World journal of clinical oncology最新文献

Background: Primary testicular lymphoma (PTL) is a rare, aggressive malignancy, representing a small fraction of testicular tumors and non-Hodgkin lymphomas, yet it is the most common testicular malignancy in older men. Diffuse large B-cell lymphoma (DLBCL), which is typically the aggressive subtype, dominates PTL and shows diffuse B-cell infiltration. Venous tumor thrombus, uncommon in lymphomas, is uniquely reported in this case of testicular DLBCL with gonadal vein involvement.

Case summary: A 62-year-old man presented with a two-month history of painless left testicular swelling and stiffness. Diagnostic imaging [ultrasonography, computed tomography (CT), and ¹⁸F-fluorodeoxyglucose positron emission tomography/CT (¹⁸F-FDG-PET/CT)] revealed bilateral testicular masses and a gonadal vein tumor thrombus (SUVmax 16.5). Left orchiectomy confirmed DLBCL with CD20, Bcl-2, and MUM1 positivity (Ki-67: approximately 80%). The disease was staged as Ann Arbor stage IVA (International Prognostic Index score 3, high-intermediate risk). The patient received Rituximab, Polatuzumab Vedotin, Cyclophosphamide, Epirubicin, and Prednisolone chemotherapy, completing the first cycle with good tolerability. No adverse events were reported, and follow-up is ongoing to assess long-term outcomes. This case highlights the diagnostic utility of ¹⁸F-FDG-PET/CT and the importance of multidisciplinary management in rare PTL presentations with tumor thrombus.

Conclusion: This case demonstrates the diagnostic complexities of PTL with gonadal vein tumor thrombus, underscoring the importance of considering lymphoma in elderly patients with testicular masses and venous involvement. A multi-disciplinary team including urologists, hematologists, and radiation oncologists is needed to ensure appropriate therapy.

Background: Cancer survivorship is a growing concern globally, yet few studies have explored the quality of life (QoL) outcomes among survivors in the Middle East, particularly in Saudi Arabia.

Aim: To assess QoL using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and to evaluate the impact of demographic and clinical factors among Saudi cancer survivors.

Methods: We conducted a cross-sectional study of 102 adult cancer survivors recruited from a tertiary hospital in Jeddah, Saudi Arabia. Participants completed the WHOQOL-BREF, which assesses four QoL domains, including physical health, psychological health, social relationships, and environment. Univariate and multivariable robust linear regression models (Huber estimator) were used to identify QoL score predictors, adjusted for key sociodemographic and clinical variables.

Results: The mean participant age was 44.5 years; 72.5% of the participants were female. The mean domain scores were as follows: physical health was 3.05 ± 0.53, psychological health was 3.56 ± 0.79, social relationships was 3.39 ± 0.84, and environment was 3.29 ± 0.74. Socioeconomic and social vulnerability factors, including low income, rental housing, widowed/divorced marital status, and lower education, were independently associated with poorer QoL scores. Residents in rural settings had significantly lower scores in all domains.

Conclusion: Our findings reveal noticeable disparities in QoL among Saudi cancer survivors driven by socioeconomic and demographic factors. These insights underscore the need for context-sensitive survivorship programs in Saudi Arabia, with special attention to social support, mental health, and economic stability.

The gut microbiome plays a pivotal role in immune homeostasis and systemic inflammatory regulation, both of which are critically involved in the pathogenesis and progression of pediatric leukemias. Recent evidence reveals that children with leukemia often exhibit distinct gut microbiome profiles at diagnosis, marked by reduced microbial diversity and the enrichment of pro-inflammatory taxa such as Enterococcus and Streptococcus. This microbial dysbiosis may promote leukemogenesis by disrupting immune regulation and driving chronic inflammation. Chemotherapy significantly alters the gut microbiome, inducing dysbiosis characterized by a loss of beneficial commensals and the dominance of pathobionts. Specific microbial signatures, such as the enrichment of Bacteroides, correlate with reduced inflammation and improved prognosis, underscoring the gut microbiome's prognostic value. Emerging therapies, including dietary adjustments, probiotics, and fecal gut microbiome transplantation, aim to restore microbial balance and reduce treatment-related complications. Moreover, gut microbiome profiling shows potential for identifying biomarkers linked to leukemia predisposition, paving the way for early diagnosis and tailored preventive strategies. This mini-review explores recent advancements in understanding the influence of the gut microbiome on pediatric leukemias, emphasizing its role as both a therapeutic target and a prognostic biomarker. Integrating gut microbiome research into clinical practice may help optimize treatment outcomes and improve quality of life for children with leukemia.

Background: Claudin-6 (CLDN6), a tight junction protein typically restricted to embryonic tissues, is re-expressed in various cancers. However, its prognostic significance in high-grade endometrial carcinoma (HGEC) remains unclear.

Aim: To investigate the expression pattern of CLDN6 in HGEC and assess its correlation with clinicopathological parameters and patient survival.

Methods: Immunohistochemical analysis of CLDN6 expression was performed on formalin-fixed, paraffin-embedded tissues from 80 patients diagnosed with HGEC. Associations between CLDN6 expression and histological subtype, the International Federation of Gynecology and Obstetrics (FIGO) stage, depth of myometrial invasion, lymphovascular space invasion, recurrence, and survival outcomes were statistically analysed. Univariate and multivariate Cox regression models were used to identify independent prognostic factors.

Results: High CLDN6 expression was detected in a subset of HGEC patients and was significantly associated with nonendometrioid histology (P = 0.026), advanced FIGO stage (P = 0.015), deep myometrial invasion (P = 0.038), and recurrence (P = 0.002). While Kaplan-Meier analysis did not reveal a statistically significant difference in disease-free survival or overall survival between the high CLDN6 expression group and the low CLDN6 expression group, multivariate Cox regression revealed that CLDN6 overexpression was an independent predictor of shorter disease-free survival [hazard ratio (HR) = 68.98, P = 0.022] and overall survival (HR = 24.023, P = 0.038).

Conclusion: CLDN6 overexpression is associated with aggressive tumor features and poor clinical outcomes in HGEC, suggesting its utility as a prognostic biomarker and potential therapeutic target.

Organelle integrity and maintenance of protein homeostasis and purpose is essential for fundamental equilibrium and survivability. Autophagy is the primary process which regulates the distribution of different cell loads to lysosomes for destruction and reuse. Extensive research illustrates the protective functions of autophagy against various diseases. Though in cancer, noticeably contrasting functions of autophagy have been evaluated in the prohibition of preliminary tumor evolution vs the continuance and, anabolic and catabolic variations of well-established and invasive tumors. Autophagy possesses numerous roles in tumor microenvironment (TME) establishment and associated immune cells function which is addressed in recent studies. Autophagic machinery which is employed in different autophagy-related pathways contributes to metastatic diseases and are distinct from classical autophagy. Therapeutic strategies based on the inhibition or induction of autophagy and related processes has helped in the designing of efficient anticancer drugs. According to the review, we evaluate and decipher the various purposes of autophagy and its association with autophagy mechanisms in course of tumor development, invasion and progression. We summarize the latest findings involving the role of these activities including tumor cells and TME and define further breakthrough in therapy aiming at autophagic activities in cancer.

Background: Human epidermal growth factor receptor 2 (HER2)-positive gastric cancer (GC) represents a distinct molecular cancer subtype that is often associated with a poor prognosis. While perioperative chemotherapy regimens are currently the primary recommendation for locally advanced HER2-positive GC, combination therapies incorporating immune checkpoint inhibitors are under active investigation.

Case summary: The present case describes a patient with locally advanced HER2-positive GC who underwent perioperative treatment with chemotherapy combined with trastuzumab. Although significant tumor shrinkage was observed, surgical pathology results did not confirm the achievement of a pathological complete response. The current treatment strategies for advanced GC were also reviewed. Relevant case reports, retrospective studies, and prospective clinical trials were retrieved for analysis after searching the PubMed/MEDLINE, EMBASE, Cochrane Library, Web of Science, and American Society of Clinical Oncology/European Society for Medical Oncology conference abstracts between 2014 and 2024.

Conclusion: Large-scale phase III clinical trials are needed to verify the efficacy of combined neoadjuvant treatment application for GC.

Background: Magnetic resonance imaging (MRI) and endoscopic ultrasonography (EUS) are recommended in combination for screening pancreatic cancer in high-risk individuals. However, in clinical practice, MRI and EUS are increasingly utilized for pancreatic surveillance during routine health examinations.

Aim: To investigate the feasibility of these imaging modalities for screening in low-risk individuals.

Methods: This retrospective study included patients at low risk for pancreatic cancer who underwent MRI or EUS at two health evaluation centers between March 2019 and December 2024. Basic characteristics, laboratory data, and imaging results were collected.

Results: A total of 3364 low-risk individuals underwent pancreatic screening: 1553 (46.1%) received MRI, and 1811 underwent EUS. No significant differences were observed in age or sex distribution between the groups. In imaging screening, EUS demonstrated a higher detection rate of abnormal pancreatic lesions (12.8% vs 2.6%; P < 0.001). MRI detected more cystic lesions than did EUS (P < 0.001). EUS identified smaller nodular lesions compared to MRI (9.2 mm vs 18.0 mm; P = 0.044). The MRI group had a higher number of confirmed intraductal papillary mucinous neoplasms (P = 0.031), whereas the EUS group identified more suspected branch-duct intraductal papillary mucinous neoplasms (P < 0.001). Pancreatic adenocarcinoma was found in three patients (0.08%), with no significant difference in detection rates between EUS and MRI (0.11% vs 0.06%; P = 0.656).

Conclusion: In low-risk individuals, MRI and EUS offer comparable effectiveness for pancreatic cancer surveillance. The choice of imaging strategy for health evaluation depends on cost considerations and degree of invasiveness.

Background: Pseudoachalasia mimics primary achalasia in symptoms and diagnostic findings, as observed in gastroscopy and barium swallow studies. However, pseudoachalasia, often associated with malignancies like metastatic breast cancer, requires prompt differentiation to avoid misdiagnosis and inappropriate treatment. This report highlights a rare case of pseudoachalasia secondary to metastatic breast cancer and highlights the diagnostic value of esophageal motility changes.

Case summary: A 52-year-old woman presented with a one-year history of intermittent dysphagia following breast cancer surgery. Initial examinations suggested achalasia, but the patient's high-resolution manometry (HRM) results showed a rapid shift from ineffective esophageal motility to type II achalasia within four months. Further investigations revealed metastatic adenocarcinoma of the cardia, originating from the breast.

Conclusion: In patients with a history of malignancy, rapidly evolving esophageal motility abnormalities should raise suspicion of pseudoachalasia. HRM plays a crucial role in differentiating between primary and secondary achalasia. Early diagnosis through advanced imaging and pathology is essential for proper management.

Background: Dissection of the right paraesophageal lymph node (RPELN) in managing papillary thyroid carcinoma remains a contentious issue. This meta-analysis assesses previously established and novel risk factors associated with RPELN metastasis.

Aim: To evaluate previously established and novel risk factors associated with RPELN metastasis in patients with papillary thyroid carcinoma papillary thyroid carcinoma through a comprehensive meta-analysis.

Methods: We searched MEDLINE (via PubMed), ScienceDirect, Scopus and EMBASE up to December 2024. Studies were assessed using the Newcastle-Ottawa Scale. Statistical analysis was conducted with RevMan version 5.4, using the Q-test and I ²-test for heterogeneity. Sensitivity was evaluated with the leave-one-out method, and publication bias with the Egger regression test and funnel plot.

Results: Of 2444 articles retrieved, 26 were included in our meta-analysis with 16427 patients. The RPELN metastasis rate was 12.98% [95% confidence interval (CI): 12.46%-13.50%]. The pooled results suggested that age < 55 years [odds ratio (OR) = 1.71, 95%CI: 1.35-2.16, P < 0.00001], sex (OR = 0.60, 95%CI: 0.54-0.67, P < 0.00001), tumor size 1 cm (OR = 3.37, 95%CI: 2.69-4.21, P < 0.00001), multifocality (OR = 1.81, 95%CI: 1.49-2.20, P < 0.00001), capsular invasion (OR = 2.94, 95%CI: 2.05-4.20, P < 0.00001), vascular invasion (OR = 2.16, 95%CI: 1.56-2.99, P < 0.00001), extra-thyroid extension (OR = 3.30, 95%CI: 1.82-5.98, P < 0.0001), central lymph node metastasis (OR = 7.77, 95%CI: 4.73-12.76, P < 0.00001), lateral lymph node metastasis (OR = 6.94, 95%CI: 6.11-7.89, P < 0.00001), Hashimoto thyroiditis (OR = 0.79, 95%CI: 0.69-0.92, P = 0.002), micro-calcifications (OR = 2.29, 95%CI: 1.20-4.37, P = 0.01), and echogenicity (OR = 0.62, 95%CI: 0.40-0.98, P = 0.04) should be considered with RPELN metastasis.

Conclusion: The male < 55, tumor size > 1 cm, multifocality, capsular and vascular invasion, extrathyroidal extension, lymph node metastasis, and Hashimoto thyroiditis were significantly associated with RPELN metastasis and should be carefully assessed during dissection.

Chimeric antigen receptor T (CAR-T) cell therapy represents a major advance in cancer immunotherapy, offering targeted treatment options, particularly for hematologic malignancies. This review comprehensively explores the structural evolution, production processes, and cytotoxic mechanisms underlying CAR-T function. Therapy involves engineering autologous T cells with synthetic receptors that allow major histocompatibility complex-independent recognition of tumor-associated antigens. Key structural components such as antigen recognition domains, spacers, transmembrane, and intracellular domains are optimized to enhance specificity, persistence, and cytotoxicity. CAR-T therapy exerts antitumor effects via granzyme-perforin degranulation, Fas/Fas ligand signaling, and cytokine secretion. Over time, the development of second- to fifth-generation CARs has incorporated costimulatory molecules, transcriptional regulation, and logic-gated control to improve efficacy and safety. Additionally, novel engineering strategies such as dual CARs, tandem CARs, SynNotch systems, and universal or inhibitory CARs have expanded antigen targeting and reduced off-tumor toxicity. Emerging gene delivery technologies, including viral vectors, transposons, CRISPR/Cas9, and RNA-based electroporation, are improving CAR-T production. Despite notable clinical success, particularly in CD19- and B-cell maturation antigen-targeted therapies, CAR-T applications face challenges, including cell exhaustion, antigen escape, and therapy-induced toxicities, such as cytokine release syndrome and neurotoxicity. Ongoing efforts in engineering innovation, clinical trials, and regulatory support continue to shape CAR-T therapy into a safer, more precise tool for cancer treatment. This review highlights current advances while outlining the barriers and future prospects of CAR-T immunotherapy.