World journal of clinical oncology最新文献

Over the past century, dietary intake of linoleic acid (LA), an essential omega-6 fatty acid, has risen markedly in industrialized regions, largely due to industrial seed oils (e.g., soybean oil). This trend parallels increased cancer incidence, though causality remains unestablished. LA's susceptibility to oxidation may generate reactive species, such as 4-hydroxynonenal, potentially inducing oxidative stress and lipid peroxidation in cellular membranes. Furthermore, excess LA might elevate pro-inflammatory eicosanoid levels (e.g., prostaglandin E2) and disrupt gut microbiota, fostering dysbiosis and immune dysregulation. Evidence, however, derives primarily from preclinical studies, with limited human data but epidemiological signals are strongest for breast (age-standardized incidence, approximately 130/100000 women), colorectal (approximately 39/100000), prostate (approximately 112/100000 men) and cutaneous melanoma (approximately 26/100000) cancers, where higher LA biomarkers or intakes have been repeatedly observed. Ketogenic diets, historically prioritized for metabolic benefits, reduce blood glucose, an effect possibly beneficial in cancer contexts, but may impair gut health by restricting fermentable fiber, potentially decreasing short-chain fatty acid production. This review explores LA's hypothetical role in cancer-related pathways and the trade-offs of carbohydrate restriction. A proposed "terrain restoration" protocol, emphasizing reduced LA intake, gradual carbohydrate reintroduction to support microbiota, and nutrients like pentadecanoic acid (C15:0) for mitochondrial function, lacks clinical validation. While optimizing diet to bolster metabolic and immune resilience holds promise for cancer prevention, rigorous research is essential.

This editorial discusses an article by Liu et al, which focuses on the development and evaluation of a modified scoring model incorporating the waist-to-hip ratio for predicting advanced colorectal neoplasia (ACN). This editorial provides an overview of the study, including the background of ACN risk prediction, the study design, key findings, and the significance and limitations of the new model. The study identified independent risk factors for ACN and developed a 7-point scoring model with better predictive performance than existing models. However, challenges, such as generalizability across ethnic groups and selection bias, exist. Further research involving multi-ethnic cohorts and the integration of novel biomarkers is needed to improve the model and its clinical application.

Background: Peritoneal metastases (PM) represent the most frequent and lethal form of dissemination in advanced gastric cancer (GC), with limited efficacy of systemic chemotherapy [median overall survival (OS): 2-9 months]. Over the past decades, hyperthermic intraperitoneal chemotherapy (HIPEC), often combined with cytoreductive surgery (CRS), has emerged as a locoregional strategy to improve peritoneal disease control. Retrospective studies have suggested promising survival benefits (median OS: 18.8 months); however, conflicting results from prospective trials have limited its widespread adoption. This systematic review hypothesizes that selected patients with advanced or high-risk GC may benefit from HIPEC and evaluates whether such benefits have been confirmed in recent prospective evidence.

Aim: To evaluate the role and outcomes of HIPEC in advanced and high-risk GC through a systematic review of prospective trials.

Methods: A systematic review of prospective randomized and controlled clinical trials (2010-2024) was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Studies were selected from PubMed, Cochrane, Scopus, and ClinicalTrials.gov. No geographical restrictions were applied in the search process. Eligible studies included patients with advanced GC (T3+, positive peritoneal cytology/PM) receiving HIPEC in either therapeutic or prophylactic settings. Exclusion criteria included retrospective studies, single-arm trials, and those lacking survival outcomes. Risk of bias was assessed using Risk of Bias 2.0 and Risk of Bias in Non-Randomized Studies of Interventions tools; sensitivity and heterogeneity analyses were also conducted.

Results: Thirteen prospective studies (eight therapeutic, five prophylactic) were included. In therapeutic settings, CRS combined with HIPEC yielded a median OS of 11-24.9 months vs 4-6 months with systemic therapy alone. Completeness of cytoreduction (CC-0) was achieved in 67.3% of cases, and associated with improved disease-free survival. In prophylactic settings, HIPEC significantly reduced peritoneal recurrence, particularly in T4 tumors. Sensitivity analyses confirmed robustness of findings, though benefit was driven by a few key trials. Heterogeneity was moderate across studies; lack of standardized HIPEC protocols and patient selection criteria limited comparability.

Conclusion: HIPEC may improve survival and reduce recurrence in selected GC patients, particularly those with low peritoneal burden and CC-0 resection. Further standardization and prospective trials are needed.

Estrogens are a group of steroid hormones produced by ovary, placenta, and other organs. They have historically been associated with female reproduction, but according to current evidence estrogens regulate also male reproductive and nonreproductive organs. Estrogens play a crucial role in female reproductive development and maintenance either directly by increasing glycogen levels, epithelial thickness and mucus secretion or indirectly, by decreasing vaginal pH through the maintenance of lactobacilli dominance and lactic acid production. Several studies demonstrated that dysbiosis and/or specific bacteria could have impact on the development of sex-hormone driven cancers such as endometrial, cervical, ovarian, breast and prostate cancers, through mechanisms involving modulation of estrogen metabolism. This modulation is realized through secretion of β-glucuronidase which deconjugates estrogens into their active forms. When gut dysbiosis occurs, microbial diversity decreases and so the deconjugation diminishes leading to a decrease of circulating estrogens. Low levels of circulating estrogen may adversely affect a wide range of physiological factors, with clinical implications especially for gut health. In this review, we discuss the different aspects of the critical interplay between gut microbiome and estrogens in sex-hormone driven cancers and the potential outcomes on their clinical management.

Background: Bone is the most common site of metastasis in breast cancer, yet limited data exist regarding the precise anatomical distribution of bone metastases by tumor subtype.

Aim: To examine the anatomical distribution of the first bone metastases in stage IV breast cancer, stratified by histological subtype. Secondary objectives include analyzing the anatomical distribution of subsequent bone metastases, Metastasis-Free Survival (MFI), Progression-Free Interval (PFI), and overall survival (OS).

Methods: A retrospective cohort study was conducted on 107 adult females with stage IV breast cancer and bone metastases between 2013 and 2023. Patients were classified by histological subtype (Luminal A/B, HER2-enriched, and Triple-Negative). First and subsequent bone metastasis locations were identified via computed tomography, positron emission tomography/CT, or magnetic resonance imaging. Survival analyses included MFI, PFI, and OS.

Results: Rib metastases were significantly more common in HER2-enriched tumors (80%, P = 0.041), while scapula/clavicle metastases were more prevalent in Triple-Negative cases (37.5%, P = 0.003). Subsequent bone metastases mirrored initial patterns, with pelvic involvement notably higher in HER2-enriched (60%) and luminal B (58%) patients (P = 0.046). No significant differences were found in MFI, PFI, or OS among subtypes. Receptor-based analysis showed no significant variation in bone metastasis locations.

Conclusion: Breast cancer subtypes are associated with suggestive bone metastasis patterns-specifically, rib involvement in HER2-enriched and scapula/clavicle in Triple-Negative cases. While anatomical variations exist, they did not translate into differential survival or fracture risk in this cohort.

The Zhang et al's study addresses an important clinical question of timing and role of salvage surgery post-downstaging procedures in patients with advanced hepatocellular carcinoma wherein different modalities like trans arterial chemoembolization, tyrosine kinase inhibitors, and anti-programmed cell death 1 antibodies have been used as downstaging procedure. Although proper selection of patients is a pre-requisite for salvage related liver failure.

Background: Hereditary factors are more prevalent in early-onset colorectal cancers (EOCRC) etiology. Lynch syndrome (LS) is the most common hereditary colorectal cancer (CRC) syndrome that results from mutations in DNA mismatch repair (MMR) genes. This phenomenon is defined as microsatellite instability (MSI). Immunohistochemistry (IHC) is a widely used, practical, and cost-effective method for the screening of MSI. However, using IHC alone may be insufficient to identify patients with MSI and LS.

Aim: To determine the clinicopathological features in EOCRC, IHC performance, and the frequency of genetic testing for EOCRC patients.

Methods: A retrospective review was conducted on patients with CRC aged ≤ 50 years who underwent surgery at our center between January 2014 and July 2021. MMR proteins were screened using IHC. Of the 131 patients included, IHC was performed on 130. Patients were classified as MSI or microsatellite-stable (MSS), and their features were compared. Additionally, data from patients who received genetic counseling were analyzed.

Results: Thirty patients with MSI were designated as group 1, whereas 100 with MSS were defined as group 2. The mean age in group 1 was the lowest (median age: 42 vs 46, P < 0.05). Group 1 exhibited a higher frequency of tumors in the right colon and a lower frequency in the rectum. Lymph node involvement and distant metastases were less common in group 1, and in group 2, tumors were generally diagnosed at a more advanced stage. Genetic testing was performed in 53 patients (40%), with a definitive LS diagnosis established in 13/17 patients (76.4%) in group 1 and 1/36 (2.7%) patients in group 2, resulting in a total of 14 patients (26.4%) with confirmed LS.

Conclusion: MSI tumors show a better prognosis. IHC is very effective for screening MSI, but may not be sufficient alone. Low genetic counseling rates highlight the need for hospital-based surveillance programs.

Background: Upper gastrointestinal cancer (UGIC), including esophageal and gastric cancers, poses a major global health challenge due to its high morbidity and mortality. During the preoperative period, patients often face functional decline, malnutrition, and psychological stress, which can impair recovery. Prehabilitation, a multidisciplinary preoperative intervention, shows promise in optimizing patients' physical and mental status.

Aim: To evaluate the impact of prehabilitation on patients undergoing UGIC surgery and provide a basis for implementation of the prehabilitation compound plan.

Methods: A computerized search of databases including Web of Science, PubMed, EMBASE, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, Wanfang, and Chinese Science and Technology Journal Database was used to collect clinical trials on the impact of prehabilitation on patients undergoing UGIC surgery. After screening, a meta-analysis was conducted using Review Manager 5.0 software, and linear regression analysis was performed on the prehabilitation duration and outcome indicators.

Results: A total of 13 clinical trials were ultimately included, with 8 literature quality evaluations at A level and 5 literature quality evaluations at B level. The meta-analysis results showed that compared with conventional nursing, the prehabilitation group had higher six-minute walk distance, lower postoperative complications and mortality rates, and shorter hospital stays, with statistically significant differences; there were no statistically significant differences in intensive care unit monitoring time and albumin levels between the two groups; regression analysis between prehabilitation duration and outcome indicators showed no significant relationship.

Conclusion: Prehabilitation can improve the perioperative functional ability of patients with UGIC and promote postoperative recovery, but its impact on nutrition, psychology, and quality of life needs to be further explored through more high-quality trials; in addition, further research is needed on the prehabilitation time, location, and specific plan.

Serological screening, endoscopic imaging, morphological visual verification of precancerous gastric diseases and changes in the gastric mucosa are the main stages of early detection, accurate diagnosis and preventive treatment of gastric precancer. Laboratory - serological, endoscopic and histological diagnostics are carried out by medical laboratory technicians, endoscopists, and histologists. Human factors have a very large share of subjectivity. Endoscopists and histologists are guided by the descriptive principle when formulating imaging conclusions. Diagnostic reports from doctors often result in contradictory and mutually exclusive conclusions. Erroneous results of diagnosticians and clinicians have fatal consequences, such as late diagnosis of gastric cancer and high mortality of patients. Effective population serological screening is only possible with the use of machine processing of laboratory test results. Currently, it is possible to replace subjective imprecise description of endoscopic and histological images by a diagnostician with objective, highly sensitive and highly specific visual recognition using convolutional neural networks with deep machine learning. There are many machine learning models to use. All machine learning models have predictive capabilities. Based on predictive models, it is necessary to identify the risk levels of gastric cancer in patients with a very high probability.

Background: Multiple primary cancers refer to the presence of two or more distinct malignant tumors in a single individual, either simultaneously or sequentially. The synchronous occurrence of cholangiocarcinoma (CCA) and cervical squamous cell carcinoma (SCC) is extremely rare. This case highlights the diagnostic challenges and significance of a multidisciplinary team in managing complex malignancies involving both the hepatobiliary and gynecologic systems. The 8^th edition of the American Joint Committee on Cancer staging system was as follows: T1aN0M0 intrahepatic CCA; the 2018 edition of the International Federation of Gynecology and Obstetrics staging system was stage IB1 cervical SCC.

Case summary: A 74-year-old postmenopausal woman (Karnofsky performance status = 80) presented with a one-day history of vaginal bleeding. Cross-sectional imaging (contrast-enhanced computed tomography, liver magnetic resonance imaging, and positron emission tomography/computed tomography) first demonstrated a single 3-cm lesion in liver segment V and a hypermetabolic cervical mass. Subsequent ultrasound-guided liver biopsy confirmed CCA, whereas cervical biopsy revealed SCC. After multidisciplinary discussion, the patient underwent laparoscopic liver resection. Pelvic external-beam radiotherapy was delivered at 45 grays in 25 fractions (6-megavolt photons) over 5 weeks, followed by high-dose-rate ¹⁹²Ir intracavitary brachytherapy, at 35 grays in 7 fractions (International Commission on Radiation Units and Measurements A-point). She received eight cycles of systemic therapy with lenvatinib, capecitabine, and camrelizumab. Over a 12-month follow-up, she remained disease-free with no signs of recurrence or metastasis.

Conclusion: Multidisciplinary management offers a promising strategy for treating synchronous complex malignancies with individualized treatment plans.