Oncology最新文献

Introduction: Patients with active cancer have a 4- to 7-fold increased risk of venous thromboembolism (VTE) compared with the general population and are known to have higher mortality rates. Pulmonary embolism (PE), as a common manifestation of VTE, represents a significant contributor to early mortality in this population. This study aimed to evaluate clinical and biochemical factors associated with short-term mortality in hospitalized patients with cancer diagnosed with acute PE.

Methods: This retrospective study included 84 patients with active malignancy and radiologically confirmed acute PE hospitalized at a tertiary care center. Demographic, clinical, and laboratory parameters were collected. The primary outcome was all-cause 1-month mortality. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. Receiver operating characteristic curve analysis was used to assess the prognostic performance of D-dimer.

Results: Among hospitalized patients with cancer with acute PE, the 30-day mortality rate was 26.2%. Non-survivors had higher D-dimer levels and lower serum albumin levels. D-dimer levels did not differ between patients with and without metastasis (p = 0.223). In the multivariate model adjusted for metastatic status, log-transformed D-dimer remained an independent predictor of 30-day mortality (OR: 37.19; p = 0.014), whereas albumin showed a borderline association (OR: 0.30; p = 0.052). A D-dimer cutoff of 4.186 ng/mL predicted mortality with 75% sensitivity and 70% specificity (AUC: 0.76). Combining D-dimer and albumin further increased predictive accuracy (AUC: 0.83).

Conclusion: D-dimer independently predicted short-term mortality in hospitalized patients with cancer with acute PE even after adjustment for metastatic status; albumin demonstrated only a borderline association. These routinely available biomarkers may support early risk assessment but should be interpreted cautiously in the context of other clinical factors. Prospective studies are needed to validate these findings.

Introduction: Hepatocellular carcinoma (HCC) is a growing burden, particularly in rural, regional, and remote areas, but samples from these communities are underrepresented in public cancer data repositories. It remains unclear whether the findings of large, commonly studied cohorts such as The Cancer Genome Atlas (TCGA) are applicable to these remote communities.

Methods: We profiled paired tumour and adjacent non-tumour liver biopsies from 19 patients admitted to the Townsville University Hospital in rural Australia. We used RNA-seq to characterize transcriptomic and mutational features and compared these with the TCGA Liver Hepatocellular Carcinoma (LIHC) cohort. Furthermore, we used these data to test a transcriptome-only adaptation of our TARGET-SL pipeline for low-cost drug target prediction.

Results: Differential expression analysis identified 923 genes altered in our cohort, of which 64% overlapped with TCGA-LIHC, and the cohort-mean gene expression correlated strongly (Spearman rho = 0.96). Somatic variant calling from RNA highlighted mutational heterogeneity, with CTNNB1 (47%) and TP53 (21%) the most frequently mutated genes, consistent with TCGA findings. Copy number inference detected recurrent deletions on 8p, 6q, and 17p, congruous with known HCC patterns. We ran TARGET-SL solely on RNA-seq to identify personalized driver genes in these patients and were able to identify a drug candidate in 63% of patients.

Conclusion: Our results demonstrate that NQ HCC shares core molecular features with larger TCGA cohorts and that a transcriptome-based approach can feasibly support precision oncology in resource-limited regional settings.

Introduction: Traditional text-based standard operating procedures (SOPs) have limitations in today's data-rich environment, as they provide limited support for automated reasoning, contextual guidance, and real-time clinical decision-making. We developed a rule-based knowledge base to overcome these challenges through digitalization of SOPs on breast cancer radiotherapy.

Methods: We designed and developed a web application with a relational database structured around common data elements, a rule-based inference engine, and a responsive user interface (UI). The system's information retrieval success was evaluated in a single-center study over 14 months, where nine radiation oncologists submitted clinical queries and provided feedback on the relevance of the results.

Results: The knowledge base incorporated 103 specific information entries covering 8 main topics, structured around critical clinicopathological features such as tumor stage, receptor status, grading, and lymphovascular invasion. During a 14-month testing period, nine radiation oncologists submitted 62 distinct clinical queries (e.g., determining boost indication for a patient of certain age and tumor situation). Of these queries, 56.5% were successfully answered as indicated by the user. Analysis of unsuccessful queries revealed that the information was mostly present but inaccessible due to user experience issues.

Conclusion: Our rule-based knowledge base demonstrates the feasibility of transforming static SOPs into interactive, evidence-linked resources. While promising, substantial user experience barriers remain. Future enhancements will prioritize UI improvements, sustainable knowledge-updating mechanisms, and AI integration to strengthen the system for practical use.

Introduction: Recently, EUS-guided biliary drainage (EUS-BD) has been widely used as the second biliary drainage method when endoscopic transpapillary drainage fails. A longer time to recurrent biliary obstruction (TRBO) is important for biliary stenting to avoid interfering with cancer treatment. However, the factors that influence the TRBO in EUS-BD are unknown. The aim of this study was to clarify the factors associated with the TRBO in EUS-BD.

Methods: All patients who underwent successful EUS-BD at Fukushima Medical University and Soma General Hospital were enrolled in this study. The factors associated with the TRBO were retrospectively analyzed (follow-up period: mean 215 ± standard deviation 214 days).

Results: RBO was observed in 21/47 (44.7%) patients. According to the multivariate analyses, a duodenal stent before RBO was significantly associated with a longer TRBO (hazard ratio 0.34, 95% confidence interval 0.12-0.98; p = 0.045). The TRBO was also longer in patients with duodenal stents before RBO (p = 0.026) and in patients with braided biliary stents (p = 0.024). The TRBO became significantly longer according to the number of factors (p = 0.02).

Conclusion: Duodenal stents before RBO and braided biliary stents might be factors associated with a longer TRBO. Early duodenal stent insertion and braided biliary stent use might prevent food backflow, strongly dilate the biliary stricture, and lead to a longer TRBO.

Background: Business intelligence (BI) solutions are nowadays offered as part of radiation oncology information systems. They support state-of-the-art extraction of structured data for business and research use cases. The variety of use cases often comes with specific customizations for which IT experts are required.

Summary: We report about our experience in implementing a BI module in a radiation oncology department, discuss key challenges, and give some recommendations for addressing them.

Key messages: The effectivity of a BI solution strongly interacts with the diverse IT ecosystem of the hospital. It is worth starting with concrete business requirements and involve IT experts from the hospital data warehouse (DWH) or architecture teams. Integration into the enterprise DWH will add value to secondary use of data in the line of good clinical practices.

Introduction: Cervical cancer patients frequently experience impaired quality of life (QoL) and treatment-related toxicities following chemoradiotherapy. This study assessed whether a dynamic integrated Chinese and Western medicine (CWM) intervention, guided by traditional Chinese medicine (TCM) syndrome differentiation, improves QoL and outcomes in these patients.

Methods: A total of 176 post-chemoradiotherapy cervical cancer patients were randomized to a control group (conventional Western care) or an intervention group (conventional care + dynamic TCM intervention). QoL (EORTC QLQ-C30), psychological resilience (CD-RISC), immune function (CD4+, CD8+, CD4+/CD8+ ratio), cancer-related fatigue, myelosuppression, gastrointestinal symptoms, and radiation enteritis incidence were evaluated pre-and post-intervention. Multivariable Cox proportional hazards regression analysis was used to analyze the independent impact of the integrated Chinese-Western medicine dynamic intervention on the overall survival (OS) of cervical cancer patients after chemoradiotherapy. The 5-year OS rate was analyzed using Kaplan-Meier.

Results: Post-intervention, the intervention group showed significantly better QLQ-C30 and CD-RISC scores than controls (p < 0.05). Survival analysis revealed a higher 5-year OS rate in the intervention group (73.10% vs. 52.74%; p = 0.0179). Multivariable Cox proportional hazards regression analysis showed that after adjusting for confounding factors such as age, clinical stage, pathological type, treatment type, and TCM syndrome type, the intervention group significantly reduced the risk of death in cervical cancer patients after chemoradiotherapy compared to the control group (HR = 0.523, 95% CI: 0.291-0.942, p = 0.028). Immune function improved significantly in the intervention group (higher CD4+, CD4+/CD8+ ratio; lower CD8+; p < 0.05). While acute gastrointestinal symptom relief and acute radiation enteritis incidence showed no significant difference, the intervention group demonstrated significantly lower fatigue, reduced myelosuppression severity, fewer delayed gastrointestinal symptoms, and lower chronic radiation enteritis incidence (p < 0.05).

Conclusion: The dynamic integrated CWM approach, through stage-specific precise intervention based on syndrome differentiation, synergistically improves QoL and survival while reducing specific toxicities in cervical cancer patients post-chemoradiotherapy.

Introduction: HER2 is expressed in a minority of patients with metastatic colorectal cancer (mCRC), yet it has proven to be a valuable therapeutic target for novel agents such as trastuzumab deruxtecan and tucatinib. Currently, testing is not mandatory in mCRC at baseline and a simple clinical tool to identify patients with a higher likelihood of being HER2 positive would be extremely helpful in guiding test requests and personalized medicine.

Methods: Two machine learning (ML) algorithms were applied to analyze 30 variables available in routine clinical practice (clinicomics) for the prediction of both overall HER2 expression (immunohistochemistry [IHC] score 1-3) and HER2 positivity (IHC score 3 or score 2 with ERBB2 gene amplification). Variables identified as relevant in a training cohort were selected to build an easy-to-use predictive model, whose utility was validated in a separate validation cohort.

Results: ML algorithms consistently showed that hemoglobin (Hb) <12 g/dL, carcinoembryonic antigen (CEA) >100 ng/mL, height >160 cm, and the presence of lymph node metastases were significantly associated with HER2 expression in the training cohort (n = 293). A model using these four variables had an area under the curve (AUC) of 67% (p = 0.0002). Patients with the presence of all predictive factors had a HER2 expression prevalence of 55%, compared to 15% in patients with none of the predictive factors (p < 0.0001), while HER2 positivity prevalence was 36% vs. 0%, respectively (p < 0.0001). The results were confirmed in the validation cohort (n = 96): AUC 68% (p = 0.004); difference in HER2 expression and positivity 58% vs. 12% (p = 0.005) and 47% vs. 0% (p = 0.0002), respectively.

Conclusion: Hb <12 g/dL, CEA >100 ng/mL, height >160 cm, and the presence of lymph node metastases were associated with HER2 expression and positivity. HER2 testing should be considered mandatory when all these factors are present. The mechanisms linking these four factors to HER2 expression require further investigation.

Introduction: Nivolumab has become an essential therapeutic agent for patients with advanced or recurrent gastric cancer. However, the impact of metastatic patterns on its clinical efficacy has not been fully elucidated. This study aimed to clarify the association between distinct metastatic patterns and outcomes of nivolumab monotherapy.

Methods: Ninety-two patients with advanced or recurrent gastric cancer who received nivolumab were retrospectively analyzed. Clinicopathological variables, including performance status, HER2 expression, and predominant metastatic pattern, were correlated with survival outcomes and response rates.

Results: The median observation period was 48.3 months. The median overall (OS) and progression-free (PFS) survival for the entire cohort were 5.80 and 2.43 months, respectively. Patients with ECOG performance status 2-3 had significantly shorter survival than those with PS 0-1. HER2-positive status was associated with longer PFS. When stratified by metastatic pattern, the lymph node metastasis group showed markedly longer survival (median OS 35.1 months, PFS 11.9 months) than the peritoneal (OS 4.66, PFS 2.36 months) and hematogenous/other groups (OS 5.80, PFS 2.10 months). The objective response and disease control rates were also significantly higher in the lymph node group.

Conclusion: The pattern of metastatic spread, particularly lymphatic involvement, appears to influence the efficacy of nivolumab in advanced or recurrent gastric cancer. Recognizing metastatic patterns may assist in optimizing patient selection and therapeutic strategies for immune checkpoint blockade.

Introduction: The regimen of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) remains the standard first-line treatment for diffuse large B-cell lymphoma (DLBCL), yet many patients relapse. Polatuzumab vedotin combined with rituximab, cyclophosphamide, doxorubicin, and prednisone (Pola-R-CHP) has shown promise in trials. This study investigates the real-world efficacy and safety of Pola-R-CHP versus R-CHOP.

Methods: We retrospectively analyzed 505 DLBCL patients treated at Peking Union Medical College Hospital between January 2011 and March 2025. Thirty-six patients received Pola-R-CHP; 36 matched R-CHOP patients were selected using 1:1 propensity score matching based on age, sex, subtype, stage, and IPI. Outcomes included interim and end-of-treatment response, overall survival (OS), progression-free survival (PFS), and adverse events (AEs).

Results: Post-matching, 72 patients were included. Pola-R-CHP achieved higher interim complete response (CR) (72.2% vs. 63.9%, p = 0.035) and objective response rate (ORR) (100.0% vs. 83.3%, p = 0.011). At the end of treatment, CR was further improved (88.9% vs. 63.9%, p = 0.007), and ORR remained superior (100.0% vs. 86.1%, p = 0.020). At a median follow-up of 13.3 months (range, 1.1-141.9 months), 1 death and 2 progressions occurred in the Pola-R-CHP group compared with 9 deaths and 9 progressions in the R-CHOP group. Median OS and PFS were not reached in either cohort. At 12 months, the estimated OS was 97% for Pola-R-CHP and 94% for R-CHOP (p = 0.825), while the estimated PFS was 86% and 94%, respectively. This represented a numerical but not statistically significant difference (p = 0.457), likely reflecting the immature survival data and limited number of events at the time of analysis, rather than a true efficacy difference. Neutropenia was the most frequent AE (69.4%) and showed comparable severity between groups, while grades ≥3 AEs were numerically less frequent with Pola-R-CHP (8.3% vs. 13.9%, p = 0.453).

Conclusion: Pola-R-CHP achieved higher interim and end-of-treatment response rates than R-CHOP with a comparable safety profile. However, survival outcomes remain immature, and given the small matched sample size (n = 72), these findings should be interpreted cautiously and confirmed in larger prospective studies.

Introduction: Hyperthermic intrathoracic chemotherapy (HITHOC) is an intraoperative treatment that involves the perfusion of heated chemotherapy agents within the thoracic cavity. Photodynamic therapy (PDT) utilizes systemically administered photosensitizing agents and targeted light exposure to eliminate residual cancer cells during the surgery. This study aimed to present our experience with local therapies in the management of pleural malignancies, describe the respective outcomes of each modality, and make a preliminary comparison.

Methods: We retrospectively and consecutively enrolled patients with advanced intrathoracic cancer (lung cancer, mesothelioma, and thymoma) with pleural involvement who underwent surgical resection followed by HITHOC or PDT at a single medical center between June 2005 and December 2022. Patients with extrathoracic metastases were excluded. The primary outcomes assessed were mortality rates and overall survival (OS), while the secondary outcomes included recurrence rates and progression-free survival (PFS).

Results: Seventy patients were included, with 15 undergoing HITHOC and 55 undergoing PDT. No significant differences were observed in terms of age, gender, or pathological stage between the two groups. Perioperative parameters, including operative time, estimated blood loss, postoperative length of stay, and intensive care unit stay duration, did not differ significantly between groups. Among patients with recurrence, 50% had localized disease within the chest cavity. HITHOC showed a 3-year OS of 70.5% and 2-year PFS of 46.8% (median follow-up 18.33 months), while PDT showed a 5-year OS of 53.4% and 5-year PFS of 25.5% (median follow-up 73.07 months).

Conclusions: The clinical outcomes of our cohort are comparable to previous studies. Our preliminary data also suggest that HITHOC and PDT may have similar efficacy in treating pleural malignancies. However, the long-term outcomes associated with different neoadjuvant and adjuvant therapies remain unidentified.