Japanese journal of clinical oncology最新文献

Objectives: This study aimed to assess the prognostic outcomes and risk of adverse events in elderly non-muscle invasive bladder cancer (NMIBC) patients receiving photodynamic diagnosis-assisted transurethral resection of bladder cancer (PDD-TURBT).

Methods: This study retrospectively included 326 patients who were over 70 years old and received either PDD-TURBT (n = 114, PDD group) or white-light TURBT (n = 212, WL group). Oncological outcomes, namely recurrence-free survival (RFS) and progression-free survival (PFS), and adverse event profiles were compared between the two groups.

Results: In the PDD and WL groups, the median RFS periods were not reached and 41.7 months (P < 0.001), and the median PFS periods were not reached and 160.2 months (P = 0.057), respectively. The Grey test which take account to overall death as a competing risk event revealed recurrence tended to decrease in PDD group (P = 0.050). The independent prognostic factors were determined by multivariate Cox regression analyses: WL-TURBT in RFS. After propensity score matching, statistically favorable RFS in the PDD group were shown (P = 0.018). The incidence of AST/ALT elevation and intraoperative hypotension (defined as systolic blood pressure ≤ 80 mmHg) were significantly higher in the PDD group than in the WL group (P = 0.003 and 0.003, respectively).

Conclusions: Prolonged RFS are expected for PDD-TURBT using oral 5-aminolevulinic acid in elderly NMIBC patients. However, the risks of liver injury and intraoperative hypotension are higher for PDD-TURBT.

Head and neck cancer (HNC) frequently presents in the advanced stage, which necessitates treatments such as chemoradiotherapy and pharyngolaryngoesophagectomy. These treatments can impair functions including swallowing, speech, and saliva production, and diminish the quality of life (QOL). Key risk factors for HNC include alcohol consumption, smoking, and genetic polymorphisms in aldehyde dehydrogenase 2, which increase the susceptibility to carcinogenesis through the 'field cancerization phenomenon.' Advances in gastrointestinal endoscopy, including narrow band imaging with magnifying endoscopy, facilitate the early detection of superficial HNC. By identifying abnormal vessel patterns and mucosal changes, these diagnostic techniques improve the detectability, differential diagnosis, and identification of the invasion depth of superficial cancers. The latter is essential because tumor thickness is an important predictor of lymph node metastasis and prognosis. Minimally invasive transoral surgeries, including endoscopic mucosal resection, endoscopic submucosal dissection, endoscopic laryngopharyngeal surgery, transoral videolaryngoscopic surgery, and transoral robotic surgery, emphasize organ preservation, and are efficacious and safe for treating superficial HNC. Early detection of metachronous cancers, which are prevalent in patients with HNC and esophageal cancer, is crucial for improving long-term outcomes. Abstinence from alcohol consumption and smoking may reduce the development of cancers in the head and neck or esophagus. Future research directions include integrating artificial intelligence to improve diagnostic accuracy, refining transoral surgical techniques, and developing systematic surveillance protocols for the early detection of metachronous cancer. Continued efforts to optimize minimally invasive treatments and prevention strategies will improve the prognosis and QOL of patients with HNC.

Background: To establish a nomogram model for predicting chemotherapy-induced nausea and vomiting (CINV) in patients with gynecological malignancies based on relevant risk factors.

Methods: This retrospective study included patients with gynecological malignancies hospitalized in the oncology department of Affiliated People's Hospital of Jiangsu University between February 2020 and October 2021. Patients were divided into a training set (between February 2020 and December 2020) and a validation set (between January 2021 and October 2021). Basic and clinical characteristics were collected and analyzed by univariate and multivariate logistic regression. A nomogram was constructed and assessed with the receiver operating characteristic curve (ROC). We have also conducted an external validation using data from 297 patients with gynecological malignancies admitted to two oncology wards at our hospital (140 patients from Ward 1 and 157 patients from Ward 2).

Results: This study comprised 148 patients in the training set and 148 in the validation set. Multivariate analysis revealed age <60 years (OR (Odds Ratio) = 4.001, 95% CI (Confidence interval) 1.349-11.872, P = 0.012), presence of motion sickness (OR = 3.841, 95% CI 1.200-12.296, P = 0.023), history of pregnancy-related vomiting (OR = 4.067, 95% CI 1.203-13.751, P = 0.024), and the use of moderate/high emetogenic chemotherapy drugs (OR = 10.299, 95% CI 2.858-37.115, P < 0.001) as independent risk factors for CINV. These factors were incorporated into a nomogram, which exhibited an area under the ROC (AUC) of 0.844, with a sensitivity of 81.4% and specificity of 80.0% at the optimal cut-off point of 159.48. The AUC for validation was 0.945, with sensitivity and specificity of 91.5% and 87.1% at the optimal cut-off point of 159.48, respectively. The external validation results showed an AUC of 0.704 (95% CI: 0.648-0.755), with a sensitivity of 93.33% and specificity of 48.15% (P = 0.001).

Conclusion: The developed nomogram, incorporating age, moderate/high emetogenic chemotherapy drugs, motion sickness, and pregnancy vomiting history, showed good discrimination for CINV.

Ensuring the high quality of colonoscopies in colorectal cancer (CRC) screening is essential to reducing CRC. Recently, computer-aided detection systems (CADe) that use artificial intelligence have attracted much attention as potentially useful tools for improving lesion detection in colonoscopy. However, evidence on the efficacy of CADe in CRC screening is lacking. We have planned a multi-national, multi-center, randomized controlled trial in the Asia-Pacific region to assess whether colonoscopy with CADe (test method) yields higher lesion detection (primary endpoint: adenoma detection rate) than colonoscopy without CADe (standard method) in CRC screening populations. The study will include 1400 participants aged 50-79 years who are due to undergo colonoscopy for CRC screening, whether as a primary screening colonoscopy or following a positive fecal immunochemical test. If the efficacy of CADe is proven from this study, the use of CADe in colonoscopy for CRC screening will become standard, leading to improved CRC screening.

Background: The JCOG1113, a multicenter, randomized phase III trial in patients with advanced/recurrent biliary tract cancer showed the non-inferiority of gemcitabine plus S-1 to gemcitabine plus cisplatin. Although liver cirrhosis (LC) is a known risk factor for intrahepatic cholangiocarcinoma (ICC), few reports focus on the efficacy and safety of chemotherapy in ICC patients with LC.

Methods: We performed a subgroup analysis of ICC patients enrolled in the JCOG1113. The presence or absence of LC was evaluated based on clinical factors such as radiographic findings, medical history, laboratory data, and physical examination at enrollment. We evaluated differences in the safety and efficacy of chemotherapy according to the presence or absence of clinically diagnosed LC.

Results: Of the 94 eligible patients with ICC, 10 were clinically diagnosed with LC. In the non-LC/clinically diagnosed LC group, grade 3 or 4 neutropenia, anemia, decreased platelet count, and non-hematological adverse events were observed in 51.2%/60%, 15.5%/0%, 11.9%/40%, and 38.1%/30% patients. The median overall survival was 13.7 months in the non-LC group and 19.0 months in the clinically diagnosed LC group (hazard ratio [HR]: 0.969, 95% confidence interval [CI]: 0.482-1.948). The median progression-free survival was 5.9 months in the non-LC group and 7.1 months in the clinically diagnosed LC group (HR, 0.995; 95% CI, 0.513-1.929).

Conclusion: The results of this study indicated that eligible ICC patients with clinically diagnosed LC, as determined by clinical and CT imaging findings, did not exhibit any apparent safety or efficacy disadvantage compared to those without LC.

The optimal timing of surgery and the number of courses of perioperative chemotherapy for high-risk soft tissue sarcoma patients are still controversial. Tumour growth during neoadjuvant chemotherapy led to limb amputation in some patients. This study aims to confirm the non-inferiority of surgery and three courses of adjuvant chemotherapy with adriamycin (30 mg/m2, days 1 and 2) plus ifosfamide (2 g/m2, days 1-5) compared with our standard treatment of three courses of neoadjuvant chemotherapy and surgery followed by two courses of adjuvant chemotherapy with adriamycin plus ifosfamide for localized high-risk soft tissue sarcoma patients. This is a multi-center, two-arm, open-label, randomized phase III trial. The primary aim is to confirm the non-inferiority in overall survival (margin: hazard ratio of 1.61). This is the first randomized controlled trial to compare neoadjuvant chemotherapy and immediate surgery for soft tissue sarcoma. This trial was initiated on 16 November 2022 and registered with the Japan Clinical Trials Registry (jRCTs031220446).

Background: Surgical resection followed by adjuvant chemotherapy is currently the first choice for the treatment of clinical N1 (cN1) non-small cell lung cancer (NSCLC). However, diagnosing cN1 correctly can be difficult, even with current imaging diagnostic technologies. We aimed to analyze the diagnostic accuracy of preoperative nodal status and the predictive factors for nodal upstaging of cN1-NSCLC.

Methods: Patients receiving surgery for cN1-NSCLC in 2010 (n = 1040) were enrolled in the Japanese Joint Committee of Lung Cancer Registry Database. We investigated the diagnostic accuracy of cN1, predictive factors for nodal upstaging, and prognostic factors for overall survival (OS) and recurrence-free survival (RFS).

Results: The 5-year OS and RFS for all patients were 58.2% and 42.7%, respectively. The postoperative pathological nodal status included N0 (36.6%), N1 (39.7%), N2 (23.6%), and N3 (0.1%). In multivariate analysis, younger age (P = .005), no history of smoking (P = .006), and adenocarcinoma (P < .001) were significant predictive factors for nodal upstaging. Older age (P < .001) and higher clinical T (cT) factor (P < .001) were significant indicators for worse OS, while older age (P = .02), higher cT factor (P = .019), high carcinoembryonic antigen value (P = .002), and adenocarcinoma (P = .008) were significant indicators for worse RFS.

Conclusions: The diagnostic accuracy of cN1 in this study was ~40%. No history of smoking and adenocarcinoma were significant predictors for nodal upstaging. Although younger age was a significant predictor for nodal upstaging, it was a significant factor for better prognosis.

Background: Survival prediction for patients with leptomeningeal metastasis (LM) is crucial for making proper management plans and counseling patients. Prognostic models in this patient domain have been limited, and existing models often include predictors that are not available in resource-limited settings. Our aim was to develop a practical, individualized survival prediction model for patients diagnosed with LM.

Methods: We collected a retrospective cohort of patients diagnosed with LM from cerebrospinal fluid at Chiang Mai University Hospital from January 2015 to July 2021. Nine candidate predictors included male gender, age > 60 years, presence of extracranial involvement, types of primary cancer, the time between primary cancer and LM diagnosis, presence of cerebral symptoms, cranial symptoms, spinal symptoms, and abnormal CSF profiles. Flexible parametric survival analysis was used to develop the survival prognostic model for predicting survival at 3, 6, and 12 months after diagnosis. The model was evaluated for discrimination and calibration.

Results: 161 patients with 133 events were included. The derived individual survival prediction model for patients with LM, or the LMsurv model, consists of three final predictors: types of primary cancer, presence of cerebral symptoms, and presence of spinal symptoms. The model showed acceptable discrimination (Harrell's C-statistics: 0.72; 95% confidence interval 0.68-0.76) and was well calibrated at 3, 6, and 12 months.

Conclusions: The LMsurv model, incorporating three practical predictors, demonstrated acceptable discrimination and calibration for predicting survival in LM patients. This model could serve as an assisting tool during clinical decision-making. External validation is suggested to confirm the generalizability of the model.

Background: Disparities in public assistance or the urbanization level of a residential region can affect cancer treatment outcomes. This study aimed to investigate whether these factors affect the overall survival (OS) of patients with epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC) using Tokushukai REAL World Data.

Methods: We analyzed the clinical data of consecutive patients with NSCLC receiving EGFR-tyrosine kinase inhibitors between April 2010 and March 2020 at 46 Tokushukai Medical Group hospitals in Japan. The patient's insurance coverage status was extracted from electronic medical records, and the urbanization level of residential regions was classified as megalopolis or other according to the secondary medical region. Univariate and multivariate Cox regression analyses were performed to examine the associations between OS and patient/tumor/treatment/socioeconomic-related factors.

Results: In total, 758 patients (58.5% females) were included in the study; 41 patients (5.4%) received public assistance, and 442 patients (58.3%) were categorized under megalopolis in the secondary medical regions. In multivariate Cox regression analyses, there was no significant difference in the OS between non-recipients of public assistance and recipients [hazard ratio (HR) 1.084; 95% confidence intervals (CIs), 0.674-1.744]. There was also no significant difference in the OS between megalopolis and other regions in the secondary medical regions (HR 1.143; 95% CIs, 0.914-1.428).

Conclusions: Our findings suggest that neither the use of public assistance nor the urbanization level in the residential region significantly impacts the prognosis of Japanese patients with EGFR mutation-positive NSCLC.

There are many histologic types of gynecologic malignancies. I reviewed three rare ovarian tumor types that have poor prognoses. Ovarian mesonephric-like adenocarcinoma (MLA) is a newly described histological type known for its aggressive behavior. It is thought to arise from mesonephric duct remnants of the female genital tract and is typically associated with endometriosis. Although MLA has some similarities to endometrioid carcinoma, they have different prognoses. Recurrence of MLA is common, even in early stage cases, and distant metastases, especially in the lungs, are often seen. MLA is characterized by positive immunohistochemical-staining for TTF-1, GATA3, PAX2, and CD10, and negative staining for estrogen and progesterone receptors. Data on treatment for MLA are scarce, and further studies are needed. Adult granulosa cell tumors, the most common type of malignant ovarian sex cord-stromal tumors, have an indolent growth pattern. Chemotherapy, hormone therapy, and radiotherapy have all shown some efficacy. However, debulking surgery remains the most important treatment because tumor disruption or remnants are risk factors for recurrence. Late recurrence is also characteristic of this tumor. Malignant transformations of mature teratoma are suspected when the patient is relatively old and the tumor is large. Squamous cell carcinoma is the most common somatic malignancy. Treatment must be tailored to the transformed histology. Chemotherapy and radiation have shown some efficacy; however, the prognosis is extremely poor in advanced cases. Because these three types of ovarian tumors are rare, research on possible treatments has been difficult, but recent significant advances in drug therapy are expected to lead to the development of effective treatments.