Clinical Medicine Insights-Oncology最新文献

Background: Cribriform pattern 4 (CP4) is an aggressive variant in prostate cancer linked to worse clinical outcomes, including biochemical recurrence, metastases, and prostate cancer-specific mortality. However, its prognostic significance across age groups remains unclear. This study investigates whether the impact of CP4 on progression-free survival (PFS) differs by age in patients undergoing radical prostatectomy (RP).

Methods: This retrospective analysis used patient data from the TCGA database, evaluating patients who underwent RP stratified by CP4 status. The primary outcome was PFS, defined as the time from RP to biochemical recurrence, radiographic progression, or death from any cause. Multivariable Fine-Gray competing risk regression analyses assessed the association between CP4 and PFS, adjusting for preoperative prostate-specific antigen (PSA), Gleason score, tumor stage, and surgical margin status. An interaction term between age (dichotomized at 60 years to facilitate clinical interpretation and applicability, approximating the cohort median age of 61 years [interquartile range = 56-66]) and CP4 status was included in the analysis.

Results: Of 431 patients, CP4 was present in 134 (31%). In multivariable analysis, CP4 was associated with significantly worse PFS in patients older than 60 years (adjusted hazard ratio [AHR]: 1.99, 95% confidence interval [CI]: 1.01-3.92, P < .001), but not in younger patients (⩽60 years; AHR: 1.00, 95% CI: 0.49-2.04, P = .997). Adjusted 5-year PFS was significantly lower in older CP4-positive patients (50.8%, 95% CI: 33.0%-78.2%) compared with older CP4-negative patients (74.6%, 95% CI: 63.6%-87.6%; P < .001).

Conclusion: CP4 strongly predicts reduced PFS in patients above 60 years but not younger patients, suggesting that age may influence the clinical impact of CP4. These findings support age-specific risk stratification in CP4-positive prostate cancer. Prospective studies are needed to validate results and explore tailored treatment strategies based on age.

Background: Our aim was to demonstrate the efficacy and safety of pembrolizumab monotherapy as second-line treatment in Vietnamese nonsmall cell lung cancer (NSCLC) patients.

Methods: We performed a single-center retrospective study of patients with advanced NSCLC who received pembrolizumab as second-line therapy at the Vietnam National Cancer Hospital between January 2017 and October 2023. The primary endpoints were overall survival (OS) and tumor response.

Results: A total of 52 patients were included. Adenocarcinoma was observed in 43 of 52 cases (82.7%), and 40.4% of patients had PD-L1 expression in at least 50% of tumor cells. Median body weight was 57 kg (range, 45-80), and 73.1% of patients received pembrolizumab at a dose of 100 mg/3 weeks, with a median dose of 1.9 mg/kg/3-weeks (range, 1.3-4.3). The overall response rate and disease control rate were 26.9% and 51.9%, respectively. Median PFS was 6.5 months (95% CI, 3.3-9.7), and 1-year and 2-year PFS rates were 28.5% and 15.9%, respectively. Median OS was 12.0 months (95% CI, 9.8-14.2); 1-year, 2-year, and 3-year OS rates were 53.1%, 22.3%, and 8.5%, respectively. ECOG status and number of organs metastases were significantly associated with PFS and OS in the multivariate analysis. No adverse events of grades 3 to 4 were reported during the treatment.

Conclusions: Second-line pembrolizumab has a good disease control rate and prolonged survival and is a viable option for the treatment of Vietnamese NSCLC patients. Further clinical studies are necessary to determine the effectiveness of administering a low dose of pembrolizumab in this setting, particularly in Asian population.

Background: Neoadjuvant chemoradiotherapy (nCRT) followed by total mesorectal excision (TME) is the current standard for locally advanced rectal cancer. This study aimed to evaluate the need for adjuvant chemotherapy and clinical outcomes in patients with ypT3-4N0M0 rectal cancer.

Methods: This is a retrospective cohort study. We reviewed the patients with locally advanced rectal cancer who had undergone radical resection after nCRT between 2010 and 2016. A total of 69 patients with ypT3-4N0M0 rectal cancer were included. The prognostic factors affecting disease-free and overall survival were analyzed.

Results: With clinical stage II-III and pathological stage II disease, the overall survival in the adjuvant chemotherapy group (n = 38) was better than that of the group without adjuvant chemotherapy (n = 31) (86.8%, vs 74.2%, P = 0.016). The disease-free survival was better in 2 groups, but the difference was not statistically significant (73.7%, vs 67.4%, P = 0.193).

Conclusions: In patients with clinical stage III rectal cancer downstaged to ypStage II after nCRT and TME, adjuvant chemotherapy may improve overall survival. nCRT combined with postoperative adjuvant chemotherapy remains an effective strategy for patients unsuitable for complete total neoadjuvant therapy protocols.

Background: Euthyroid sick syndrome (ESS) is associated with cancer staging and influences prognosis in patients with lung and various other solid tumors. Although previous studies have examined the association between ESS and factors such as age, body mass index, Eastern Cooperative Oncology Group performance status (ECOG PS), hemoglobin (Hb), and acute-phase reactants in patients with solid cancers, its relationship with 25-hydroxyvitamin D [25(OH)D] remains unclear. In this study, we investigated the factors associated with ESS and explored the relationship between 25(OH)D levels and ESS in hospitalized patients with solid cancers (HSC).

Methods: This retrospective study included 105 patients with HSC. Laboratory parameters were assessed using the initial blood samples collected upon hospitalization. Patients with low fT3, normal or low fT4, and normal thyrotropin (TSH) levels were classified as having ESS.

Results: The overall prevalence of ESS was 37.1%. Among HSC receiving supportive care, the ESS rate was 40.3%, whereas it was lower-28.6%-in those hospitalized for chemotherapy. A statistically significant association was observed between ESS and ECOG PS, C-reactive protein (CRP), and Hb levels. Specifically, a poor ECOG PS (P < .001), low Hb levels (P = .001), and elevated CRP levels (P < .001) were significantly associated with ESS. However, no significant relationship was found between 25(OH)D levels and ESS (P = .118).

Conclusion: Euthyroid sick syndrome may be relatively common among patients with HSC and is more frequently observed in those hospitalized for supportive care. In this patient population, ESS was significantly associated with ECOG PS, Hb, and CRP; however, no significant association was identified between ESS and 25(OH)D.

Background: To evaluate the efficacy and safety of cisplatin combined with alternating temozolomide (TMZ) for recurrent high-grade glioma, as current treatments lack standardized protocols and predictive markers.

Methods: This study evaluated cisplatin (20 mg/m² IV, days 1-3) and TMZ (125 mg/m² orally, days 1-7 and 15-21) in 35 patients, using the RANO criteria with 6-month progression-free survival (PFS-6) as the primary endpoint. The Kaplan-Meier analysis was applied for survival, and tumor molecular profiles were retrospectively assessed.

Results: A median follow-up time was 61.2 months. The PFS-6 rate was 45.2%, and the median time to progression was 5.07 months. Four patients showed partial response, 16 had stable disease, and 11 had disease progression, with predominantly grade I to II toxicities. Low CD8+ tumor-infiltrating lymphocytes (TILs) correlated with improved disease control (P = .031). Data from the CGGA showed that low CD8+ TILs were associated with better survival, while high CD8+ TILs indicated increased immune response and higher immune checkpoint expression, including programmed death 1 (PD-1).

Conclusions: The cisplatin plus alternating TMZ regimen is feasible and safe for recurrent high-grade gliomas, with low CD8+ TILs potentially predicting favorable responses.

In China, esophageal cancer (EC) is one of the most prevalent malignant tumors of the digestive system. EC has a high incidence and mortality rate, of which esophageal squamous cell carcinoma (ESCC) accounts for more than 90%. Due to a lack of effective prevention and treatment methods, the 5 year survival rate is less than 30%. In recent years, microecology has become a hot spot in cancer research, and dysbiosis may play an important role in the etiology of EC. Presently, research on the relationship between the microbiome and ESCC remains in its early stages. This narrative review examines the relationship between the oral and esophageal microbiota and ESCC. A better understanding of this relationship may facilitate early detection and the optimization of treatment strategies.

Cryoablation is gaining attention as a minimally invasive treatment option for prostate cancer (PCa), offering a balance between effective oncological control and preserving genitourinary functions and quality of life. Focal cryoablation is emerging as a viable option for patients with PCa, particularly those who prioritize functional outcomes such as erectile functions and urinary continence. Whole-gland cryoablation, on the contrary, may be more appropriate for intermediate- and high-risk PCa where complete ablation of the prostate is necessary to ensure oncological control. Despite promising results, there is considerable heterogeneity in the available data regarding the long-term oncological and functional outcomes of cryoablation techniques, making it premature to issue definitive treatment recommendations. Further studies, particularly randomized controlled trials, are needed to clarify the role of cryoablation in PCa treatment. This narrative review aims to present the most relevant and up-to-date evidence on both focal and whole-gland cryoablation in PCa, providing a comprehensive overview of their current clinical applications, outcomes, and future potential.

Background: Non-Hodgkin Lymphoma (NHL) is an increasingly prevalent hematological malignancy in Egypt, highlighting the need for a better understanding of its genetic risk factors. The TP53 and MDM4 genes play critical roles in cellular homeostasis and cancer development. This study aimed to assess the frequency of the TP53 (SNP rs1042522) Arg72Pro and MDM4 (SNP rs4245739) A > C polymorphisms as potential risk factors for NHL in adult Egyptian patients.

Methods: A case-control study was conducted involving 80 adult NHL patients and 100 control age- and sex-matched healthy controls. Genotyping for the TP53 (rs1042522) Arg72Pro and MDM4 (rs4245739) A > C polymorphisms was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.

Results: A significant association was found between the homozygous TP53 Pro/Pro genotype and increased susceptibility to NHL (47.5% in patients vs 4.0% in controls; P < .001), as well as a higher frequency of the mutant C allele among NHL cases (63.8% vs 28.0%; P < .001). In contrast, no significant association was observed between MDM4 polymorphisms and NHL risk. In addition, analysis of treatment outcomes revealed no statistically significant differences in overall survival or progression-free survival based on TP53 or MDM4 genotypes.

Conclusions: These findings suggest that the TP53 Arg72Pro polymorphism is a significant genetic marker for NHL susceptibility in the Egyptian population, while MDM4 polymorphisms do not appear to contribute to disease risk. Further studies are warranted to elucidate the genetic mechanisms underlying NHL and to explore their implications for risk stratification and therapeutic strategies.