosuppressive and desmoplastic tumor microenvironment (TME), characterized by low tumor mutational burden, dense stroma, and abundant immunosuppressive cell populations. Therefore, strategies capable of enhancing tumor immunogenicity and overcoming immune evasion are urgently needed. Oncolytic virotherapy is a promising approach, offering not only tumor-selective cytotoxicity, but also potent immunomodulatory effects. Of these agents, Telomelysin (OBP-301, Suratadenoturev), a telomerase-specific oncolytic adenovirus, demonstrated clinical safety but limited efficacy in refractory tumors. To address this challenge, we developed OBP-702, a next-generation, p53-armed, oncolytic adenovirus designed to augment antitumor activity. Preclinical studies have shown that OBP-702 exerts robust cytotoxicity through multiple mechanisms, including p53-mediated apoptosis and autophagy, E1A-E2F1-mediated p21 suppression, and inhibition of oncogenic KRAS pathways. Importantly, OBP-702 induces strong immunogenic cell death, activates dendritic cells, and promotes tumor-specific T-cell responses, effectively converting immunologically "cold" pancreatic tumors into "hot" tumors. OBP-702 also remodels the immunosuppressive TME by reducing granulocyte-macrophage colony-stimulating factor (GM-CSF) secretion, suppressing myeloid-derived suppressor cells (MDSCs), and targeting stromal components, such as cancer-associated fibroblasts (CAFs). These effects contribute to enhanced responses to ICIs and standard chemotherapies. Given its multifaceted antitumor functions and ability to overcome key barriers in pancreatic cancer, OBP-702 represents a highly promising therapeutic candidate. A first-in-human clinical trial evaluating endoscopic ultrasonography-guided intratumoral injection of OBP-702 is currently in preparation, expected to advance clinical translation of this novel virotherapeutic strategy.

Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), are associated with an increased risk of intestinal neoplasia, representing a major long-term complication of chronic inflammation. This review summarizes the recent epidemiological trends and clinicopathological features of IBD-associated colorectal cancer (CRC) and dysplasia in UC and CD. In UC, the cumulative risk of CRC has declined in recent decades, possibly reflecting improvements in medical management and surveillance strategies. However, long disease duration, extensive colitis, concomitant primary sclerosing cholangitis, prior dysplasia, and family history of CRC remain major risk factors. UC-associated neoplasia (UCAN) typically presents as flat lesions with indistinct margins, often accompanied by surrounding dysplasia and frequently exhibits multifocal or infiltrative histological features. The prognosis of UCAN is reportedly poorer than that of sporadic CRC, particularly in advanced stages. In CD, although the overall incidence of neoplasia is lower, the relative risk of colorectal and small intestinal cancer remains significantly higher than in the general population. Geographic variations are notable, with anorectal and fistula-associated carcinomas being most prevalent in East Asia. Risk factors for CD-associated neoplasia (CDAN) include long-standing and early-onset disease, extensive colonic involvement, strictures, and a family history of CRC. Survival outcome of CDAN is worse than that of sporadic CRC, with a higher local recurrence rate. IBD-associated intestinal neoplasia exhibits distinct epidemiological and clinicopathological profiles compared with sporadic CRC. Recent nationwide multicenter studies from Japan provide important insights into UCAN and CDAN, underscoring the importance of region-specific understanding to optimize surveillance and management strategies.

Background: Regarding concurrent chemoradiotherapy (CCRT), the combination of docetaxel and cisplatin (DP regimen) is a promising option for treating head and neck squamous cell carcinoma (HNSCC) with a relatively low dose of cisplatin; however, its non-inferiority to other chemotherapies in efficacy and tolerability remains unclear.

Methods: In this retrospective multi-institutional study, the efficacy and safety of the DP regimen were compared with those of other chemotherapy regimens in patients who underwent CCRT for HNSCC. Overall survival, progression-free survival, and adverse effects-including estimated glomerular filtration rate (eGFR)-were evaluated as outcome measures.

Results: Study results showed that a total of 211 patients were included. The prevalence of oropharyngeal, hypopharyngeal, and laryngeal cancer was 44%, 33%, and 17%, respectively. Overall response and recurrence rates were comparable between the DP regimen and high-dose CDDP alone. Although overall and progression-free survival tended to be longer with the DP regimen than with high-dose CDDP, the differences were not statistically significant. Neutropenia was more frequently observed with the DP regimen, but the chemotherapy completion rate was comparable to that of high-dose CDDP alone. Regarding renal function, eGFR significantly decreased with high-dose CDDP but not with the DP regimen.

Conclusions: A combination of docetaxel and cisplatin in concurrent chemoradiotherapy was a favorable option for treating HNSCC with acceptable efficacy and manageable toxicity.

Background: Breast cancer is the most common cancer among women globally, with incidence rates rising annually. However, systematic comparative studies on the burden of breast cancer among women of reproductive age in East Asian countries are currently lacking.

Methods: This study utilized the Global Burden of Disease (GBD) 2021 database to extract incidence, prevalence, mortality, disability-adjusted life years (DALYs) for breast cancer among women of reproductive age in China, Japan, and South Korea. Cross-national comparisons were conducted using age-standardized rates (ASR), and estimated annual percentage change (EAPC) and average annual percentage change (AAPC) were calculated. Joinpoint regression analysis identified trend turning points, and ARIMA models projected trends for 2022-2036.

Results: From 1990 to 2021, China, Japan, and South Korea exhibited upward trends in age-standardized incidence rates (ASIR) and age-standardized prevalence rates (ASPR) for breast cancer (ASIR: China's EAPC = 2.17, Japan's EAPC = 0.93, South Korea's EAPC = 3.86). Age-standardized mortality rates (ASMR) and age-standardized DALYs rates (ASDR) generally declined in China and Japan but increased in South Korea (ASMR: China's EAPC = -1.10, Japan's EAPC = -0.64, South Korea's EAPC = 0.11). Projections for the next 15 years indicate rising ASIR and ASPR in China, declining trends in Japan, and stabilization in South Korea; overall declines in ASMR and ASDR across all three countries.

Conclusion: The findings emphasize the importance of enhanced, country-specific screening and prevention efforts for breast cancer among reproductive-age women in East Asia to address disparities in disease burden and early detection.

Background: Mediastinal tumor surgery and extended thymectomy for myasthenia gravis (MG) have undergone significant changes with the advancement of minimally invasive techniques. However, nationwide population-based data capturing these trends in Japan remain limited. This study aimed to characterize national surgical trends for mediastinal tumors and MG using a comprehensive administrative claims database.

Methods: We analyzed data extracted from the National Database of Health Insurance Claims and Specific Health Checkups (NDB), covering over 95% of insured procedures in Japan. We classified surgeries from 2014 to 2023 by disease category (benign tumor/malignant tumor/MG) and approach (open/thoracoscopic/robotic-assisted). Crude and age-standardized surgery rates were calculated per 100,000 person-years. Temporal trends were assessed using linear and Poisson regression models.

Results: In 2023, a total of 6214 surgeries was performed: 54.4% for benign tumors, 41.6% for malignant tumors, and 4.0% for MG. Thoracoscopic approaches accounted for 76.4% of all procedures (29.4% robotic-assisted), while open surgery comprised 23.6%. Over the decade, age-standardized overall mediastinal tumor surgeries increased significantly (P = 0.0001), driven by marked rises in malignant, thoracoscopic, and robotic-assisted surgeries (each P < 0.0001). In contrast, extended thymectomies and open surgeries declined (P = 0.0019, and < 0.0001, respectively). Age-standardized malignant tumor surgery rates rose in both sexes (relative risk = 1.051 for males, 1.065 for females, and 1.058 overall; P < 0.0001), especially among those aged ≥ 40 years in both sexes (P < 0.0024).

Conclusion: This nationwide study reveals growing surgical demand for mediastinal tumors and underscores the widespread adoption of minimally invasive techniques.

Background: The effectiveness of peer support for breast cancer survivors has varied substantially, and no previous study has examined patient-supporter matching. This study protocol describes a decentralized, multicenter, open-label pilot randomized controlled trial designed to explore the effectiveness of online peer support for breast cancer survivors and to develop a matching algorithm for use in future research.

Methods: Fifty breast cancer survivors within 3 years of completing initial treatment will be recruited and will provide electronic informed consent. They will be randomly assigned to either the peer support group, which will schedule a peer support session immediately after registration, or the waitlist control group, which will schedule their session 2 weeks later. Peer support sessions will be conducted online by two trained peer supporters. The primary outcome is the score on the UCLA Loneliness Scale, assessed 1 week after the session in the peer support group and at the end of the 2-week waiting period in the control group. Secondary outcomes include satisfaction with peer support and other psychosocial measures, all assessed through an electronic patient-reported outcome system. Effect sizes will be calculated to inform sample size estimation for future trials. Potential factors associated with satisfaction, such as similarity between participants and peer supporters, will also be explored to guide matching algorithm development.

Discussion: The findings will inform a future confirmatory trial incorporating an optimized matching algorithm. Trial registration UMIN000056741.