Journal of Neuro-Oncology最新文献

Background: Neuro oncologists bear the responsibility of disclosing prognostic information to patients with glioblastoma. Despite this obligation, prognostic information is neither routinely nor effectively communicated.

Methods: A narrative review of empiric data related to prognostic disclosure in cancer and in GBM is performed, and a normative framework based on this data and our own clinical and ethical experience and consideration is presented.

Analysis: The authors propose a framework of staged disclosure of prognostic information, where the incurability of glioblastoma and the likelihood of neurocognitive decline are discussed at the first patient encounter, but estimations of life expectancy are deferred until a subsequent visit. This approach pragmatically balances oncologists' obligation to preserve patient autonomy and prioritize advance care planning, while also aiming to prevent information overload, allowing the news to be delivered in the context of an increasingly trustful patient-physician relationship, and allowing for more accurate estimations in light of complete pathology results, which are not often available at the first visit.

Conclusion: Staged prognostic discussions about glioblastoma balance oncologists' ethical obligations and optimize communication of prognostic information to patients and their families. Further empirical studies implementing this approach are warranted.

Objective: To assess the differences in clinicopathological features and outcomes of non-functioning pituitary neuroendocrine tumors (PitNETs) based on transcription factor expression.

Methods: Clinical data were collected from patients diagnosed with non-functioning PitNETs at our hospital. Tumors were classified into transcription factor-based subgroups for comparison. Clinical characteristics were analyzed across these subgroups, and prognostic data were obtained through postoperative outpatient records and telephone follow-ups.

Results: A total of 409 patients were included, comprising 202 males (49.4%) and 207 females (50.6%). Of these, 245 (59.9%), 101 (24.7%), 39 (9.5%), and 24 (5.9%) patients were classified into the steroidogenic factor-1 (SF1), T-box transcription factor 19 (TPIT), POU class 1 homeobox 1 (PIT1), and no distinct lineage groups, respectively. The SF1 subgroup was associated with lipid metabolism disorders. The TPIT subgroup had the largest and most invasive tumors. Patients in the PIT1 and no distinct lineage groups were more likely to present with hyperprolactinemia and galactorrhea and showed a lower tendency to invade the cavernous sinus. The median follow-up duration was 801 days. The PIT1 and TPIT subgroups had shorter tumor-free survival, particularly the former. Further survival analysis revealed that patients with TPIT and PIT1 lineages had poorer prognoses.

Conclusions: Transcription factor expression was associated with distinct clinical features and short-term outcomes. The PIT1 and TPIT lineages were linked to shorter tumor-free survival. Enhanced postoperative surveillance is recommended for these subgroups. These findings underscore the clinical and prognostic heterogeneity of non-functioning PitNETs.

Background: Vestibular Schwannomas (VS) are benign nerve sheath tumors arising from Schwann cells of the vestibulocochlear nerve, occurring sporadically or in association with neurofibromatosis type 2 (NF2). Clinical management of VS is challenging due to the tumor's location adjacent to critical neural and vascular structures. The primary morbidities are hearing loss and facial nerve dysfunction, which significantly affect quality of life. There are no FDA-approved medical therapies, and treatment typically consists of surgery or radiation, with treatment decisions centered on optimizing hearing and facial nerve preservation.

Methods: This review synthesizes recent advances in the molecular characterization of VS.

Results: The loss of NF2 function, leading to Merlin inactivation, is a key driver of VS tumorigenesis, disrupting multiple growth and survival pathways. Beyond NF2 inactivation, emerging genomic studies have revealed additional molecular alterations, including chromatin remodeling defects and oncogenic gene fusions, broadening our understanding of VS heterogeneity. Recent single-cell and multi-omic studies have uncovered distinct tumor subtypes and highlighted the role of the tumor microenvironment, particularly the interaction between Schwann cells and tumor-associated macrophages (TAMs).

Conclusions: These findings have important implications for therapeutic development, as they suggest differential treatment strategies based on molecular and immune profiles. While surgery and radiotherapy remain the standard of care, targeted therapies such as kinase inhibitors, anti-angiogenic agents, and immunotherapies are being investigated to improve patient outcomes.