Cancer Medicine最新文献

Background

Testicular cancer (TC) disproportionately affects younger men and carries unique psychosocial and physiological consequences that extend well beyond treatment. Despite favorable survival rates, TC survivors frequently report diminished health-related quality of life (HRQoL). These burdens are often compounded by masculinity-related identity disruptions, fear of recurrence, sexual dysfunction, and a lack of tailored psychosocial support. Existing interventions remain limited, with most programs focused on physical rehabilitation or early detection. Few address the multidimensional stressors that shape the TC survivorship experience.

Aims

This narrative review examines the literature on HRQoL among TC survivors and evaluates the potential of mindfulness-based interventions (MBIs) as a viable therapeutic strategy.

Materials and Methods

A comprehensive literature search identified artivles that were produced in the past two decades+ that investigated the relationship between MBIs and TC survivor HRQoL.

Discussion

Evidence from broader cancer populations demonstrates that MBIs, such as meditation, breathing exercises, and mindfulness-based psychoeducation, can reduce psychological distress and promote emotional regulation. Programs like MindCAN have shown promise in improving self-awareness, affect, and coping. Importantly, MBIs offer a low-cost, flexible, and sustainable approach that aligns with the autonomy often valued by men navigating survivorship.

Conclusion

To date, no fully developed mindfulness trials have been developed specifically for TC survivors. Given the early age of diagnosis and long survivorship trajectories, as well as the unique psychological and physiological health outcomes associated with TC, MBIs may be especially well-suited to this population. This review calls for a renewed focus on implementing mindfulness-based strategies designed for the lived realities of TC survivors. Doing so may meaningfully enhance post-treatment outcomes, reduce disparities in male mental health care, and promote holistic wellness in one of the most underserved cancer survivor populations.

Background

Health disparities remain a critical global public health challenge, particularly in access to advanced treatments for blood cancers. Racial and socioeconomic factors influence healthcare accessibility, contributing to inequities in patient outcomes. Despite the potential of CAR-T therapy in treating blood cancers, disparities in financial resources, education, gender, and race hinder equitable access. This study evaluates literature on CAR-T therapy to identify access disparities and proposes policy recommendations.

Methods

The PRISMA-ScR guidelines were followed for study selection and reporting. A comprehensive search strategy was used across databases like PubMed and Google Scholar, using keywords and MeSH terms. Inclusion criteria included peer-reviewed studies in English since 2000. A basic quality appraisal was conducted to ensure the relevance and credibility of included studies, despite the diversity of study designs and the primary focus on mapping key themes across the literature.

Results

Twenty-five relevant (25) studies, including analytical studies, observational studies, and literature reviews, were analyzed. Findings indicate significant racial and socioeconomic disparities in CAR-T therapy accessibility, with financial constraints, lack of awareness, and systemic biases limiting equitable distribution. Challenges include high treatment costs, lack of insurance coverage, and underrepresentation of minority groups in trials.

Conclusion

Addressing these disparities requires targeted policy interventions, increased funding, and improved patient education. Continued research and collaboration are essential to ensure equitable access for all individuals.

Hepatoid adenocarcinoma (HAC) is a rare extrahepatic tumor of non-germ cell origin that morphologically resembles hepatocellular carcinoma (HCC). HAC has a propensity to metastasize to the liver and therefore may be mistaken for HCC. There is a lack of standardized treatment protocols, and further studies are needed to evaluate the benefit of targeted therapy and immunotherapy. Recent studies have reported that tumor protein 53 (TP53) gene mutations are associated with increased expression of programmed cell death ligand-1 (PD-L1), which may be a predictor of response to PD-L1 targeted checkpoint inhibitors.

This review provides a clinical guidance for the management of patients with HAC by summarizing the salient clinical features, risk factors, diagnostic criteria, differential diagnosis, new therapeutic approaches, and prognosis of this rare tumor. Furthermore, we reviewed the Mayo Clinic experience to describe the clinical characteristics of 15 patients diagnosed with HAC.

HAC is usually diagnosed at an advanced stage with distant metastases. In patients diagnosed with liver lesions that have similar radiologic and histologic features to HCC, particularly in the absence of underlying chronic liver disease, further evaluation should be performed to rule out HAC. Communication between medical subspecialties is important to avoid misdiagnosis and prevent further disease progression. In our patient cohort TP53 was the most frequently mutated gene (5 out of 8, 62.5%) and PD-L1 expression showed a positive score in 3 out of 6 patients (50%). However, only a few patients received immunotherapy (6 out of 14, 42.9%) suggesting that the numbers are too small to draw a conclusion about its efficacy in treating HAC.

Objectives

This study aims to assess the incremental cost per quality-adjusted-life-year (QALY) gained in treating patients with early oral squamous cell carcinoma (OSCC) using sentinel lymph node biopsy (SLNB) guided neck dissection.

Methods

A Markov model was created to simulate disease-free survival, recurrence, and overall survival in a hypothetical cohort of patients with early OSCC in India. Three groups were assessed: Group I—SLNB-guided neck dissection, Group II—elective neck dissection (END) alone, and Group III—END with frozen section (FS). Costs and QALY were assessed using a payer's perspective, lifetime horizon, and 3% discount, and incremental cost utility ratios (ICUR) were computed. Interventions with ICUR less than one-time gross domestic product (GDP) per capita were considered cost-effective. Both one-way and probabilistic-sensitivity analyses were conducted to examine model uncertainty.

Results

In comparison to Group II and Group III, Group I incurs additional costs of INR 5564 (US$ 67) and INR 2507 (US$ 30) per patient, respectively, and results in an incremental gain of 0.31 and 0.33 additional QALYs, respectively, over a lifetime horizon. The ICURs for Group I versus Group II and Group III are INR 8088 (US$ 97) and INR 16,709 (US$ 200), respectively. At a threshold of one-time per-capita GDP, SLNB demonstrates a 94% probability of being cost-effective.

Conclusion

SLNB-guided neck dissection is a cost-effective strategy for management of early OSCC in India. Our findings support inclusion of SLNB-guided neck dissection in the Indian Government's insurance program.

Background

Lung cancer remains the leading cause of cancer-related mortality worldwide, highlighting the urgent need for earlier detection within real-world screening and patient management pathways. Recent advances in multi-omics technologies have created new opportunities for identifying biomarkers associated with early-stage lung cancer, particularly in high-risk populations under clinical surveillance.

Methods

This review systematically evaluates early diagnostic biomarkers across multiple omics layers, including genomics, epigenomics, transcriptomics, proteomics, metabolomics and microbiomics. It also summarises the application of artificial intelligence (AI), particularly machine learning and deep learning approaches, for integrating and analysing complex multi-omics datasets to support biomarker discovery and clinical decision-making.

Results

Multi-omics strategies are accelerating the identification of molecular signatures relevant to early lung cancer detection. AI-driven methods enable the extraction of latent patterns from high-dimensional data, facilitating risk stratification, diagnostic refinement, histological subtyping and treatment planning. The review highlights the clinical utility of these biomarkers and their potential incorporation into screening algorithms, as well as the development of AI-based clinical decision support systems (CDSS) aligned with real-world clinical workflows. However, major barriers to clinical translation remain, including multi-centre data heterogeneity, limited model interpretability affecting clinical trust, regulatory and cost-effectiveness challenges and insufficient validation in prospective cohorts.

Conclusions

Emerging technologies, such as single-cell and spatial multi-omics, along with federated learning frameworks, offer promising solutions to bridge the gap between computational discovery and clinical implementation. The integration of AI and multi-omics approaches has the potential to advance risk-adapted and personalised early detection strategies for lung cancer.

Objective

To evaluate the independent predictive value of tumour–periprostatic adipose tissue (PPAT) interface features on preoperative multiparametric magnetic resonance imaging (mpMRI) for extraprostatic extension (EPE) in prostate cancer and to compare discrimination and clinical net benefit with a baseline clinical model.

Methods

This single-centre retrospective cohort included patients who underwent radical prostatectomy with mpMRI completed within 8 weeks. On a single axial slice at maximum tumour diameter, five simplified interface features were measured using standard PACS tools: contact length, contact angle, T2 signal intensity ratio, interface apparent diffusion coefficient (3-mm annular zone) and capsular integrity score (0–2 scale). A baseline clinical model (prostate-specific antigen [PSA], PSA density, PI-RADS and biopsy Gleason score) and a combined model (baseline variables plus LASSO-selected interface features) were constructed. Bootstrap internal validation (1000 iterations) with bias correction was performed. Discrimination was assessed using the area under the curve (AUC), and calibration curves and decision curve analysis evaluated accuracy and net clinical benefit.

Results

A total of 240 patients were included, with an EPE prevalence of 34.2% (82/240). The combined model achieved a bias-corrected AUC of 0.823 (95% confidence interval [CI]: 0.768–0.878), suggesting improvement over the baseline model's AUC of 0.744 (95% CI: 0.680–0.808). Decision curve analysis revealed a higher net benefit for the combined model across clinically relevant threshold probabilities (10%–50%).

Conclusions

Simplified tumour–PPAT interface features independently predict EPE without increasing imaging complexity, improving discrimination and clinical value for preoperative risk stratification.

Objective

To evaluate demographic and clinical factors influencing survival in patients with major salivary gland tumors (MSGTs) using the surveillance, epidemiology, and end results (SEER) database.

Study Design

A retrospective cohort study using SEER data from 2000 to 2021.

Setting

Data were collected from the SEER registry, a comprehensive database capturing cancer statistics across the United States.

Methods

Patients diagnosed with major salivary gland malignancies were analyzed for demographic factors, including age, sex, race, marital status, and income, as well as clinical variables, including tumor grade and site. Stratification by sex was done to assess sex-specific outcomes.

Results

The cohort included 13,869 patients. Key findings include that older age and male sex were associated with worse survival outcomes. Single patients had better survival than married individuals, likely due to younger age at diagnosis. Additionally, higher income and Asian/Pacific Islander race conferred a survival advantage. There were disparate impacts between males and females in income, marital status, and race, with higher income and marriage providing a survival advantage for male patients but none for females. Additionally, Black females but not Black males, and widowed females but not widowed males, had slightly increased hazard ratios compared to White individuals.

Conclusion

Men and women experience disparate effects that impact survival and outcomes in major salivary gland tumors. These findings highlight the need for targeted interventions to address disparities in care and improve survival outcomes while emphasizing the importance of further research to understand the underlying mechanisms driving these disparities.

Background

Excess adiposity has been recognized as a significant modifiable risk factor for ovarian cancer (OC), but the epidemiology of OC attributable to high BMI remain largely unknown.

Methods

Utilizing comprehensive data from the Global Burden of Disease 2021 study, this investigation quantifies the epidemiological impact of elevated body mass index (BMI) on OC.

Results

Our study demonstrated a striking 17,344 mortality cases attributable to BMI in 2021, with a 153.2% increase compared to 1990. The age-standardized mortality rate (ASMR) and disability-adjusted life years (DALYs) rate associated with excessive BMI rose from 0.18 per 100,000 (95% UI: −0.04–0.33) and 4.57 per 100,000 (95% UI: 0.94–8.6) in 1990 to 0.2 per 100,000 (95% UI: 0.05–0.36) and 5.46 per 100,000 (95% UI: 1.3–9.62) in 2021, respectively, with DALYs showing a 152.6% increase during this period. Notably, geriatric populations and low-income nations exhibited disproportionately elevated mortality and DALY counts in 2021. The Bayesian age-period-cohort (BAPC) predictive modeling framework was used to quantify the average yearly rate of the obesity-related OC and demonstrated a continued rise in both incidence and mortality rates over the next 25-year period.

Conclusion

These findings highlight metabolic dysfunction as a critical public health challenge in OC pathogenesis, emphasizing the urgent need to address modifiable metabolic determinants and associated conditions.

Background

In recent years, the incidence of early upper gastric cancer has increased, leading to a wider adoption of proximal gastrectomy (PG) as a possible treatment option. PG is preferred over total gastrectomy (TG) due to its superior postoperative nutritional status and improved surgical safety. However, PG is associated with a considerable risk of anastomosis-related complications, such as gastroesophageal reflux and anastomotic stenosis, which limit its widespread application.

Methods

We conducted a narrative review of comparative studies, prospective studies and retrospective study, that described reconstructive techniques after PG. End-points of interest were incidence of reflux esophagitis, anastomotic stenosis, time of follow-up, nutritional parameters.

Results

Esophago-gastrostomy, the simplest reconstruction method, was associated with highest reflux rates of 18%–55% and stenosis rates of 1.1%–27.8%. Anti-reflux modifications such as side-overlap, double-flap technique (DFT) and gastric tube lowered reflux rate distinctly, especially DFT, lowered reflux rates to 2%–16.7%. But DFT carried a 4%–26.3% stenosis risk and longer operative time. Jejunal interposition (JI) gave 2.1%–100% reflux rates and 0%–31.8% stenosis, yet required three anastomoses and limited endoscopic surveillance. Double-tract reconstruction (DTR) achieved the promising anti-reflux outcome, with preserved duodenal passage. However, it may increase surgery costs and prolong surgical time.

Conclusion

Our findings provide a solid foundation for reconstruction methods selection that enhance postoperative quality of life and highlight future directions for improving PG outcomes. DTR and DFT, currently offer the best balance between reflux control and anastomotic stenosis after PG. Prospective clinical research and innovation are expected to further improve these techniques and may discover an optimal universal approach to address long-term challenges.

Purpose

Phakomatoses-associated primary central nervous system (CNS) tumors are therapeutically challenging due to young age of onset, multiple tumors, and prolonged morbidity from long-term survival. This study evaluated demographics, survival, and prognostic factors of patients with phakomatoses-associated CNS tumors treated at a specialized neuro-oncology service in India.

Materials and Methods

Consecutive patients diagnosed and managed between 2000 and 2022 were included in this retrospective study. Data were retrieved from electronic medical records. Treatment decisions were multidisciplinary and included maximal safe resection, radiation (RT), and systemic therapy as indicated. Kaplan–Meier survival analysis evaluated overall survival (OS) and progression-free survival (PFS). Univariate analyses used the log-rank test, and multivariate analyses the restricted mean survival time.

Results

A total of 121 patients were analysed: NF1 (61.2%), NF2 (23.1%), VHL (10.7%), and TSC (5.0%). For NF1, median follow-up was 36.5 months (95% CI: 1–254); 3-year PFS and OS were 76.4% (95% CI: 66.5–87.8) and 87.7% (95% CI: 80.1–96.1) respectively. On univariate analysis, NF1 high-grade glioma patients who did not receive RT had inferior outcomes, though not significant on RMST. For NF2, median follow-up was 40.5 months (95% CI: 1–199); 5-year PFS and OS were 37.3% (95% CI: 20.5–68.1) and 100% respectively. For VHL, median follow-up was 66.5 months (95% CI: 3–426); 5-year PFS and OS were 77.9% (95% CI: 54.6–100) and 100% respectively. For TSC, median follow-up was 71 months (95% CI: 1–228); 5-year PFS and OS were 75% (95% CI: 42.5–100) and 100% respectively.

Conclusion

Phakomatoses-associated CNS tumors show promising outcomes with multimodality management. Further research into targeted multimodality treatment is warranted.