Oncology Research and Treatment最新文献

Background: Ovarian cancer is the gynecological cancer with the worst overall survival worldwide. Around 70% of patients are diagnosed in an advanced stage. Since low residual tumor after surgery has been repeatedly observed to deeply affect survival, achieving complete resection of tumor with no macroscopic residual disease through primary debulking surgery (PDS) has become the standard of care in advanced ovarian cancer.

Summary: The concept of neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) was introduced in order to improve resectability in patients who otherwise, due to advanced age, poor performance status, or extensive tumor burden, cannot be optimally operated. Patient-related factors like age, performance status, comorbidities, and nutritional status can all affect the survival and are all key factors in the selection process. Accurately assessing tumor extension and therefore allocating a patient to the NACT/IDS strategy is of great importance and can be achieved either through imaging (CT scan, ultrasound, MRI, PET scan) or laparoscopy using different validated laparoscopic scoring systems.

Key messages: There is sizable randomized evidence to support the NACT/IDS as an acceptable strategy in patients with advanced ovarian cancer, in whom a PDS is not possible or would have a suboptimal outcome. Patient- and tumor-related factors play a key role in allocating the right management plan to the right patient.

Introduction: The role of immunotherapy in the treatment of locally advanced head and neck squamous cell carcinoma (LA HNSCC) remains uncertain, particularly in cases of unresectable LA HNSCC. This meta-analysis aimed to evaluate the efficacy of immunotherapy in patients with unresectable LA HNSCC through a systematic review of the existing literature.

Methods: This meta-analysis followed a registered protocol on the INPLASY platform with the registration number INPLASY202510102. We systematically collected studies that compared the combination of immunotherapy and standard of care (SOC) with SOC alone for patients with unresectable LA HNSCC. Review Manager, Stata, and R software were employed to conduct single-group rate meta-analysis, pairwise meta-analysis, and Bayesian network meta-analysis.

Results: A meta-analysis of fifteen eligible studies involving 3,055 patients revealed no significant improvement in progression-free survival (PFS) or overall survival (OS) with the addition of immunotherapy. Specifically, in patients with human papilloma-positive (HPV+) LA HNSCC, the combination of pembrolizumab and concurrent chemoradiotherapy (CCRT) resulted in 2-year PFS and OS rates of 93% and 97%, respectively. In contrast, LA HNSCC patients treated with chemoradiotherapy followed by sequential pembrolizumab exhibited 2-year PFS and OS rates of 89% and 94%, respectively. Furthermore, our study demonstrated that the combination of pembrolizumab and CCRT achieved a higher 2-year PFS rate compared to the combination of avelumab and CCRT.

Conclusion: Although the addition of immunotherapy to SOC regimens did not result in a survival benefit, patients with HPV+ unresectable LA HNSCC may potentially derive benefit from immunotherapy.

Introduction: The concept of oncological communication skills training (CST) has already proven to be effective and has been incorporated into the relevant guidelines. The current status of CSTs in Germany is unclear.

Methods: We approached all oncology centers in Germany certified by Deutsche Krebsgesellschaft (DKG) and investigated quantitative and qualitative aspects of CST programs in a mixed-methods approach using questionnaires and interviews.

Results: Only a quarter (23.7%, n = 18/76) of the responding centers demonstrated a regular CST. These CSTs were partially congruent with the consensus recommendations while deviating significantly in other areas, such as duration, scope, and course content. We asked centers that do not offer CST or do not offer fully satisfactory CST (respondents n = 60) for factors that hinder successful implementation, which were identified as, e.g., scarce time and personnel resources (92%), no counterpart funding (27%), lack of appreciation (25%) and knowledge about the concept (3%), organizational obstacles (22%), and low prioritization (12%). Steps that could facilitate nationwide implementation were found, such as support for implementation through concrete instructions (27%), mandatory participation (20%), an active management level in the question of responsibility (17%), inclusion in the certification criteria for oncology centers (12%), and an integration into the Weiterbildungsordnung (WBO, specialist training guideline) (10%).

Conclusion: Although previous studies have shown that CSTs have positive effects, sufficient implementation has not yet been achieved across the board in Germany. Individual starting points have been identified; further efforts are needed to advance this goal.

Introduction: Epidural anesthesia is a standard procedure to mitigate pain during surgery for endometrial cancer (EC). Little data exist about the influence of epidural anesthesia on the oncological outcome in elderly patients with EC. This retrospective study aimed to investigate potential correlations between epidural anesthesia and cancer recurrence in patients with EC.

Methods: We screened the medical records of patients ≥60 years treated surgically for EC at the University Medical Center Mainz between January 2008 and December 2019. All women underwent general anesthesia (GA) alone or combined with epidural anesthesia (EGA). Cox regression, the Kaplan-Meier method and propensity score matching were used to analyze the prognostic influence of the anesthesiologic regime on survival.

Results: A total of 152 women with EC were included. Twenty-nine patients (19.1%) formed the EGA cohort. The median time of follow-up (FU) was 31 months (interquartile range [IQR]: 8-67.5). The EGA cohort showed more in-hospital complications (27.6 vs. 8.9%; p = 0.006), especially thromboembolic events (3 vs. 0 events; p = 0.006), as well as a longer hospital stay (11 [IQR: 8-13] vs. 7 [IQR: 4-9] days; p < 0.001). Twenty-six patients (17.1%) developed a recurrence in the follow-up at a median of 13 months [IQR: 7.75-29.5]. Thirty-two patients died during FU (21.1%). The EGA cohort showed higher FIGO stages and a higher histological grading than the GA cohort. In the Kaplan-Meier analysis, EGA showed a significantly reduced 5-year recurrence-free survival (RFS) (36.5% vs. 72.6%, p < 0.001) and overall survival (OS) (58.6% vs. 79.9%, p = 0.008). However, in multivariate Cox regression analysis including FIGO stages and histological grading, EGA did not influence RFS (HR: 2.02; 95%-CI: [0.99-4.12], p = 0.054), and OS (HR: 1.03; 95%-CI: [0.40-2.66], p = 0.951). This was backed up by the propensity score- matched analysis for survival (RFS: p = 0.604, OS: p = 0.86).

Conclusion: Considering risk factors, epidural anesthesia in combination with GA did not differ in recurrence-free and overall survival compared to GA. Prospective randomized trials are warranted in order to further evaluate this topic.

Introduction: This study aimed to evaluate the effectiveness of GPT-4o, with and without retrieval-augmented generation (RAG), in responding to soft tissue sarcoma (STS)-related queries.

Methods: The study used a 20-question dataset derived from clinical scenarios related to adult STS. The responses were generated by GPT-4o with and without the RAG approach. The RAG system incorporated the English version of German evidence-based S3 guidelines through an embedding-based retrieval system. Two sarcoma experts evaluated the responses for accuracy, comprehensiveness, and safety using a Likert scale. Statistical analyses were conducted to compare the performances.

Results: GPT-4o with RAG outperformed the model without RAG across all evaluated areas (p < 0.05). GPT-4o without RAG had a 40% error rate, which was reduced to 10% by the RAG approach. In 90% of the questions, the pages with the relevant information that addressed the questions were correctly cited using the retrieval system.

Conclusion: The RAG approach significantly enhanced the performance of GPT-4o in answering STS-related questions. However, the model still produced incorrect responses in certain complex scenarios. GPT-4o, even with RAG, should be used cautiously in clinical settings, particularly for rare diseases like sarcoma. Human expertise remains irreplaceable in medical decision-making.

Introduction: The COVID-19 pandemic has impacted the treatment of prostate cancer (PCa). The study examines any predictions that could point to future models.

Methods: Two interrupted time series analyses were conducted: one for the pre-COVID period (January 2017 to December 2019) and another for the post-COVID period during 2022. Information on age, total prostate-specific antigen (PSA), abnormal digital rectal exam (DRE), prostate volume, previous negative biopsy, number of positive biopsies, Gleason score, and biopsy outcome were collected for all patients. The categories for the results were no cancer, insignificant, low and intermediate, high-risk, and very high-risk PCa. Using a generalized linear model (GLM), the outcomes are modeled. The area under the curve (AUC) and accuracy were used to assess how well multi-class predictions performed.

Results: Overall, 244 patients who had biopsies following the COVID-19 pandemic and 832 patients who had biopsies before the pandemic were compared. The accuracy of the GLM was only 0.635. The AUC for categories no-cancer, low- and intermediate-risk, and very high-risk patients was 0.821, 0.716, and 0.926. With scaled relevance values, PSA was the most critical test. The two features that significantly influenced the treatment model prediction for PCa were biopsy PSA level and DRE, respectively.

Conclusion: Advanced age and a very high-risk group appear to have a detrimental impact on the results of biopsies conducted after the first wave of the COVID-19 era. At the same time, PSA levels and abnormal DRE are the most significant predictors in GLM.