World journal of clinical oncology最新文献

Tumor heterogeneity is one of the central challenges in oncology, contributing to treatment resistance and disease recurrence. Bulk RNA sequencing has advanced understanding of tumor biology, yet its averaging effect conceals cell type-specific alterations. Single-cell RNA sequencing overcomes this limitation by capturing gene expression and cellular phenotypes with high-resolution, thereby illuminating tumor composition and the surrounding microenvironment. Within this framework, differential abundance (DA) detection has emerged as a powerful strategy to quantify shifts in cell population proportions across conditions. Unlike differential gene expression, DA highlights compositional changes in cellular ecosystems, offering a structural perspective on tumor dynamics. This review introduces the main categories of DA methods in single-cell RNA sequencing analysis, outlining their modeling strategies, assumptions, and representative applications in oncology. We also discuss key challenges, including reliance on clustering quality and batch correction. By linking methodological principles with biological insight, this review clarifies the role of DA detection in single-cell oncology and provides a conceptual framework for integrating compositional analysis into efforts to understand tumor evolution, treatment response, and disease stratification.

Background: An observed correlation between increased colorectal cancer (CRC) incidence in patients with obesity [body mass index (BMI) ≥ 30 kg/m²] has been identified in past literature. However, there has been limited data in recent decades. This, along with a dramatic global increase in obesity rates, exposure to environmental and lifestyle risk factors for CRC development, and large updates to the proposed biological mechanisms underpinning this relationship, warrants an updated review of recent data between CRC and obesity.

Aim: To determine if an updated correlation exists between obesity and the risk of CRC development.

Methods: We evaluated recent data, synthesising pooled estimate effects to determine if an updated correlation exists between obesity and CRC. Observational studies were identified from a range of databases (PubMed, EMBASE, Scopus and the Cochrane database). From the studies identified, sex-stratified meta-analyses were conducted. Additionally, studies included in this review that were unfit for meta-analysis underwent qualitative analysis.

Results: In a pooled sample size of 83506 male participants obtained from six observational studies, a significant positive correlation between obesity and CRC incidence was identified with a hazard ratio (HR) of 1.71 [95% confidence interval (CI): 1.44-2.02]. A pooled sample size of 152043 female participants from six observational studies also revealed a positive correlation with an HR effect of 1.26 (95%CI: 1.03-1.53). Qualitative analysis of studies not included in the meta-analysis consistently supported this relationship for both sexes.

Conclusion: Obesity, diagnosed by a BMI ≥ 30 kg/m², significantly increases the risk of CRC incidence compared to those of a healthy BMI underscoring the importance of focused strategies to prevent obesity as a modifiable risk factor to reduce CRC incidence.

Background: We have previously reported that the cancer/testis antigen Kita-Kyushu lung cancer antigen-1 (KK-LC-1) is frequently expressed in gastric cancer (GC), with a particularly high positivity rate observed in patients with multiple GCs. Thus, we conducted a preliminary study to further investigate the relationship between KK-LC-1 expression and multiple GCs. Specifically, we aimed to explore the potential clinical utility of KK-LC-1 as a biomarker for identifying patients at risk of developing multiple gastric cancers, with a focus on its expression in the initial tumor lesions.

Aim: To investigate the association between KK-LC-1 expression and the development of multiple GCs in a preliminary cohort.

Methods: Among 124 patients (177 lesions) treated for GC at Toho University Medical Center Ohashi Hospital between September 2020 and November 2023, 109 (single cancer: 82; multiple cancers: 27) with available initial tumor specimens were enrolled. KK-LC-1 expression was assessed using immunohistochemistry, and clinicopathological correlations were analyzed using Fisher's exact test. Tumor locations were classified anatomically and analyses were performed, focusing on the initial cancer sites.

Results: In tumors located in the upper stomach, KK-LC-1 expression did not correlate with clinicopathological features. However, in the middle and lower stomach, KK-LC-1 expression was significantly associated with older age, differentiated histological types, and multiple cancers. Notably, all patients with multiple GCs had KK-LC-1-positive tumors (100%) in their initial lesions. The KK-LC-1 positivity rate in the initial tumors of multiple cancers in the middle and lower region was significantly higher than that in solitary cancers. Conversely, the absence of KK-LC-1 expression in a solitary tumor located in the middle and lower region may suggest a reduced risk for the subsequent development of multiple primary cancers.

Conclusion: KK-LC-1 expression in the initial gastric tumors, particularly in the middle and lower stomach regions, may serve as a predictive biomarker for the future development of multiple GCs.

Background: Adult sacrococcygeal teratoma (SCT) is extremely rare in clinical practice, with most cases manifesting as mature cystic types. Given the scarcity of clinical studies and literature on this topic, standardized surgical guidelines for adults are notably absent, and current treatment strategies are predominantly derived from pediatric surgical practices. Furthermore, data on surgical outcomes and risk factors for postoperative dysfunction or recurrence in adult patients remain limited. Continued research on tumor treatment modalities and risk factors is still warranted.

Aim: To assess surgical outcomes and identify risk factors for dysfunction and recurrence in adult mature cystic SCTs.

Methods: We conducted a retrospective analysis of 64 adult patients with mature cystic SCT who received surgical treatment at Shandong Provincial Hospital Affiliated to Shandong First Medical University, from January 2005 to December 2020, ensuring all had complete clinical and follow-up data. We compared the clinical outcomes of three different surgical approaches: Laparoscopic-assisted anterior (Type A), posterior (Type B), and combined laparoscopic-posterior (Type C), evaluating them through perioperative indicators. Univariate and multivariate logistic regression analyses were performed to determine risk factors for postoperative dysfunction and tumor recurrence.

Results: The study incorporated 64 patients, all of whom had been pathologically confirmed to have mature cystic SCTs. The clinical efficacy in adult mature cystic SCTs was not significantly impacted by the various surgical approaches employed. Maximum tumor diameter of 10 cm or more, Altman classification of type III/IV, and intraoperative blood loss of 400 mL or greater were risk factors for postoperative dysfunction (anorectal dysfunction, urinary dysfunction and lower extremity motor dysfunction). The sacrococcyx being left unresected was determined to be an independent risk factor for tumor recurrence.

Conclusion: Surgical approach does not affect outcomes; larger tumors, advanced Altman type, blood loss, and unresected sacrococcyx increase risks of dysfunction and recurrence.

Esophageal cancer poses a severe global healthcare burden, with a dismal prognosis primarily due to late-stage diagnosis - only 10%-30% of patients survive 5 years when symptoms trigger medical attention. Endoscopic submucosal dissection (ESD) has emerged as a transformative minimally invasive therapy for early esophageal neoplastic lesions, offering curative potential while preserving organ function. However, the clinical landscape of early esophageal neoplasia is highly heterogeneous, with low-grade intraepithelial neoplasia, high-grade intraepithelial neoplasia, early-stage carcinoma, and superficial carcinoma differing significantly in biological behavior, endoscopic features, and treatment response. This article examines the recent retrospective study published by Zhang et al, which analyzed 245 patients with 264 lesions treated with ESD between 2014 and 2022. The study fills a critical gap in understanding this heterogeneity by systematically linking lesion stage to clinicopathological characteristics, ESD efficacy, and long-term prognosis. It not only validates ESD's role in early disease but also raises urgent questions about refining stratified management and addressing unmet needs in high-risk populations. This article discusses the implications of the study's findings, contextualizes them within current clinical practice, and outlines directions for future research to advance care for patients with early esophageal neoplasia.

Background: Lymphoproliferative neoplasms (LPNs) such as chronic lymphocytic leukemia and non-Hodgkin lymphomas are clinically heterogeneous and frequently associated with recurrence and poor outcomes. Immune checkpoint markers, including programmed death-ligand 1 (PD-L1) and programmed cell death protein 1 (PD-1), as well as C-X-C motif chemokine receptor 3 (CXCR3) and inflammation-based indices [systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI)], have shown promise in risk stratification but remain underexplored in Egyptian populations.

Aim: To assess the prognostic value of PD-L1/PD-1 co-expression with CXCR3, SII, SIRI, and CXCR3 expression on monocyte subsets and lymphocytes in Egyptian patients with LPNs.

Methods: A case-control study was conducted at Kafr Elsheikh University Hospitals (January 2024 to January 2025), including 90 patients with LPNs (chronic lymphocytic leukemia, diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma) and 90 matched healthy controls. All participants underwent clinical evaluation, laboratory testing (including complete blood count, C-reactive protein, lactate dehydrogenase, and ferritin), and flow cytometry for PD-L1, PD-1, and CXCR3. Inflammatory indices (SII, SIRI, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and ferritin-to-lymphocyte ratio) were calculated. Clinical outcomes included remission, recurrence, and survival.

Results: Patients with LPNs had marked hematological and biochemical alterations, including anemia, thrombocytopenia, and reduced neutrophils, with significantly elevated lactate dehydrogenase, C-reactive protein, ferritin, and systemic inflammatory indices (SII, SIRI). Inflammatory ratios (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio) were lower, whereas the ferritin-to-lymphocyte ratio was higher compared with controls. Immune profiling showed significantly increased PD-L1/CXCR3 and PD-1/CXCR3 co-expression and higher CXCR3 expression on T lymphocytes. Post-treatment, PD-L1/CXCR3, CXCR3/T lymphocyte expression, SII, and SIRI decreased. Prognostic evaluation revealed that SIRI, PD-L1/CXCR3, and PD-1/CXCR3 had high accuracy for identifying stage IV disease, with patients showing low baseline levels achieving superior survival (100% follow-up). Clinically, 21.1% achieved complete remission, 26.7% relapsed, and 15.6% died.

Conclusion: PD-L1/PD-1 co-expression with CXCR3, combined with SII and SIRI, constitutes a practical prognostic panel for staging and outcome prediction in Egyptian patients with LPNs. These biomarkers may guide personalized management and therapeutic monitoring.

Background: Myeloid sarcoma (MS) is a rare hematological malignancy that may be associated with myelodysplastic or myeloproliferative neoplasms. Herein, we report a case of transformation from myelofibrosis to MS.

Case summary: A 56-year-old male patient was found to have multiple bone lesions by the pelvic magnetic resonance imaging. Pathological analysis of the lesions indicated a myeloid tumor, and immunohistochemistry revealed a TP53 mutation. Bone marrow aspiration was consistent with myelofibrosis. Based on the patient's history of polycythemia and the immunohistochemical findings of the surgically resected lesions, a transformation from a myeloproliferative neoplasm to MS was suggested. The patient developed hematological toxicity after receiving chemotherapy with idarubicin plus cytarabine, and treatment was subsequently adjusted to ruxolitinib combined with venetoclax. However the patient exhibited suboptimal treatment response.

Conclusion: Cases of myelofibrosis transforming into MS are extremely rare. The TP53 mutation is a key molecular marker associated with poor tumor prognosis. Because it can be easily mistaken for other tumors, it is crucial to perform relevant examinations and establish a clear diagnosis as early as possible. This facilitates the timely formulation of an appropriate treatment plan and may help prolong the patient's life.

The immunosuppressive tumor microenvironment (TME) of oral squamous cell carcinoma (OSCC) is marked by hypoxia, acidity, and abundant stromal cells, such as cancer-associated fibroblasts, tumor-associated macrophages, and myeloid-derived suppressor cells, along with factors such as tobacco and alcohol exposure, human papillomavirus infection, and microbial imbalance that drive immune evasion and poor immunotherapy responses. This review critically evaluated nanotechnology-driven strategies for reprogramming the OSCC TME, focusing on overcoming immunosuppression, hypoxia, stromal barriers, and OSCC-specific challenges to enhance immunotherapy outcomes. Personalized nanotherapies guided by TME profiling, combination with radiotherapy/chemotherapy, and theranostic nanoparticles show promise despite manufacturing/regulatory challenges. Nanotechnology enables transformative TME reprogramming to potentiate OSCC immunotherapy, necessitating interdisciplinary research and clinical validation.

Background: Early-onset colorectal cancer (EOCRC) is an aggressive malignancy with rising incidence and poor prognosis in young adults. Circulating immune cells may hold prognostic value, yet their role in EOCRC outcomes remains unclear.

Aim: To develop machine learning-based prognostic models using peripheral immune markers in a retrospective cohort of EOCRC patients.

Methods: A cohort of 123 EOCRC patients undergoing radical resection, from January 2017 to December 2020 was included. Data were extracted from medical records with a follow-up till July 2025. Blood samples were processed for flow cytometry to assess immune markers.

Results: Univariable screening identified disease stage and CD16+CD56+ natural killer (NK) cell percentage as top predictors. A parsimonious Cox model integrating stage and high NK cells outperformed random survival forests (concordance index 0.693 vs 0.256). High-risk patients (stage III/IV, high NK cells) had inferior 5-year progression-free survival (61.2%; 95% confidence interval: 49.0-76.5) vs low-risk (86.4%; 95% confidence interval: 78.9-94.6; log-rank P = 0.001). Time-dependent areas under the curve ranged from 0.671 to 0.693, with robust calibration.

Conclusion: This two-factor model offers moderate accuracy for personalized EOCRC risk stratification, highlighting systemic NK cell dysfunction as a potential immunotherapy target. External validation is warranted.

Background: Long-term proton pump inhibitor (PPI) therapy is widely prescribed for acid-related disorders. Emerging evidence associates prolonged use with potential adverse outcomes, including gastric cancer. Despite increasing prescriptions, little is known about patients' awareness of these risks or factors influencing discontinuation. We hypothesized that limited risk awareness and family support significantly affect patients' willingness to deprescribe PPIs.

Aim: To evaluate patients' awareness of PPI risks and factors associated with deprescribing.

Methods: A cross-sectional observational study was conducted in community clinics and pharmacies across Israel, including 3000 adult PPI users recruited consecutively. Participants completed a multilingual survey (Hebrew, Arabic, Russian) assessing risk awareness, family support, and quality of life. A composite risk scale (0-12) was used to quantify perceived cancer risk. Descriptive statistics and multivariate logistic regression were performed to identify factors associated with high-risk awareness and willingness to discontinue PPIs.

Results: Among 3000 participants, fatigue occurred in 20%, constipation in 31.3%, infections in 9.3%, renal issues in 4.6%, and no side effects in 12.5%. Pantoprazole cancer-risk perception was 26.5%. Overall, 30% desired to discontinue PPIs and 15% reported symptom recurrence. High composite risk score (≥ 2) was associated with family support [odds ratio (OR) = 1.9, 95% confidence interval (CI): 1.3-2.8; P < 0.01] and longer PPI use (> 1 year; OR = 1.6, 95%CI: 1.1-2.4; P = 0.02). Attempted discontinuation correlated with high-risk score (OR = 2.1, 95%CI: 1.5-3.0; P < 0.001).

Conclusion: Patients show limited awareness of long-term PPI risks. Family support and longer treatment duration are strongly associated with higher risk awareness and willingness to discontinue PPIs.