Oncology最新文献

Introduction: Immune checkpoint inhibitors (ICIs) have improved lung cancer treatment but are associated with an increased risk of cardiotoxicity. We investigated whether statins could mitigate ICI-associated cardiovascular risks in lung cancer patients.

Methods: We performed a retrospective, propensity score-matched cohort study utilizing the TriNetX database. We identified lung cancer patients receiving ICIs between April 2013 and June 2023. We created two cohorts: statin users and non-users. The primary efficacy outcome was major adverse cardiovascular events (MACE), defined as a composite of myocardial infarction, ischemic stroke, and heart failure. The secondary efficacy outcomes were myocarditis and cardiac arrest. Safety outcomes were all-cause mortality and serious immune-related adverse events (irAEs).

Results: A total of 16,650 lung cancer patients undergoing ICIs were identified, consisting of 6,812 statin users and 9,838 non-users. After propensity score matching, 4,379 patients were well-matched in baseline characteristics. Over a follow-up period of 12 months, statin use was associated with a lower risk of MACE (HR: 0.87, 95% CI: 0.78-0.98), primarily driven by reductions in myocardial infarction (HR: 0.75, 95% CI: 0.58-0.97) and heart failure (HR: 0.85, 95% CI: 0.74-0.98). For safety outcomes, statin use was associated with a reduction in all-cause mortality (HR: 0.83, 95% CI: 0.77-0.90) and did not result in an increased risk of serious irAEs.

Conclusion: The use of statins in lung cancer patients with cardiovascular risk factors and without previous cardiovascular events undergoing immunotherapy was associated with a reduction in MACE and all-cause mortality without an increased risk of serious adverse events.

Introduction: Predicting post-treatment prognosis in hepatocellular carcinoma (HCC) patients undergoing conventional transarterial chemoembolization (cTACE) is challenging due to tumor heterogeneity. We here assessed the utility of the modified albumin-bilirubin grade and α-fetoprotein (mALF) score for predicting the prognosis of cTACE-treated HCC patients.

Methods: This retrospective observational study included 206 early- and intermediate-stage HCC patients who had undergone cTACE. We calculated baseline and post-treatment mALF scores by assigning one point for a modified albumin-bilirubin grade of 2b or 3 and one point for an alpha-fetoprotein level of ≥100 ng/mL.

Results: The baseline mALF scores were 0, 1, and 2 points for 66 patients (32%), 95 patients (47%), and 45 patients (21%), respectively, and their median survival times were 42.3 months, 21.1 months, and 14.0 months, respectively. The baseline mALF score was also associated with overall survival, independent of the Barcelona Clinic Liver Cancer stage and the tumor burden score (hazard ratio, 1.97; 95% confidence interval, 1.56-2.49; p < 0.001). One month after cTACE, the mALF score had decreased in 26 patients and increased in 31 patients. In those with a baseline mALF score of 0 or 1, the increased mALF score was significantly associated with shorter survival periods after cTACE.

Conclusion: The baseline mALF score was useful in stratifying HCC patients undergoing cTACE, according to post-treatment prognosis. Increased mALF scores after cTACE were associated with poor prognosis in patients with a baseline mALF score of 0 or 1. Assessment of baseline and post-treatment mALF scores may help in predicting prognosis in HCC patients following cTACE.

Introduction: Despite recent advancements, outcomes for unresectable hepatocellular carcinoma (HCC) treated with atezolizumab plus bevacizumab (atezo/bev) remain suboptimal, with drug resistance posing a major challenge. This study evaluated the efficacy of additional locoregional treatments (LRTs) for oligo-atezo/bev-resistant lesions.

Methods: We retrospectively analyzed patients with intermediate-stage and advanced-stage HCC who developed drug-resistant lesions during first-line atezo/bev therapy. Patients were divided into two groups: the combination therapy group (n = 10) receiving additional LRT and the atezo/bev alone group (n = 26). Progression-free survival (PFS) 1 was measured from atezo/bev therapy initiation to progressive disease (PD) or death, whereas PFS2 was calculated from atezo/bev therapy initiation to PD of second-line therapy or death. The PFS1 in the combination therapy group was compared to the PFS1 and PFS2 in the atezo/bev alone group. Two analyses were performed for the PFS and overall survival (OS): one including the total cohort and the other restricted to those eligible for LRT upon the appearance of atezo/bev-resistant lesions. Changes in the hepatic reserve before and after LRT were also assessed.

Results: LRT, followed by continued atezo/bev therapy, safely eradicated drug-resistant lesions in the combination therapy group, without compromising the hepatic reserve. All patients in the combination therapy group transitioned to second-line treatment due to preserved hepatic reserve after PD. The PFS1 in the combination therapy group was longer than the PFS1 and PFS2 in the atezo/bev alone group in both the total cohort and LRT-eligible subgroup. Similarly, the OS in the combination therapy group was longer than in the atezo/bev alone group in both analyses.

Conclusion: LRTs may provide a viable option for managing oligo-drug-resistant lesions during first-line atezo/bev therapy for unresectable HCC when safely administered.

Background: Kidney transplant recipients are increasing, as is their life expectancy. Due to immunosuppression, skin cancers are the neoplasms more common in this population.

Summary: Cancer immunotherapy is the choice treatment for squamous cell non-melanoma skin cancer (NMSC) patients who are not candidates for local therapies such as radiotherapy and surgery. For basal cell carcinomas requiring systemic therapies, hedgehog inhibitors (HHis) are necessary. Traditionally, special populations, such as solid organ transplant recipients, were excluded from clinical studies. We reviewed the literature on immunotherapy and HHis for NMSC in this specific population.

Key messages: Immunotherapy may be administered to selected patients following a thorough multidisciplinary evaluation. Factors such as prior episodes of rejection, high proteinuria, and elevated anti-donor antibody levels should be considered relative contraindications. Similarly, HHis may be prescribed with caution in selected patients, with careful monitoring of renal function and the potential development of additional squamous cell carcinomas.

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.

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 (SUVmax) (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), SUVmax (p < 0.01), lower lobe (p < 0.01), and pN2 (p < 0.01) for lung metastasis; CIPI (p < 0.01), SUVmax (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: Following resection for gastroesophageal cancer, patients may experience symptoms like reflux, anorexia, and weight loss that can significantly impact their quality of life (QoL). Patient-reported outcomes (PROs) are becoming more important for symptom monitoring. Nevertheless, there is limited knowledge on symptom management post-gastroesophageal cancer resection.

Methods: A single-center, randomized controlled trial was conducted on postoperative patients with gastroesophageal cancer. Participants were randomly assigned to the PRO group and usual care (the control group), with a 1:1 ratio. The PRO-based symptom management included symptom assessment, monitoring, and personalized interventions such as lifestyle guidance, nutritional support, and drug therapy. An electronic system was developed on the Research Electronic Data Capture (REDCap) platform to monitor and assess patients' symptoms, QoL, and provide diagnosis and treatment. The study focused on five key symptom events: anorexia, reflux, depression, nutritional risk, and underweight. In the PRO group, assessments were conducted every 3-4 weeks for a minimum of 16 weeks. Interventions for this group primarily involved counseling, patient education, and medication prescriptions based on individual symptoms. The control group's symptoms and QoL were assessed only at baseline and week 16. The primary outcome measure was the total number of symptoms at 16 weeks, with secondary outcomes including the incidence of symptoms at the same time point. QoL was also evaluated as part of the study.

Results: Between April 2021 and May 2022, a total of 124 patients were divided into two groups: 60 in the PRO group and 64 in the control group. The PRO group exhibited notably fewer overall symptoms at the 16-week mark compared to the control group (1.20 ± 1.16 vs. 2.50 ± 1.47), along with a lower prevalence of nutritional risk (63.3% vs. 81.3%), anorexia (18.3% vs. 60.9%), reflux (13.3% vs. 57.8%), and depression (5.0% vs. 20.3%). The QoL scores were markedly higher in the PRO group. Furthermore, the PRO group displayed lower nutritional status, reflux, and depression scale trends, as well as higher anorexia trends when compared to the control group.

Conclusions: PRO-based symptom management led to superior symptom control and enhanced QoL in postoperative gastroesophageal cancer patients when compared to standard care.

Introduction: Maximum tumor diameter (MTD) is one of the key aggressiveness features of hepatocellular carcinoma (HCC). However, the clinical associations and causes of large size HCC are not well understood. The aim was to compare small and large MTD (≤/>6 cm) HCCs with respect to clinical associations.

Methods: MTD ≤/> 6 cm HCCs were compared by clinical characteristics and analyzed through logistical regression models, as well as Cox proportional hazard models for death, on clinical parameters.

Results: Patients with larger HCCs had more portal vein thrombosis (PVT) and tumor multifocality, higher AST, ALKP and GGT levels and lower albumin levels. A logistic regression model of MTD (≤/>6 cm) showed the highest risk for PVT and platelet-lymphocyte ratio (PLR) >150, while albumin and female gender were protective. The combination of male gender, PLR >150, plus PVT had an odds ratio of 12.124. In Cox proportional hazard models, the highest hazard ratio for death was for PVT, and only albumin was significantly protective. PVT plus low albumin had a hazard ratio of 4.254.

Conclusion: PVT, albumin, PLR, and gender were significant for ≤/>6 cm MTD. PVT and albumin were significant for survival.

Background: Noncoding RNAs (ncRNAs), including microRNAs, lncRNAs, and circRNAs, play essential roles in physiological and pathological processes, including cancer, where they act as drivers or suppressors. Aberrant ncRNA expression in tumors has been linked to tumor promotion or suppression, making them potential cancer biomarkers. Pyroptosis, a newly discovered form of programmed cell death, is characterized by cell swelling, membrane rupture, and inflammation, offering a novel strategy for tumor elimination.

Summary: Pyroptosis can activate anti-tumor immunity, while ncRNAs regulate pyroptosis pathways, influencing tumorigenesis through diverse mechanisms. However, the role of ncRNAs in pyroptosis, including potential initiators and their impact on tumor resistance, immunity, and cancer progression, remains unclear. The specific role of circRNAs in pyroptosis also requires further exploration.

Key messages: This article explores the role of ncRNAs in pyroptosis, with a particular focus on ncRNA-mediated mechanisms, and highlights their potential as diagnostic and prognostic markers in cancer.

Introduction: Antihistamines (AHs) have beneficial effects as adjuvant anticancer agent in several preclinical and observational studies. We aimed to evaluate the effect of AHs on stage IV lung cancer patients.

Methods: We used data from the Cancer Registry Database provided by the Cancer Center of Kaohsiung Veterans General Hospital to investigate whether AH use is associated with improved survival among patients with stage IV lung cancer. We analyzed AHs use across various patient subgroups, including sex, age, comorbidities, co-medications, smoking status, histologic type, treatment modality, and survival time. The primary endpoint was overall survival (OS).

Results: A total of 1,886 lung cancer patients were enrolled. Of them, 41 (2.1%) patients were AH users, 1,845 (97.8%) were AH nonusers before lung cancer diagnosis, and 594 (31.6%) patients were AH users, 1,292 (68.4%) were AH nonusers after lung cancer diagnosis. AH users were more to have comorbidities with hypertension (p < 0.001), diabetes mellitus (p < 0.001), allergic disease (p < 0.001), chronic obstructive pulmonary disease (p = 0.002), co-medications with targeted therapy (p < 0.001), and nonaspirin NSAID (p < 0.001). Pre-diagnostic AH users did not show improved survival outcomes. Post-diagnostic AH users tend to have a better OS among patients with a survival period of more than 90 days (median, 28.4 months and 15.1 months, respectively; HR: 0.49; 95% confidence interval: 0.43-0.55).

Conclusion: AHs use was associated with improved OS in patients with stage IV lung cancer. Further prospective studies are needed to better elucidate the role of AHs in the treatment of lung cancer.