中华肿瘤杂志最新文献

Objective: To analysis the prevalence characteristics of cancer mortality among the elderly in Qidong City, Jiangsu Province, from 1972 to 2021, and to provide scientific basis for the development of precise prevention and control strategies for cancer in the elderly. Methods: Data of cancers were obtained from Qidong Cancer Registry, a descriptive study method was used to calculate the crude mortality rate (CMR) of cancer among the elderly (≥60 years old). The China age-standardized rate (ASR-C) was calculated using the age structure of the Chinese population in 2000, and world age-standardized rate (ASR-W) was calculated using Segi's world standard population. Joinpoint regression analysis was performed using Joinpoint 4.9.1.0 software to calculate the annual percentage change (APC) and average annual percentage change (AAPC) of mortality. Results: From 1972 to 2021, there were 74 723 cancer deaths in the elderly in Qidong, with CMR of 752.08/10⁵, ASR-C of 666.03/10⁵ (994.22/10⁵ for males and 470.29/10⁵ for females) and ASR-W of 681.11/10⁵. The ASR-C showed little fluctuation before 2000, increased rapidly from 2001 to 2011, and then decreased from 2011 to 2021. From 2017 to 2021, the CMR was 791.01/10⁵, the ASR-C was 689.80/10⁵ (956.77/10⁵ for males and 469.98/10⁵ for females), and the ASR-W was 657.53 /10⁵. The CMR for the 60-64, 65-69, 70-74, 75-79, and 80+ age groups from 2012 to 2021 were 385.42/10⁵ 505.51/10⁵, 721.64/10⁵, 1 213.28/10⁵, and 1 705.32/10⁵, respectively. The CMR of elderly under 75 years old were lower from 2012 to 2021 than in other periods, while those of elderly people aged more than 75 years were higher from 2012 to 2021 than in other periods. The AAPC for ASR-C of all cancers over the 50 years was 0.22%, with APC of -1.59% in 2008-2021 (both P＜0.05). Over the 50 years, the top five cancers in terms of mortality were lung cancer, gastric cancer, liver cancer, colorectal cancer, and esophageal cancer. Their AAPCs of ASR-C were 1.61%, -2.36%, -0.10%, 1.44%, and -2.03%, respectively. The increasing trends of mortality rates for lung cancer and colorectal cancer and the decreasing trends for gastric cancer and esophageal cancer were statistically significant (P＜0.05). Conclusions: The mortality of cancers among elderly is at a high level in Qidong. The overall mortality since 2008 have shown a decreasing trend, and the prevention and control of some cancers have been effective.

Objective: With the aggravation of population aging, the burden of malignant tumors in the elderly population is becoming more and more heavy. This study aims to analyze the incidence and mortality of malignant tumors in the elderly population in Hebei Province in the past decade. Methods: The incidence and mortality data of malignant tumors in people aged ≥60 years old in 38 cancer registration areas in Hebei Province from 2011 to 2020 were collected, and the incidence and mortality were analyzed by gender, urban and rural areas, and age groups. The age standardized rates were calculated using the 2000 Chinese population census and Segi's world population. The trend of incidence and mortality was analyzed using the Joinpoint model and the average annual percent change (AAPC). Results: From 2011 to 2020, 216 200 new cases of malignant tumors were reported in the elderly population in the cancer registration areas of Hebei Province, and 170 700 deaths were reported. The peak ages of incident cases number for males and females were 65-69 years old and 60-64 years old, respectively. The crude incidence rate of malignant tumors in the elderly was 905.42/10⁵, and the crude mortality rate was 714.96/10⁵. In general, the incidence and mortality in rural areas were higher than those in urban areas, and the incidence and mortality in males were higher than those in females. The peak ages of incidence and mortality were 80-84 years old and 85+ years old, respectively. From 2011 to 2020, lung cancer, gastric cancer, esophageal cancer, female breast cancer, and colorectal cancer were the main malignant tumors of incidence rate in the elderly population in Hebei Province, and lung cancer, gastric cancer, liver cancer, esophageal cancer, and colorectal cancer were the main malignant tumors in the mortality rate. From 2011 to 2020, the incidence and mortality of malignant tumors in the elderly population in Hebei Province showed a decreasing trend, and AAPC for the age-standardized incidence and mortality were -4.69% and -5.53%, respectively. The rank of incidence and mortality rate of each cancer had changed, but the top two were still lung cancer and stomach cancer. Conclusions: The incidence and mortality of cancer in the elderly population in Hebei province have decreased, but the burden is still heavy. Lung cancer and stomach cancer are still the focus of prevention and treatment in the elderly population in Hebei province.

Objective: The 5th edition of the WHO classification of central nervous system (CNS) tumors in 2021 made significant revisions to the nomenclature and grading system of solitary fibrous tumors (SFT). This study aimed to explore the changes in the grading of CNS SFT and its relationship with clinical pathological features and prognosis. Methods: This study retrospectively reviewed the clinical and pathological data of 82 patients with CNS SFT diagnosed at the First Affiliated Hospital of Fujian Medical University from March 2006 to June 2021, reassessed their grading according to the WHO 5th edition CNS tumor classification, and conducted a comprehensive analysis of their histological morphology, immunohistochemical characteristics, and clinical imaging data. Results: The age of the patients ranged from 21 to 83 years, with a median age of 48 years. Follow-up was completed for 82 patients, during which 10 patients died, 24 recurred, and 5 metastasized. MRI imaging showed that SFT exhibited isointense signals on T1-weighted imaging (T1WI) and complex signals on T2-weighted imaging (T2WI), with signal intensity decreasing as the content of collagen fibers increased. According to the 2021 grading criteria, there was a significant change in the grading of SFT, with the number of grade 1 SFT increasing from 10 cases under the 2016 standard to 39 cases, while the number of grade 2 and 3 SFT decreased accordingly. The 2016 grading system was significantly correlated with the overall survival (OS) of patients (P=0.009), while the 2021 grading system did not reach statistical significance. Both grading systems were correlated with histological phenotype, Ki-67 index, mitotic figures, and necrosis (P＜0.05). All cases expressed STAT6, and showed varying degrees of expression of vimentin, CD99, BCL-2, and CD34. The staining intensity of type Ⅳ collagen fibers, as analyzed semi-quantitatively, was correlated with the OS of the patients (P=0.017). Conclusions: The new grading system for CNS SFT has undergone significant changes, and its association with OS requires further validation. In-depth study of the content and fine structure of collagen fibers in SFT may have important clinical significance for the prognosis assessment and the formulation of treatment plans for patients. Moreover, quantitative analysis of T2WI signal intensity may provide a new method for preoperative preliminary assessment of the collagen fiber content in SFT.

Skull base sarcomas of the head and neck originate from the mesenchymal tissues of the skull base and head and neck region, exhibiting a highly aggressive behavior and can occur at all ages. Skull base sarcomas are rare in adults, with an incidence of less than 1% of head and neck tumors. However, in the pediatric population, the incidence can be as high as 35%. These tumors can arise in various locations, involving soft tissues, bones, or nerves of the skull base, face, and neck. The pathological types of skull base sarcomas are diverse, primarily including liposarcoma, angiosarcoma, leiomyosarcoma, rhabdomyosarcoma, Ewing sarcoma, osteosarcoma, undifferentiated pleomorphic sarcoma. Treatment typically involves a multimodal approach, with surgery being the preferred method. However, the surgical challenges posed by skull base sarcomas and the inconsistent efficacy of radiotherapy and chemotherapy contribute to the overall difficulty in treatment. Currently, there are no established guidelines or consensus for the diagnosis and management of skull base sarcomas in China. In response, Chinese Anti-Cancer Association Cancer Neurology Committee, Chinese Medical Education Association Head and Neck Oncology Professional Committee and Chinese Medical Education Association Oncology Chemotherapy Youth Committee have organized multidisciplinary expert discussions. Based on evidence from clinical research, we have summarized clinical application recommendations in the areas of epidemiology, histopathology, molecular pathology, imaging, surgery, radiotherapy, chemotherapy, targeted therapy, and immunotherapy, with the aim of providing clinical practice evidence to enhance the treatment of skull base sarcomas and improve patient prognosis and quality of life.

Objective: The clinicopathological features of pulmonary epithelioid hemangioendothelioma (PEHE) were analyzed to provide guidance for clinical practice. Methods: The clinical manifestations, imaging examination, pathological morphology and molecular characteristics, treatment and prognosis of patients with pulmonary epithelioid hemangioendothelioma were retrospectively collected. All cases were admitted to Fujian Medical University Union Hospital from January 2012 to May 2023. Results: Of 7 PEHE cases, 2 underwent tumor biopsy and 5 underwent tumor resection. There were 4 males and 3 females, with a median age of 58 years old. Six cases showed multiple bilateral nodules, and only one case showed a single lesion in the lower left lung lobe. Five patients presented with respiratory symptoms, like cough, sputum, hemoptysis, shortness of breath. There were round-like solid lesions with clear border and homogeneous density on lung CT. Histologically, it showed nodular growth with a distinctive myxohyaline stroma. Necrosis was seen in the center of some cases. Epithelioid tumor cells were arranged in cords, solid pattern or single cells, with abundant eosinophilic cytoplasm and occasional intracytoplasmic vacuoles. The plasmacytoid nucleus were round to oval in shape with obvious nucleoli, minimal pleomorphism and few mitoses. The tumor cells were positive for vascular endothelial markers: CD31 (7/7), CD34 (5/7), ERG (6/6), and Fli-1 (5/6); CKpan was focally positive in 3 cases (3/7), and TFE3 in 2 cases. Ki-67 index ranged from 5% to 10%. Additionally, the tumor cells partially express PD-L1 in two cases. Moreover, lung carcinoma-related gene detection was negative in one case. The TFE3 break-apart probe in two cases did not display a split signal. In terms of treatment, 4 cases were treated with surgery, 1 case was treated with chemotherapy and surgery, and 2 cases were follow-up observation. After the median 34.4 months follow-up time, one was lost to follow-up, six were survived. Their CT scans showed slight enlargement of pulmonary nodules without other organ metastases. Conclusions: PEHE is a rare vascular-derived tumor, which is usually characterized by multiple solid bilateral nodules with slow growth. It tends to lack specific clinical symptoms, and is prone to be misdiagnosed as a metastatic carcinoma. Diagnosis primarily rely on pathology, with the use of an immunohistochemical package being crucial for definitive and differential diagnosis.

Objective: To compare the short-term and long-term clinical effects of Ivor-Lewis and Mckeown esophagectomy in the treatment of middle or lower thoracic esophageal cancer. Methods: The clinical data of 716 patients with middle and lower thoracic esophageal cancer who underwent radical resection of Ivor Lewis or McKeown esophageal cancer in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Science from March 2015 to October 2018 were analyzed retrospectively, and the perioperative indicators, postoperative complications and survival of the two surgical methods were compared. Results: Among 716 patients, 135 patients underwent Ivor Lewis esophagectomy and 581 patients underwent McKeown esophagectomy. Mckeown group was significantly superior to Ivor Lewis group in terms of total number of lymph node dissection [median number was 27 (19~37) vs 25(18~33)], total number of lymph node dissection stations [median number was 5(4~7) vs 5(4~5)], and number of lymph nodes dissection along recurrent laryngeal nerve [median number was 3 (1~6) vs 0 (0~3), P＜0.05]. However, the incidence of recurrent laryngeal nerve palsy in Mckeown group was significantly higher than that in Ivor Lewis group [10.7% (62/581) vs 1.5%(2/135), P＜0.001]. There was no significant difference in the 1 -, 3 -, 5-year overall survival between the Ivor Lewis group(91.0%, 70.5%, 52.9%) and the Mckeown group (89.7%, 68.4%, 62.4%, P＞0.05), and there was also no significant difference in the 1 -, 3 -, 5-year disease free survival between the Ivor Lewis group(77.0%, 54.1%, 44.0%) and the Mckeown group (78.3%, 59.0%, 52.8%, P＞0.05). Conclusions: Ivor Lewis esophagectomy and Mckeown esophagectomy are feasible, safe, good short-term efficacy and similar survival rate for middle and lower thoracic esophageal cancer. Ivor Lewis surgery has lower incidence of recurrent laryngeal nerve palsy. Mckeown operation has more advantages in lymph node dissection, especially in lymph node dissection beside the recurrent laryngeal nerve.

Objective: To explore the molecular mechanism of miR-4508 regulating the inflammatory response of human bronchial epithelial cells induced by representative chrysotile asbestos. Methods: The chrysotile asbestos was ground into ultrafine dust using a horizontal planetary instrument, and human bronchial epithelium (16HBE) cells were taken as the object of infection. Cell survival rate was detected by cell counting kit-8 method, cytotoxicity was detected by lactate dehydrogenase (LDH) kit. The released of inflammatory factor IL-6 was detected by electrochemical luminescence. The released inflammatory factor IL-8 was detected by enzyme-linked immunosorbent assay. The expression level of miR-4508 was screened and verified by reverse transcription-quantitative real-time polymerase chain reaction. After 16HBE cells were treated with AKT inhibitor MK2206, the phosphorylation levels of AKT and PTEN were detected by western blot. The expression levels of AKT and PTEN and the contents of IL-6 and IL-8 were detected in miR-4508 overexpression and interference experiments. Results: With the increase of chrysotile asbestos exposure concentration, the cell survival rate decreased in a concentration-dependent manner, and the LDH content gradually increased. The secretion of IL-6 and IL-8 in chrysotile 25, 50 and 75 µg/ml groups were (325.92±8.61) pg/ml, (331.51±4.96) pg/ml, (378.74±13.77) pg/ml, and (94.95±3.11) pg/ml, (357.60±1.80) pg/ml, (537.19±3.11) pg/ml, respectively, while the group with 0 µg/ml chrysotile was (95.85±1.20) pg/ml and (7.81±0.00) pg/ml (P＜0.05). In addition, chrysotile asbestos exposure to 16HBE could induce the high expression of miR-4508. After pretreatment with MK2206, the phosphorylation levels of AKT and PTEN were decreased, the contents of IL-6 and IL-8 were significantly decreased, and the expression level of miR-4508 was significantly reduced. Overexpression of miR-4508 significantly increased the expressions of AKT and PTEN, and the contents of IL-6 and IL-8 (P＜0.01). After interfering with miR-4508, the expressions of AKT and PTEN were significantly decreased, and the contents of IL-6 and IL-8 were significantly decreased (P＜0.01). Conclusions: Chrysotile asbestos can induce the inflammatory response of 16HBE cells and up-regulate the expression level of miR-4508. The up-regulation of miR-4508 promotes the 16HBE inflammatory response induced by chrysotile asbestos through the PI3K/AKT pathway.

Objective: ANXA2 plays a crucial role in cancer metastasis, but its mechanism is not yet fully understood. Therefore, it is necessary to establish an ANXA2 gene knockout mouse model to provide an effective tool for subsequent studies on ANXA2-related mechanisms. Methods: A gene knockout mouse model was constructed using CRISPR/Cas9 technology. The model was validated through tissue DNA extraction followed by polymerase chain reaction (PCR), sequencing, and western blot to confirm ANXA2 genotype and protein expression. The successfully constructed models were divided into a model group and a wild-type (WT) group for the creation of a mouse tail vein injection Lewis lung carcinoma (LLC) metastasis model. Metastatic foci formation was monitored using in vivo imaging technology, and the survival rates of the two groups were compared. Results: An sgRNA sequence targeting the first exon of ANXA2 was designed, and 16 founder mice were obtained through microinjection. Through consanguineous hybridization, 30 homozygous offspring were ultimately acquired. After establishing the strains of the mouse model, mice were divided into the ANXA2 knockout group and the WT group, with 8 mice in each group. An LLC lung metastasis model was established in both groups. Compared with the WT group, the number of metastatic foci was significantly increased in the ANXA2 knockout group (7 vs. 1), and the fluorescence intensity was stronger in the WT group than in the knockout group (P=0.002). Using the GEPIA2 database to analyze ANXA2 gene expression in tumor tissues and normal tissues of lung cancer patients, it was found that ANXA2 expression levels were significantly higher in lung cancer tumor tissues compared to normal tissues (P＜0.05). The database included data from 478 lung cancer patients, and patients were stratified into high-expression and low-expression groups based on ANXA2 levels. Compared to the low-expression group, patients in the high-expression group exhibited significantly shorter disease-free survival and overall survival (P＜0.05, respectively). The survival time of mice in the ANXA2 knockout group (median survival time, 43 days) was significantly longer compared to the WT group (median survival time, 26 days; P=0.017). Additionally, ANXA2 expression is significantly associated with the prognosis of lung cancer patients (P=6.4e-14). Conclusions: ANXA2 is closely associated with cancer metastasis and holds potential as a new target for metastasis treatment. Further in-depth research will greatly facilitate the transition of ANXA2 from basic research to clinical application.

To establish diagnosis, treatment management pathways, and quality control guidelines tailored to county-level hospitals, standardize ovarian cancer care, improve treatment quality, and promote the equitable distribution of high-quality medical resources, the Expert Committee on Ovarian Cancer under the National Cancer Quality Control Center formulated the "Guidelines for diagnosis, treatment management pathways, and quality control of ovarian cancer in county-level regions (2025 edition)". This guideline integrates existing national standards for ovarian cancer diagnosis and treatment with evidence-based medicine and clinical expertise. Structured as a pathway framework, this guideline addresses hierarchical diagnosis and treatment, diagnostic workflows, therapeutic approaches, and follow-up protocols for ovarian cancer in county-level settings, offering 13 specific recommendations. The guideline clarifies the roles of county-level hospitals in ovarian cancer management, including primary diagnosis and treatment, administration of antitumor therapies, maintenance therapy, adverse event management, recurrence monitoring, rehabilitation guidance, two-way referrals, and follow-up. For cases beyond local capacity, timely referral to higher-level hospitals or qualified county-level facilities is advised. County-level hospitals may perform surgery for early-stage ovarian cancer, but suspected advanced-stage cases should be promptly referred. The guideline emphasizes the importance of multidisciplinary collaboration in county-level hospitals and recommend that initial chemotherapy for newly diagnosed patients should be conducted at higher-level or adequately equipped county-level institutions. Follow-up evaluations may be performed locally, but suspected recurrence or metastasis requires referral to higher-level hospitals for assessment. Detailed pathways are provided for diagnosis, treatment (including surgery, chemotherapy, maintenance therapy, and recurrence management), and follow-up, with recommendations for incorporating online follow-up methods to enhance patient monitoring. By defining the roles of county-level hospitals, standardizing referral processes, and strengthening multidisciplinary coordination, the guideline aims to promote standardized ovarian cancer care. Its implementation is expected to improve county-level hospitals' diagnostic and therapeutic capabilities, foster collaboration with higher-level institutions, and ultimately enhance patient outcomes and quality of life. These efforts will optimize medical resource allocation, elevate national ovarian cancer care standards, and advance balanced regional healthcare development.