Cancer diagnosis & prognosis最新文献

Background/aim: The albumin-bilirubin (ALBI) grade is an assessment tool for hepatic function and prognosis in patients with hepatocellular carcinoma (HCC). However, its significance in patients with non-small cell lung cancer (NSCLC) treated with an epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) remains unclear. We retrospectively investigated the relationship between pre-treatment ALBI grade and hepatotoxicity and treatment efficacy in patients with NSCLC receiving EGFR-TKIs.

Patients and methods: We analyzed data from 182 patients with NSCLC treated with EGFR-TKIs. Patients were categorized into ALBI grades 1/2a and 2b/3 groups. We examined the association between ALBI grade, hepatotoxicity, and time to treatment failure (TTF) using univariate and multivariate analyses.

Results: In the univariate Kaplan-Meier analysis, ALBI grade was not associated with hepatotoxicity (log-rank p=0.56). This finding was consistent with the multivariate analysis of patients treated with gefitinib and erlotinib (n=158). However, In the univariate Kaplan-Meier analysis, the median TTF for the ALBI grade 1/2a group was 10.6 months, compared to 5.8 months for the ALBI grade 2b/3 group (hazard ratio=1.66, 95% confidence interval=1.19-2.33, p=0.003). Multivariate analysis confirmed that ALBI grade 2b/3 (hazard ratio=1.64, 95% confidence interval=1.16-2.30, p<0.01) was independently associated with shortened TTF.

Conclusion: Pretreatment ALBI grade classification can predict efficacy in patients with NSCLC treated with EGFR-TKIs.

Background/aim: Significant transcription factors - including c-Fos (gene locus: 14q24.3) and c-Jun (gene locus: 1p32-p31) - regulate cell homeostasis preventing abnormal signal transduction to nucleus. Their over-activation seems to be associated with an aggressive phenotype in non-small cell lung carcinomas (NSCLCs). In the current study, our aim was to co-analyze c-FOS/c-JUN protein expression in a series of NSCLCs correlating them to the corresponding clinico-pathological features.

Materials and methods: A set of fifty (n=50) paraffin embedded NSCLC tissue sections were selected comprising of adenocarcinomas (n=25) and squamous cell carcinomas (n=25), respectively. Immunocytochemistry (IHC) for the c-FOS/c-JUN markers was implemented. Digital image analysis (DIA) was also performed for evaluating objectively the corresponding immunostaining intensity levels of the examined proteins.

Results: All the examined tissue samples expressed the markers in different protein levels. High staining intensity levels were detected in 34/50 (68%) and 24/50 (48%), respectively. C-FOS over expression was statistically significant correlated to stage (p=0.033), whereas C-JUN over expression was associated with NSCLC histotype (p=0.05) and with maximum tumor diameter (p=0.046).

Conclusion: C-FOS/C-JUN co- over activation is observed frequently in NSCLC, playing potentially a central role in the aggressiveness of the malignancy's phenotype (advanced stage, increased metastatic potential). Development and implementation of novel agents that target these transcription factors is a promising approach for applying targeted therapeutic strategies in NSCC patients based on specific genetic signatures and protein profiles.

Background/aim: Reduction in skeletal muscle mass during chemotherapy is associated with poor outcomes. This study investigated the impact of changes in the psoas muscle index (PMI) on the prognosis of patients with unresectable colorectal liver metastases (CRLM) undergoing chemotherapy, including subgroup analyses based on the initial treatment response assessment.

Patients and methods: We evaluated 47 patients with unresectable CRLM who underwent systematic chemotherapy and assessed changes in PMI to determine their prognosis.

Results: Changes in PMI were significantly associated with the presence or absence of primary tumor resection and the chemotherapeutic responses to first-line chemotherapy. The PMI reduction group was significantly associated with poor prognosis in both overall survival (OS) and progression-free survival (PFS) in patients with CRLM, and in both OS and PFS in the partial response (PR) group at the initial chemotherapy response assessment.

Conclusion: Skeletal muscle loss at chemotherapy initiation was significantly associated with poorer survival in patients with unresectable CRLM. Maintaining muscle mass could serve as a new indicator for identifying patients with a PR at the initial chemotherapy response assessment for prognosis. Personalized interventions should be investigated to determine whether they can improve muscle mass and lead to better clinical outcomes.

Background/aim: The aim of the present study was to evaluate the clinical impact of the Global Immune-Nutrition-Information Index (GINI) in patients with esophageal cancer (EC) who received curative treatment and to clarify the potential of the GINI as a prognostic factor.

Patients and methods: Patients who underwent curative resection for EC at Yokohama City University between 2000 and 2020 were consecutively chosen based on their medical records. The GINI was defined as follows: GINI=[C-reactive protein×platelet×monocyte×neutrophil]/[albumin×lymphocyte].

Results: This study included 180 patients. Among them, 67 were categorized into the GINI-low group and 113 were categorized into the GINI-high group, with a cutoff value of 5000. The 3- and 5- year overall survival (OS) rates were 75.6% and 64.9%, respectively, in the GINI-low group and 55.3% and 48.1% in the GINI-high group (p=0.005). According to a multivariate analysis for OS, the GINI was identified as an independent prognostic factor [hazard ratio=2.106, 95% confidence interval=1.252-3.544, p=0.005]. Similar results were observed for RFS. In addition, the GINI affects preoperative tube feeding and the induction rate of neoadjuvant chemotherapy (NAC).

Conclusion: The GINI is a promising biomarker for the treatment and management of EC.

Background/aim: This study examined the treatment outcomes of radical cystectomy (RC) for micropapillary subtype (MPS) bladder cancer treated at our hospital.

Patients and methods: Histopathological findings of RC specimens collected from 2003 to 2020 were evaluated. Recurrence-free survival (RFS) and overall survival (OS) after RC, as well as the efficacy of chemotherapy in cases of recurrence, were retrospectively assessed.

Results: Of 202 patients who underwent RC, seven (3.4%) had MPS bladder cancer. All seven patients underwent immediate RC without neoadjuvant chemotherapy. The median patient age was 58 years (range=52-71 years), and all patients were male. After RC, median RFS was 14 months (range=6-115 months), and median OS was 31 months (range=18-115 months). The clinical tumor stage was cT1 or lower in two patients (28.5%), cT2 in two patients (28.5%), and cT3 or higher in three patients (42.8%). No preoperative lymph node metastasis was observed. The pathological tumor stage was pT1 or lower in one patient (14.2%), pT2 in one patient (14.2%), and pT3 or higher in five patients (71.4%). The pathological lymph node stage was observed in five patients (71.4%). Although six of seven patients (85.7%) received adjuvant chemotherapy, all patients experienced relapse. The objective response rates of primary and secondary chemotherapy at relapse were both 33%. One patient received immune checkpoint inhibitor therapy and maintained stable disease for 12 months.

Conclusion: The recurrence rate after RC for MPS bladder cancer was high, and prognosis was poor.

Background/aim: Elderly patients with early-stage breast cancer have potentially been underrepresented in clinical trials. Thus, treatment strategies for a minority of elderly patients with hormone receptor (HR)-negative breast cancer may be inadequately informed.

Patients and methods: We retrospectively reviewed 126 patients with HR-negative breast cancer aged ≥65 years. Patients aged ≥75 years (group A) were compared with those aged 65-74 years (group B). Of the 126 surgically treated patients, 48 were in group A and 78 were in group B.

Results: The number of patients who did not undergo axillary lymph node surgery was significantly higher in group A than that in group B (15% vs. 2%, respectively, p=0.047). The number of patients who received radiotherapy was significantly lower in group A than B (13% vs. 44%, respectively, p<0.01). The number of patients who did not receive chemotherapy was significantly higher in group A than B (79% vs. 23%, respectively, p<0.01). Breast cancer-specific survival and overall survival showed no significant difference between groups.

Conclusion: Omission of axillary surgery, radiation, or chemotherapy may not have a significant prognostic impact in patients with HR-negative breast cancer aged ≥75 years. Multiple age-related factors complicate the standardization of optimal treatment decisions for these patients.

Background/aim: Remnant stomach influx (RSI) from the anastomotic jejunal-remnant stomach, a physiological food passage, develops after proximal gastrectomy with double-tract reconstruction (PGDT). Sometimes, food passes into the jejunal-loop (JL). We investigated the association of the food passage route in PGDT (RSI/JL) with postoperative esophageal reflux and malnutrition.

Patients and methods: We retrospectively collected data for 50 patients with upper-third gastric cancer and esophagogastric junction cancer with PGDT. Using one-year postoperative fluoroscopy findings, 40 propensity score-matched patients were classified into RSI and JL groups (n=20/group), respectively. The groups were comparatively evaluated for: clinicopathological characteristics [age, sex, body mass index (BMI), visceral fat index (VFI), subcutaneous fat index (SFI), skeletal muscle index, pathological stage]; perioperative factors [approach, postoperative complications ≥ Clavien-Dindo Grade 2, postoperative food passage); and esophageal reflux (reflux esophagitis frequency ≥ Grade A, degree of reflux based on fluoroscopy findings). Univariate and multivariate analysis identified predictive factors for post-operative malnutrition in all 50 patients.

Results: After propensity score matching, grade of reflux esophagitis and degree of reflux was significantly lower (p=0.014, p<0.001) in the RSI versus JL group. The RSI group showed significantly attenuated percent decrease in BMI, VFI, and SFI (p=0.049, p=0.002, p=0.006). Multivariate analysis identified food passage route (JL) and pathological stage as predictive factors for postoperative malnutrition.

Conclusion: Postoperative esophageal reflux and malnutrition were attenuated by food passage mainly via the RSI after PGDT. Improved jejunal-remnant stomach is requisite to ensure satisfactory remnant stomach influx.

Background/aim: For second-line chemotherapy of soft-tissue sarcoma, gemcitabine is administered in combination with docetaxel. However, more effective treatments are required for advanced soft-tissue sarcoma, where the efficacy is limited. The purpose of the present study was to compare the efficacy of rMETase and gemcitabine against HT1080 human fibrosarcoma cells and Hs27 normal fibroblasts, as well as to identify and effectively treat HT1080 cells that are resistant to gemcitabine associated with elevated c-MYC.

Patients and methods: Cell viability was measured with the WST-8 reagent. Four groups of in vitro tests were conducted involving HT1080 and Hs27 cells: gemcitabine alone, rMETase alone, and a combination of gemcitabine plus rMETase. Gemcitabine resistant cells (GR-HT1080) were established by culturing HT-1080 cells in increasing concentrations of gemcitabine, ranging from 0.016 nM to 16 nM over five months. Western immunoblotting was performed to measure c-MYC levels in HT1080 and GR-HT1080 cells.

Results: Gemcitabine had an IC₅₀ of 12.8 nM against HT1080 cells, 30.8 nM against GR-HT1080 cells, and 4.48 nM against Hs27 cells. The rMETase IC₅₀ value for HT1080 was 0.75 U/ml. The IC₅₀ value of rMETase for GR-HT1080 cells was 0.85 U/ml. The IC₅₀ value for rMETase on Hs27 cells was 0.93 U/ml. Gemcitabine and rMETase demonstrated synergy in killing fibrosarcoma cells, but no synergy was observed on normal fibroblasts. The c-MYC level that was more than 5.1 times higher in GR-HT1080 cells compared to HT-1080 cells. Both the parental HT1080 cells and the GR-HT1080 cells had a similar high sensitivity to rMETase alone.

Conclusion: rMETase may be used as a future clinical strategy to overcome gemcitabine resistance in sarcoma.

Background/aim: The role of lenvatinib as neoadjuvant chemotherapy for patients with advanced thyroid cancer has not been firmly established. In some cases, surgery may be considered when lenvatinib treatment becomes challenging to continue.

Case report: We present four cases of unresectable thyroid cancer diagnosed histologically as papillary carcinoma. The patients were a 61-year-old female (T4aN1bM0), a 75-year-old male (T4aN1bM0), a 61-year-old female (T3N1bM0), and a 64-year-old female (T4aN1bM0). Initial lenvatinib doses were 24, 10, 24, and 14 mg/day, respectively. The treatment administration periods were 8, 29, 3, and 6 months, with final doses of 4, 4, 10, and 14 mg/day, respectively. Tumors had primarily invaded the surrounding tissues, mainly the common carotid artery, and were considered unresectable. After lenvatinib administration, tumor shrinkage was observed. Despite complications from lenvatinib that resulted in difficulty in the administration of the drug, successful tumor resection was achieved, and local control was achieved in all patients.

Conclusion: Preoperative lenvatinib treatment may offer a less invasive alternative for advanced thyroid cancer cases that would otherwise require invasive surgery.

Background/aim: Although transarterial chemo-embolization (TACE) is a key treatment for hepatocellular carcinoma (HCC), its effectiveness depends on the cannulation of the microcatheter tip into the feeding artery. Steerable microcatheters allow remote operation of the tip, enabling its insertion into feeding arteries otherwise difficult to reach. This study investigated the indications and effectiveness of steerable microcatheters in TACE for HCC.

Patients and methods: We retrospectively examined 22 patients with HCC who underwent TACE using steerable microcatheters at our Department between December 2014 and July 2024. Previous TACE administration, number of TACE sessions, and feeding artery disruption affecting TACE were examined.

Results: Among the first TACE cases requiring steerable catheters, three demonstrated steep bifurcation of the celiac artery or superior mesenteric artery from the parent artery, two had sharp bends in the posterior segment, and four had the left hepatic artery bifurcating from the left gastric artery. All three procedures performed in the inferior phrenic artery required second TACE sessions. Steerable microcatheters were used in two patients during their eighth TACE session; both procedures involved selective cannulation of neovessels feeding from a new anastomotic branch to segment 4, following damage to the main feeding artery from repeated treatments.

Conclusion: Steerable microcatheters were effective in reaching steep or strongly bending branches of the parent or feeding artery in the first TACE cases or neovessels and anastomotic branches in previous TACE cases. Studies with larger sample sizes are warranted to validate the use of steerable microcatheters for effective TACE.