Pancreatic cancer remains a highly lethal malignancy, primarily due to late-stage diagnosis. Current screening paradigms, which focus exclusively on high-risk individuals, leave the vast "low-risk" population unscreened. This conventional binary risk stratification, based predominantly on family history and known genetic syndromes, fails to incorporate emerging risk dimensions such as polygenic risk scores, lifestyle factors, and novel biomarkers. We propose a paradigm shift from this static model towards a dynamic, multidimensional risk stratification framework. By integrating genetic susceptibility (e.g., newly identified variants in NOC2L, HNF4G), lifestyle metrics (e.g., new-onset diabetes), and liquid biopsy biomarkers (e.g., circulating tumor DNA, carbohydrate antigen 19-9 dynamics), we can reclassify a subset of "low-risk" individuals who may benefit from targeted screening. The integration of artificial intelligence for prospective validation, as seen in ongoing trials, is crucial for implementing this approach.
Background: Patients with esophageal cancer exhibit marked variability in prognosis, highlighting the need for metabolism-related biomarkers. Although metabolic reprogramming is considered to be correlated with the prognosis of patients with esophageal squamous cell carcinoma (ESCC), its specific association mechanisms remain unclear.
Aim: To explore the triglyceride-glucose (TyG) index and its derivatives - indicators for insulin resistance, a core feature of metabolic syndrome. Given their controversial associations with cancer and limited research on their dynamic changes in ESCC patients post-treatment, this study aims to analyze these dynamic changes.
Methods: The present retrospective study analyzed 360 East Asian patients with ESCC who received definitive chemoradiotherapy to explore the associations of TyG, TyG-body weight, and TyG-body mass index (both pre- and post-treatment) with overall survival.
Results: Elevated levels of post-treatment TyG and its derivatives (postTyG, postTyG-body weight, postTyG-body mass index) were significantly associated with a reduced risk of death, showing a superior prognostic value compared to the baseline levels (preTyG). Restricted cubic spline analysis confirmed the presence of non-linear or monotonic associations, with more pronounced correlations observed in male patients.
Conclusion: Post-treatment TyG and its derivatives may serve as independent prognostic indicators for East Asian patients with ESCC, providing a basis for personalized diagnosis and treatment.
Transarterial chemoembolization is a common treatment modality that significantly improves prognosis in patients with intermediate-advanced hepatocellular carcinoma. However, this procedure is associated with a spectrum of potential arterial and biliary complications, ranging from mild self-limiting ones to those severely affecting patient outcomes. This review systematically integrates recent studies to explore the epidemiological characteristics, risk factors, and management strategies of these two groups of complications. Arterial complications, primarily hepatic artery stenosis, pseudoaneurysm, and arterial rupture hemorrhage, exhibit a biphasic distribution pattern with the majority occurring within 72 hours postoperatively, while a notable portion occurs within 1-4 weeks. Biliary complications, including biliary fistulas, biliary strictures, and ischemic cholangitis, exhibit higher incidence rates and more insidious clinical manifestations than arterial complications. Risk factors include the severity of cirrhosis, tumor location, procedural technique, and chemotherapeutic drug toxicity. Management strategies emphasize careful preoperative planning (primarily with computed tomography angiography), standardized intraoperative procedures (like superselective embolization), and multi-pronged postoperative monitoring (imaging combined with laboratory indicators of liver function). Interventional embolization or surgical reconstruction is used for arterial complications, while endoscopic therapy or surgical drainage is selected based on the severity of injury for biliary complications. Future research should further explore individualized treatment regimens and novel embolic materials to reduce complication rates and enhance the safety of transarterial chemoembolization.
Background: The technical complexity and potential for complications associated with endoscopic submucosal dissection (ESD) pose limitations on the widespread use of this procedure for stage 1 rectal neuroendocrine tumors (NETs), despite its high success rate in achieving complete resection (R0).
Aim: To examine the results of ESD and hybrid ESD, a simpler adaptation of the ESD technique, for stage 1 rectal NETs.
Methods: Seventy-nine patients with 84 lesions of clinical stage 1 rectal NETs who received treatment at Sun Yat-sen University Cancer Center from January 2010 to June 2021 were reviewed retrospectively.
Results: Sixty-one lesions in 58 patients were treated with ESD, while 23 in 21 patients were treated with hybrid ESD. The 84 rectal NETs had a median diameter of 8 (5) mm (range, 3-20 mm), with the median lesion size 8 (5) mm for ESD and 8 (4) mm for hybrid ESD (P = 0.359). For ESD, the median duration of procedure was 46.00 (14.00) minutes, while for hybrid ESD, it was 32.00 (15.00) minutes (P < 0.001). Both the ESD and hybrid ESD groups had identical rates of en bloc resection (100.00% vs 100.00%, P = 1.000), R0 resection (86.89% vs 86.96%, P = 1.000), perforation (1.64% vs 0.00%, P = 1.000), and delayed bleeding (1.64% vs 4.35%, P = 0.475). After a median of 27.50 (30.00) months of observation, neither group had recurrence.
Conclusion: For endoscopic excision of stage 1 rectal NETs, both ESD and hybrid ESD were well tolerated and produced positive results, with similar efficacy and safety.
The consumption of ultra-processed foods (UPFs) is continuously increasing, and there is growing evidence that these foods contribute to the development and progression of cancer. For oncology patients alone, maintaining nutritional status is crucial for tolerating treatments and improving survival. The aim of this paper is to review the role of UPFs in the diet of oncology patients, highlighting their potential health-damaging effects (e.g., increased inflammation, microbiome disruption, nutrient deficiencies) and potential benefits (e.g., easy accessibility, high energy content, specially formulated nutritional supplements) particularly in the context of addressing the energy and nutrient needs and nutritional challenges of patients experiencing cancer-related cachexia or anorexia. Using a literature review, we examine how the UPFs can impact oncology patients' health, supporting the quality of life and clinical outcomes of oncology patients.
Chemoresistance remains a major challenge in non-small cell lung cancer, especially for cisplatin (DDP)-based therapies, which are a mainstay of treatment. In their study, Dai et al investigate how inflammatory cytokines within the tumor microenvironment contribute to DDP resistance. By analyzing tumor samples from 20 non-small cell lung cancer patients and two resistant cell lines (A549/ DDP and SK-MES-1/DDP), the authors show that increased levels of interleukin (IL)-6, IL-8, and tumor necrosis factor-α are linked to resistance. Logistic regression identifies IL-6 and IL-8 as key risk factors. Functional experiments using tocilizumab, an IL-6 receptor antagonist, demonstrate a reduction in DDP half maximum inhibitory concentration, higher apoptosis rates, and decreased migration and invasion in resistant cells. Although the study has certain limitations, such as the analysis of only five inflammatory cytokines in a small, non-stratified patient cohort; it demonstrates that targeting the IL-6 cytokine axis may help overcome DDP resistance. Overall, the study highlights the inflammatory component of the tumor microenvironment as a modifiable driver of chemoresistance and provide a rationale for integrating cytokine blockade into platinum-based chemotherapy regimens to enhance therapeutic response.
Background: The purpose of this paper is to demonstrate a practical stem cell collection method that provides sufficient stem cells for autologous stem cell transplantation (ASCT) in multiple myeloma (MM) patients despite low peripheral CD34 (pCD34) counts and to describe the benefits of this method for MM patients with limited resources.
Aim: To demonstrate a practical method for stem cell collection.
Methods: Stem cell collection data on the last 300 patients at a community cancer center in Washington were reviewed. We report on the methods of collection, including medications used and timing, used by the blood blank as well as their outcomes. The three MM patients with initially very low pCD34 counts all successfully underwent stem cell collection in a single trip to the transplant center for their ASCT.
Results: Three patients whose pre-collection pCD34 counts were the lowest and less than 2.5 cells/μL were identified. These patients had the commonality of having multiple barriers to transportation and likely would have been able to make only one trip for the stem cell collections.
Conclusion: Despite particularly low pre-collection peripheral blood CD34 counts, successful autologous stem cell collection in MM patients is feasible by routinely adding plerixafor to granulocyte-colony stimulating factor on day 4 of mobilization. There is limited analysis demonstrating that sufficient stem cells for one or more transplants can be collected using this method. This practical and novel approach may benefit the high number of MM patients who face limited resources, finances, long travel times, and social support. These results are highly relevant to physicians treating similar patients.
Sirtuin 3 (SIRT3) is a primary mitochondrial deacetylase. Studies have confirmed that it directly activates mitophagy by modulating mitochondrial protein acetylation. As a key homeostatic mechanism, mitophagy activation alleviates oxidative stress-induced imbalance between cell proliferation and apoptosis, corrects stress-driven mitochondrial metabolic dysfunction, and thus inhibits excessive tumor growth, exerting significant antitumor effects. These functions establish SIRT3 as a key target for regulating mitophagy and cancer therapy. Clinically, strategies centered on its precise regulation may offer a novel direction for gastric cancer (GC) prevention and treatment, with selective activation remaining a critical challenge. SIRT3 could also serve as an auxiliary indicator in clinical guidelines for assessing tumor progression. Given this potential, this mini-review systematically examines SIRT3's mechanisms in regulating mitophagy, its role in GC pathogenesis, and translational prospects for targeting SIRT3 in GC management.
Background: Anaplastic lymphoma kinase (ALK) gene fusion is a molecular subtype of non-small cell lung cancer, representing 4%-6% of lung adenocarcinomas. Axillary lymph node (ALN) metastasis from lung cancer is rare, and massive bleeding from such lesions is an even more unusual and life-threatening complication. This case demonstrates how localized radiotherapy can be used as an effective hemostatic and tumor-controlling measure when conventional interventions fail.
Case summary: A 48-year-old male presented in October 2019 with ALK-positive lung adenocarcinoma and multiple metastases. He received multiple lines of ALK tyrosine kinase inhibitor therapy, whole-brain radiotherapy, stereotactic radiotherapy, chemotherapy, and targeted agents over 4 years and 7 months. In February 2024, rapid enlargement and rupture of a left ALN metastasis caused massive bleeding. Interventional and surgical hemostasis were not feasible. Localized radiotherapy was initiated at 15 Gray in 5 fractions, later increased to a total of 39 Gray in 13 fractions, resulting in rapid bleeding control and partial tumor response. The patient subsequently received chemotherapy, and the axillary lesion healed without recurrent bleeding. However, three months later, he developed severe pneumonia with mixed bacterial, mycobacterial, and fungal infections and died despite intensive care.
Conclusion: Radiotherapy can effectively control bleeding and achieve local tumor control in ALK-positive lung cancer with ruptured ALN metastasis when other treatments are ineffective.
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