Clinical Medicine Insights-Oncology最新文献

Background: Cervical cancer is the second most common cancer in Bangladesh and is primarily caused by persistent high-risk human papillomavirus (HR-HPV) infection. Several risk factors, including immunological, genetic, environmental, and viral factors, may contribute to the development of cervical cancer. Moreover, a disruption in an otherwise delicate balance between immune response and cytokine production may lead to diseased states. Henceforth, this study aimed to determine and compare selected cytokines, including interleukin-6 (IL-6), interleukin-1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α), interferon-gamma (INF-γ), interleukin-10 (IL-10), GM-CSF, interleukin-8 (IL-8), and MCP-1 among HR-HPV-infected patients with cervical cancer, precancer individuals, and healthy participants to test the propensity of these cytokines to serve as predictive biomarkers for the detection of cervical cancer during its early stages.

Methods: A cross-sectional study was conducted on female patients visiting two referral hospitals in Bangladesh from September to November 2022. Among them, 80 women were enrolled in the study as patients with cervical cancer and precancerous lesions along with HPV DNA-negative healthy individuals. The selected cytokines in the cervical swab were estimated by flow cytometry.

Result: Cervical cancer and precancer were primarily detected in patients aged above 40 years (73.3% and 46.7% of the patients in the respective groups). Other significant risk factors, including poor educational, socioeconomic status and nutritional conditions, age of first coitus, multiparity, and tobacco and betel nut consumption, were found significant for the development of cervical cancer and precancer (P < .05). The levels of IL-6, IL-1β, IL-10, IL-8, and MCP-1 were substantially elevated in patients with cancer than in patients with precancer and healthy individuals (P < .001). Moreover, the levels of IL-6, IL-1β, IL-10, and IL-8 were also significantly increased in patients with precancer than in healthy individuals (P < .05).

Conclusions: Thus, IL-6, IL-1β, IL-10, IL-8, and MCP-1 can be used as potential biomarkers for diagnostic and prognostic purposes in HPV-induced cervical cancer and precancer.

Background: Bone metastases (BMs) are a common complication in patients with cancer, often leading to significant pain that adversely affects quality of life, necessitating effective pain management strategies. This study aims to evaluate the effectiveness of pain management in patients with BMs undergoing palliative radiotherapy and to identify determinants of pain management adequacy.

Methods: We conducted an observational analysis of 560 patients from the Palliative Radiotherapy and Inflammation Study (PRAIS) trial across several European centers, focusing on the Pain Management Index (PMI) for assessing pain management adequacy. Key predictors examined included Karnofsky Performance Status (KPS), treatment setting, primary tumor type, and site of BMs.

Results: Our findings indicate that 19.0% of patients experienced inadequate pain management (PMI < 0). Specifically, patients with KPS ⩾ 90 had a notably lower rate of adequate analgesic therapy (59.3%) compared with those with a KPS < 90 (85.0%). Among outpatients, 23.7% reported inadequate pain management, contrasted with a significantly lower inadequacy rate (3.8%) in palliative care or hospice settings. In addition, in outpatients, pain management adequacy varied with the primary tumor type, showing improved outcomes for patients with lung cancer (89.2%) versus other primary tumors (79.1%). Moreover, in non-outpatients, pain management was less effective for patients receiving radiotherapy on pelvic BMs (89.5%) compared with other sites (95.7%).

Conclusion: Although overall rates of inadequate pain management were lower than seen in previous studies, significant variability exists based on patient health status, care setting, primary tumor type, and site of BMs. These results underscore the need for personalized pain management approaches and highlight specific areas for improvement in outpatient settings and among patients with generally good health but significant pain from BMs.

Background: Research proved the prognostic significance of the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), and red blood cell distribution width (RDW) in some hematological malignancies. This study aimed to analyze the role of pretreatment NLR, LMR, PLR, RDW coefficient of variation (RDW-CV), and RDW standard deviation (RDW-SD) as prognostic markers for acute myeloid leukemia (AML).

Methods: This retrospective cohort study included 204 patients newly diagnosed with AML in the Department of Hematooncology and Bone Marrow Transplantation of the Medical University of Lublin.

Results: In the univariate models, higher RDW-CV and lower LMR predicted a poorer response to induction chemotherapy (odds ratio [OR] = 1.21, 95% confidence interval [CI95] = [1.09-2.36], P < .001; OR = 0.95, CI95 = [0.89-0.99], P = .045, respectively). In the multivariate model, age of diagnosis, ECOG (Performance Status Assessment by Eastern Cooperative Oncology Group) score, cytogenetic risk, NLR, and RDW-CV affected the odds of no response to chemotherapy significantly. The risk of progression was influenced by NLR and RDW-CV in the univariate analysis (hazard ratio [HR] = 1.20, CI95 = [1.09-1.33], P < .001; HR = 1.10, CI95 = [1.04-1.17], P = .002, respectively). In the multivariate settings, cytogenetic risk, leukocyte count, and RDW-CV affected progression free survival (PFS) significantly. Based on univariate models, the risk of death, when overall survival (OS) was taken into account, was influenced by NLR, LMR, and RDW-CV (HR = 1.05, CI95 = [1.00-1.09], P = .034; HR = 0.94, CI95 = [0.89-0.98], P = .010; HR = 1.06, CI95 = [1.01-1.10], P = .014, respectively).

Conclusions: Higher NLR, higher RDW, lower LMR, and possibly lower PLR are poor prognostic factors that may help in the risk stratification of patients with AML.

[This retracts the article DOI: 10.1177/11795549211012666.].

Background: Surgical intervention, complemented by radiotherapy and chemotherapy with temozolomide, constitutes the conventional treatment protocol for patients with newly diagnosed grade 4 glioma. We have conducted a research to evaluate the efficacy and safety of an integrated treatment regimen that incorporates tumor-treating fields with concurrent chemoradiotherapy.

Methods: This retrospective research analyzed the clinical data of 39 adults who were newly diagnosed with World Health Organization (WHO) grade 4 gliomas at the First Affiliated Hospital of Nanjing Medical University, between February 2022 and April 2023. Each participant received a concurrent treatment regimen consisting of temozolomide (75 mg/m² daily), tumor-treating fields (200 kHz), and brain irradiation (60 Gy delivered in 30 fractions). Maintenance treatment comprised ongoing temozolomide and tumor-treating fields. Adverse events were documented in accordance with the Common Terminology Criteria for Adverse Events version 5.0 (CTCAE 5.0) and specific grading criteria for dermatological adverse events associated with tumor-treating fields.

Results: Among the 39 enrolled patients, disease progression was observed in 22 individuals (56.4%), with a median progression-free survival (PFS) of 14.2 months (95% confidence interval [CI]: 13.1-14.3 months). The median overall survival (OS) was 18.2 months (95% CI: 17.3 months to not reached). Patients diagnosed with glioblastoma had a median PFS of 13.1 months (95% CI: 12.9-14.2 months) and a median OS of 18.2 months (95% CI: 17.3 months to not reached). In contrast, patients diagnosed with astrocytoma had a median PFS of 14.3 months (95% CI: 12.8 months to not reached) and a median OS of 17.0 months (95% CI: 10.6 months to not reached). Twenty-five patients (64.1%) experienced dermatological adverse events, and 30 (77.0%) experienced mild hematological adverse reactions related to chemoradiotherapy.

Conclusion: The application of tumor-treating fields concurrent with post-surgery chemoradiotherapy is both safe and effective for treating patients with newly diagnosed WHO grade 4 gliomas, exhibiting only limited toxicity.

Background: Bile duct carcinoma (BTC) is an uncommon malignant tumor of the gastrointestinal tract. Management is limited after the progress of first-line treatment. Immune checkpoint inhibitors (ICIs) have been proven popular in solid tumors. Immunotherapy plus chemotherapy has been a standard scheme in the management of multiple types of cancer. However, their efficacy and safety still need further exploration in patients who diagnosed BTC. This research mainly discusses the efficacy of immunotherapy in the second-line use of cholangiocarcinoma.

Methods: In total, 126 individuals with BTC diagnosis from 2014 to 2024, who were treated with first-line or neoadjuvant treatment but were evaluated for progression or intolerance, were retrospectively included. All patients received standard chemotherapy, 57 received ICIs in combination with targeted therapy or not, and 69 did not. Patients were divided into simple chemotherapy (SC) and CT. Differences in efficacy, adverse events, progression-free survival (PFS), overall survival (OS), progressive disease (PD), and efficacy of multiple factors and efficacy were analyzed. The primary endpoint is defined as OS. The secondary endpoint is defined as PFS, objective response rate (ORR), disease control rate (DCR), and treatment-related adverse reactions (TRAEs).

Results: The PFS and OS of 4.68 and 30.26 months for ICIs with or without targeted therapy were proven statistically significant (P = .0012; P < .001). The ORR was 5.26% (3/57) in the CT group and 1.45% (1/69) in the SC group, and the DCR was 54.39% (31/57) compared with 33.33% (23/69). Cox analysis showed that TNM stage, T stage, histology grade, CA199 level, and treatment assessment grade were associated with OS (P < .05). Histologic differentiation (P = .009) and CA199 reduced (P = .003) were proven as independent prognostic factors. The highest grade of 3 to 4 adverse reactions (TRAEs) was a reduction in hemoglobin (29.37%).

Conclusion: Our work concluded that immunocombined chemotherapy with or without specific treatment showed significant antitumor activity and acceptable safety. Immune checkpoint inhibitors are likely to be a reliable second-line therapy for advanced BTC.

Background: In Hong Kong, breast cancer is the commonest female cancer. In addition to intrinsic risk factors that cannot be modified, other factors may be potentially modifiable. The objective of this report was to determine modifiable risk factors in association with breast cancer among Chinese women in our locality.

Methods: This is a case-control study that enrolled breast cancer patients from the Hong Kong Breast Cancer Registry and healthy matched controls from the local community between 2014 and 2017. Potential risk factors were analyzed using multiple logistic regression.

Results: In total, 5186 breast cancer patients and 5571 controls were recruited. Several modifiable risk factors were identified. Self-perceived high stress level (adjusted odd ratios [AOR]= 3.44; 95% confidence intervals [CI] = 3.13-3.78), dairy-rich diet (AOR = 3.33; 95% CI = 2.01-5.52), delayed child-bearing (AOR = 2.23; 95% CI = 1.79-2.79), meat-rich diet (AOR = 1.77; 95% CI = 1.54-2.04), ever use of oral contraceptives (AOR = 1.34; 95% CI = 1.22-1.47), nulliparity (AOR = 1.21; 95% CI = 1.08-1.35), and being overweight/obese (AOR = 1.21; 95% CI = 1.10-1.32) were found to be associated with an increased risk of breast cancer. On the other hand, breastfeeding (AOR = 0.76; 95% CI = 0.69-0.83) and exercise (odds ratio = 0.62; 95% CI = 0.56-0.68) were associated with decreased risk.

Conclusions: In our locality, high-stress level, meat- and dairy-rich diet, reproductive history, use of oral contraceptives, and being overweight/obese were identified to be modifiable risk factors for breast cancer. Lifestyle modification may help reduce breast cancer incidence in the coming decades.

Background: The correlation between fibrinogen levels and adrenocortical carcinoma (ACC) remains unclear. This study aimed to explore the value of preoperative plasma fibrinogen as a biomarker for ACC.

Methods: We identified 40 patients with ACC and 170 patients with adrenal adenoma (AA) who underwent surgery at our institution between 2015 and 2022. Plasma fibrinogen levels and postoperative tumor recurrence information of the patients were also recorded. For intergroup comparisons, data obtained from the AA and ACC groups were evaluated using a t-test. The cutoff value of fibrinogen level was determined using a receiver operating characteristic (ROC) curve.

Results: Mean fibrinogen levels in the AA and ACC groups were 2.81 ± 0.59 g/L and 3.88 ± 1.75 g/L, respectively (P < .001). Fibrinogen level, which can help distinguish between AA and ACC, was evaluated using the ROC curve. The cutoff fibrinogen level was estimated as 3.87 g/L according to the Youden index. With this value, the sensitivity was 62.5%, specificity was 95.7%, and the area under the ROC curve (AUC) was 0.74 (P < .001). Fibrinogen level, which can help distinguish between recurrence and non-recurrence, was evaluated using the ROC curve. The cutoff fibrinogen level was estimated as 3.96 g/L according to the Youden index. The sensitivity, specificity, and AUC were 90%, 71.4%, and 0.85, respectively (P < .001).

Conclusion: According to the data in this study, plasma fibrinogen could be used to distinguish ACC from AA. Most importantly, plasma fibrinogen may be used to identify recurrence of postoperative ACC.

Despite the expanding therapeutic options available to cancer patients, therapeutic resistance, disease recurrence, and metastasis persist as hallmark challenges in the treatment of cancer. The rise to prominence of generative artificial intelligence (GenAI) in many realms of human activities is compelling the consideration of its capabilities as a potential lever to advance the development of effective cancer treatments. This article presents a hypothetical case study on the application of generative pre-trained transformers (GPTs) to the treatment of metastatic prostate cancer (mPC). The case explores the design of GPT-supported adaptive intermittent therapy for mPC. Testosterone and prostate-specific antigen (PSA) are assumed to be repeatedly monitored while treatment may involve a combination of androgen deprivation therapy (ADT), androgen receptor-signalling inhibitors (ARSI), chemotherapy, and radiotherapy. The analysis covers various questions relevant to the configuration, training, and inferencing of GPTs for the case of mPC treatment with a particular attention to risk mitigation regarding the hallucination problem and its implications to clinical integration of GenAI technologies. The case study provides elements of an actionable pathway to the realization of GenAI-assisted adaptive treatment of metastatic prostate cancer. As such, the study is expected to help facilitate the design of clinical trials of GenAI-supported cancer treatments.