Oncology最新文献

Introduction: The aim was to evaluate the prognostic values of pretreatment 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) parameters for predicting local failure in nasopharyngeal carcinoma (NPC) patients in the intensity-modulated radiotherapy (IMRT) era.

Methods: Retrospective analysis was performed on 759 patients with NPC who underwent pretreatment 18F-FDG PET. The optimal cutoff values for maximum standardized uptake value (SUVmax) and metabolic tumor volume (MTV) were determined by receiver operating characteristic curve analysis. Univariate and multivariate analysis was performed to identify the prognostic factors influencing local failure-free survival (LFFS). Survival curves for the different risk groups were plotted using the Kaplan-Meier survival analysis method and compared using the log-rank test.

Results: The median follow-up period was 49.0 months (range: 3.0-118.0 months). The optimal cutoff of SUVmax and MTV were 7.44 and 22.21 mL, respectively. Patients with higher SUVmax and MTV were associated with worse LFFS. The survival curves of different groups were significantly separated. The univariate analysis showed the statistical significance of SUVmax, MTV, and their composite in LFFS (p = 0.002 for SUVmax; p = 0.001 for MTV; p < 0.002 for their composite). The multivariate analysis showed that higher SUVmax and MTV was an independent negative prognostic factor for LFFS (HR = 1.805, 95% CI: 1.004-3.245, p = 0.049). The subgroups of stages III-IV further confirmed the impact of SUVmax and MTV on LFFS (HR = 1.884, CI: 1.087-3.708, p = 0.026).

Conclusion: Patients with higher SUVmax and MTV were associated with local failure as well as in the III-IV advanced stage.

Introduction: Research on esophageal squamous cell carcinoma (ESCC) in Asian American (AsA) populations frequently aggregates data, thereby overlooking the considerable diversity inherent within this demographic. The aim of this study was to investigate the variations in ESCC characteristics and clinical outcomes among AsA.

Methods: Patients diagnosed with ESCC were identified through the Surveillance, Epidemiology, and End Results (SEER) 17 database. The AsA cohort was categorized into specific subgroups: Chinese, Japanese, Filipino, Korean, Vietnamese, South Asian (Asian Indian or Pakistani), and other Asian. The Kaplan-Meier method was employed to estimate unadjusted overall survival (OS), while Cox proportional hazards models were utilized to assess adjusted OS.

Results: A total of 9,252 patients were included, with the cohort comprising 1,100 Asian, 2,135 Black, 951 Hispanic, and 5,066 White individuals. AsA patients demonstrated the highest unadjusted OS (P < .001). The Vietnamese subgroup exhibited the highest proportion of male patients at 92.1%. South Asian patients showed the highest unadjusted OS among the distinct Asian subgroups, with survival rates of 56% at one year (95% CI 49-64), 31% at three years (95% CI 25-40), and 23% at five years (95% CI 17-32). After adjusting, only Chinese and South Asian patients displayed significantly improved OS compared to the White reference group (P < .05).

Conclusion: Considerable disparities in ESCC characteristics and outcomes exist among AsA populations. Socioeconomic, genetic, and epigenetic factors may influence these differences. Further research is essential to clarify the mechanisms of this discrepancy. .

Introduction: Chimeric antigen receptor (CAR) T-cell therapy has emerged as a promising treatment for hematologic malignancies, offering significant therapeutic benefits. However, this therapy is also associated with adverse effects such as cytokine release syndrome and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS), which can lead to severe neurological symptoms. The pathophysiology of ICANS remains unclear but is believed to involve immune-mediated inflammation in the brain. This study investigates the potential of S100, a protein marker associated with blood-brain barrier integrity, as an early indicator of ICANS.

Methods: We retrospectively analyzed daily blood samples for S100 levels in patients undergoing CAR T-cell therapy, correlating these levels with the onset and severity of ICANS.

Results: The results show that S100 levels significantly increased in patients who developed ICANS, with a positive correlation between the duration of elevation and the severity of the neurological symptoms.

Conclusion: These findings suggest that S100 may serve as a useful biomarker for early detection of ICANS and could potentially guide therapeutic interventions. However, further studies are needed to fully understand its prognostic value in this context.

Introduction: Central nervous system solitary fibrous tumors (cSFTs) are rare, accounting for less than 1% of CNS tumors. Treatment guidelines are limited, especially for frail or elderly patients. Gross total resection followed by radiotherapy is recommended for higher-grade cases, but the role of hypofractionated radiotherapy (HF) versus standard fractionation (SF) in this population remains unclear. This study evaluates outcomes of HF compared to SF in frail patients with cSFT.

Methods: A retrospective analysis of 51 frail patients (age >65, KPS <80) with cSFT treated from 2005-2023 was performed. Patients received either HF (21 patients) or SF (30 patients). Data extracted included demographics, tumor characteristics, surgical outcomes, radiation regimens, and oncologic outcomes. Descriptive and survival analyses were conducted using Kaplan-Meier methods, with multivariable analysis via Cox regression models to assess factors influencing local control and overall survival.

Results: The median follow-up was 19 months (11-55 months). HF regimens varied from 35-48 Gy in 10-15 fractions, while SF was predominantly 54-60 Gy in 28-30 fractions. Local control was achieved in 76.2% of HF and 80% of SF patients (p=0.154). No statistical difference in overall survival was observed between HF (18 months) and SF (18 months, p=0.54). Higher tumor grade (HR=3.5, p=0.021) and incomplete resection (HR=0.72, p=0.035) negatively impacted local control. KPS ≤50 was associated with reduced survival (HR=2.3, p=0.035).

Conclusions: Hypofractionated radiotherapy appears feasible and safe for frail patients with cSFT, providing comparable outcomes to standard fractionation. The reduced treatment burden of HF may benefit patients with limited performance status. Further research is needed to guide optimal treatment approaches for this unique population.

Background: Core-binding factor acute myeloid leukemia (CBF-AML) is characterized by t(8;21) or inv(16)/t(16;16) chromosomal rearrangements.

Methods: In this retrospective study of 71 CBF-AML cases from Qatar's National Center for Cancer Care & Research (2013-2022), we analyzed clinicopathological characteristics and survival outcomes.

Results: The cohort was predominantly male (76%) with a median age of 40 years, and 96% were de novo AML. The t(8;21) translocation was more frequent (69%) than inv(16)/t(16;16). Patients under 40 years showed higher white blood cell counts and blast percentages. Standard "3+7" induction chemotherapy (used in 69% of cases) achieved remission in 67% of patients. Median overall survival was 81% at 37 months, with median progression-free survival of 34 months. No significant survival differences were observed based on FLT3-ITD status, translocation type, complex karyotype, KIT mutation status, or allogeneic stem cell transplantation (performed in 19% of patients), though patients under 60 years demonstrated better survival outcomes.

Conclusions: This study highlights CBF-AML heterogeneity and challenges established prognostic markers, suggesting a need for risk stratification reassessment, treatment strategy optimization, ELN guidelines implementation, and continuous molecular monitoring.

Introduction: Adjuvant treatment for patients with stage I non-seminomatous germ cell tumors (NSGCT) could be active surveillance (AS), chemotherapy, or retro-peritoneal lymph node dissection (RLND). AS is the preferred option in most cas-es. The aim of this study was to evaluate long-term survival and prognostic factors in our population with AS approach.

Methods: We collected information from patients with stage I NSGCT of the testis in medical records from 1995 to 2016. Patients had negative serum tumor mark-ers and imaging of chest, abdomen, and pelvis with no evidence of metastasis. At relapse, if occurs, patients were treated with chemotherapy, surgery, or both. Kaplan-Meier method was used to estimate survival. Relationships with outcomes were analyzed using multivariable Cox regression and log-rank analysis.

Results: 457 patients were included. The median age at diagnosis was 25 years. The median follow-up was 65.3 meses (range 12 to 270 months). Relapses were detected in 92 (20%) patients with a median time to recurrence of 7.1 months (range 1.1 to 123 months). Retroperitoneal lymph nodes were the most common site of relapsed (41.3%), and most patients presented biochemical and imaging recurrence (67.4%). Vascular invasion (VI) was significantly associated with re-currence [HR 2.38 (CI 95%, 1.24-4.56), p=0.008] in the multivariate analysis, and rete testis invasion in the univariate analysis (p=0.027). After salvage treatment, 83 patients (91.1%) were disease-free. The overall survival was 98.25% at 20 years.

Conclusions: AS is an effective non-adapted risk-based approach in patients with stage I NSGCT. Almost 100% are alive at 20 years. Nearly all relapses were cured with salvage therapy. Toxicity related to adjuvant treatments, as well as overtreatment, could be avoided.

Objective: The objective of this study is to develop an automated method for segmenting spleen computed tomography (CT) images using a deep learning model. This approach is intended to address the limitations of manual segmentation, which is known to be susceptible to inter-observer variability. Subsequently, a prediction model of gastric cancer (GC) lymph node metastasis was constructed in conjunction with radiomics and deep learning features, and a nomogram was generated to explore the clinical guiding significance.

Methods: This study enrolled 284 patients with pathologically confirmed GC from two centers. we employed a deep learning model, U-Mamba, to obtain fully automatic segmentation of the spleen CT images. Subsequently, radiomics features and deep learning features were extracted from the entire spleen CT images, and significant features were identified through dimensionality reduction. The clinical features, radiomic features, and deep learning features were organized and integrated, and five machine learning methods were employed to develop 15 predictive models. Ultimately, the model exhibiting superior performance was presented in the form of a nomogram.

Results: A total of 12 radiomics features, 17 deep learning features, and 2 clinical features were deemed valuable. The DRC model demonstrated superior discriminative capacity relative to other models. A nomogram was constructed based on the logistic clinical model to facilitate the usage and verification of the clinical model.

Conclusion: Radiomics and deep learning features derived from automated spleen segmentation to construct a nomogram demonstrate efficacy in predicting LNM in GC. Concurrently, fully automated segmentation provides a novel and reproducible approach for radiomics research.

Introduction: Immune checkpoint inhibitor-related pneumonitis (ICI-P) is a life-threatening complication, limiting immune checkpoint inhibitors (ICIs) clinical application in non-small cell lung cancer (NSCLC). But risk factors for developing ICI-P have not been well defined.

Methods: This study employed a retrospective analysis method. Following approval from the Ethics Committee of Chinese PLA General Hospital, we retrieved patient information on NSCLC registered in the hospital's PRIDE workstation, selecting patients who received treatment with ICIs from January 1, 2018 to September 30, 2023. Complete medical records of patients were collected and verified. Logistic regression analysis was used to identify independent high-risk factors for the occurrence of ICI-P.

Results: A total of 753 patients with NSCLC who received treatment with ICIs were included, with mean age of (63±9.5) years. 102 patients diagnosed with ICI-P were identified, resulting in an incidence rate of 13.5%. Development of ICI-P was independently associated with history of interstitial lung disease (ILD) (OR, 3.85; CI, 1.99-7.46; P<0.001), prior thoracic radiotherapy (OR, 2.65; CI, 1.56-4.48; P<0.001), concurrent thoracic radiotherapy (OR, 3.56; CI, 1.69-7.47; P<0.001) and treatment with programmed cell death 1 (PD-1) inhibitors compared with programmed death-ligand 1 (PD-L1) inhibitors (OR, 3.54; CI, 1.05-11.98; P=0.04).

Conclusion: Independent risk factors for ICI-P occurrence included the history of ILD, previous chest radiotherapy, concurrent chest radiotherapy, and the use of PD-1 inhibitors (compared to non-PD-1 inhibitors). Specialty assessment of ILD before treatment and cautious use of ICIs in radiotherapy patients, represent feasible strategies to prevent the occurrence of ICI-P.

Introduction: Next-generation sequencing (NGS) is commonly used in clinical practice to decide treatment based on genomic information. This study was performed to optimize the proportion of actionable gene profiling and treatment based on genetic alterations in breast cancer at one of cancer centers in Japan.

Methods: Patients with breast cancer who reported NGS results at one of cancer centers in Japan from August 2019 to December 2023 were retrospectively investigated by reviewing their electronic medical records. Patients were examined using the OncoGuideTM NCC Oncopanel System, FoundationOne® CDx, or FoundationOne® Liquid CDx. The evidence levels for drug recommendation were added for each gene alteration according to the guidelines from three Japanese oncology-related societies. ''Actionable alterations'' were those at evidence levels A-D, including high microsatellite instability and high tumor mutation burden status. "Patients with recommended drug" (approved, investigational, and off-label drugs) were defined as those who were selected by the Molecular Tumor Board.

Results: Of the 106 patients, 54 were tested using the NCC Oncopanel System and 50 using FoundationOne CDx. The most frequent alterations were TP53 mutations (52.8%) and PIK3CA mutations (31.1%). Of the 56 patients (52.8%) with recommended drugs, 11 (10.4%) received genome-matched therapy and only three (2.8%) participated in clinical trials. The most common reason for not receiving genome-matched therapy was patient refusal for personal reasons, although clinical trials were available (18 patients).

Conclusion: The top reasons for patients not receiving the recommended genome-matched therapy were factors related to the patient, including a number of prior treatments higher than what was allowed by the eligibility criteria of the clinical trials, and poor physical condition. Most patients received four or more regimens of cytotoxic chemotherapy before NGS. NGS is only available at the late phase of treatment in Japan, which would constitute a problem for the treatment of breast cancer.

Introduction: Sarcomas are rare mesenchymal malignancies (<1% of all cancer types), with 5-15% occurring in the head and neck. Common types include osteosarcoma, chondrosarcoma, and rhabdomyosarcoma. They often recur and have poor survival rates. Treatment involves surgery, radiation, and/or chemotherapy, utilizing a multidisciplinary approach. This study aims to overview sarcomas at our hospital and illustrate the interdisciplinary management of pharyngeal and laryngeal cases.

Methods: This single-center study provides a comprehensive analysis of head and neck sarcomas (HNS) and examines interdisciplinary treatment approaches for pharyngeal and laryngeal sarcomas in patients treated at the Department of Head and Neck Surgery, Technical University of Munich, from 2007 to 2022. The study encompasses data on age, gender, histopathological diagnoses, treatment modalities, follow-up, and outcomes, with an emphasis on histopathological findings and collaborative therapeutic strategies.

Results: 27 cases of HNS were identified (2007-2022). Among these, 11 were pharyngeal or laryngeal sarcomas. All pharyngeal sarcomas underwent primary resection with reconstruction based on tumor location and extent. In laryngeal sarcomas, three required laryngectomy, one had a hemilaryngectomy, and one patient opted for primary radiochemotherapy over laryngopharyngectomy. Adjuvant radiotherapy was given in 5 cases, and radiochemotherapy in 3. Diagnoses included a range of soft tissue and bone sarcomas, such as liposarcoma, synovial sarcoma, and osteosarcoma. During the study period, 4 patients survived, 5 patients were noted as deceased, and survival data for 2 patients remain unavailable. Patients exhibited an average survival of 7,6 (± 10,4) years. The survival times within this limited patient population exhibit significant variation. Histologically, a wide spectrum of low and high-grade soft tissue and bone sarcomas were diagnosed including liposarcoma, synovial sarcoma, Ewing, osteo- or chondrosarcoma.

Conclusion: HNS are rare and challenging to treat. Surgery is the primary treatment, with postoperative radiotherapy recommended for incomplete resections or high-risk subtypes. Advanced surgical techniques and reconstruction allow for radical resections while preserving function. Incorporating genetic insights and better sarcoma classification can further optimize treatments.