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Uncharted Territory: Investigating Long-Term Quality of Survival After A Prostate Cancer Diagnosis. 未知领域:调查前列腺癌诊断后的长期生存质量。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2025-01-01 DOI: 10.6004/jnccn.2024.7354
Alicia K Morgans, Charles J Ryan
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引用次数: 0
Urinary Circular RNA Panels to Detect HBV-Related Hepatocellular Carcinoma: A Multicenter, Large-Scale, Case-Control Study. 尿环状RNA检测hbv相关肝细胞癌:一项多中心、大规模病例对照研究
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-12-27 DOI: 10.6004/jnccn.2024.7058
Zijun Xie, Guangping Gan, Guanlin Zhou, Jiabao Zhang, Jiamin Ling, Jianhong Zhang, Yijun Zeng

Purpose: More than 60% of patients with hepatocellular carcinoma (HCC) do not receive curative therapeutics due to late clinical manifestations and diagnosis. The 5-year survival rate for advanced HCC is approximately 2%. However, curative therapies for HCC detected early can improve the 5-year survival rate to >70%. We aimed to identify sensitive and noninvasive biomarkers in urine for detecting HCC.

Patients and methods: For this study, 4 groups of individuals (healthy controls, patients with chronic hepatitis B [CHB], patients with hepatitis B virus [HBV]-induced liver cirrhosis, and patients with HBV-related HCC) were recruited, and each group was allocated to discovery, training, and validation phases. A total of 14 circular RNAs (circRNAs) were chosen as putative biomarkers in urine due to their differential expressions in HCC tissue and blood reported in related literature. Their expression levels in urine were measured by quantitative PCR (qPCR). Logistic regression models were created using a training cohort (n=312) and then validated using an independent cohort (n=741). Area under the receiver operating characteristic curve (AUC) was used to assess the diagnostic performances.

Results: Three circRNA panels (circ_0075792, circ_0005397, and circ_0000976) were obtained with high diagnostic performances for differentiating HCC from the 3 control groups, with sensitivity >80%, specificity >90%, and AUC >0.9.

Conclusions: Urinary circRNA panels identified and validated based on these results show desirable diagnostic performances for detecting HCC, especially early HCC. Accordingly, using these biomarkers to detect early HCC will enable patients who would have otherwise missed the curative therapeutic window to benefit from optimal treatments.

目的:60%以上的肝细胞癌(HCC)患者因临床表现和诊断较晚而未接受根治性治疗。晚期HCC的5年生存率约为2%。然而,对早期发现的HCC进行根治性治疗可将5年生存率提高至约70%。我们的目的是在尿液中寻找检测HCC的敏感和非侵入性生物标志物。患者和方法:本研究招募了4组个体(健康对照组、慢性乙型肝炎患者、乙型肝炎病毒(HBV)诱导的肝硬化患者和HBV相关的HCC患者),每组分为发现阶段、训练阶段和验证阶段。由于相关文献报道了14种环状rna (circRNAs)在HCC组织和血液中的差异表达,因此我们选择它们作为尿液中的推定生物标志物。采用定量PCR (qPCR)检测其在尿液中的表达水平。使用训练队列(n=312)创建逻辑回归模型,然后使用独立队列(n=741)进行验证。采用受试者工作特征曲线下面积(AUC)评价诊断效果。结果:3个circRNA (circ_0075792、circ_0005397和circ_0000976)对3个对照组的HCC鉴别具有较高的诊断效能,敏感性>80%,特异性>90%,AUC >0.9。结论:基于这些结果识别和验证的尿circRNA面板在检测HCC,特别是早期HCC方面具有理想的诊断性能。因此,使用这些生物标志物检测早期HCC将使那些错过治愈治疗窗口的患者受益于最佳治疗。
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引用次数: 0
Response to EGFR/NTRK/MET Co-Inhibition Guided by Paired NGS in Advanced NSCLC With Acquired EGFR L858R/T790M/C797S Mutations. 在获得性EGFR L858R/T790M/C797S突变的晚期NSCLC中,配对NGS引导下EGFR/NTRK/MET共抑制的应答
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-12-27 DOI: 10.6004/jnccn.2024.7070
Xue Yang, Xintong Li, Jiaqi Yan, Yuanxin Liu, Jie Yin, Weikang Shao, You Lu, Jianxin Xue

EGFR tyrosine kinase inhibitors (TKIs) have significantly improved clinical outcomes for patients with non-small cell lung cancer (NSCLC) harboring EGFR-activating mutations. However, resistance to TKI therapy often develops due to secondary EGFR mutations or the activation of bypass signalling pathways. Next-generation sequencing (NGS) can efficiently identify actionable genetic alterations throughout treatment. MET amplification is a well-established off-target resistance mechanism. Additionally, rarer mechanisms, such as NTRK1 gene fusions, have been reported. This report highlights a case of a 58-year-old male diagnosed with bone-metastatic NSCLC harboring the EGFR L858R mutation. After receiving dacomitinib and almonertinib sequentially, plasma-based NGS revealed the emergence of EGFR T790M-trans-C797S mutations, prompting a switch to a combination therapy of almonertinib and gefitinib. Upon disease progression, repeat NGS identified EGFR T790M-cis&trans-C797S mutations and a novel POT1::NTRK3 fusion in the blood. The fusion retained a complete NTRK kinase domain without frameshift variants, making it a target for treatment. Larotrectinib was incorporated into the dual EGFR-TKI regimen, forming a triplet therapy. Although this resulted in grade 3 dermatitis, the condition resolved after discontinuing gefitinib. At multiorgan progression, matched tissue- and plasma-based NGS identified MET amplification. Subsequently, the patient was started on a triple-inhibition regimen targeting EGFR, NTRK, and MET, which achieved a partial response with favorable tolerability. This is the first reported case of a novel, targetable POT1::NTRK3 fusion as a potential off-target mechanism mediating EGFR-TKI resistance, occurring alongside MET amplification in a patient with NSCLC harboring acquired EGFR L858R/T790M/C797S mutations. Concomitant inhibition of EGFR, NTRK, and MET was safe and resulted in a significant response, underscoring the importance of precision medicine guided by matched NGS.

EGFR酪氨酸激酶抑制剂(TKIs)可以显著改善携带EGFR激活突变的非小细胞肺癌(NSCLC)患者的临床结果。然而,对TKI治疗的耐药性通常是由于继发性EGFR突变或旁路信号通路的激活而产生的。下一代测序(NGS)可以在整个治疗过程中有效地识别可操作的基因改变。MET扩增是一种成熟的脱靶抗性机制。此外,罕见的机制,如NTRK1基因融合,已被报道。本报告重点报道了一例58岁男性被诊断为骨转移性非小细胞肺癌,其中含有EGFR L858R突变。在连续接受达克米替尼和阿莫那替尼治疗后,基于血浆的NGS显示EGFR T790M-trans-C797S突变的出现,促使转向阿莫那替尼和吉非替尼联合治疗。随着疾病进展,重复NGS鉴定出EGFR t790m -顺式和反式c797s突变和血液中新的POT1::NTRK3融合。融合保留了一个完整的NTRK激酶结构域,没有移码变体,使其成为治疗的靶标。larorectinib被纳入双重EGFR-TKI方案,形成三重治疗。虽然这导致了3级皮炎,但停用吉非替尼后病情得到缓解。在多器官进展中,匹配的组织和基于血浆的NGS鉴定出MET扩增。随后,患者开始了针对EGFR、NTRK和MET的三重抑制方案,该方案获得了部分缓解和良好的耐受性。这是首次报道的一种新的、可靶向的POT1::NTRK3融合作为一种潜在的脱靶机制介导EGFR- tki耐药的病例,它与MET扩增一起发生在具有获得性EGFR L858R/T790M/C797S突变的NSCLC患者中。同时抑制EGFR、NTRK和MET是安全的,并产生了显著的反应,强调了在匹配的NGS指导下精准医疗的重要性。
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引用次数: 0
Optimizing Ewing Sarcoma and Osteosarcoma Biopsy Acquisition: A Children's Oncology Group Bone Tumor Committee Consensus Statement. 优化尤文氏肉瘤和骨肉瘤活检获取:儿童肿瘤组骨肿瘤委员会共识声明。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-12-27 DOI: 10.6004/jnccn.2024.7063
Matthew S Dietz, Alyaa Al-Ibraheemi, Jessica L Davis, C Matthew Hawkins, Brian T Craig, Roshni Dasgupta, David S Geller, David S Shulman, Sarah Cohen-Gogo, Ajay Gupta, Susan L Whiteway, Emily K Slotkin, Christine M Heske, Safia K Ahmed, Daniel J Indelicato, Catherine M Albert, Nicole Montgomery, Jesse K Sandberg, Holcombe E Grier, Mark Krailo, Michael S Isakoff, Elyssa Rubin, Elizabeth R Lawlor, Steven G DuBois, Leo Mascarenhas, Patrick J Grohar, Odion Binitie, Damon Reed, Katherine Janeway, Ryan D Roberts, Kelly M Bailey

Trends in diagnostic biopsy sample collection approaches for primary bone sarcomas have shifted in the past 2 decades. Although open/incisional biopsies used to be the predominant approach to obtain diagnostic material for Ewing sarcoma and osteosarcoma, image-guided core needle biopsies have increased in frequency and are safe for patients. These procedures are less invasive and reduce recovery times but have potential limitations. The quantity and quality of tissue obtained through these procedures vary between institutions. Acquired viable tissue volumes can be low, limiting the conduct of downstream expanded clinical workup, molecular analyses, and research. Patients with advanced Ewing sarcoma and osteosarcoma continue to have overall poor outcomes despite dose-intensive cytotoxic chemotherapy. The biology of treatment resistance is not currently well understood, partly due to limited availability of relevant tissue to study. There is a need for access to quality tumor specimens for molecular and other analyses to identify high-risk tumor subsets and drive discovery to improve patient outcomes. Given broad variability in bone tumor tissue procurement and processing across member institutions, the Children's Oncology Group Bone Tumor Committee convened a multidisciplinary group of experts to outline the current and near-future tissue needs for optimal clinical care and access to research platforms. The goal of this working group was to provide high-level guidance on biopsy practices that safely meet these evolving needs. Harmonizing tissue collection practices is paramount to improving the care of children, adolescents, and young adults diagnosed with Ewing sarcoma and osteosarcoma.

在过去的二十年中,原发性骨肉瘤的活检样本采集方法的趋势发生了变化。虽然开放/切口活检曾经是获得尤文氏肉瘤和骨肉瘤诊断材料的主要方法,但图像引导下的核心针活检的频率增加了,对患者来说是安全的。这些手术侵入性较小,减少了恢复时间,但也有潜在的局限性。通过这些程序获得的组织的数量和质量因机构而异。获得的活组织体积可能很低,限制了下游扩大临床检查、分子分析和研究的进行。晚期尤文氏肉瘤和骨肉瘤患者尽管进行了高剂量的细胞毒性化疗,但总体预后仍很差。目前对治疗耐药的生物学还不是很了解,部分原因是相关组织的可用性有限。有必要获得高质量的肿瘤标本进行分子和其他分析,以确定高危肿瘤亚群,并推动发现以改善患者的预后。鉴于各成员机构骨肿瘤组织采购和处理的广泛差异,儿童肿瘤组骨肿瘤委员会召集了一个多学科专家小组,概述当前和近期的组织需求,以获得最佳临床护理和研究平台。该工作组的目标是提供高水平的活检实践指导,以安全地满足这些不断变化的需求。协调组织收集实践对于改善诊断为尤文氏肉瘤和骨肉瘤的儿童、青少年和年轻人的护理至关重要。
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引用次数: 0
First-Line PD-1 Blockade Combined With Chemotherapy for Stage IV Penile Squamous Cell Carcinoma: A Multicenter Retrospective Study. 一线PD-1阻断联合化疗治疗IV期阴茎鳞状细胞癌:一项多中心回顾性研究
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-12-20 DOI: 10.6004/jnccn.2024.7074
Longbin Xiong, Xingli Shan, Huali Ma, Shengjie Guo, Jiyan Liu, Xianda Chen, Wenjun Meng, Bin Guo, Lijuan Jiang, Ru Yan, Xin An, Yanxia Shi, Yijun Zhang, Ting Xue, Lichao Wei, Daming Xu, Zhiling Zhang, Zike Qin, Kai Yao, Yajian Li, Philippe E Spiess, Linjun Hu, Nianzeng Xing, Hui Han

Background: The purpose of this study was to evaluate the efficacy and safety of PD-1 blockade combined with cisplatin and paclitaxel (TP)-based chemotherapy as first-line treatment for advanced penile squamous cell carcinoma (PSCC).

Patients and methods: A retrospective review was performed of 32 eligible patients with high-risk stage IV (cN3M0-1) PSCC who received first-line PD-1 blockade combined with TP-based chemotherapy at 5 medical centers (2019-2023). Clinical responses were assessed using RECIST version 1.1. Treatment-related adverse events (TrAEs) and postsurgical complications were graded according to CTCAE version 5.0. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Multiplex immunofluorescence was used to explore potential biomarkers and to present the tumor microenvironment landscape before and after treatment.

Results: After a median treatment duration of 4 cycles (range, 2-6), the overall objective response rate was 78.1% (25/32). Among 27 patients with locally advanced PSCC, 13 (48.1%) subsequently underwent consolidative surgery and 6 (22.2%) achieved a pathologic complete response (pCR). Additionally, 8 (25.0%) patients in the overall cohort underwent consolidated radiotherapy. Median follow-up was 21.1 months (95% CI, 14.1-42.7). Median PFS and OS were 15.0 months (95% CI, 11.4-not available [NA]) and 19.3 months (95% CI, 16.7-NA), respectively. All patients experienced TrAEs, with 50% (16/32) of them having grade ≥3 TrAEs. Higher intratumoral CD8+ T-cell infiltration was observed in pretreatment samples of responders compared with nonresponders (P=.03). CD4+ T-cells, natural killer cells, and macrophages, among others, exhibited significant changes after treatment (all P<.05), suggesting their potential involvement in the antitumor response to immunochemotherapy.

Conclusions: PD-1 blockade plus TP-based chemotherapy was effective and well tolerated, with favorable survival outcomes for patients with stage IV PSCC. High pretreatment intratumoral CD8+ T-cell infiltration may help to identify potential responders.

背景:本研究的目的是评价PD-1阻断联合顺铂和紫杉醇(TP)化疗作为晚期阴茎鳞状细胞癌(PSCC)一线治疗的疗效和安全性。患者和方法:回顾性分析了5个医疗中心(2019-2023)32例接受一线PD-1阻断联合tp化疗的高危IV期(cN3M0-1) PSCC患者。使用RECIST 1.1版评估临床反应。治疗相关不良事件(TrAEs)和术后并发症按照CTCAE 5.0分级。使用Kaplan-Meier法估计无进展生存期(PFS)和总生存期(OS)。多重免疫荧光技术用于探索潜在的生物标志物,并显示治疗前后的肿瘤微环境景观。结果:中位治疗时间为4个周期(范围,2-6)后,总体客观有效率为78.1%(25/32)。在27例局部晚期PSCC患者中,13例(48.1%)随后进行了巩固手术,6例(22.2%)实现了病理完全缓解(pCR)。此外,整个队列中有8例(25.0%)患者接受了巩固放疗。中位随访时间为21.1个月(95% CI, 14.1-42.7)。中位PFS和OS分别为15.0个月(95% CI, 11.4-not available [NA])和19.3个月(95% CI, 16.7-NA)。所有患者均出现trae,其中50%(16/32)的trae≥3级。缓解者的瘤内CD8+ t细胞浸润高于无缓解者(P=.03)。CD4+ t细胞、自然杀伤细胞和巨噬细胞等在治疗后发生了显著变化(均为pdp)。结论:PD-1阻断+ tp化疗有效且耐受性良好,对IV期PSCC患者具有良好的生存结局。高预处理肿瘤内CD8+ t细胞浸润可能有助于识别潜在的应答者。
{"title":"First-Line PD-1 Blockade Combined With Chemotherapy for Stage IV Penile Squamous Cell Carcinoma: A Multicenter Retrospective Study.","authors":"Longbin Xiong, Xingli Shan, Huali Ma, Shengjie Guo, Jiyan Liu, Xianda Chen, Wenjun Meng, Bin Guo, Lijuan Jiang, Ru Yan, Xin An, Yanxia Shi, Yijun Zhang, Ting Xue, Lichao Wei, Daming Xu, Zhiling Zhang, Zike Qin, Kai Yao, Yajian Li, Philippe E Spiess, Linjun Hu, Nianzeng Xing, Hui Han","doi":"10.6004/jnccn.2024.7074","DOIUrl":"10.6004/jnccn.2024.7074","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to evaluate the efficacy and safety of PD-1 blockade combined with cisplatin and paclitaxel (TP)-based chemotherapy as first-line treatment for advanced penile squamous cell carcinoma (PSCC).</p><p><strong>Patients and methods: </strong>A retrospective review was performed of 32 eligible patients with high-risk stage IV (cN3M0-1) PSCC who received first-line PD-1 blockade combined with TP-based chemotherapy at 5 medical centers (2019-2023). Clinical responses were assessed using RECIST version 1.1. Treatment-related adverse events (TrAEs) and postsurgical complications were graded according to CTCAE version 5.0. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Multiplex immunofluorescence was used to explore potential biomarkers and to present the tumor microenvironment landscape before and after treatment.</p><p><strong>Results: </strong>After a median treatment duration of 4 cycles (range, 2-6), the overall objective response rate was 78.1% (25/32). Among 27 patients with locally advanced PSCC, 13 (48.1%) subsequently underwent consolidative surgery and 6 (22.2%) achieved a pathologic complete response (pCR). Additionally, 8 (25.0%) patients in the overall cohort underwent consolidated radiotherapy. Median follow-up was 21.1 months (95% CI, 14.1-42.7). Median PFS and OS were 15.0 months (95% CI, 11.4-not available [NA]) and 19.3 months (95% CI, 16.7-NA), respectively. All patients experienced TrAEs, with 50% (16/32) of them having grade ≥3 TrAEs. Higher intratumoral CD8+ T-cell infiltration was observed in pretreatment samples of responders compared with nonresponders (P=.03). CD4+ T-cells, natural killer cells, and macrophages, among others, exhibited significant changes after treatment (all P<.05), suggesting their potential involvement in the antitumor response to immunochemotherapy.</p><p><strong>Conclusions: </strong>PD-1 blockade plus TP-based chemotherapy was effective and well tolerated, with favorable survival outcomes for patients with stage IV PSCC. High pretreatment intratumoral CD8+ T-cell infiltration may help to identify potential responders.</p>","PeriodicalId":17483,"journal":{"name":"Journal of the National Comprehensive Cancer Network","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Symptom Burden and Survivorship Care for Patients With Prostate Cancer on Androgen Deprivation Therapy. 雄激素剥夺治疗前列腺癌患者的症状负担及生存护理。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-12-20 DOI: 10.6004/jnccn.2024.7047
Daniel Sentana-Lledo, Anurag Saraf, Alicia K Morgans

Prostate cancer survivors represent a growing population of patients with a diagnosis of prostate cancer, whether they were cured using local therapies or continue to receive systemic treatment of advanced disease. Many patients receive androgen deprivation therapy (ADT) during treatment, which is associated with many long-lasting physical and psychological effects. Identifying and addressing the needs of survivors is imperative for improving their health and well-being. This narrative review highlights the most common issues associated with ADT affecting survivorship in prostate cancer, including cardiovascular and metabolic effects, musculoskeletal health, sexual morbidity, and local therapy effects, as well as the mental and psychological toll. A special emphasis is placed on the existing literature examining specific interventions to alleviate these symptoms, along with describing existing gaps in knowledge, with the goal of promoting dedicated studies aimed at enhancing the survivorship experience of patients with prostate cancer.

前列腺癌幸存者代表了越来越多被诊断为前列腺癌的患者,无论他们是通过局部治疗治愈还是继续接受晚期疾病的全身治疗。许多患者在治疗期间接受雄激素剥夺治疗(ADT),这与许多长期的生理和心理影响有关。确定和解决幸存者的需求对于改善他们的健康和福祉至关重要。这篇叙述性综述强调了与ADT影响前列腺癌存活相关的最常见问题,包括心血管和代谢影响、肌肉骨骼健康、性发病率、局部治疗效果以及精神和心理损失。特别强调的是,现有的文献研究了缓解这些症状的具体干预措施,同时描述了现有的知识空白,目的是促进旨在提高前列腺癌患者生存经验的专门研究。
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引用次数: 0
Do Appendiceal Neuroendocrine Tumors Metastasize Post Appendectomy or Right Hemicolectomy? 阑尾神经内分泌肿瘤会在阑尾切除术或右半结肠切除术后转移吗?
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-12-20 DOI: 10.6004/jnccn.2024.7069
Taymeyah Al-Toubah, Mintallah Haider, Eleonora Pelle, Maria Grazia Maratta, Jonathan Strosberg

Background: Neuroendocrine tumors (NETs) of the appendix are typically detected incidentally during appendectomy. Recent studies reported no metachronous metastases among patients with primary tumors <2 cm, regardless of lymph node status or referral for completion hemicolectomy. However, questions persist regarding the possibility of metastases developing decades after surgical resection, particularly because appendiceal NETs are frequently diagnosed in young adults and children. Therefore, we sought to evaluate patients with metastatic appendiceal NETs to assess whether any had been diagnosed previously with an early-stage appendiceal NET.

Methods: We analyzed a large institutional neuroendocrine tumor database to identify appendiceal NETs of all stages and ascertain whether any patients with localized tumors developed metastases and whether any with metastatic disease had initially presented with an early-stage tumor.

Results: Of 3,795 patients with gastroenteropancreatic (GEP) NETs seen in an oncologic NET clinic between January 2008 and August 2023, 124 presented with appendiceal NETs. Of these, only 10 (<0.3% of the total GEP-NET population) had stage IV disease, 8 of whom were diagnosed synchronously at the time of initial diagnosis. Two patients with metastatic disease had reportedly undergone surgical resection for a primary appendiceal NET approximately 20 years before the diagnosis of metastatic disease, but medical records were not available to confirm an appendiceal primary.

Conclusions: Stage IV appendiceal NETs are exceptionally rare, and distant metastases are synchronous in nearly all cases. The risk of metastatic spread after resection of local appendiceal NETs is negligible. Patients with tumors <2 cm should not be managed with completion right hemicolectomy, and the role of this operation for larger tumors is questionable. Postoperative surveillance is unlikely to be of benefit.

背景:阑尾神经内分泌肿瘤通常是在阑尾切除术中偶然发现的。方法:我们分析了一个大型的机构神经内分泌肿瘤数据库,以确定所有阶段的阑尾NETs,并确定是否有局限性肿瘤发生转移,是否有转移性疾病最初表现为早期肿瘤。结果:在2008年1月至2023年8月期间,在肿瘤科NET诊所就诊的3795例胃肠胰(GEP) NET患者中,124例表现为阑尾NET。结论:IV期阑尾NETs非常罕见,几乎所有病例的远处转移都是同步的。局部阑尾NETs切除后转移扩散的风险可以忽略不计。肿瘤患者
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引用次数: 0
Definitive Radiotherapy for Oligometastatic and Oligoprogressive Thyroid Cancer: A Potential Strategy for Systemic Therapy Deferral. 少转移和少进展甲状腺癌的最终放疗:延迟全身治疗的潜在策略。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-12-11 DOI: 10.6004/jnccn.2024.7072
Stephanie O Dudzinski, Maria E Cabanillas, Sarah Hamidi, Vicente R Marczyk, Naifa L Busaidy, Ramona Dadu, James Welsh, Mimi I Hu, G Brandon Gunn, Chenyang Wang, Steven G Waguespack, Jack Phan, Thomas H Beckham, Joe Y Chang, Steven I Sherman, Jay P Reddy, Anita K Ying, Michael S O'Reilly, Aileen Chen, Anna Lee, Saumil J Gandhi, Zhongxing Liao, Ethan B Ludmir, Quynh-Nhu Nguyen, Steven H Lin, Mark E Zafereo, Matthew S Ning

Background: Definitive radiotherapy (dRT) has been shown to be an effective option for patients with oligometastatic and oligoprogressive cancers; however, this approach has not been well-studied in metastatic thyroid cancer.

Methods: This retrospective cohort included 119 patients with oligometastatic (34%) and oligoprogressive (66%) metastatic thyroid cancer treated from 2005 to 2024 with 207 dRT courses for 344 sites (50% thoracic, 37% bone, 7.5% brain, 4% abdominopelvic, and 1.5% neck/skull base). Histologies included 61% papillary, 15% poorly differentiated, 13% follicular, and 10% oncocytic, and 114 (96%) patients had radioiodine-refractory disease prior to dRT. Each course involved 1 to 5 sites, with prescriptions intended for definitive control (median BED10, 72 Gy), and palliative RT was excluded. Somatic mutation testing for oncologic drivers was performed in 103 (87%) patients.

Results: Each patient had an average of 3 sites (range, 1-23) treated over 2 courses (range, 1-9). Follow-up from first dRT was a median 2.5 years, with overall survival at 3 and 5 years of 81.5% and 70%, respectively. Actuarial local control per site was 91% at 3 years. Median progression-free survival (PFS) after first course was 17 months (95% CI, 10-24 months), with poorly differentiated histology associated with worse outcomes (hazard ratio [HR], 2.20; 95% CI, 1.24-3.90; P=.007), BRAF mutation with improved PFS (HR, 0.59; 95% CI, 0.37-0.95; P=.029), and no significant findings with respect to systemic therapy. At initial dRT, 92 (77%) patients were not on systemic therapy; and after first dRT, freedom from systemic therapy escalation was a median 4.1 years (95% CI, 1.7-6.5 years), with 2- and 5-year continued deferral rates of 73% and 46%, respectively. Grade 3 toxicities were noted for 1.5% of courses, with no grade 4-5 events observed.

Conclusions: This study underscores the potential of dRT as a feasible strategy for deferring systemic therapy escalation in patients with oligometastatic and oligoprogressive metastatic thyroid cancer, demonstrating that sequential dRT courses impart excellent local control and are safe to deliver repeatedly for multiple distant sites. Further studies are warranted to validate these findings and elucidate the full benefit of dRT as part of a multidisciplinary approach for metastatic thyroid cancer.

背景:明确放疗(dRT)已被证明是低转移性和低进展性癌症患者的有效选择;然而,这种方法尚未在转移性甲状腺癌中得到充分研究。方法:该回顾性队列包括119例2005年至2024年期间接受治疗的少转移性(34%)和少进展性(66%)转移性甲状腺癌患者,共207个疗程,344个部位(50%胸腔,37%骨,7.5%脑,4%腹盂,1.5%颈部/颅底)。组织学包括61%的乳头状、15%的低分化、13%的滤泡和10%的嗜瘤细胞,114例(96%)患者在dRT前患有放射性碘难治性疾病。每个疗程涉及1至5个部位,处方用于最终控制(中位BED10, 72 Gy),姑息性放疗被排除在外。103例(87%)患者进行了肿瘤驱动因素的体细胞突变检测。结果:每位患者平均有3个部位(范围,1-23)治疗2个疗程(范围,1-9)。第一次dRT的随访中位数为2.5年,3年和5年的总生存率分别为81.5%和70%。3年时,每个站点的精算局部控制率为91%。首疗程后的中位无进展生存期(PFS)为17个月(95% CI, 10-24个月),组织学分化差与预后较差相关(风险比[HR], 2.20;95% ci, 1.24-3.90;P=.007), BRAF突变伴PFS改善(HR, 0.59;95% ci, 0.37-0.95;P= 0.029),在全身治疗方面没有显著的发现。在初始dRT时,92例(77%)患者未接受全身治疗;第一次dRT后,免于全身治疗升级的中位时间为4.1年(95% CI, 1.7-6.5年),2年和5年的持续延迟率分别为73%和46%。1.5%的疗程出现3级毒性反应,未观察到4-5级毒性反应。结论:本研究强调了dRT作为延迟低转移性和低进展性转移性甲状腺癌患者全身治疗升级的可行策略的潜力,表明顺序的dRT疗程具有良好的局部控制效果,并且对于多个远处部位的重复治疗是安全的。需要进一步的研究来验证这些发现,并阐明dRT作为转移性甲状腺癌多学科治疗方法的一部分的全部益处。
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引用次数: 0
Frailty in Long-Term Prostate Cancer Survivors and Its Association With Quality of Life and Emotional Health. 长期前列腺癌幸存者的衰弱及其与生活质量和情绪健康的关系
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-12-11 DOI: 10.6004/jnccn.2024.7066
Valentin H Meissner, Kolja Imhof, Matthias Jahnen, Lukas Lunger, Andreas Dinkel, Stefan Schiele, Donna P Ankerst, Jürgen E Gschwend, Kathleen Herkommer

Background: Frailty is emerging as an important determinant for quality of life (QoL) and emotional health in older patients with cancer, and specifically in long-term prostate cancer survivors, but quantitative studies are lacking. The current study assesses the prevalence of frailty and its association with QoL and emotional health in long-term prostate cancer survivors after radical prostatectomy.

Patients and methods: A total of 2,979 prostate cancer survivors from the multicenter German Familial Prostate Cancer cohort completed questionnaires on frailty (Groningen Frailty Indicator [GFI]), QoL (EORTC QoL Questionnaire-Core 30), and emotional health (anxiety/depression symptoms via the Patient Health Questionnaire-4). Modified Poisson regression analysis was used to assess factors associated with frailty.

Results: Average patient age was 79.4 years [SD, 6.4 years] and average time since radical prostatectomy was 17.4 years [SD, 3.8 years]. Among the cohort, 33.1% (n=985) of patients were classified as frail (GFI ≥4). Frail patients reported worse emotional health than nonfrail patients (depression symptoms: 24.0% vs 4.0%; anxiety symptoms: 20.6% vs 2.0%; both P<.001) and lower QoL (mean [SD], 53.4 [19.2] vs 72.7 [16.0]); P<.001). Higher age (relative risk [RR], 1.02; 95% CI, 1.01-1.03) and worse depressive (RR, 1.18; 95% CI, 1.12-1.24) and anxiety symptoms (RR, 1.17; 95% CI, 1.11-1.23) were associated with frailty. Living in a partnership (RR, 0.76; 95% CI, 0.67-0.86) and a higher QoL (RR, 0.86 for a 10-point increase; 95% CI, 0.84-0.89) were associated with nonfrailty.

Conclusions: In a large German cohort, every third long-term prostate cancer survivor after radical prostatectomy was frail. The association of frailty with lower QoL and poorer mental health indicates the need for an integrated care approach including further geriatric assessment and possible interventions to improve health outcomes targeted to frail patients.

背景:衰弱正在成为老年癌症患者,特别是长期前列腺癌幸存者生活质量(QoL)和情绪健康的重要决定因素,但缺乏定量研究。本研究评估了根治性前列腺切除术后长期前列腺癌幸存者的虚弱患病率及其与生活质量和情绪健康的关系。患者和方法:来自多中心德国家族性前列腺癌队列的2979名前列腺癌幸存者完成了衰弱(格罗宁根衰弱指标[GFI])、生活质量(EORTC生活质量问卷- core 30)和情绪健康(患者健康问卷-4的焦虑/抑郁症状)的问卷调查。采用修正泊松回归分析评估与虚弱相关的因素。结果:患者平均年龄79.4岁[SD, 6.4岁],根治性前列腺切除术后平均时间17.4年[SD, 3.8年]。在队列中,33.1% (n=985)的患者被分类为虚弱(GFI≥4)。体弱多病患者报告的情绪健康状况比非体弱多病患者差(抑郁症状:24.0% vs 4.0%;焦虑症状:20.6% vs 2.0%;结论:在一项大型德国队列研究中,根治性前列腺切除术后三分之一的长期前列腺癌幸存者身体虚弱。虚弱与较低的生活质量和较差的精神健康之间的关联表明,需要采取综合护理方法,包括进一步的老年评估和可能的干预措施,以改善针对虚弱患者的健康结果。
{"title":"Frailty in Long-Term Prostate Cancer Survivors and Its Association With Quality of Life and Emotional Health.","authors":"Valentin H Meissner, Kolja Imhof, Matthias Jahnen, Lukas Lunger, Andreas Dinkel, Stefan Schiele, Donna P Ankerst, Jürgen E Gschwend, Kathleen Herkommer","doi":"10.6004/jnccn.2024.7066","DOIUrl":"10.6004/jnccn.2024.7066","url":null,"abstract":"<p><strong>Background: </strong>Frailty is emerging as an important determinant for quality of life (QoL) and emotional health in older patients with cancer, and specifically in long-term prostate cancer survivors, but quantitative studies are lacking. The current study assesses the prevalence of frailty and its association with QoL and emotional health in long-term prostate cancer survivors after radical prostatectomy.</p><p><strong>Patients and methods: </strong>A total of 2,979 prostate cancer survivors from the multicenter German Familial Prostate Cancer cohort completed questionnaires on frailty (Groningen Frailty Indicator [GFI]), QoL (EORTC QoL Questionnaire-Core 30), and emotional health (anxiety/depression symptoms via the Patient Health Questionnaire-4). Modified Poisson regression analysis was used to assess factors associated with frailty.</p><p><strong>Results: </strong>Average patient age was 79.4 years [SD, 6.4 years] and average time since radical prostatectomy was 17.4 years [SD, 3.8 years]. Among the cohort, 33.1% (n=985) of patients were classified as frail (GFI ≥4). Frail patients reported worse emotional health than nonfrail patients (depression symptoms: 24.0% vs 4.0%; anxiety symptoms: 20.6% vs 2.0%; both P<.001) and lower QoL (mean [SD], 53.4 [19.2] vs 72.7 [16.0]); P<.001). Higher age (relative risk [RR], 1.02; 95% CI, 1.01-1.03) and worse depressive (RR, 1.18; 95% CI, 1.12-1.24) and anxiety symptoms (RR, 1.17; 95% CI, 1.11-1.23) were associated with frailty. Living in a partnership (RR, 0.76; 95% CI, 0.67-0.86) and a higher QoL (RR, 0.86 for a 10-point increase; 95% CI, 0.84-0.89) were associated with nonfrailty.</p><p><strong>Conclusions: </strong>In a large German cohort, every third long-term prostate cancer survivor after radical prostatectomy was frail. The association of frailty with lower QoL and poorer mental health indicates the need for an integrated care approach including further geriatric assessment and possible interventions to improve health outcomes targeted to frail patients.</p>","PeriodicalId":17483,"journal":{"name":"Journal of the National Comprehensive Cancer Network","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Oncologist Outside the Exam Room. 检查室外的肿瘤学家。
IF 14.8 2区 医学 Q1 ONCOLOGY Pub Date : 2024-12-01 DOI: 10.6004/jnccn.2024.0063
Daniel M Geynisman
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引用次数: 0
期刊
Journal of the National Comprehensive Cancer Network
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