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Drug Combination Nanoparticles Containing Gemcitabine and Paclitaxel Enable Orthotopic 4T1 Breast Tumor Regression 含有吉西他滨和紫杉醇的药物组合纳米粒子可使离体 4T1 乳腺肿瘤消退
Pub Date : 2024-08-08 DOI: 10.3390/cancers16162792
Jesse Yu, Xiaolin Xu, J. I. Griffin, Qingxin Mu, Rodney J Y Ho
Early diagnosis, intervention, and therapeutic advancements have extended the lives of breast cancer patients; however, even with molecularly targeted therapies, many patients eventually progress to metastatic cancer. Recent data suggest that residual breast cancer cells often reside in the lymphatic system before rapidly spreading through the bloodstream. To address this challenge, an effective drug combination composed of gemcitabine (G) and paclitaxel (T) is administered intravenously in sequence at the metastatic stage, but intravenous GT infusion may limit lymphatic GT drug accessibility and asynchronous drug exposure in cancer cells within the lymph. To determine whether co-localization of intracellular gemcitabine and paclitaxel (referred to as GT) could overcome these limitations and enhance the efficacy of GT, we have evaluated a previously reported GT drug-combination formulated in nanoparticle (referred to as GT-in-DcNP) evaluated in an orthotopic breast tumor model. Previously, with indocyanine green-labeled nanoparticles, we reported that GT-in-DcNP particles after subcutaneous dosing were taken up rapidly and preferentially into the lymph instead of blood vessels. The pharmacokinetic study showed enhanced co-localization of GT within the tumors and likely through lymphatic access, before drug apparency in the plasma leading to apparent long-acting plasma time-course. The mechanisms may be related to significantly greater inhibitions of tumor growth—by 100 to 140 times—in both sub-iliac and axillary regions compared to the equivalent dosing with free-and-soluble GT formulation. Furthermore, GT-in-DcNP exhibited dose-dependent effects with significant tumor regression. In contrast, even at the highest dose of free GT combination, only a modest tumor growth reduction was notable. Preliminary studies with MDA-231-HM human breast cancer in an orthotopic xenograft model indicated that GT-in-DcNP may be effective in suppressing human breast tumor growth. Taken together, the synchronized delivery of GT-in-DcNP to mammary tumors through the lymphatic system offers enhanced cellular retention and greater efficacy.
早期诊断、干预和治疗方法的进步延长了乳腺癌患者的生命;然而,即使采用分子靶向疗法,许多患者最终还是会发展为转移性癌症。最近的数据表明,残留的乳腺癌细胞在通过血液迅速扩散之前,通常会滞留在淋巴系统中。为了应对这一挑战,由吉西他滨(G)和紫杉醇(T)组成的有效药物组合在转移阶段依次静脉注射,但静脉注射GT可能会限制淋巴GT药物的可及性和淋巴内癌细胞的非同步药物暴露。为了确定细胞内吉西他滨和紫杉醇(简称GT)的共定位是否能克服这些限制并提高GT的疗效,我们在正位乳腺肿瘤模型中评估了之前报道的一种纳米颗粒GT药物组合(简称GT-in-DcNP)。此前,我们曾报道过使用吲哚菁绿标记的纳米粒子,皮下注射后 GT-in-DcNP 颗粒会被迅速吸收,并优先进入淋巴而不是血管。药代动力学研究表明,GT 在肿瘤内的共定位性增强,可能通过淋巴途径,然后药物在血浆中透明化,导致明显的长效血浆时间过程。与使用游离和可溶性 GT 制剂的同等剂量相比,这种机制可能与在髂下和腋窝区域抑制肿瘤生长的效果显著提高 100 到 140 倍有关。此外,GT-in-DcNP 还表现出剂量依赖效应,肿瘤明显消退。相比之下,即使使用最高剂量的游离 GT 复方制剂,肿瘤生长也仅有轻微下降。对 MDA-231-HM 人类乳腺癌进行的正位异种移植模型的初步研究表明,GT-in-DcNP 可有效抑制人类乳腺癌的生长。总之,GT-in-DcNP 通过淋巴系统同步输送到乳腺肿瘤可提高细胞存留率和疗效。
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引用次数: 0
Surface Markers and Chemokines/Cytokines of Tumor-Associated Macrophages in Osteosarcoma and Other Carcinoma Microenviornments—Contradictions and Comparisons 骨肉瘤和其他癌症微环境中肿瘤相关巨噬细胞的表面标记物和趋化因子/细胞因子--矛盾与比较
Pub Date : 2024-08-08 DOI: 10.3390/cancers16162801
Rikito Tatsuno, Yoshihiro Komohara, Cheng Pan, Tomonori Kawasaki, Atsushi Enomoto, Takahiro Jubashi, Hiroyuki Kono, M. Wako, Tomoyuki Ashizawa, Hirotaka Haro, Jiro Ichikawa
Osteosarcoma (OS) is the most common primary bone tumor in children and adolescents. Prognosis is improving with advances in multidisciplinary treatment strategies, but the development of new anticancer agents has not, and improvement in prognosis for patients with pulmonary metastases has stalled. In recent years, the tumor microenvironment (TME) has gained attention as a therapeutic target for cancer. The immune component of OS TME consists mainly of tumor-associated macrophages (TAMs). They exhibit remarkable plasticity, and their phenotype is influenced by the TME. In general, surface markers such as CD68 and CD80 show anti-tumor effects, while CD163 and CD204 show tumor-promoting effects. Surface markers have potential value as diagnostic and prognostic biomarkers. The cytokines and chemokines produced by TAMs promote tumor growth and metastasis. However, the role of TAMs in OS remains unclear to date. In this review, we describe the role of TAMs in OS by focusing on TAM surface markers and the TAM-produced cytokines and chemokines in the TME, and by comparing their behaviors in other carcinomas. We found contrary results from different studies. These findings highlight the urgency for further research in this field to improve the stalled OS prognosis percentages.
骨肉瘤(Osteosarcoma,OS)是儿童和青少年最常见的原发性骨肿瘤。随着多学科治疗策略的进步,骨肉瘤的预后正在得到改善,但新抗癌药物的开发却没有取得进展,肺转移患者的预后改善也停滞不前。近年来,肿瘤微环境(TME)作为癌症的治疗靶点备受关注。OS TME 的免疫成分主要包括肿瘤相关巨噬细胞(TAMs)。它们表现出显著的可塑性,其表型受到 TME 的影响。一般来说,CD68 和 CD80 等表面标记物具有抗肿瘤作用,而 CD163 和 CD204 则具有促肿瘤作用。表面标志物具有诊断和预后生物标志物的潜在价值。TAMs 产生的细胞因子和趋化因子可促进肿瘤生长和转移。然而,迄今为止,TAMs 在 OS 中的作用仍不明确。在这篇综述中,我们通过聚焦 TAM 表面标志物和 TAM 在 TME 中产生的细胞因子和趋化因子,并比较它们在其他癌症中的行为,来描述 TAM 在 OS 中的作用。我们发现不同的研究得出了相反的结果。这些发现凸显了在这一领域开展进一步研究以改善停滞不前的 OS 预后百分比的紧迫性。
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引用次数: 0
Exploring Predictive and Prognostic Biomarkers in Colorectal Cancer: A Comprehensive Review 探索结直肠癌的预测和预后生物标记物:全面回顾
Pub Date : 2024-08-08 DOI: 10.3390/cancers16162796
Karam Ashouri, Alexandra Wong, Pooja Mittal, Lesly Torres-Gonzalez, Jae Ho Lo, S. Soni, S. Algaze, Taline Khoukaz, Wu Zhang, Yan Yang, J. Millstein, H. Lenz, F. Battaglin
Colorectal cancer (CRC) remains the second leading cause of cancer-related mortality worldwide. While immune checkpoint inhibitors have significantly improved patient outcomes, their effectiveness is mostly limited to tumors with microsatellite instability (MSI-H/dMMR) or an increased tumor mutational burden, which comprise 10% of cases. Advancing personalized medicine in CRC hinges on identifying predictive biomarkers to guide treatment decisions. This comprehensive review examines established tissue markers such as KRAS and HER2, highlighting their roles in resistance to anti-EGFR agents and discussing advances in targeted therapies for these markers. Additionally, this review summarizes encouraging data on promising therapeutic targets and highlights the clinical utility of liquid biopsies. By synthesizing current evidence and identifying knowledge gaps, this review provides clinicians and researchers with a contemporary understanding of the biomarker landscape in CRC. Finally, the review examines future directions and challenges in translating promising biomarkers into clinical practice, with the goal of enhancing personalized medicine approaches for colorectal cancer patients.
结直肠癌(CRC)仍然是全球癌症相关死亡的第二大原因。虽然免疫检查点抑制剂大大改善了患者的预后,但其疗效大多局限于微卫星不稳定(MSI-H/dMMR)或肿瘤突变负荷增加的肿瘤,而这部分病例占 10%。推进 CRC 的个性化治疗取决于确定指导治疗决策的预测性生物标志物。本综述对 KRAS 和 HER2 等已确立的组织标志物进行了研究,强调了它们在抗 EGFR 药物耐药性中的作用,并讨论了针对这些标志物的靶向疗法的进展。此外,这篇综述还总结了有望成为治疗靶点的令人鼓舞的数据,并强调了液体活检的临床实用性。通过综合现有证据并找出知识差距,本综述为临床医生和研究人员提供了对 CRC 生物标记物现状的当代理解。最后,这篇综述探讨了将有前景的生物标记物转化为临床实践的未来方向和挑战,目的是加强针对结直肠癌患者的个性化医疗方法。
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引用次数: 0
Physical Deconditioning in Lung Cancer Patients Who Underwent Lung Resection Surgery in Spain: A Prospective Observational Study 西班牙接受肺切除手术的肺癌患者的体能下降情况:前瞻性观察研究
Pub Date : 2024-08-08 DOI: 10.3390/cancers16162790
Alejandro Heredia-Ciuró, Florencio Quero-Valenzuela, Javier Martín-Núñez, A. Calvache-Mateo, G. Valenza-Peña, L. López-López, M. Valenza
Background. Lung resection represents the main curative treatment modality for lung cancer. These patients present with physical deterioration that has been studied previously using objective variables; however, no previous studies have evaluated the self-perceived physical fitness of these patients. For these reasons, to increase the current knowledge on lung cancer patients’ impairment, the aim of this study was to characterize the self-perceived physical deconditioning of lung cancer patients undergoing lung resection in the short and medium term after surgery. Methods. A longitudinal, observational, prospective cohort study was performed in the Thoracic Surgery Service of the Hospital Virgen de las Nieves (Granada). Symptoms (pain, fatigue, cough and dyspnea) and physical fitness (upper and lower limbs) were assessed before surgery, at discharge and at one month after discharge. Results. Among the total of 88 patients that we included in our study, significant differences were found at discharge in symptoms (p < 0.05) and physical fitness (p < 0.05). One month after surgery, higher levels of pain (p = 0,002) and dyspnea (p = 0.007) were observed, as well as poorer results in the upper (p = 0.023) and lower limbs’ physical fitness, with regard to the initial values. Conclusions. Patients undergoing lung resection present an increase in symptoms and physical fitness deterioration at discharge, which is maintained one month after surgery.
背景。肺切除术是治疗肺癌的主要方法。以前曾使用客观变量对这些患者的体能衰退情况进行过研究;但是,以前没有研究对这些患者的自我感觉体能进行过评估。因此,为了增加目前对肺癌患者体能损伤的了解,本研究旨在描述接受肺切除术的肺癌患者在术后中短期内自我感觉的体能下降情况。研究方法在格拉纳达 Virgen de las Nieves 医院胸外科开展了一项纵向、观察性、前瞻性队列研究。在手术前、出院时和出院后一个月对患者的症状(疼痛、疲劳、咳嗽和呼吸困难)和体能(上肢和下肢)进行了评估。结果在纳入研究的 88 名患者中,出院时的症状(P < 0.05)和体能(P < 0.05)存在显著差异。术后一个月,疼痛(p = 0.002)和呼吸困难(p = 0.007)程度较高,上肢(p = 0.023)和下肢体能与初始值相比也较差。结论接受肺切除术的患者出院时症状加重,体能下降,术后一个月症状依然存在。
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引用次数: 0
The Comprehensive Characterization of B7-H3 Expression in the Tumor Microenvironment of Lung Squamous Cell Carcinoma: A Retrospective Study 肺鳞癌肿瘤微环境中 B7-H3 表达的综合特征:一项回顾性研究
Pub Date : 2024-06-04 DOI: 10.3390/cancers16112140
A. Asakawa, Ryoto Yoshimoto, Maki Kobayashi, Nanae Izumi, Takanori Maejima, Tsuneo Deguchi, K. Kubota, H. Takahashi, Miyuki Yamada, S. Ishibashi, Iichiroh Onishi, Yuko Kinowaki, Morita Kurata, Masashi Kobayashi, H. Ishibashi, Kenichi Okubo, Kenichi Ohashi, Masanobu Kitagawa, Kouhei Yamamoto
Lung squamous cell carcinoma (LSCC) is refractory to various therapies for non-small cell cancer; therefore, new therapeutic approaches are required to improve the prognosis of LSCC. Although immunotherapies targeting B7 family molecules were explored as treatments for several cancer types, the expression and significance of B7-H3 in the tumor microenvironment (TME) and its relationship with other immune checkpoint molecules have not yet been investigated in detail. We used high-throughput quantitative multiplex immunohistochemistry to examine B7-H3 expression in the TME. We investigated the relationship between B7-H3 expression and prognosis as well as changes in the TME with B7-H3 expression using 110 surgically resected pathological specimens retrospectively. We examined the correlation between B7-H3 and programmed cell death-ligand 1 (PD-L1) expression in single cells. High B7-H3 expression in tumor cells was associated with a better prognosis and a significant increase in the number of CD163+PD-L1+ macrophages. Quantitative analysis revealed that there is a positive correlation between B7-H3 and PD-L1 expression in tumor and stromal cells, as well as in intratumoral tumor-infiltrating lymphocytes and tumor-associated macrophages in the same cells. CD68+, CD163+, and CK+ cells with PD-L1+ phenotypes had higher B7-H3 expression compared to PD-L1− cells. Our findings demonstrate a correlation between B7-H3 and PD-L1 expression in the same cells, indicating that therapies targeting B7-H3 could provide additional efficacy in patients refractory to PD-L1-targeting therapies.
肺鳞状细胞癌(LSCC)对非小细胞癌的各种疗法均难治,因此需要新的治疗方法来改善 LSCC 的预后。虽然针对 B7 家族分子的免疫疗法已被探索用于多种癌症类型的治疗,但 B7-H3 在肿瘤微环境(TME)中的表达和意义及其与其他免疫检查点分子的关系尚未得到详细研究。我们使用高通量定量多重免疫组化技术检测了 B7-H3 在肿瘤微环境中的表达。我们利用 110 例手术切除的病理标本,回顾性地研究了 B7-H3 表达与预后之间的关系,以及 TME 中 B7-H3 表达的变化。我们研究了B7-H3与单细胞中程序性细胞死亡配体1(PD-L1)表达之间的相关性。肿瘤细胞中 B7-H3 的高表达与较好的预后和 CD163+PD-L1+ 巨噬细胞数量的显著增加有关。定量分析显示,B7-H3 和 PD-L1 在肿瘤细胞和基质细胞以及瘤内肿瘤浸润淋巴细胞和肿瘤相关巨噬细胞中的表达呈正相关。与 PD-L1- 细胞相比,具有 PD-L1+ 表型的 CD68+、CD163+ 和 CK+ 细胞具有更高的 B7-H3 表达。我们的研究结果表明,B7-H3和PD-L1在相同细胞中的表达存在相关性,这表明针对B7-H3的疗法可为PD-L1靶向疗法难治性患者带来额外疗效。
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引用次数: 0
Site-Specific Response and Resistance Patterns in Patients with Advanced Non-Small-Cell Lung Cancer Treated with First-Line Systemic Therapy 接受一线系统疗法的晚期非小细胞肺癌患者的特异部位反应和抗药性模式
Pub Date : 2024-06-04 DOI: 10.3390/cancers16112136
Lauren Julia Brown, J. Ahn, Bo Gao, Harriet Gee, Adnan Nagrial, Eric Hau, Inês Pires da Silva
Patients with advanced NSCLC have heterogenous responses to immune checkpoint inhibitors (ICIs) with or without chemotherapy. In NSCLC, the impact of the distribution of metastatic sites and the response to systemic therapy combinations remain poorly understood. In a retrospective cohort study of patients with unresectable stage III/IV NSCLC who received first-line systemic therapy, we sought to assess the association between the site of metastases with patterns of response and progression. Data regarding demographics, tumour characteristics (including site, size, and volume of metastases), treatment, and outcomes were examined at two cancer care centres. The endpoints included organ site-specific response rate, objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). Two-hundred and eighty-five patients were included in the analysis. In a multivariate analysis, patients with bone metastases had a reduced ORR, PFS, and OS. Primary resistance was also more likely in patients with bone metastases. Patients with bone or liver metastases had a shorter OS when receiving ICIs with or without chemotherapy, but not with chemotherapy alone, suggesting an immunological basis for therapeutic resistance. A directed assessment of the tumour microenvironment in these locations and a deeper understanding of the drivers of organ-specific resistance to immunotherapy are critical to optimise novel combination therapies and sequencing in these patients.
晚期 NSCLC 患者对免疫检查点抑制剂(ICIs)化疗或不化疗的反应各不相同。在NSCLC中,转移部位的分布和对全身治疗组合反应的影响仍鲜为人知。在一项针对接受一线系统治疗的不可切除的 III/IV 期 NSCLC 患者的回顾性队列研究中,我们试图评估转移部位与反应和进展模式之间的关联。我们在两家癌症治疗中心研究了有关人口统计学、肿瘤特征(包括转移部位、大小和体积)、治疗和预后的数据。研究终点包括器官部位特异性反应率、客观反应率(ORR)、无进展生存期(PFS)和总生存期(OS)。共有 285 名患者参与了分析。在一项多变量分析中,骨转移患者的ORR、PFS和OS均有所降低。骨转移患者也更容易出现原发耐药。有骨转移或肝转移的患者在接受 ICIs 与化疗或不接受化疗的情况下,OS 较短,而单独接受化疗的患者则不短,这表明耐药性的产生有免疫学基础。对这些部位的肿瘤微环境进行定向评估,并深入了解器官特异性免疫疗法耐药的驱动因素,对于优化这些患者的新型联合疗法和排序至关重要。
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引用次数: 0
Topical and Intralesional Immunotherapy for the Management of Basal Cell Carcinoma 用于治疗基底细胞癌的局部和鞘内免疫疗法
Pub Date : 2024-06-04 DOI: 10.3390/cancers16112135
A. Fernández‐Galván, P. Rodríguez‐Jiménez, Beatriz González-Sixto, M. Abalde-Pintos, B. Butrón‐Bris
Basal Cell Carcinoma (BCC) is the most common type of cancer among the white population. Individuals with fair skin have an average lifetime risk of around 30% for developing BCC, and there is a noticeable upward trend in its incidence rate. The principal treatment objectives for BCC involve achieving the total excision of the tumor while maximizing the preservation of function and cosmesis. Surgery is considered the treatment of choice for BCC for two main reasons: it allows for the highest cure rates and facilitates histological control of resection margins. However, in the subgroup of patients with low-risk recurrence or medical contraindications for surgery, new non-surgical treatment alternatives can provide an excellent oncological and cosmetic outcome. An evident and justified instance of these local therapies occurred during the COVID-19 pandemic, a period when surgical interventions carried out in hospital settings were not a viable option.
基底细胞癌(BCC)是白人中最常见的癌症类型。皮肤白皙的人一生中患 BCC 的平均风险约为 30%,而且其发病率有明显的上升趋势。BCC 的主要治疗目标是完全切除肿瘤,同时最大限度地保留功能和外观。手术治疗被认为是 BCC 的首选治疗方法,主要有两个原因:一是治愈率最高,二是便于对切除边缘进行组织学控制。然而,在低复发风险或有手术禁忌症的亚组患者中,新的非手术治疗方法可以提供极佳的肿瘤和美容效果。在 COVID-19 大流行期间,在医院进行外科手术并不是可行的选择。
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引用次数: 0
Functional Investigation of IGF1R Mutations in Multiple Myeloma 多发性骨髓瘤中 IGF1R 基因突变的功能研究
Pub Date : 2024-06-04 DOI: 10.3390/cancers16112139
Sofia Catalina Heredia-Guerrero, Marietheres Evers, S. Keppler, Marlene Schwarzfischer, Viktoria Fuhr, Hilka Rauert-Wunderlich, Anne Krügl, T. Nedeva, T. Grieb, Julia Pickert, Hanna Koch, Torsten Steinbrunn, Otto-Jonas Bayrhof, R. Bargou, Andreas Rosenwald, T. Stühmer, E. Leich
High expression of the receptor tyrosine kinase (RTK) insulin-like growth factor-1 receptor (IGF1R) and RTK mutations are associated with high-risk/worse prognosis in multiple myeloma (MM). Combining the pIGF1R/pINSR inhibitor linsitinib with the proteasome inhibitor (PI) bortezomib seemed promising in a clinical trial, but IGF1R expression was not associated with therapy response. Because the oncogenic impact of IGF1R mutations is so far unknown, we investigated the functional impact of IGF1R mutations on survival signaling, viability/proliferation and survival response to therapy. We transfected four human myeloma cell lines (HMCLs) with IGF1RWT, IGF1RD1146N and IGF1RN1129S (Sleeping Beauty), generated CRISPR-Cas9 IGF1R knockouts in the HMCLs U-266 (IGF1RWT) and L-363 (IGF1RD1146N) and tested the anti-MM activity of linsitinib alone and in combination with the second-generation PI carfilzomib in seven HMCLs. IGF1R knockout entailed reduced proliferation. Upon IGF1R overexpression, survival signaling was moderately increased in all HCMLs and slightly affected by IGF1RN1129S in one HMCL, whereby the viability remained unaffected. Expression of IGF1RD1146N reduced pIGF1R-Y1135, especially under serum reduction, but did not impact downstream signaling. Linsitinib and carfilzomib showed enhanced anti-myeloma activity in six out of seven HMCL irrespective of the IGF1R mutation status. In conclusion, IGF1R mutations can impact IGF1R activation and/or downstream signaling, and a combination of linsitinib with carfilzomib might be a suitable therapeutic approach for MM patients potentially responsive to IGF1R blockade.
受体酪氨酸激酶(RTK)胰岛素样生长因子-1受体(IGF1R)的高表达和RTK突变与多发性骨髓瘤(MM)的高风险/不良预后有关。在一项临床试验中,pIGF1R/pINSR抑制剂来西替尼与蛋白酶体抑制剂硼替佐米联用似乎很有希望,但IGF1R的表达与治疗反应无关。由于IGF1R突变的致癌影响迄今尚不清楚,我们研究了IGF1R突变对存活信号转导、存活率/增殖和存活率对治疗反应的功能性影响。我们用IGF1RWT、IGF1RD1146N和IGF1RN1129S(睡美人)转染了四种人类骨髓瘤细胞系(HMCLs),在HMCLs U-266(IGF1RWT)和L-363(IGF1RD1146N)中产生了CRISPR-Cas9 IGF1R基因敲除,并在七种HMCLs中测试了来西替尼单独或与第二代PI卡非佐米联合使用的抗骨髓瘤活性。IGF1R 基因敲除会导致增殖减少。IGF1R过表达时,所有HCML的存活信号都会适度增加,而在一个HMCL中,IGF1RN1129S会略微影响存活信号,但存活率不受影响。表达 IGF1RD1146N 会降低 pIGF1R-Y1135,尤其是在血清减少的情况下,但不会影响下游信号传导。无论 IGF1R 突变情况如何,来替尼和卡非佐米在七种 HMCL 中的六种都显示出更强的抗骨髓瘤活性。总之,IGF1R突变会影响IGF1R的激活和/或下游信号转导,对于可能对IGF1R阻断产生反应的骨髓瘤患者来说,来西替尼与卡非佐米联合用药可能是一种合适的治疗方法。
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引用次数: 0
Prognostic Impact and Clinical Implications of Adverse Tumor Grade in Very Favorable Low- and Intermediate-Risk Prostate Cancer Patients Treated with Robot-Assisted Radical Prostatectomy: Experience of a Single Tertiary Referral Center 采用机器人辅助前列腺癌根治术治疗的极佳低危和中危前列腺癌患者肿瘤不良分级的预后影响和临床意义:一家三级转诊中心的经验
Pub Date : 2024-06-04 DOI: 10.3390/cancers16112137
A. Porcaro, A. Bianchi, S. Gallina, A. Panunzio, A. Tafuri, E. Serafin, R. Orlando, Giovanni Mazzucato, P. Ornaghi, Francesco Cianflone, Francesca Montanaro, Francesco Artoni, Alberto Baielli, Francesco Ditonno, Filippo Migliorini, Matteo Brunelli, Salvatore Siracusano, M. Cerruto, Alessandro Antonelli
Objectives: To assess the prognostic impact and predictors of adverse tumor grade in very favorable low- and intermediate-risk prostate cancer (PCa) patients treated with robot-assisted radical prostatectomy (RARP). Methods: Data of low- and intermediate PCa risk-class patients were retrieved from a prospectively maintained institutional database. Adverse tumor grade was defined as pathology ISUP grade group > 2. Disease progression was defined as a biochemical recurrence event and/or local recurrence and/or distant metastases. Associations were assessed by Cox’s proportional hazards and logistic regression model. Results: Between January 2013 and October 2020, the study evaluated a population of 289 patients, including 178 low-risk cases (61.1%) and 111 intermediate-risk subjects (38.4%); unfavorable tumor grade was detected in 82 cases (28.4%). PCa progression, which occurred in 29 patients (10%), was independently predicted by adverse tumor grade and biopsy ISUP grade group 2, with the former showing stronger associations (hazard ratio, HR = 4.478; 95% CI: 1.840–10.895; p = 0.001) than the latter (HR = 2.336; 95% CI: 1.057–5.164; p = 0.036). Older age and biopsy ISUP grade group 2 were independent clinical predictors of adverse tumor grade, associated with larger tumors that eventually presented non-organ-confined disease. Conclusions: In a very favorable PCa patient population, adverse tumor grade was an unfavorable prognostic factor for disease progression. Active surveillance in very favorable intermediate-risk patients is still a hazard, so molecular and genetic testing of biopsy specimens is needed.
目的评估机器人辅助根治性前列腺切除术(RARP)对非常有利的低危和中危前列腺癌(PCa)患者的预后影响以及不良肿瘤分级的预测因素。方法从前瞻性维护的机构数据库中检索低危和中危 PCa 患者的数据。肿瘤不良分级定义为病理 ISUP 分级大于 2 级。疾病进展定义为生化复发和/或局部复发和/或远处转移。相关性通过考克斯比例危害和逻辑回归模型进行评估。结果2013年1月至2020年10月期间,该研究共评估了289例患者,其中包括178例低危病例(61.1%)和111例中危病例(38.4%);82例(28.4%)患者的肿瘤分级不利。29例患者(10%)出现了PCa进展,不良肿瘤分级和活检ISUP分级2组可独立预测PCa进展,前者比后者(HR = 2.336; 95% CI: 1.057-5.164; p = 0.036)显示出更强的相关性(危险比,HR = 4.478; 95% CI: 1.840-10.895; p = 0.001)。年龄较大和活检 ISUP 分级 2 组是肿瘤分级不良的独立临床预测因素,与最终出现非器官封闭性疾病的较大肿瘤有关。结论在非常有利的 PCa 患者群体中,肿瘤分级不良是疾病进展的不利预后因素。对非常有利的中危患者进行积极监测仍然是一种危险,因此需要对活检标本进行分子和基因检测。
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引用次数: 0
Prevention of Brain Metastases: A New Frontier 预防脑转移:新领域
Pub Date : 2024-06-04 DOI: 10.3390/cancers16112134
A. Pellerino, Tara Marie Davidson, Shreyas Bellur, M. Ahluwalia, Hussein A Tawbi, R. Rudà, Riccardo Soffietti
This review discusses the topic of prevention of brain metastases from the most frequent solid tumor types, i.e., lung cancer, breast cancer and melanoma. Within each tumor type, the risk of brain metastasis is related to disease status and molecular subtype (i.e., EGFR-mutant non-small cell lung cancer, HER2-positive and triple-negative breast cancer, BRAF and NRAF-mutant melanoma). Prophylactic cranial irradiation is the standard of care in patients in small cell lung cancer responsive to chemotherapy but at the price of late neurocognitive decline. More recently, several molecular agents with the capability to target molecular alterations driving tumor growth have proven as effective in the prevention of secondary relapse into the brain in clinical trials. This is the case for EGFR-mutant or ALK-rearranged non-small cell lung cancer inhibitors, tucatinib and trastuzumab–deruxtecan for HER2-positive breast cancer and BRAF inhibitors for melanoma. The need for screening with an MRI in asymptomatic patients at risk of brain metastases is emphasized.
本综述将讨论如何预防最常见的实体瘤类型,即肺癌、乳腺癌和黑色素瘤的脑转移。在每种肿瘤类型中,脑转移的风险与疾病状态和分子亚型(即表皮生长因子受体突变的非小细胞肺癌、HER2 阳性和三阴性乳腺癌、BRAF 和 NRAF 突变的黑色素瘤)有关。预防性颅内照射是对化疗有反应的小细胞肺癌患者的标准治疗方法,但代价是后期神经认知功能下降。最近,在临床试验中,几种能够靶向驱动肿瘤生长的分子改变的分子药物被证明在预防脑部二次复发方面非常有效。表皮生长因子受体(EGFR)突变或 ALK 重组非小细胞肺癌抑制剂、治疗 HER2 阳性乳腺癌的图卡替尼(tucatinib)和曲妥珠单抗(trastuzumab-deruxtecan)以及治疗黑色素瘤的 BRAF 抑制剂都是如此。强调了对有脑转移风险的无症状患者进行磁共振成像筛查的必要性。
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引用次数: 0
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