中华肿瘤杂志最新文献

Breast cancer is the most common malignancy among women worldwide, with its incidence continuing to rise, posing a serious threat to women's health. In recent years, with the widespread adoption of molecular subtyping in diagnosis and treatment, breast cancer therapy has entered an era of individualized precision medicine. Early-stage breast cancer is primarily managed with surgery, combined with chemotherapy, radiotherapy, endocrine therapy, and targeted therapies (such as trastuzumab and pertuzumab), significantly improving cure rates. However, for recurrent or metastatic breast cancer, particularly refractory subtypes such as triple-negative and HER2-positive breast cancer, the efficacy of traditional treatments remains limited, and patients still face a poor prognosis. Antibody-drug conjugates (ADCs), as an innovative targeted therapy strategy, combine the precise targeting of monoclonal antibodies with the potent cytotoxicity of payload drugs, delivering cytotoxic agents directly to tumors through targeted chemotherapy, achieving "precision delivery and efficient killing". ADCs represent a relatively novel class of highly targeted anticancer biologics. In the field of breast cancer treatment, ADCs have made groundbreaking progress. Agents such as T-DM1 and T-DXd have significantly prolonged progression-free survival and overall survival in HER2-positive patients, providing critical treatment options for advanced-stage patients, markedly improving survival outcomes, and are now being explored in earlier lines of therapy, reshaping the treatment landscape of breast cancer. Although ADCs are generally well-tolerated, their unique structure-comprising antibodies, cytotoxic payloads, linkers, and conjugation processes-leads to distinct adverse effects and heterogeneous safety profiles within the class. Based on the latest research advances in ADC therapy for breast cancer and incorporating clinical experience from both domestic and international settings, the Breast Cancer Professional Committee of China Anti-Cancer Association, along with Breast Cancer Prevention and Treatment Research Professional Committee of Maternal and Child Health Research Society of China have jointly developed the "Guidelines for managing adverse reactions to antibody-drug conjugates in breast cancer (2025 edition)". This guideline aims to provide healthcare professionals with practical guidance on the early identification, regular assessment, timely management, and follow-up monitoring of ADC-related adverse reactions or events.

Objective: To investigate the differences in apolipoprotein B mRNA editing enzyme, catalytic polypeptide-like (APOBEC) between human papillomavirus (HPV)-positive and HPV-negative head and neck squamous cell carcinoma (HNSCC) patients, analyze its association with the immune microenvironment and the cGAS-STING pathway, and evaluate its predictive value for immunotherapy efficacy. Methods: Whole-exome sequencing data from HNSCC patients (from September 2017 to March 2020 at the Third Affiliated Hospital of Kunming Medical University) were collected for somatic mutation profiling. APOBEC enrichment scores were calculated and integrated with differentially expressed genes (DEGs) to perform Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis and Gene Set Enrichment Analysis (GSEA). Single-cell RNA sequencing (scRNA-seq) data were utilized to validate the relationship between APOBEC3 expression, immune cell composition, and cGAS-STING module activity. Furthermore, an immunotherapy cohort was analyzed to evaluate the association of APOBEC3 family gene expression with immune checkpoint genes and therapeutic outcomes. Results: APOBEC mutational signatures were prevalent in both HPV-negative and HPV-positive HNSCC patients, but their driving patterns differed significantly: HPV-positive patients were dominated by APOBEC3A mutations, whereas the HPV-negative group exhibited a synergistic effect of multiple family members, including APOBEC3A/3B/3C/3D/3F. Pathway analysis indicated that in HPV-negative HNSCC, APOBEC activity was significantly associated with the enhancement of the cGAS-STING pathway, interferon response, and inflammatory response. Single-cell analysis confirmed that tumors with high APOBEC3 expression had richer immune cell infiltration, and the activities of four functional modules of the cGAS-STING pathway (cGAS-STING, NF-κB, interferon stimulation, and antigen presentation) were significantly upregulated. In the immunotherapy cohort, patients with high APOBEC3 expression exhibited higher expression of immune checkpoint molecules, and their treatment response rates were significantly superior to those in the low-expression group. Conclusions: APOBEC exhibits distinct driving mechanisms in HNSCC depending on HPV status. Its activity is closely related to cGAS-STING pathway activation, enhanced immune infiltration, and improved immunotherapy efficacy, suggesting potential predictive and therapeutic value.

Small cell carcinoma of the esophagus (SCEC) is a rare and highly aggressive neuroendocrine tumor with poor prognosis. The clinical manifestations are lack of specificity, and the diagnosis depends on gastroscopic biopsy pathology and immunohistochemistry. Ultrasonic gastroscope+-, enhanced CT or PET-CT, and brain MRI are recommended for accurate staging. The combination of American Joint Committee on Cancer - Tumor, Node, Metastasis (AJCC-TNM) staging system and Veterans Administration Lung Study Group (VALSG) staging systems is recommended to guide the treatment. The treatment emphasizes the multidisciplinary comprehensive mode of chemotherapy, radiotherapy and surgery. For the patients with limited disease, chemotherapy combined with local treatment (surgery or radiotherapy) is recommended. For operable patients, radical chemoradiotherapy or perioperative treatment combined with surgery is recommended. The unresectable patients were treated with radical chemoradiotherapy. Patients with extensive stage were treated with systemic chemotherapy. Etoposide combined with platinum is the first choice for chemotherapy. If systemic treatment was effective, additional local treatment could be performed for residual lesions, and symptomatic metastatic lesions are recommended for palliative care. There is still a lack of high-level evidence-based medical evidence for immunotherapy, and relevant clinical trials are recommended. This consensus aims to promote the standardization of diagnosis and treatment of SCEC and improve the quality of life and long-term survival of patients through multidisciplinary collaboration.

Chemotherapy-induced neutropenia (CIN) is a common hematological adverse event and dose-limiting toxicity of chemotherapy. CIN may lead to dose reduction or delay of chemotherapeutic agents, febrile neutropenia (FN), and severe infections, which results in increased treatment costs, reduced chemotherapy efficacy, and even life-threatening complications. Therefore, standardized assessment of the risk of CIN in cancer patients, timely identification and intervention of FN, and appropriate prevention and treatment are essential to reduce CIN-related complications, improve patients' quality of life, and enhance chemotherapy outcomes. Based on the "Consensus on clinical diagnosis, treatment, and prevention of chemotherapy-induced neutropenia in China (2023 edition)", the Committee of Medical Oncology and the Committee of Neoplastic Supportive-care of China Anti-Cancer Association have thoroughly reviewed and summarized the latest evidence and clinical practices worldwide. This update puts forward 11 recommendations regarding the definition, grading, risk assessment, prevention, and treatment strategies for CIN, aiming to provide more timely and standardized guidance for Chinese oncologists in the diagnosis, treatment, and prevention of CIN.

The phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) signaling pathway (PAM pathway) is a crucial signaling network regulating cell proliferation, survival, and metabolism, which plays a central role in the pathogenesis and progression of breast cancer. Targeting the PAM pathway with inhibitors provides a novel precision therapeutic option for cancer patients. However, the broad suppression of physiological PAM pathway functions in normal tissues, combined with the distinct characteristics of their molecular targets, leads to both the uniqueness of adverse reactions associated with these agents and heterogeneity within their safety profiles. Given the complexity of the adverse reaction spectrum and the specialized management requirements for PAM pathway inhibitors, Cancer Drug Clinical Research Committee of China Anti-Cancer Association and Standard Construction Committee of China Anti-Cancer Association jointly convened a multidisciplinary expert panel to develop this consensus. This document systematically synthesizes epidemiological features, pathological mechanisms, and risk factors of PAM pathway inhibitor-associated adverse reactions. It provides clinicians with evidence-based guidance on standardized prevention strategies, early warning systems, assessment frameworks, intervention protocols, and long-term monitoring pathways. The ultimate goals are to maximize medication safety, optimize treatment adherence, and ultimately enhance antitumor efficacy and patient quality of life.

In recent years, the incidence of B-cell non-Hodgkin lymphoma (B-NHL) in China has shown a steady increase, accounting for approximately 85%-90% of all lymphomas. Although standard immunochemotherapy regimens such as R-CHOP have led to long-term remission in some patients, approximately 30%-40% still experience relapse or refractory disease, with dismal prognosis and a median survival of less than one year. For patients who fail multiple lines of therapy, conventional options such as chemotherapy, radiotherapy, or hematopoietic stem cell transplantation offer limited benefits, highlighting an urgent need for innovative treatments. Chimeric antigen receptor T-cell (CAR-T) therapy, a breakthrough form of adoptive cellular immunotherapy, modifies autologous T cells to specifically recognize and eliminate malignant B cells, thereby achieving significant survival improvement in patients with relapse or refractory B-NHL. The clinical research and clinical application of CAR-T in the treatment of hematological tumors in China are in a state of rapid development. At present, there are two targeting CD19 CAR-T cells for the treatment of B-cell lymphoma, which gradually changed the diagnosis and treatment practice of lymphoma in China. At the same time, the clinic is actively exploring and improving the whole-process management experience of CAR-T therapy in lymphoma patients. So the Lymphoma Quality Control Expert Committee of the National Cancer Quality Control Center organized experts to form the consensus through discussion and revision many times, aiming to provide better guidance for clinicians to standardize the whole-process management of CAR-T cell therapy for B-cell Lymphoma, and further improve the survival benefits of patients.

Malnutrition and metabolic disorders occur in a high proportion of oncology patients, and malnutrition has a significant impact on both treatment and prognosis, resulting in a heavy disease and economic burden. In recent years, as awareness of the nutritional status of oncology patients has improved, especially the multiple negative effects of malnutrition, it has highlighted the lack of clinical treatment and insufficient knowledge of adverse effects, leading to the lack of special medical use foods for oncology patients as well as irregularities in their use. In order to further promote the clinical and family standardised application of special medical purpose foods for oncology patients, the expert group collects and collates high-quality evidence in recent years, and discusses and summarises the opinions on clinical application, and consolidates the consensus "Expert consensus on clinical application of whole nutritional oncology foods for special medical purposes (2025 edition)", aiming to promote the standardisation of oncology nutritional treatment, meet the special nutritional needs of oncology patients, improve the clinical knowledge on the application of special medical purpose foods for oncology, and provide detailed and practical guidance on clinical operation.

Amivantamab is the first fully humanized bispecific antibody approved for the treatment of non-small cell lung cancer (NSCLC) in the world. Amivantamab can block epidermal growth factor receptor (EGFR) pathway and mesenchymal-epithelial transformation factor (MET) pathway simultaneously, trigger the internalization and degradation of EGFR and MET, and activate the antitumor immune response. Amivantamab has been approved by the National Medical Products Administration for the treatment of adult patients with locally advanced or metastatic NSCLC with EGFR exon 20 insertion mutation, EGFR exon 19 deletion or exon 21 L858R substitution mutation, and is expected to be widely used in clinical practice soon. How to reasonably manage the adverse reactions related to amivantamab and maximize its efficacy is an urgent problem to be solved. Based on the existing medical evidence, combined with clinical experience, the expert group of this consensus finally formulated this "Expert consensus on amivantamab clinical application and adverse reaction management (2025 edition)" after multiple discussions. The contents of the consensus include the clinical use and management of adverse reactions of amivantamab. The recommendations focus on the prevention of infusion-related reactions, skin adverse reactions, venous thromboembolism, peripheral edema, oral mucositis, ocular toxicity and interstitial lung disease, amivantamab dose adjustment and treatment when adverse events occur, in order to provide guidance for clinicians to correctly use amivantamab and manage related adverse reactions.

Objective: To analyze the predictive model of lymph node metastasis rate (LNR) in patients with intrahepatic cholangiocarcinoma and its relationship with prognosis. Methods: This study included clinical characteristics and prognostic information of 172 patients with intrahepatic cholangiocarcinoma. Receiver operating characteristic (ROC) curves were used to calculate the optimal cutoff values for groups. Kaplan Meier survival curves were plotted using R language, and critical factors affecting prognosis were determined by Cox regression analysis. A prognostic prediction model was constructed and visualized using nomogram, and this model was validated using the SEER database. Results: Through ROC curve analysis, with 3-year overall survival (OS) as the benchmark, an LNR of 0.15 was identified as the optimal cutoff value for predicting the prognosis of intrahepatic cholangiocarcinoma patients, with an area under the curve of 0.764 (95% CI: 0.690, 0.838). Patients were divided into a low LNR group (LNR＜0.15, n=97) and a high LNR group (LNR≥0.15, n=75) based on the LNR value. Statistically significant differences were observed between the two groups in terms of carbohydrate antigen 19-9, tumor size, lymph node metastasis, tumor number, and stage (all P＜0.05). The median survival time of the high LNR group was 20 months (95% CI: 13-23), significantly shorter than that of the low LNR group, which was 36 months (95% CI: 21-43) (P＜0.001). Multivariate analysis revealed that a high LNR value (HR=0.55, 95% CI: 0.32-0.95, P=0.033), age＞60 years (HR=0.53, 95% CI: 0.35-0.81, P=0.004), and tumor diameter＞5.5 cm (HR=0.62, 95% CI: 0.41-0.93, P=0.022) were independent factors affecting OS. A prognostic prediction model was established based on these independent factors, and the predicted 1-year, 2-year, and 3-year survival rates were close to the actual observed values. Validation using the SEER database also demonstrated the high predictive accuracy of this model. Conclusion: The clinical prognostic model based on lymph node metastasis rate can effectively predict the postoperative survival of patients with intrahepatic cholangiocarcinoma and provide important basis for clinical decision.