Oncology最新文献

Introduction: Oral cancer (OC) is the second most common type of cancer in Pakistan, and early diagnosis can improve survival rates. However, 75% of these cases are diagnosed at an advanced stage. To reduce the incidence and mortality associated with OC, emphasis should be placed on the detailed screening of the oral cavity by dentists. Prevention and early detection practices are important because they increase 5-year survival and reduce recurrence. This study aimed to assess the early detection practices of OC by dentists and determine the factors influencing their screening practices.

Methods: This cross-sectional study was conducted from June 1, 2022, to October 31, 2022, among 235 dentists from the public and private sectors of Islamabad, Pakistan. A validated survey questionnaire with 62 closed-ended items was used. The outcome variable "early detection practices of oral carcinomas" was measured on a scale of 0-8 based on the steps involved in the screening practices. Knowledge scores related to clinical presentation (0-14) and risk factors (0-16) of OC were generated by assigning one point to each correct response. Multivariate linear regression analysis was used to evaluate factors influencing early detection practice scores.

Results: A total of 81.7% of participants had low knowledge related to clinical presentation (mean score = 7.5, SD = 2.2), and 55.3% had high knowledge (mean score = 10.4, SD = 2.06) related to the risk factors of OCs. The mean score for practices related to the early detection of oral carcinomas was 5.4 (SD = 2.04). The duration since attending professional development courses significantly predicted early detection practice scores (p < 0.001). With increasing duration, the early detection practice scores decreased. Moreover, "guidelines about OC examinations" significantly predicted practice scores (higher scores where written guidelines were present) (p < 0.001).

Conclusion: This study offers new evidence on dentists' early detection practices in Pakistan and factors that influence them supporting future training and policy initiatives. It highlights that the early detection of OC improves prognosis, reduces mortality, and minimizes treatment costs. These results emphasize regular professional development courses for the early detection of OC among dentists. This indicates that early detection practices are better in facilities with written guidelines, further emphasizing the need for comprehensive educational materials and training of dentists to improve screening practices. Healthcare authorities should put efforts into implementing a continuous dental education system tailored to the needs of dentists in Pakistan.

Introduction: Human epidermal growth factor receptor 2 (HER-2) in the development of gastric cancer has been widely discussed in the literature. This meta-analysis aimed to assess the relationship between HER-2 and lymph node metastasis in gastric cancer using systematic evaluation and meta-analysis, which can be of some clinical value for treatment and prognosis.

Methods: Relevant databases were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart. PubMed, Embase, Cochrane Library, and Web of Science databases were used to systematically search the literature published up to May 1, 2024. Twenty-one articles were screened and included for quantitative analysis, a data collection form was created, and the quality of the literature was evaluated using the Newcastle-Ottawa Scale (NOS). The results were represented by a Forest plot. I2 was used to assess heterogeneity, Begg's funnel plot was used to test for possible publication bias, and the source of heterogeneity was clarified by the Galbraith plot. Subgroup analyses were performed according to country and test method after excluding studies with significant heterogeneity. All statistical analyses were calculated using stata17.0. This study followed the PRISMA 2020 reporting specifications and the full checklist is available in the online supplementary material (online suppl. Table 4).

Results: A total of 624 articles were retrieved, and 21 were selected and included. Meta-analysis showed that there was heterogeneity between HER-2 positive and HER-2 negative mediators in the study (I2 = 68.0%, p < 0.000). Therefore, the 95% CI (3.12, 95% CI: 2.10, 4.65) of the combined OR calculated by the random-effects model was statistically significant. By comparing the incidence of lymph node metastasis between the HER-2 positive group and the HER-2 negative group, it was found that the incidence of lymph node metastasis between the two groups was significantly different. It is suggested that patients with HER-2 overexpression in cancer tissues may be more prone to lymph node metastasis.

Conclusion: This meta-analysis showed an association between HER-2 and positive lymph node status in gastric cancer patients. This could be valuable for selecting treatment options for gastric cancer patients.

Introduction: This study aimed to evaluate AI-based chatbots (GPT, DeepSeek, Copilot, Gemini) in disseminating information on liver cancer, emphasizing content quality, adherence to established guidelines, and ease of comprehension.

Methods: Between January and February 2025, four chatbots were examined using publicly accessible free versions lacking independent reasoning capabilities. Three frequently searched Google Trends questions ("What is liver cancer awareness?," "What are the symptoms of liver cancer?", and "Is liver cancer treatable?") were posed. Their responses were assessed via the DISCERN instrument, Coleman-Liau Index, Patient Education Materials Assessment Tool for Print, and alignment with American Association for the Study of Liver Diseases, National Comprehensive Cancer Network, and European Society for Medical Oncology recommendations. Statistical analysis was performed using SPSS 22.

Results: All chatbots largely provided relevant and impartial information. GPT and DeepSeek scored lower on specifying information sources and update timelines, whereas Copilot omitted local therapies (e.g., radiofrequency ablation, transarterial chemoembolization, transarterial radioembolization), resulting in reduced scientific accuracy. Gemini and Copilot performed better in "understandability," while GPT and DeepSeek excelled in "actionability." Although GPT demonstrated consistency across multiple treatment options, it did not explicitly reference international guidelines. Study limitations included language constraints, variations in chatbot updates, and reliance on a single inquiry round.

Conclusions: AI chatbots show potential as initial informational tools for liver cancer but cannot replace professional medical consultation. In complex diseases requiring multidisciplinary management, frequent guideline-based updates, expert validation, and diverse data sources are critical to enhancing clinical relevance and patient outcomes.

Introduction: Radiofrequency ablation (RFA) generally involves the insertion of a radiofrequency electrode into the hepatocellular carcinoma (HCC) nodule under ultrasonography (US) guidance. However, the procedure is often not feasible for patients whose HCC is undetectable on conventional US. Advances in imaging technology, such as fusion imaging (FI) and cone-beam computed tomography (CBCT), may enhance treatment precision and efficacy for these challenging cases. This study assessed the efficacy of RFA guided by FI and CBCT in managing HCC poorly visualized on US.

Methods: HCC nodules were classified into GOOD (clearly delineated), POOR (poorly delineated), and NONE (undetectable) based on US visualization. All nodules underwent RFA guided by FI and CBCT either in combination with transcatheter arterial chemoembolization (TACE) or without TACE. The technical success rate and local tumor progression post-RFA were evaluated using dynamic contrast-enhanced imaging. Between-group differences were analyzed retrospectively.

Results: A total of 420 patients with 595 HCC nodules were enrolled. Complete ablation rates were 91.4%, 94.9%, and 86.2% in the GOOD, POOR, and NONE groups, respectively. For nodules with over 50% lipiodol accumulation, the complete ablation rates were 91.5%, 96.5%, and 88.8%; for those with less than 50% lipiodol accumulation, they were 95.5%, 100%, and 62.5%; and for those without lipiodol accumulation, they were 89.5%, 77.8%, and 82.4% in the GOOD, POOR, and NONE groups, respectively. Significant factors associated with complete ablation included larger nodule size and lipiodol accumulation. Cumulative local tumor progression rates at 1 year were 4.5%, 0%, and 3.8%, with no significant differences among groups.

Conclusion: FI and CBCT guidance effectively achieve local control for HCC, including nodules poorly visualized on US, with outcomes comparable to US-visible nodules, especially for those with lipiodol accumulation.

Introduction: In recent years, the therapeutic scenario of metastatic biliary tract cancers (BTCs) beyond first-line has profoundly changed owing to target therapies. human epidermal growth factor receptor-2 (HER2) represents a promising molecular target that is frequently altered in BTC. The present meta-analyses aimed to describe the response rates and survival outcomes in patients with HER2-positive locally advanced/metastatic BTC treated with anti-HER2 therapies. Moreover, the study is intended to provide an update on the evolving therapeutic scenario of HER2-overexpressed BTC.

Methods: We performed a systematic review of the literature to identify clinical trials investigating any regimen comprising a HER2-targeted therapy for metastatic BTC, and we conducted three subsequent meta-analyses on second-line phase II trials. The first one was performed to compare the group of HER2 3+ versus the group of HER2 2+ BTC patients for objective response rate (ORR). The second one compared patients according to the tumor location (gallbladder carcinoma [GBC] or extrahepatic cholangiocarcinoma [eCCA] versus intrahepatic cholangiocarcinoma [iCCA]) for ORR. The third one evaluated the overall outcomes in terms of overall survival (OS) and progression-free survival (PFS).

Results: Patients with advanced BTC and HER2 3+ had better ORR compared to HER2 2+, with a 3.7-fold higher probability of experiencing objective responses (HR 3.70, 95% CI, 1.34-10.25, p = 0.0119). Likewise, patients with GBC or eCCA had a 2.74-fold higher probability of experiencing an objective response compared to patients with iCCA (HR 2.74, 95% CI, 1.12-6.73, p = 0.0275). The weighted pooled analysis of trials with anti-HER2 agents in second line or beyond revealed an mPFS of 4.9 months (95% CI, 4.2-5.6), while mOS was 10.8 months (95% CI, 9.0-12.8).

Conclusions: Our meta-analyses have revealed improved efficacy in patients with HER2 3+ metastatic BTC and in patients with GBC or eCCA treated with anti-HER2 therapies, with a considerable mPFS and mOS in the overall population of the phase II trials analyzed. Further studies are paramount to confirm our preliminary results.

Introduction: Access to highly specialized interventional oncology procedures such as transarterial chemoembolization (TACE) and radioembolization (TARE) may be limited in nonmetropolitan areas of the USA. This study aimed to evaluate whether disparities in access to TACE and TARE exists in these regions.

Methods: This study characterizes the distribution of these procedures across regions by metropolitan status through utilization of a large commercial healthcare claims database (Truven Merative Marketscan). Patients with a diagnosis of primary hepatocellular carcinoma (n = 41,280) were categorized into those who received TACE (n = 1,780) or TARE (n = 1,179). Chi-squared tests of association were utilized to analyze regional data.

Results: Statistical analyses showed significant differences between most regional comparisons with most patients receiving these procedures originating from metropolitan areas overall.

Conclusion: Though limited to TACE and TARE, this study reveals a disparate distribution of TACE and TARE utilization across regions with preference toward metropolitan over nonmetropolitan areas, which may represent a barrier for access to care for nonmetropolitan patients, though this remains to be studied.

Introduction: Atezolizumab plus bevacizumab (ATZ + BV) is used for the treatment of Barcelona Clinic Liver Cancer (BCLC) stage B unresectable hepatocellular carcinoma (u-HCC) patients. However, the efficacy of ATZ + BV in various BCLC stage B conditions, especially the up-to-seven criteria in/out, has not been fully investigated.

Methods: We enrolled 83 BCLC stage B u-HCC patients with Child-Pugh class A who were treated with ATZ + BV as the first-line systemic chemotherapy in the study. All patients were evaluated for initial responses by dynamic computed tomography or magnetic resonance imaging after the initiation of ATZ + BV, and therapeutic efficacy was assessed.

Results: When stratified by up-to-seven criteria, progression-free survival (PFS) was significantly prolonged in patients with up-to-seven in (in vs. out: median 21.0 vs. 8.2 months, p = 0.006), and the Cox proportional hazard model showed that up-to-seven out/in was the significant factor contributing to PFS (out vs. in: HR 2.58, p = 0.007). We next evaluated PFS stratified by the maximum intrahepatic tumor diameter and number of intrahepatic tumors, which constitute the up-to-seven criteria. The number of tumors was a significant factor contributing to PFS (>7 vs. ≤7: HR 1.75, p = 0.040), but maximum tumor size was not (>5 cm vs. ≤5 cm: HR 1.19, p = 0.588).

Conclusion: In BCLC stage B u-HCC patients treated with ATZ + BV, a high number of intrahepatic tumors were associated with poor PFS. Therefore, it may be better to consider additional treatment strategies in these patients.

Introduction: The prognostic value of the modified Glasgow Prognostic Score (mGPS), a systemic inflammatory response marker, has been reported in various cancers. However, its role in patients with metastatic colorectal cancer (mCRC) undergoing first-line FOLFOXIRI + bevacizumab (BV) therapy remains unclear. In this study, we aimed to evaluate the prognostic significance of pretreatment mGPS and other inflammatory markers in this patient population.

Methods: This study retrospectively reviewed 133 patients with mCRC treated with first-line FOLFOXIRI + BV. We assessed the prognostic value of pretreatment mGPS and other inflammatory markers (neutrophil-to-lymphocyte, platelet-to-lymphocyte, and lymphocyte-to-monocyte ratios) in relation to progression-free survival (PFS) and overall survival (OS).

Results: Higher mGPS (score 2) was significantly associated with poor PFS and OS. Multivariate analysis identified mGPS 2 as an independent predictor of worse PFS (hazard ratio: 2.76, p = 0.004) and OS (hazard ratio: 3.43, p < 0.001). No significant associations were found between other inflammatory markers and survival outcomes.

Conclusions: Pretreatment mGPS is a simple and useful prognostic factor for mCRC patients receiving FOLFOXIRI + BV therapy and may serve as a convenient indicator for accurate prognosis prediction and treatment decision-making.

Introduction: MiRNAs play important roles in development of various cancers including gastric cancer. Exosomes are extracellular vesicles for translocating molecules. This study aimed to investigate the tumor suppressive roles of miR-379-5p in gastric cancer and to investigate the roles of exosomes in transporting miR-379-5p from intracellular to extracellular.

Methods: Fifty-three pairs of gastric cancer and non-tumor tissue samples were collected. Five cell lines were applied. Functional assays including cell proliferation, cell migration and invasion, and cell adhesion assay were performed. Targets of miR-379-5p were screened and validated by Western blot. Expressions of endogenous miR-379-5p in gastric cancer cells and exosomal miR-379-5p in cell culture medium were evaluated by RT-qPCR. Medium of culturing AGS or BCG23 was applied for culturing MKN45 and HEK293T.

Results: The results indicated that miR-379-5p was significantly downregulated in gastric cancer tissue samples and cell lines. Enforced expression of miR-379-5p inhibited gastric cancer cell proliferation, migration, and invasion, while miR-379-5p mimic enhanced cell adhesion to extracellular matrix. IGF1R was a potential target of miR-379-5p in gastric cancer. Expression of miR-379-5p was dramatically higher in exosomes in cell culture medium than its endogenous expression. Exosomes from cell culture medium of AGS or BCG23 could regulate endogenous expression of miR-379-5p in HEK293T cells.

Conclusions: MiR-379-5p was significantly downregulated and it functioned as a tumor suppressor in gastric cancer. MiR-379-5p was highly expressed in exosomes of culture medium than its endogenous expression. MiR-379-5p could be translocated from cells into cell culture medium and entered certain cell types via exosomes.

Introduction: Artificial intelligence (AI) is increasingly being researched and developed in the medical field and holds the potential to transform healthcare after successful implementation. For patients with colorectal cancer liver metastases (CRLM), many AI models have been developed, but knowledge about translation of these models in the clinical workflow is lacking. Therefore, this systematic review aimed to provide a contemporary overview of the current maturity status of AI models for patients with CRLM.

Methods: A systematic search of the literature until November 2, 2023, was conducted in PubMed, Embase.com, and Clarivate Analytics/Web of Science Core Collection to identify eligible studies. Studies using AI and/or radiomics for patients with CRLM were considered eligible. Data on the study aim, study design, size of dataset, country, type of AI application, level of validation and clinical implementation status (NASA technology readiness levels) were collected. Risk of bias and applicability of the individual studies were evaluated using the Prediction Model Risk of Bias Assessment Tool (PROBAST).

Results: A total of 117 studies were included. Ninety-seven studies (83%) have been published in the last 5 years. The most common study design was retrospective (96%). Thirty-five studies (30%) utilized a dataset of fewer than 50 patients with CRLM. Internal validation was performed in 63% of the studies and external validation in 17%. The remaining studies did not report validation. Half of the studies were classified as high risk of bias. None of the included studies performed real-time testing, workflow integration, clinical testing, or clinical integration.

Conclusion: Although a rapid increase in research describing the development of AI models for patients with CRLM has been observed in recent years, not a single AI model has been translated into clinical practice.