Japanese journal of clinical oncology最新文献

Background: To evaluate the current state of hereditary cancer syndrome management in patients with ovarian and endometrial cancer and to identify the barriers to uptake of genetic testing.

Methods: We conducted a cross-sectional multicenter study at five regional cancer centers in Japan, including 229 patients with ovarian cancer and 454 with endometrial cancer treated between January 2021 and December 2022. We assessed the proportion of patients who received information about hereditary cancer syndromes from gynecologists, underwent genetic counseling with genetic experts, and completed genetic testing; in addition, we explored the barriers to testing uptake.

Results: Among patients with ovarian cancer, 152 (66.4%) received information about hereditary cancer syndromes from their gynecologists, with 61 (26.6%) subsequently receiving genetic counseling and 58 (25.3%) undergoing genetic testing. By contrast, patients with endometrial cancer demonstrated markedly lower rates: only 76 (16.7%) received initial information, 22 (5.3%) accessed genetic counseling, and 13 (2.9%) completed genetic testing. Among patients who received information about hereditary cancer syndromes from their gynecologists, 38% with ovarian cancer and 14% with endometrial cancer underwent genetic testing. Among patients identified as high-risk for hereditary cancer syndromes through tumor profiling, 27.6% (8/29) with ovarian cancer and 70.6% (12/17) with endometrial cancer did not undergo genetic testing. Patient disinterest was the primary barrier to genetic testing among high-risk individuals.

Conclusions: The barriers to uptake of genetic testing arise primarily from inadequate provider communication and patient disinterest in hereditary cancer syndromes.

Background: Postoperative delirium (POD) is a common and serious complication, especially among older adults. The economic burden of POD, particularly in patients undergoing highly invasive cancer resection who are at high risk of delirium, remains unclear. We aimed to clarify the economic burden of subsyndromal delirium (SSD) and severe delirium in this population.

Methods: We prospectively enrolled 281 adults undergoing highly invasive cancer resection and evaluated the impact of severe delirium and SSD diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the Delirium Rating Scale-Revised-98 severity scale. The primary outcome was diagnosis procedure combination (DPC) costs. Propensity score matching was performed to estimate the effect of delirium within a background-matched cohort, and generalized estimating equations with two-way cluster-robust standard errors were applied at both matched-set and patient levels. Sensitivity analyses were performed using direct medical costs (fee-for-service [FFS]).

Results: Fifty-five patients (19.6%) developed severe delirium. DPC costs showed no significant mean difference, whereas total FFS costs were significantly higher in severe delirium (mean difference: US$2364, 95%CI: US$122 ~ US$4606). Component analyses indicated higher costs for prescriptions, infusions, wound-related procedures, and laboratory tests. SSD had no significant economic impact.

Conclusion: Severe postoperative delirium after highly invasive cancer resection was associated with increased FFS expenditures, particularly for prescriptions, infusions, wound care, and laboratory tests, whereas no significant differences were observed in DPC costs. Findings underscore the importance of preventing severe delirium.

Objective: The aim of this study was to compare survival and the incidence of complications between stereotactic body radiotherapy/proton beam therapy (SBRT/PBT) and sublobar resection for vulnerable elderly patients with clinical stage IA non-small cell lung cancer (NSCLC).

Methods: We included patients aged ≥75 years who underwent sublobar resection without mediastinal lymph node dissection or SBRT/PBT for solid predominant clinical stage IA non-small cell lung cancer measuring ≤3 cm in total size. Propensity score matching was used to reduce the selection bias. Complication and survival rates were compared between groups.

Results: Of the 119 included patients, 86 received stereotactic body radiotherapy (62 received X-ray radiotherapy and 24 received proton beam therapy), while 33 received sublobar resection (11 received segmentectomy and 22 received wedge resection). The SBRT/PBT group included significantly older patients (median: 82 vs. 79 years) and larger tumors (median: 18 vs. 16 mm) than did the surgery group. After propensity score matching, 24 patients were analysed in each group. The incidence of ≥Grade 2 complications was not significantly different between the two groups (12.5% vs. 29.1%; OR = 0.35, 95% CI: 0.08-1.55; P = 0.286). Moreover, there were no significant differences in overall and recurrence-free survival rates (OS: HR = 0.68; 95% CI: 0.31-1.50; P= 0.343; RFS: HR = 0.69; 95% CI: 0.33-1.46; P = 0.336, respectively) and the cumulative incidence of recurrence (sHR = 0.87; 95% CI: 0.31-2.40; P = 0.781).

Conclusions: For vulnerable elderly patients with NSCLC, SBRT/PBT may be comparable with sublobar resection in terms of patient survival and safety. Prospective randomized controlled trials are required to confirm these findings.

Intravascular large B-cell lymphoma (IVLBCL) is a rare type of extranodal large B-cell lymphoma characterized by the proliferation of tumor cells within the lumina of small vessels in systemic organs. Diagnosis remains challenging due to the frequent presentation of non-specific symptoms such as fever and general malaise. Since its listing as a distinct disease entity in the 4th edition of the World Health Organization classification, awareness of IVLBCL has increased, leading to improvements in diagnostic accuracy. Nevertheless, patients with delayed or difficult diagnosis continue to be reported. Recent genetic studies have identified recurrent genetic abnormalities associated with IVLBCL, and the potential utility of liquid biopsy for diagnosis and treatment monitoring has been suggested. However, despite these advances, a gap remains between translational research and clinical application, particularly regarding how liquid biopsy can be incorporated into clinical practice. Regarding treatment, although standard chemotherapy with central-nervous-system-directed therapy has demonstrated favorable outcomes in initial management, the efficacy and safety of emerging immune cell therapies in IVLBCL remain largely unknown. This article aims to review recent advances in the understanding and management of IVLBCL, with the ultimate goal of improving clinical outcomes and advancing therapeutic management of IVLBCL.

Background: Recently, a transbronchial needle biopsy (TBNB) method using a three-plane symmetric Acquire needle with Franseen geometry was developed to improve diagnostic yield. This study describes our experience with Endobronchial ultrasound (EBUS)-TBNB for pulmonary and mediastinal diseases.

Methods: A retrospective review was conducted involving 37 patients who underwent EBUS-TBNB with an Acquire 22G needle between July 2021 and September 2024. Enlarged lymph nodes were sampled, and medical records were analyzed to evaluate diagnostic outcomes, including histological core tissue acquisition, programmed death-ligand 1 (PD-L1) expression testing, and next-generation sequencing (NGS).

Results: We sampled a total of 48 lymph nodes (26 subcarinal [#7], 12 right lower paratracheal [#4R], and 10 right hilar [#11]) with a median longest diameter of 23.1 mm (range, 9.3-44.6 mm). Definitive diagnoses were achieved in 36 patients, including 25 cases of lung cancer, one large-cell neuroendocrine carcinoma, one renal cell carcinoma, five cases of sarcoidosis, and four cases of unspecified lymphadenopathy. The overall diagnostic yield was 97.3% (95% confidence interval: 85.8%-99.5%). Both PD-L1 expression testing and NGS were successfully performed in all lung adenocarcinoma cases (nine using the Oncomine Dx Target Test and four using the AmoyDx Pan Lung Cancer polymerase chain reaction (PCR) Panel). Histological samples were successfully obtained from 35 patients, whereas only two cases of lung squamous cell carcinoma were cytologically diagnosed due to necrotic and calcified samples. The nucleic acid yield from a single puncture was sufficient for analysis using the Lung Cancer Compact Panel.

Conclusions: EBUS-TBNB demonstrated high efficacy for diagnosing lung cancer, including PD-L1 testing and NGS, and for obtaining histological core tissue.

Objective: Immune checkpoint inhibitors (ICPis) are widely used clinically to improve the prognosis of various cancers. However, little is known about their hematologic immune-related adverse events (irAEs). This study aimed to comprehensively investigate the incidence and clinical characteristics of irAEs induced by ICPis through a cross-organ research approach.

Methods: Patients who received at least one ICPi dose at the Osaka International Cancer Institute between January 2014 and September 2021 were reviewed, irrespective of their tumor type. We analyzed the cumulative incidence of hematological irAEs and investigated the clinical course of patients who underwent bone marrow examination owing to suspected hematological irAEs.

Results: During the study period, 1500 patients in total received ICPis. Based on clinical data and the histopathological evaluation of bone marrow samples, we identified seven cases of hematologic irAEs (four of immune thrombocytopenia, two of hemophagocytic lymphohistiocytosis, and one of agranulocytosis). Additionally, we observed six cases of primary hematologic disease, four of bone marrow findings consistent with cytopenia and subsequent recovery secondary to infections or cytotoxic agents, two of bone marrow involvement by primary cancer, and one of an unknown cause. With the median follow-up of 297 days (0-2087 days), the cumulative incidence rates of hematologic irAEs at 90 days and 1 year were 0.1% (95% CI, 0.0-0.4) and 0.4% (95% CI, 0.2-1.0), respectively. None of the patients with hematological irAEs died.

Conclusion: Severe hematological irAEs are rare but can be life-threatening. When hematological abnormalities are detected during ICPi therapy, it is important to explore the possibility of irAEs, including bone marrow abnormalities.

Background: Lymphedema has a significant impact on patient quality of life. However, it remains unclear whether the provision of lymphedema treatment in Japan is uniform across regions. This study aimed to clarify the current situation regarding lymphedema treatment with emphasis on complex decongestive therapies (CDT) availability and implementation in Japan.

Methods: A nationwide web-based survey was conducted. Respondents included healthcare professionals from designated cancer care hospitals and other medical institutions treating lymphedema in Japan. The distribution of variables, including the implementation of lymphedema treatment, was compared between designated cancer care hospitals and other facilities using the chi-square test. Japan was divided into nine regions to compare and analyze access to medical institutions providing CDT for lymphedema on both inpatient and outpatient bases.

Results: Of the 372 facility responses analyzed, ˃95% reported treating secondary lymphedema of the extremities, whereas ˂30% treated head and neck lymphedema. The number of CDT inpatients per 100 000 people in the region with the lowest patient volume was approximately 2% of that in the region with the highest volume. Similarly, the number of CDT outpatients per 100 000 people in the lowest-volume region was one-third of that in the highest-volume region. There was no significant correlation between facilities with high outpatient numbers and those with low outpatient numbers (ρ =0.57, P-value = 0.11).

Conclusion: Eliminating regional disparities in access to lymphedema treatment facilities, particularly for inpatient CDT, would improve quality of life and enable patients to manage the condition regardless of where they live.

Treatment strategies for breast cancer have become increasingly complex over the years, requiring a deep understanding of disease pathology and the individualization of treatments on the basis of biomarkers. Circulating tumor DNA (ctDNA) enables non-invasive evaluation of the entire tumor, and its potential is being explored for treatment development. Numerous studies have evaluated ctDNA in various breast cancer subtypes during postoperative follow-up or after neoadjuvant chemotherapy, consistently showing that ctDNA positivity is associated with a higher risk of recurrence. Clinical trials evaluating therapeutic interventions on the basis of ctDNA status are also underway. Moving forward, the development of more sensitive assays and appropriate treatment strategies will be required. As the clinical application of ctDNA advances, the individualization of breast cancer treatment is expected to be further refined.

Objective: To investigate healthcare professionals' perceptions of suicide-related behaviors among people with head and neck cancers in Japan.

Methods: A two-phase, multicenter retrospective study was conducted. First, head and neck cancer specialists completed a survey on their experience with suicide-related behaviors and institutional prevention efforts. Second, a medical record review explored associations between suicide-related behaviors and treatment factors.

Results: There were 152 respondents, of whom 82 (53.9%) had encountered suicide-related behaviors, and 69 (45.4%) had experienced patient suicides. A total of 110 cases of suicide were reported. Only 4.6% of respondents had attended lectures on preventing suicide, although 37.5% had implemented preventive measures. Overall, 27 cases were analyzed, including 18 suicides, and nine attempts. The majority of these involved men who were either smokers or drinkers. Behaviors often occurred when people were post-treatment without any recurrence. Common preceding factors were eating difficulties, speech impairment, and psychological decline.

Conclusions: Suicide risk among people with head and neck cancer extends well beyond diagnosis and remains under-addressed. Increased awareness and education among healthcare professionals, and provision of multidisciplinary support, are essential for comprehensive prevention.