World journal of clinical oncology最新文献

Gallbladder cancer (GBC) is a lethal biliary tract malignancy, which is infrequent in most developed countries, but common in many developing countries in specific geographical regions of the world. Non-specific symptoms leading to late diagnosis is one of the primary factors contributing to poor prognosis in GBC. An understanding of the complex relationship between molecular genetics and epidemiological variances in the incidence rates of GBC is thus of utmost importance. Present review summarizes recent updates on population-specific dysregulated genetic expressions in the genesis of GBC, highlighting the pattern of ethno-geographic variations and on advances in targeted therapies conducted till date; points out the lacunae that deserve further attention and suggest possible new directions for future clinical trials in GBC. The review calls for the need of genetic screening of each GBC patients and for more extensive clinical trials on targeted therapies to move towards the goal of personalized medicine, bringing about more favourable survival outcomes.

Colon cancer (CC) laterality (right vs left) is recognized as a key determinant of clinical outcomes and treatment decisions in metastatic CC. Right-sided CC (RCC) often presents in older individuals and is associated with higher rates of Kirsten rat sarcoma viral oncogene homolog and v-raf murine sarcoma viral oncogene homolog B1 mutations and deficient mismatch repair, leading to microsatellite instability-high status. Left-sided CC typically presents in younger individuals, demonstrates a more favorable prognosis, and is often Kirsten rat sarcoma viral oncogene homolog/neuroblastoma RAS viral oncogene homolog/v-raf murine sarcoma viral oncogene homolog B1 wild-type, making it more responsive to anti-epidermal growth factor receptor therapy. RCC typically responds poorly to anti-epidermal growth factor receptor agents; however, it may benefit from triplet chemotherapy (5-fluorouracil + leucovorin + oxaliplatin + irinotecan) with or without anti-angiogenic agents. Comprehensive molecular profiling remains challenging in low-resource settings due to limited access to advanced diagnostic tools. This review explores key epidemiological and molecular differences between RCC and left-sided CC. In the absence of complete genomic data, tumor sidedness can be a helpful guide for making treatment decisions. Here, we propose a practical algorithm that integrates basic immunohistochemistry to assess a tumor's mismatch repair status and laterality, potentially facilitating therapy selection in resource-constrained environments. Recognizing laterality-specific trends in prognosis and treatment response can improve personalized care and outcomes for patients with CC in these environments, highlighting the essential role of cost-effective biomarker strategies.

Non-coding RNAs, which do not encode proteins, significantly influence signal regulation. Circular RNAs (circRNAs), produced through a post-splicing mechanism, constitute a recently identified subset of non-coding RNAs distinguished by their multifunctional covalently closed loop structures. With an in-depth exploration of circRNAs' biological characteristics, their potential roles in gastrointestinal cancer have garnered significant attention. CircRNAs can significantly influence tumor initiation and progression. This review consolidates recent research progress on circRNAs in digestive system cancers such as esophageal, gastric, hepatic, pancreatic, and colorectal cancer. We explore the potential of circRNAs as biomarkers and therapeutic targets, alongside their roles in immune modulation and chemoresistance. This review seeks to offer a thorough understanding of circRNAs' implications in digestive system tumors by outlining the current research landscape and identifying existing challenges, thereby encouraging further exploration in this emerging field.

Molecular profiling of biliary tract cancers (BTCs) has paved the way for a broader range of therapeutic options, leading to improved survival outcomes. Given the challenges of tissue evaluation in BTCs, circulating tumor DNA (ctDNA) has emerged as a promising non-invasive biomarker for genomic profiling. Bile has been proven to be a reliable ctDNA source, demonstrating higher concordance with tumor tissue than plasma. More importantly, ctDNA provides valuable insights into both clonal evolution and treatment response, including the detection of resistance mechanisms and mutation clearance, which are often associated with disease control. Although its role in recurrence monitoring remains investigational, early studies suggest that ctDNA detection may precede radiological recurrences. This review examines recent advancements in ctDNA analysis for patients with BTC, highlighting key developments, current clinical implications, and ongoing challenges. Large-scale prospective studies are needed to validate the clinical utility of ctDNA and to support its integration into BTC management.

Treatment delays during radiotherapy for head and neck cancer (HNC) are a well-established factor negatively affecting clinical outcomes, with similar trends observed in other cancers. In this first part of a two-part review, we assessed the impact of overall treatment time (OTT) prolongation on locoregional control (LRC) and survival (SV) in cervical cancer (CC), prostate cancer (PC), and anal cancer (AC), while updating evidence for HNC. A comprehensive literature search was performed in evidence-based databases, including MEDLINE, identifying studies evaluating the relationship between OTT prolongation and outcomes. Particular attention was paid to the strength of evidence, distinguishing univariate analysis from multivariate analysis (MV-An). For CC, 37 articles were identified, with 88.8% reporting a detrimental impact on LRC and/or SV, mostly supported by MV-An. In AC, 15 studies were found, with 33.3% showing negative impacts, although with weaker evidence. For PC, 12 articles were reviewed, with 66.6% demonstrating detrimental effects mainly on LRC or biochemical control, and occasional associations with cancer-specific SV. Recent studies in HNC reinforced prior findings. When available, radiobiological parameters and practical recommendations are provided. In conclusion, strong evidence confirms that prolonged OTT worsens outcomes in HNC and CC, with less consistent but relevant effects in PC and AC.

Significant progress has been made in cancer control in China over the past decades, but one of the crucial issues remains the low proportions of early-stage diseases among the leading cancers. Subnational cancer control in China has diverse and specific features, especially in rural areas, where needs support to improve screening accessibility and medical intervention quality. Using cancer registry data from Yibin for a subnational observational study, urban-rural disparities in cancer incidence, mortality, and mortality indexes were analyzed. The crude incidence of all-site cancers was higher in urban districts. The crude mortality of all-site cancers was comparable between urban and rural areas, but the mortality index of all-site cancers was higher in rural areas. Awareness of cancer control both among public healthcare providers and the public should be enhanced to improve the early detection of cancers. In particular, more facilitated medical education and public health education are needed to improve domestic awareness of cancer control and increase the public awareness rate of core knowledge on cancer control. Massive and opportunistic screening and surveillance of high-risk subpopulations require more comprehensive encouragement and greater compliance. Therefore, increasing the detection rate of early-stage cancers is of paramount importance to substantially improve cancer survival rates in China.

Background: Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality worldwide. Despite improvements in surgical techniques and systemic therapies, long-term outcomes after liver resection are limited by high recurrence rates. While adjuvant strategies have shown limited benefit, the role of neoadjuvant immunotherapy in resectable HCC is still under investigation.

Aim: To assess the efficacy, feasibility, and safety of neoadjuvant immunotherapy in resectable HCC through a meta-analysis of current literature.

Methods: A systematic search was conducted across PubMed, Web of Science, EMBASE, Cochrane Library, and Scopus for studies published in the past five years evaluating neoadjuvant immunotherapy in resectable HCC. Primary endpoints included major pathological response (MPR), pathological complete response (pCR), overall response rate (ORR), resection rate, and grade 3-4 treatment-related adverse events (TRAEs). A random-effects meta-analysis was conducted using log odds ratios (ORs) and pooled event rates were calculated to provide absolute estimates of clinical endpoints.

Results: Twelve studies were included in the final analysis. The pooled ORs were 0.28 (95%CI: 0.19-0.41) for MPR, 0.54 (95%CI: 0.25-1.14) for ORR, 0.26 (95%CI: 0.11-0.66) for pCR, 5.37 (95%CI: 2.70-10.66) for resection rate, and 0.33 (95%CI: 0.22-0.50) for grade 3-4 TRAEs. Corresponding pooled event rates were 19% for MPR, 35% for ORR, 22% for pCR, 81% for resection feasibility, and 19% for severe TRAEs.

Conclusion: Neoadjuvant immunotherapy appears to be a feasible and safe approach in patients with resectable HCC, achieving moderate pathological responses and high resection rates.

Background: Human epidermal growth factor receptor 2 (HER2) plays pivotal roles in cellular proliferation, survival, and differentiation of several malignancies. Upper tract urothelial carcinoma (UTUC) is a relatively rare malignancy. The clinical and molecular significance of HER2 expression level in UTUC remains poorly characterized vs bladder cancer.

Aim: To comprehensively evaluate HER2 expression patterns and their association with UTUC patients' clinicopathological features.

Methods: Data were retrospectively collected from patients diagnosed with UTUC at The First Affiliated Hospital of Guangxi Medical University between January 2023 and December 2024. HER2 status was evaluated by immunohistochemistry in 145 UTUC patients who met the inclusion criteria. Its associations with tumor grade, tumor stage, and other clinicopathological parameters were assessed. The χ ² test or Fisher's exact test, along with univariate and multivariate logistic regression analyses, were performed to determine the influences of clinicopathological factors on HER2 expression.

Results: HER2 positivity was significantly associated with high tumor grade (P = 0.003), while other variables, including sex, anatomical tumor location, pathological T stage, Ki-67 proliferation index, nodal metastasis status, lymphovascular invasion, and tumor laterality failed to demonstrate statistically significant correlations. These findings were further substantiated through univariate logistic regression modeling, yielding an odds ratio of 3.56 [95% confidence interval (CI): 1.30-9.75; P = 0.013] for the association between high tumor grade and HER2 positivity. Importantly, this relationship remained robust (hazard ratio = 3.42, 95%CI: 1.22-9.60; P = 0.019) even after implementing multivariate logistic regression analysis. With a median follow-up time of 8 months (interquartile range, 4-14) months, 14 patients experienced intravesical recurrence after radical nephroureterectomy. Certain patient characteristics, such as HER2-negative, male sex, high-grade tumors, and luminal phenotype, were associated with a higher risk of intravesical recurrence.

Conclusion: In UTUC, HER2 overexpression is closely associated with tumor dedifferentiation (high grade), while it does not correlate with conventional indicators of disease progression, indicating that HER2 may serve a distinct biological function in this cancer type.

Gastric carcinoma is a leading cause of cancer-related mortality worldwide, yet reliable noninvasive biomarkers for its early detection remain limited. As research continues to elucidate the inflammatory underpinnings of tumor initiation and progression, it has become increasingly clear that pro-inflammatory cytokines may hold promise as diagnostic adjuncts. Serum cytokines such as interleukin (IL)-1β, IL-6, IL-8, and interferon-gamma have been frequently reported as elevated in gastric cancer patients compared to healthy individuals. These molecules, known for their roles in modulating tumor-promoting inflammation, angiogenesis, and immune evasion, may serve as accessible indicators of disease presence or progression. Several studies have shown that individual cytokines, particularly IL-6 and IL-8, can achieve receiver operating characteristic curves and area under the curve values exceeding 0.70, suggesting reasonable diagnostic utility. We assess the comparative utility of individual cytokines versus multiplex panels, evaluate their roles in tumor biology and treatment resistance, and situate these findings within the broader inflammatory biomarker landscape. Limitations of the current literature, including small sample sizes, heterogeneity in study design, and lack of specificity, are critically discussed. We advocate for prospective, multicenter validation studies and highlight the promise of integrating inflammatory cytokine profiling into diagnostic algorithms. Composite cytokine panels may better reflect the complex immunobiology of tumor progression and offer a scalable, accessible adjunct to current gastric cancer screening strategies.

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality, with a majority of patients presenting at intermediate or advanced stages, precluding curative interventions. Radioembolization, also known as selective internal radiation therapy, has emerged as a promising locoregional therapy that delivers high-dose yttrium-90 microspheres directly to hepatic tumors while sparing healthy parenchyma. This technique is especially beneficial for patients with portal vein tumor thrombosis or impaired liver function. This editorial provides a comprehensive overview of the mechanism, technical considerations, and clinical efficacy of radioembolization in advanced HCC. Landmark trials such as SARAH, SIRveNIB, and DOSISPHERE-01 demonstrate comparable or superior outcomes to systemic therapies like sorafenib, particularly when personalized dosimetry is applied. Radioembolization contributes to tumor downstaging, transplant bridging, and improved disease control rates. The integration of radioembolization with systemic therapies, including immune checkpoint inhibitors and tyrosine kinase inhibitors, represents a key area of ongoing research. Despite current challenges such as microsphere heterogeneity, dosimetry standardization, and limited accessibility, emerging innovations in imaging, isotopes, and personalized treatment strategies are expected to refine its application. Overall, radioembolization is poised to play an increasingly central role in the multidisciplinary management of advanced HCC.