中华肿瘤杂志最新文献

Objective: To investigate the predictive value of neutrophil extracellular traps (NETs) on the prognosis of patients with epidermal growth factor receptor (EGFR) wild-type lung adenocarcinoma. Methods: A total of 132 surgical paraffin specimens of EGFR wild-type lung adenocarcinoma diagnosed at the Tumor Hospital Affiliated to Xinjiang Medical University from January 2016 to December 2023 and 12 pairs of cancer and paracancerous fresh tissues from patients with EGFR wild-type lung adenocarcinoma diagnosed in March-July 2024 were collected with their clinical information. Western blotting and immunofluorescence were used to detect the expression levels of citrullinated histone H3 (CitH3) and myeloperoxidase (MPO) in cancerous and paraneoplastic tissues. Immunohistochemistry was used to detect the infiltration of PD-L1, CD4⁺ T cells and CD8⁺ T cells in the tumors. The clinical and prognostic correlations between NETs and EGFR wild-type lung adenocarcinoma patients were analyzed. Results: The expression of MPO (P＜0.001) and CitH3 (P=0.009) was significantly increased in the tumors compared with the paracancerous tissues. The rate of high expression of NETs in cancer tissues was higher in patients with EGFR wild-type lung adenocarcinoma who were in stage Ⅲ and Ⅳ, with lymph node metastasis, distant metastasis, pleural invasion, high expression of Ki-67, low expression of CD8⁺ T, and lowered lymphocyte counts when compared to paraneoplastic tissues (P＜0.05). Patients were stratified based on TNM stage Ⅱb for prognostic analysis. Kaplan-Meier univariate analysis showed that the median overall survival (OS) (stage Ⅰ to Ⅱb: 47 vs 87 months; stage Ⅲ to Ⅳ: 27 months vs not reach) and the median disease-free survival (DFS) (stage Ⅰ to Ⅱb: 42 vs 78 months; stage Ⅲ to Ⅳ: 18 vs 39 months) of patients with high expression of NETs in stage Ⅰ to II b and stage Ⅲ to Ⅳ were lower than those with low expression (stage Ⅰ to Ⅱb: OS, P＜0.001; DFS, P＜0.001; stage Ⅲ to Ⅳ: OS, P=0.001; DFS, P=0.022). The OS (stage Ⅰ to Ⅱb: HR=3.513, 95% CI: 1.966-6.277, P＜0.001; stage Ⅲ to Ⅳ: HR=3.215, 95% CI: 1.324-7.806, P=0.010) and the DFS (stage Ⅰ to Ⅱb: HR=2.478 ,95% CI: 1.396-4.400, P=0.002; stage Ⅲ to Ⅳ: HR=2.248, 95% CI: 1.089-4.638, P=0.028) in the group with high expression of NETs in either stage Ⅰ to Ⅱb or stage Ⅲ to Ⅳ were significantly shorter than those in the group with low expression. Conclusion: The EGFR wild-type lung adenocarcinoma patients with high expression of NETs have relatively shorter DFS and OS, which are independent risk factors for the prognosis of patients with EGFR wild-type lung adenocarcinoma, and are likely to be the potential biomarkers for the diagnosis and treatment of EGFR wild-type lung adenocarcinoma.

Cancer stands as a significant global public health challenge, and cancer screening serves as a pivotal strategy for reducing its mortality. Presently, only a limited number of cancer types have appropriate screening methods available. Traditional single-cancer screening approaches are fraught with limitations, including invasiveness, low accuracy, and poor patient compliance. Multi-cancer early detection (MCED) leveraging liquid biopsy technology enables non-invasive and efficient early detection of multiple cancers by analyzing biomarkers such as cell-free DNA, cell-free RNA, proteins, and metabolites in blood and other bodily fluids. This innovative approach substantially broadens the spectrum of detectable cancers and enhances population coverage, showcasing immense potential for improving existing cancer screening strategies. This expert consensus comprehensively reviews the progress of liquid biopsy-based MCED, biomarker selection and detection technologies, the criteria for cancer type selection, research design and clinical utility evaluation, as well as implementation pathways. The overarching goal of this consensus is to offer scientific guidance for further research and the widespread adoption of MCED, thereby facilitating the continuous optimization of cancer screening strategies.

Lung cancer exhibits the highest incidence and mortality among all malignancies in China, with incidence peaking after age 65. The growing elderly population has led to a significant increase in both the number and proportion of elderly lung cancer patients, necessitating standardized management for this group. The "Consensus of Chinese experts on medical treatment of advanced lung cancer in the elderly (2022 edition)" has provided essential clinical guidance in the past 2 years. However, evolving evidence-based medical findings and pharmaceutical advancements necessitate consensus updates. Against this backdrop, the Expert Committee on Geriatric Oncology Prevention and Treatment of the Chinese Society of Clinical Oncology (CSCO) has developed the "Expert consensus on the treatment of advanced lung cancer in elderly patients (2025 edition). Based on the 2022 edition, this revision encompasses five key domains: definition and characteristics of the elderly population, comprehensive geriatric assessment for elderly advanced lung cancer patients, treatment of advanced non-small cell lung cancer (NSCLC) and extensive-stage small cell lung cancer (ES-SCLC) in elderly patients, and management of treatment-related adverse events. The core features of this consensus update are highlighted as follows: 1. Refined age-stratified management. Patients are categorized into three strata: younger-old (65-74 years), middle-old (75-84 years), and oldest-old (≥85 years), with precision management emphasized for each stratum. 2. Elevated role of comprehensive geriatric assessment. Positioning comprehensive geriatric assessment as an essential core tool throughout diagnosis and treatment. 3. Stratified precision treatment strategies. Treatment selection for NSCLC/ES-SCLC patients should balance efficacy and quality of life based on age stratification and comprehensive geriatric assessment. 4. Enhanced focus on drug safety and interactions. Prioritizing drug-drug interactions (DDIs) alongside safer drug selection and adverse event monitoring. Nine key recommendations were finalized to guide clinical practice, promoting rational and standardized management of advanced lung cancer in elderly patients in China.

Prostate cancer represents a prevalent malignancy within the male genitourinary system. In recent years, its incidence in China has gradually increased, becoming a significant public health issue. While early detection correlates strongly with improved prognosis, the majority of newly diagnosed prostate cancer patients in China are already in intermediate or advanced stages, precluding curative-intent interventions and contributing to marked survival disparities. The progression of prostate cancer is lengthy, typically encompassing diagnosis, treatment, progression, metastasis, and death, accompanied by a decline in quality of life. Personalized treatment plans should be developed based on the disease stage and patient preferences. In non-metastatic prostate cancer, where the tumor is confined to the prostate, surgery and radiotherapy are the primary treatments, supplemented by neoadjuvant and adjuvant therapies to delay metastasis. For metastatic prostate cancer, systemic therapy is prioritized to prolong survival. In metastatic hormone-sensitive prostate cancer, controlling androgen levels is crucial, while treatment options for metastatic castration resistant prostate cancer are relatively limited, necessitating individualized and precise treatment. During prostate cancer management, prostate-specific antigen levels are closely linked to prognosis and require monitoring. Bone metastasis, the most common site in prostate cancer patients, often triggers skeletal-related events, demanding effective prevention and management. Treatment-related adverse reactions are also a clinical challenge, requiring balanced risk-benefit assessments and judicious drug selection to preserve quality of life. Rapid advancements in screening technologies, surgical innovations, drug development, and China-specific epidemiological factors further complicate decision-making in holistic prostate cancer management. To optimize the standardization of prostate cancer diagnosis and treatment in China, the Genitourinary Oncology Committee of Chinese Anti-cancer Association synthesized global guidelines, clinical evidence and clinical expertise, and addressed critical challenges in the whole-course management of prostate cancer to formulate a multidisciplinary consensus. The expert consensus on whole-course management of prostate cancer (2025 edition) establishes standardized protocols to guide clinical practice, improve treatment outcomes, and enhance patient quality of life.

Ovarian cancer, cervical cancer, and endometrial cancer are the three major malignant tumors in gynecologic oncology, with an increasing incidence rate in recent years. Chemotherapy, radiotherapy, immunotherapy, and targeted therapy remain the mainstays of treatment; however, all may cause varying degrees of myelosuppression, with neutropenia being the most common adverse effect. Notably, the incidence of grade ≥3 neutropenia among gynecologic oncology patients undergoing antitumor therapy is significantly higher than that in patients with other solid tumors, leading to increased risk of severe infections, prolonged hospitalization, and potentially life-threatening complications. Therefore, effective prevention and management of neutropenia are crucial to ensuring treatment adherence and maintaining patients' quality of life. A growing body of evidence has demonstrated the clinical value of long-acting granulocyte colony-stimulating factor (G-CSF) in the prevention and management of neutropenia. Based on the latest evidence in evidence-based medicine, this expert consensus provides an overview of neutropenia commonly encountered during chemoradiotherapy in patients with gynecologic malignancies and highlights its potential impact on treatment outcomes. It then systematically introduces the long-acting G-CSF currently approved by the U.S. Food and Drug Administration (FDA) and Chinese regulatory authorities. The consensus further elaborates on the clinical applications of long-acting G-CSF in the prevention of chemotherapy-induced neutropenia (CIN) and febrile neutropenia (FN), and presents corresponding recommendations. Additionally, it outlines the differentiated use of long-acting G-CSF in primary and secondary prophylaxis, along with recommended dosing regimens and administration strategies based on recent literature. Potential adverse effects and corresponding management strategies of long-acting G-CSF are also systematically reviewed. To promote the standardized use of long-acting G-CSF in gynecologic cancer treatment, this 2025 edition of the expert consensus has been jointly developed by leading domestic experts, providing comprehensive guidance and evidence-based recommendations for rational clinical use in this field.

Lorlatinib is a novel third-generation anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor (TKI) used for the treatment of patients with ALK-positive non-small cell lung cancer (NSCLC) patients. This drug exhibits high affinity, effectively overcoming various resistance mutations, and can penetrate the blood-brain barrier, demonstrating significant efficacy against brain metastases. Lorlatinib exhibits generally manageable safety profiles. To improve patients' adherence and maximize patients survival outcome, physicians need pay attention to lorlatinib related adverse events such as hyperlipidemia, edema, and hypertension, necessitating dose adjustments and symptom management based on individual patient conditions. The Beijing Cancer Prevention and Treatment Research Association has organized relevant experts to formulate the "Lorlatinib primary hospital patient health management expert consensus (2025 edition)". This expert consensus provides standardized guidance on the use of lorlatinib for primary hospitals, including pharmacological characteristics, indications, dosage, high-level evidence-based medical research, adverse event management strategy and individualized treatment options. The consensus emphasizes the periodically monitor, identification, assessment, and management of adverse reactions, as well as the importance of long-term follow-up, aiming to maximize the clinical benefits of lorlatinib, ensure the therapeutic effectiveness, improve patients' quality of life and achieve long-term survival.

Objective: To explore the prognosis of patients with gastric cancer peritoneal metastasis (PM) receiving programmed cell death-1 (PD-1) antibody therapy, and investigate the biomarkers that affect the prognosis of anti-PD-1 therapy. Methods: This restrospecific study collected the clinic-pathological data of 56 patients with peritoneal metastasis of gastric cancer who received first-line treatment in the Nanjing Drum Town Hospital from March 2020 to September 2023, among which 41 had received anti-PD-1 immunotherapy and 15 hadn't. The relationship between overall survival (OS) and anti-PD-1 immunotherapy was evaluated by Kaplan-Meier analysis. The relationship between baseline peripheral blood indicators and treatment response of patients with anti-PD-1 treatment was analyzed using unpaired t-test. Subsequently, the Cox proportional risk regression model was used to explore the clinical prognostic factors that may affect anti-PD-1 immunotherapy by univariate and multivariate analysis. The clinical prognostic factors included baseline data and baseline peripheral blood indexes such as anti-PD-1 treatment lines, Eastern Cooperative Oncology Group performance status (ECOG PS), combined positive score (CPS), expression of human epidermal growth factor receptor 2 (Her-2), EBER status, pathological types, other metastatic lesions, ascites content before immunotherapy, with or without abdominal drainage during anti-PD-1 treatment, blood lipid indicators, inflammatory indicators, and tumor indicators. Results: Kaplan-Meier survival statistics showed similar OS (15.9 vs. 15.2 months, P=0.600) in patients with anti-PD-1 therapy compared to those without anti-PD-1 therapy. Patients with baseline high-density lipoprotein (HDL) ≥0.97 mmol/L (n=22) demonstrated a significantly longer median OS compared to those with HDL＜0.97 mmol/L (15.2 vs. 13.5 months; P=0.018). Similarly, the cohort with apolipoprotein A1 (ApoA1) levels ≥0.86 g/L (n=21) showed superior survival outcomes, with a median OS of 17.7 months versus 12.3 months in the ApoA1＜0.86 g/L group (n=20; P=0.006). In contrast, elevated baseline alpha-fetoprotein (AFP) levels (n=2) were associated with markedly reduced survival (median OS: 5.7 vs. 15.2 months in normal AFP group, n=37; P=0.005). Notably, elevated pretreatment ApoA1 levels correlated with enhanced immunotherapy response (P=0.017). Multivariate Cox regression analysis revealed that ApoA1 deficiency (≥0.86 g/L) independently predicted better OS following PD-1 antibody therapy (HR=0.35, 95% CI: 0.12-0.98, P=0.046) in gastric cancer patients with PM. Conclusions: In our study, it is first proposed that ApoA1 could be a significant predictor of the survival advantages of immunotherapy in gastric cancer patients with PM.

Over the past half-century of the global effort against cancer, the vast majority of investigations in both tumor basic research and clinical practice have centered on the "somatic mutation" theory, such as in molecular classification, individualized precision medicine strategies, gene therapy approaches, the development of neoantigen-based tumor vaccines, and advancements in sequencing technologies. Even in the extensively studied tumor microenvironment (including tumor immunity), which has garnered significant attention in recent years, the underlying mechanisms frequently revert to specific genes and mutations within tumor cells or microenvironmental cells as the primary driving forces. However, despite the dominance of the "somatic mutation" paradigm, truly effective approaches for curing cancer in clinical settings remain elusive. Undoubtedly, if the prevailing "somatic mutation theory" continues to monopolize cancer research, meaningful progress in understanding and treating cancer will likely remain frustratingly out of reach. At this critical juncture in the evolution of cancer research, a comprehensive re-evaluation of cancer not only is necessary but also imperative, highlighting the urgent need for a profound transformation in our conceptual framework. This article systematically elucidates the novel perspective offered by the "tumor system" for comprehending the essence of cancer, the foundational principles of "tumor ecology" and their potential applications in treatment, and explores in depth the theoretical framework and research significance of the emerging field of "ecological pathology". Beyond merely advocating for the abandonment of the currently dominant linear reductionist paradigm of cancer, this commentary strives to construct a pragmatic and systematically structured framework to guide the trajectory of the "post-genomic revolution in oncology" and the "tumor ecological philosophy", ultimately fostering the realization of the overarching societal goal of eradicating cancer.