Oncology最新文献

Introduction: 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 and 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 guideline implementation, and continuous molecular monitoring.

Introduction: The aim of this study was to investigate the association of pre-treatment-modified Glasgow Prognostic Score (mGPS) with survival-related outcomes in patients with bladder cancer (BC) and prostate cancer (PC).

Methods: A systematic search was performed in PubMed, EMBASE, Web of Science, and Scopus databases for cohort studies in adult participants (≥18 years). The exposure was pre-treatment mGPS, and the outcomes of interest were overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). Eligible studies compared low mGPS (considered as a score of 0) with a score of ≥1. A random-effects model was used for the analysis. Pooled effect sizes were reported as hazard ratio (HR) with 95% confidence intervals (CIs). Subgroup analysis was performed based on the tumour stage (≤T2 and >T2), sample size (≥200 and <200), treatment (surgical and non-surgical), and the Newcastle-Ottawa Scale (NOS) score (≥8 and ≤7).

Results: Of 20 studies included in the analysis, 19 studies were retrospective cohort studies. Fourteen studies reported data of patients with BC, and the remaining 6 studies focused on PC patients. Compared to mGPS of 0, higher scores were associated with reduced OS (HR: 2.65; 95% CI: 1.99, 3.52), CSS (HR: 1.64; 95% CI: 1.19, 2.26), and RFS (HR: 1.77; 95% CI: 1.50, 2.08). There was no evidence of publication bias (Egger's p > 0.05). These associations remained valid in subgroup analysis.

Conclusion: Higher mGPS values were found to be associated with significantly reduced survival outcomes. These findings underscore the prognostic significance of mGPS, thereby highlighting its potential clinical utility in risk stratification and treatment decision-making.

Introduction: Febrile neutropenia (FN) is linked to significant morbidity and mortality in cancer patients. Therefore, our study aimed to determine the cut-off value of the MASCC score to predict mortality in hospitalized FN patients.

Methods: We included 354 hospitalized cancer patients, divided into two groups: the mortality group (n = 116) and the survival group (n = 238). We defined risk factors of all-cause mortality according to a Cox regression model. The optimal cut-off value for the MASCC score was found using Youden's index.

Results: The 30-day, 60-day, and 90-day mortality rates were 25.1% (n = 89), 30.2% (n = 107), and 32.7% (n = 116), respectively. Having a hematological malignancy, advanced age, comorbidities, higher levels of C-reactive protein, and procalcitonin on admission, profound neutropenia and a lower MASCC score were statistically different in the mortality group compared to the survival group. The only independent risk factor was the MASCC score to predict all-cause mortality according to the multivariate Cox regression models. A MASCC score below 17 showed a sensitivity of 83.6% and a specificity of 94.1% for predicting all-cause mortality in hospitalized FN patients.

Conclusions: In this cohort study, we showed 30, 60 and 90-day mortality rates of hospitalized patients and determined the risk factors. We supported that the MASCC score was an independent risk factor for predicting mortality in hospitalized FN patients. We contributed to the literature by establishing a threshold value for the MASCC score, below 17, showing notably high sensitivity and specificity for predicting all-cause mortality in FN patients.

Background: Esophageal squamous cell carcinoma (ESCC) is one of the most serious malignancies worldwide, seriously affecting the survival and living quality of patients. Abnormal expression of microRNAs plays a pivotal role in the development and progression of tumor, while exosomes are usually involved in some biological functions as tools for the delivery of intercellular substances, including miRNAs. The purpose of our study was to investigate the impact of exosome miR-148a-3p expression on ESCC.

Methods: qRT-PCR was used to examine the relative expression of miR-148a-3p in plasma exosomes and in vitro cells. Cell proliferation ability was tested by CCK-8; the migration and invasion function were tested using Transwell assay. The overall survival (OS) and cancer-specific survival rate of ESCC patients were calculated using the Kaplan-Meier method.

Results: The expression of exosomal miR-148a-3p in ESCC patients' plasma can clearly distinguish the survival rate, and the OS rate with high expression of exosomal miR-148a-3p is clearly higher than the patients with low expression. In cell function tests, the miR-148a-3p expression of ESCC cell lines was lower than in control group. After transfecting miR-148a-3p mimic, the proliferation, migration, and invasion ability of experimental group was reduced than the control group.

Conclusions: Above experimental results explained that miR-148a-3p showed significant tumor inhibition function both in serum exosomes of ESCC patients and in functional tests of cancer cell lines in vitro, suggesting that exosome miR-148a-3p can inhibit tumor progression and has the potential to be used as an indicator of clinical ESCC diagnosis and prognosis.

Introduction: In colorectal cancer (CRC), the prognostic significance of Adenomatous polyposis coli (APC) mutations remains controversial. We aimed to investigate the effect of APC mutations on the prognosis of patients with CRC and to elucidate the clinicopathological features associated with these mutations.

Methods: Formalin-fixed, paraffin-embedded CRC specimens were tested for APC mutations using targeted next-generation sequencing, mismatch repair (MMR) deficiency was evaluated using immunohistochemical staining. Clinicopathological features were obtained from medical records and through a review of hematoxylin and eosin slides.

Results: APC mutations and MMR deficiencies were detected in 72.8% and 8.9% of the patients with CRC, respectively. APC mutations were significantly correlated with male sex (p = 0.046) and left colon cancer (p < 0.001). They were inversely correlated with age (p = 0.020), serum 19-9 elevation (p = 0.047), distant metastasis (p = 0.005) and MMR deficiency (p < 0.001). In univariate analysis, APC mutations correlated with longer overall survival in patients with CRC.

Conclusions: APC mutations are associated with favorable prognostic factors and longer overall survival. Further investigation is needed to understand the mechanisms of association between APC mutations to favorable cancer prognosis and their correlation MMR protein expression.

Introduction: Rapid development of systemic treatments has resulted in improved prognosis for unresectable hepatocellular carcinoma (uHCC) patients. Since immune therapy shows a favorable therapeutic efficacy, use of tumor markers as biomarkers for monitoring treatment response is necessary. This study aimed to elucidate changes in positive rates of 3 available tumor markers in Japan, including alpha-fetoprotein (AFP), des-gamma-carboxy prothrombin (DCP), and lens culinaris agglutinin-reactive AFP (AFP-L3) in uHCC patients treated with systemic therapies over time.

Methods: From 2009 to 2023, 1,470 uHCC patients with data of tumor markers before starting treatment were enrolled. The positivity cutoff value for AFP was 20 ng/mL, for AFP-L3 was 10%, and for DCP was 40 mAU/mL. After dividing the 15 years examined into three periods of 5 years each (period I, II, and III), clinical features of the enrolled patients were evaluated, retrospectively.

Results: The percentage of Barcelona Clinic Liver Cancer stage B patients who received systemic therapy increased from period I to III (27.7%, 38.5%, 46.6%, respectively, p < 0.001), which was also seen for HCC patients with a nonviral etiology (alcohol and others) (29.9%, 39.7%, 49.6%, respectively p < 0.001). Positive rates for AFP (67.8%, 62.1%, 50.8%, respectively) and DCP (84.1%, 80.5%, 72.7%, respectively) were decreased (each p < 0.001), while the AFP-L3 rate did not show a significant change (54.4%, 57.7%, 51.9%, respectively, p = 0.390). Among the AFP-negative patients, the rate of positive for DCP or AFP-L3 was increased (24.4%, 28.1%, 35.4%, respectively, p = 0.002).

Conclusion: Based on introduction of systemic treatment in an early stage and increasing numbers of HCC cases with a nonviral etiology, the positive rate of AFP level has been declining. Thus, determination of DCP and AFP-L3 in addition to AFP as markers should be more actively utilized in clinical practice, as well as clinical trials for monitoring and evaluating treatment response in this era of combination immunotherapy as a powerful treatment.

Introduction: Changes in liver function in patients with unresectable hepatocellular carcinoma (u-HCC), following extended periods from the initiation of atezolizumab plus bevacizumab (Atez/Bev), have not been fully investigated.

Methods: Of 148 u-HCC patients treated with first-line Atez/Bev, the study enrolled 38 u-HCC patients treated with first-line Atez/Bev, whose treatment response was initially evaluated as non-progressive disease (non-PD) and later as PD on imaging, and who then received second-line systemic chemotherapy. We evaluated the relationship between the period from the initiation of first-line Atez/Bev to that of second-line systemic chemotherapy with liver function and prognosis.

Results: According to the periods from the initiation of Atez/Bev to that of the second-line therapy, patients were classified into a long continuation group (Group-L, n = 19), ≥11 months; or a short continuation group (Group-S, n = 19), <11 months. The albumin-bilirubin (ALBI) score at the initiation of the second-line therapy did not differ significantly between the groups (median: -2.38 vs. -2.02, p = 0.559), and the change in ALBI score also did not differ significantly between the groups (median: 0.42 vs. 0.51, p = 0.770). Group-L had significantly better overall survival (OS) than Group-S (not reached vs. 18 months, p = 0.008).

Conclusions: Liver function did not decrease even after long-term treatment with first-line Atez/Bev in patients who were able to progress to second-line therapy, indicating that long continuation of first-line Atez/Bev may be valuable for improving OS.

Introduction: We investigated the association between the pretreatment cachexia index (CXI) and survival outcomes in patients with unresectable hepatocellular carcinoma (u-HCC) receiving atezolizumab plus bevacizumab (Atez/Bev).

Methods: We conducted a retrospective analysis of 195 patients with u-HCC treated with Atez/Bev from September 2020 to December 2023. The skeletal muscle mass index (SMI) was calculated by normalizing the psoas muscle area by the square of the height (cm2/m2). The CXI was defined as the SMI × serum albumin level (g/dL)/neutrophil-to-lymphocyte ratio. Propensity score matching (PSM) was applied to minimize the effect of potential confounders. Associations between CXI, overall survival (OS), and progression-free survival (PFS) were assessed.

Results: From the initial cohort, CXI cutoffs of 7.23 for males and 4.99 for females were established. PSM matched 60 pairs of patients with low and high CXI, showing no significant differences in confounding factors between groups. Kaplan-Meier analysis indicated that the low CXI group had shorter median OS (12.5 vs. 26.1 months, p = 0.009) and PFS (6.1 vs. 11.1 months, p = 0.045) compared with the high CXI group. No significant differences existed between groups in overall response rate (p = 0.994) and disease control rate (p = 0.090). Multivariate Cox proportional hazards analysis identified low CXI as an independent prognostic factor for OS (HR: 1.89, 95% CI: 1.11-3.22, p = 0.019) and PFS (HR: 1.53, 95% CI: 1.01-2.34, p = 0.047).

Conclusions: The CXI may be a valuable prognostic tool for predicting survival outcomes in patients with u-HCC receiving Atez/Bev.

Introduction: Although several prognostic risk factors have been identified for non-small cell lung cancer (NSCLC) patients who undergo pulmonary resection, the significance of several factors remains unclear, including the number and location of recurrent foci. Here, we investigated associations between clinicopathological characteristics and the risk of recurrence patterns.

Methods: We retrospectively evaluated the prognostic impact of the recurrence pattern and individual recurrence sites for 1,000 NSCLC patients who underwent pulmonary resection between 2002 and 2021. The recurrence was defined by imaging tools, and the data were analyzed using logistic regression and Cox proportional hazards regression models.

Results: Simultaneous intrathoracic and extra-thoracic recurrence was associated with significantly shorter overall survival compared with either recurrence pattern alone. Multivariate analyses identified significant risk factors for sites of recurrence as follows: age (p = 0.03), prognostic nutrition index (p = 0.03), lymphatic invasion (p = 0.03), pathological lymph node metastasis (pN)1 (p = 0.02), and pN2 (p < 0.01) for bone metastasis; cancer-inflammation prognostic index (CIPI) (p = 0.04), maximum standardized uptake value (SUV_max) (p < 0.01), and pN2 (p < 0.01) for brain metastasis; histological type without adenocarcinoma and squamous cell carcinoma (p < 0.01) for liver metastasis; age (p < 0.01), SUV_max (p < 0.01), lower lobe (p < 0.01), and pN2 (p < 0.01) for lung metastasis; CIPI (p < 0.01), SUV_max (p < 0.01), Ly (p = 0.01), pN1 (p < 0.01), and pN2 (p = 0.01) for lymph node metastasis; and CIPI (p < 0.01) for pleural dissemination.

Conclusion: Simultaneous intrathoracic and extra-thoracic recurrence was a significant prognostic indicator of poor overall survival. Identification of the risk factors for each recurrence site may assist in planning optimal routine postoperative surveillance strategies.

Introduction: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide. While curative resection offers the best chance for long-term survival, the high postoperative recurrence rate suggests a persistent need for effective perioperative therapies. We investigated a multimodal approach, combining sequential lenvatinib with transarterial chemoembolization (TACE), as a presurgical treatment (PST) for resectable HCC.

Methods: This retrospective study included 19 patients with technically resectable HCC who underwent the PST protocol followed by surgery between March 2022 and September 2024. The protocol involved four phases: Pre-TACE lenvatinib administration (Pre-LEN), TACE, Post-TACE lenvatinib administration, and surgery. We assessed the feasibility, safety, and pathological response of the protocol. Liver function was evaluated using the albumin-bilirubin (ALBI) score, modified ALBI (mALBI) grade, and tumor response was assessed using the Response Evaluation Criteria in Cancer of the Liver (RECICL).

Results: The PST protocol demonstrated high efficacy and safety. The median tumor reduction rate was 22.9%, and the median pathological tumor necrosis rate was 95%. The preoperative overall RECICL response was a complete response in 84.2% of patients. With a median follow-up of 22 months, the 2-year recurrence-free survival rate was 84.6%, and the overall survival rate was 100%. A significant association was found between mALBI grade and the decision to proceed with surgery at two time points: Pre-LEN (p = 0.023) and before surgery (p = 0.006).

Conclusion: Presurgical sequential lenvatinib-TACE therapy is a feasible and safe strategy for resectable HCC. This protocol achieved a high pathological response and favorable survival outcomes, suggesting that it may mitigate the risk of early recurrence. Our findings highlight the importance of mALBI grade monitoring for patient selection and provide a rationale for larger, prospective studies.