中华肿瘤杂志最新文献

Objectives: To examine the proportion and trends of cervical adenocarcinoma in cervical cancer (ICC), mainly including cervical adenocarcinoma (CADC) and squamous cervical cancer (SCC) in China, and to analyze the distribution of human papilloma virus (HPV) in CADC and SCC. Methods: Published studies reporting HPVs distribution in various histological types or relative proportions of CADC in ICC in China were identified manually and searched systematically in Medline, Embase, Cochrane Library databases, CNKI and Wanfang since the databases were established until October 2022. Meta-analysis was performed using Stata 16.0 software. And we applied the random-effects models to estimate the combined effect values due to the high heterogeneity. Results: Twenty-three studies were eligible. The relative prevalence of CADC was 9.0% (95% CI, 7.7%－10.3%). According to the diagnosis time of ICC, the patients were divided into three time periods, which is 1979-2005, 2006-2011, 2012-2022 respectively. The prevalence of CADC by time was: 6.0% in 1979-2005, 8.1% in 2006-2011, and 9.5% in 2012-2022, respectively, with no statistically significant trend in proportions over time (χ²=5.03, P=0.081). Meanwhile, the percentage of CADC also varies by regions, and the highest percentage of CADC was found in the eastern region (11.2%), followed by the western region (7.3%) and the central region (5.9%). The total prevalence of HPV infection in CADC was 72.3%, which was lower than 92.0% in SCC, and the difference was statistically significant (χ²=300.89, P＜0.01). To be specific, the top three HPV types prevalent in CADC were HPV18 (45.0%), HPV16 (22.0%), and HPV52 (7.3%), and those prevalent in the SCC were HPV16 (64.2%), HPV52 (5.6%), HPV18 (5.4%). The results of the Egger's test, and Begg's test showed that there was no publication bias in this study and sensitivity analysis showed that the results of this study were fairly stable. Conclusions: The proportion of CADC in China has increased in a limited way in the past decades, and there are regional differences in the proportion of CADC. The predominant type is HPV18 in CADC and HPV16 in SCC. To eliminate the limitations of the secondary literature, a multicenter study with consistent diagnostic levels and identical HPV genotyping tests is still needed in the future to better characterize the relative proportion of cervical adenocarcinoma and the trend of HPV changes, which will provide a basis for the improvement of HPV vaccine and screening policies.

Lung cancer is one of the malignant tumors with high morbidity and mortality worldwide. Small cell lung cancer (SCLC) is a highly aggressive neuroendocrine tumor that is closely associated with tobacco exposure, accounting for 13% to 15% of all lung cancer cases. It is characterized by a high proliferation rate and exceptional metastatic capacity. At the time of diagnosis, approximately 70% of the patients have metastasized and are classified as extensive-stage small cell lung cancer (ES-SCLC). From 1980 to 2018, chemotherapy and radiotherapy were the main treatment strategies for SCLC. Etoposide combined with platinum has remained the standard first-line treatment for ES-SCLC. Although SCLC is very sensitive to initial treatment, the majority of patients have disease progression within 6 months, and treatment options after recurrence are very limited, and the median survival time is only about 8-10 months. The advent of immune checkpoint inhibitors (ICIs), particularly programmed death-ligand 1 (PD-L1) and programmed death -1 (PD-1) inhibitors, has brought new hope to patients with SCLC. PD-1/PD-L1 plus chemotherapy have significantly prolonged overall survival of patients with ES-SCLC, which has become the new standard of first-line treatment for ES-SCLC. Currently, a raised number of immune checkpoint inhibitors (ICIs) have been approved in China for the treatment of SCLC, providing more treatment options for SCLC patients. To further standardize the clinical practice of SCLC immunotherapy, the "Expert Consensus on Immunotherapy for SCLC" has been developed based on domestic and international guidelines, consensus, and relevant medical evidence, aiming to provide reference and guidance for domestic clinicians.

Lung cancer has the highest incidence and mortality rates among malignant tumors in both men and women in China. According to the latest analysis of the incidence of malignant tumors released by the National Cancer Center in 2022, there were 1.0606 million new cases of lung cancer and 733 300 deaths, resulting in a significant treatment burden. In recent years, research into the mechanisms of combining immune checkpoint inhibitors with radiation therapy has deepened, and clinical evidence is rapidly accumulating, making this area a clinical focus. However, there are still many questions regarding treatment choices, highlighting the urgent need for standardized guidance. To further promote the standardization of the combined use of immunotherapy and radiation therapy in China, the National Cancer Center and the Oncology Multidisciplinary Medical Committee of Chinese Medical Doctor Association organized a group of multidisciplinary experts to conduct in-depth discussions on the synergistic mechanisms, application models, and safety of immune checkpoint inhibitors combined with radiation therapy in lung cancer (including non-small cell lung cancer and small cell lung cancer). This effort led to the formation of the "Expert consensus on immune checkpoint inhibitors combined with radiation therapy for lung cancer in China" (referred to as "the consensus"). This consensus aims to provide guidance for the combined use of immunotherapy and radiation therapy, effectively benefiting lung cancer patients.

Surgical excision is the only radical treatment for presacral cysts, which are difficult and risky because of the complex anatomical structure around them, involving important blood vessels and nerves. Improper surgical procedures will lead to recurrence of presacral cysts after surgery, causing great pain to patients. With the deepening of clinical research on presacral cysts, some new problems have been found to be overcome. On the basis of the Chinese Expert Consensus on Standardized Treatment of Presacral Cysts (2021 edition), the Pelvic Tumor Integration Professional Committee of the Chinese Anti-Cancer Association organized authoritative experts in relevant professional fields including general surgery, gastrointestinal surgery, colorectal and anal surgery, gynecological oncology, bone and soft tissue surgery, neurosurgery, pathology, imaging and other departments, to formulate the Chinese Expert Consensus on the Standardized Diagnosis and Treatment of Presacral Cysts (2024 edition) after a consensus meeting. The 2024 consensus provides a comprehensive introduction to the following seven aspects, including the origin and pathology of presacral cysts, related anatomy and classification of surgery, diagnosis and differential diagnosis, surgical philosophy, surgical methods for excision, perioperative complications and management, follow-up, and subsequent treatment, and has reached a consensus after repeated discussions and revisions. Compared with the 2021 consensus, the main updates in the 2024 consensus include the following aspects: in the anatomy and classification section, the anatomical classification of high and low, single and multiple cysts of the presacral space has been added; in the surgical concept section, it is emphasized to protect the sacral nerves for presacral cysts with sacral variations; in the surgical approach section for excision, the surgical approach for different anatomical types of presacral cysts has been further clarified. For patients with preoperative enterocutaneous fistula, the use of gluteus maximus muscle flap to repair the fistula reduces the probability of preventive stoma. For suspected malignant presacral cysts, multidisciplinary consultation is required, and if radical resection is not possible, further biopsy is performed to clarify the pathology and develop a comprehensive treatment plan.

Objective: To construct a remote screening network for breast cancer based on automated breast ultrasound (ABUS) and explore the value of ABUS with remote reading for breast cancer screening. Methods: We constructed a remote breast cancer screening network including one remote reading center and 48 image-acquisition centers. We recruited women to participate in breast cancer screening at one of these image-acquisition centers from January 2021 to January 2023. The technicians collected the whole breast images using the ABUS. The images were then sent to the reading center through the PVBUS System and interpreted independently by two radiologists using the Breast Imaging Reporting and Data System (BI-RADS). BI-RADS categories 1 and 2 indicate negative screening results, and women diagnosed with these categories were recommended for annual breast ultrasound screening. BI-RADS categories 3, 4, and 5 indicate positive results. Women with BI-RADS category 3 lesions were recommended for follow-up examinations every 6 months using ABUS or handheld ultrasound, while those with BI-RADS 4 and 5 lesions were suggested to undergo pathological examinations. Results: In our study, we enrolled 10 344 women who completed the ABUS screening and were followed up for more than 12 months. After remote reading, 6 164 women were diagnosed with BI-RADS category 1 and 2 626 woman were within BI-RADS category 2. In contrast, 1 404 women were within BI-RADS category 3, a total of 135 women were within BI-RADS category 4, and 15 women were within BI-RADS category 5. The positive screening rate of ABUS was 15.0% (1 554/10 344). The ABUS with remote reading had a detection rate of 3.7/1 000 (38/10 344) for breast cancer screening, with a sensitivity of 97.4% (38/39) and a specificity of 85.3% (8 789/10 305). Among the 38 breast cancer cases detected, 92.1% (35/38) were invasive carcinomas, and 63.2% (24/38) were stage 0 or Ⅰ breast cancers. Conclusions: Breast cancer screening based on ABUS with remote reading provided an efficient and feasible solution to the problem of unevenly distributed medical resources and medical staff levels in various regions of China, enabling the decentralization of high-quality medical resources and improving the accessibility of high-quality screening services. It has provided an alternative for breast cancer screening in China.

Objective: To compare the clinical efficacy of neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant chemo-immunotherapy (nCIT) for locally advanced esophageal squamous cell carcinoma (ESCC). Methods: Clinical data of patients who received nCRT or nCIT followed by esophagectomy for locally advanced ESCC between January 2010 and December 2022 were retrospectively collected from Zhejiang Cancer Hospital, with 155 patients in the nCRT group and 470 patients in the nCIT group. Propensity score matching (PSM) was performed in the two groups. After PSM, 120 patients were allocated to the nCRT group and 192 patients to the nCIT group. The pathological response and disease recurrence were compared between the two groups after PSM. Log rank test were used to compare the survival outcomes before and after PSM. Univariate and multivariate Cox regression analyses were performed to identify the prognostic factors for locally advanced ESCC. Results: After PSM, the R0 resection rate in the nCRT group and the nCIT group was 93.3% (112/120) and 93.8% (180/192), respectively, with no statistical significance (P=0.884). However, the pathological complete response rate in the nCRT group [36.7% (44/120)] was higher than that in the nCIT group [21.4% (41/192), P=0.003]. For patients with R0 resection, the major recurrence pattern was distant metastasis [18.8% (21/112)] in the nCRT group, while the pattern was locoregional recurrence [12.2% (22/180)] in the nCIT group. The 3-year disease-free survival rates were 52.7% and 66.1% (P=0.022) and the 3-year overall survival rates were 59.2% and 75.5% (P=0.002) in the nCRT and nCIT groups, respectively. Multivariate Cox regression analysis also revealed that the neoadjuvant therapy mode was an independent prognostic factor for patients with locally advanced ESCC. Compared with nCRT, nCIT could significantly prolong disease-free survival (HR=0.58, 95% CI: 0.40-0.86) and overall survival (HR=0.53, 95% CI: 0.35-0.79). Conclusion: These results suggest that nCIT could significantly improve disease-free survival rate and overall survival rate over nCRT in locally advanced ESCC, even with lower pathological complete response rate.