Cancer diagnosis & prognosis最新文献

Background/aim: Parotid oncocytomas typically present as benign, unilateral, slow-growing, painless, and solitary masses that are histologically firm and multilobulated. They are often misdiagnosed as pleomorphic adenomas, hemangiomas, or other forms of oncocytosis. However, in our case, the parotid oncocytomas initially mimicked bilateral parotid gland metastasis of advanced oropharyngeal cancer. Here, we present a case of oropharyngeal cancer with bilateral parotid oncocytomas treated with chemoradiotherapy (CCRT).

Case report: We report the case of a 74-year-old man with a sore throat, neck pain, right earache, oropharyngeal cancer, and bilateral parotid gland oncocytoma. Head and neck computed tomography and magnetic resonance imaging (MRI) showed soft-tissue swelling in the right tonsillar fossa and several enlarged level II neck lymph nodes. MRI revealed enhancing masses in both parotid glands, initially suspected to be metastatic lymph nodes. A biopsy of the right palatine tonsil confirmed squamous cell carcinoma with human papilloma virus-16 positivity. A positron emission tomography scan was performed, and biopsy-proven malignant lesions were observed in the right tonsillar region with metastatic lymph nodes in the right and left neck. Focal hypermetabolism was observed in the parotid glands, suspected to be pathological lesions such as metastatic intra-parotid lymph node or Warthin's tumor. An ultrasonography-guided biopsy of the left parotid gland confirmed an oncocytoma. Based on these results, the patient was scheduled for CCRT. After pathological confirmation of parotid oncocytoma, CCRT was administered, excluding the parotid glands within the radiotherapy field.

Conclusion: This is a case of bilateral parotid gland oncocytoma mimicking oropharyngeal cancer.

Background/aim: The therapeutic efficacy of the paclitaxel (PTX) + cetuximab (Cmab) combination regimen was investigated in patients with recurrence or metastasis after superselective intraarterial chemoradiotherapy (SSIACRT) for oral cancer, and the safety was retrospectively examined.

Patients and methods: All enrolled patients with advanced oral cancer or who had refused surgery over 10 years from December 2012 to December 2022 underwent SSIACRT for 6 to 9 weeks [cisplatin (CDDP): total 160-630 mg/m² and radiotherapy: total 50-70 Gy]. Nine cases (tongue cancer, maxillary gingival cancer, and mandibular gingival cancer; three cases each) were subjected to PTX + Cmab therapy. Recurrence or metastases were observed within six months after the onset of treatment, complicating the conduct of salvage surgery. Cmab (first dose: 400 mg/m² and second and following doses: 250 mg/m²) and PTX (80 mg/m²) were administered weekly.

Results: The overall response rate was 44.4% (four of nine cases), and the disease control rate was 88.9% (eight of nine cases), whereas the median progression-free survival was seven months, and the overall survival was 11 months. Grade 3-4 adverse events were neutropenia in 33.3% of the cases, leukopenia in 55.6%, anemia in 22.2%, and acneiform skin rash in 22.2%. Based on the above, PTX + Cmab therapy for recurrent and metastatic cases after SSIACRT had comparable results to other second-line modalities and enabled to cope with the side effects of myelosuppression.

Conclusion: PTX + Cmab therapy may be an effective treatment mode for recurrent or metastatic head and neck cancer resistant to CDDP after SSIACRT treatment.

Background/aim: Radiotherapy (RT) for advanced oropharyngeal cancer (OPC) is effective, especially when combined with chemotherapy (CRT). However, its success can vary depending on factors, such as tumor stage, HPV infection (p16 status), and the patient's nutritional and immune status. This study examined the controlling nutritional status (CONUT) score and tumor immunity as predictive factors for treatment outcomes in OPC, aiming to develop a personalized risk score.

Patients and methods: A retrospective analysis was conducted on 84 patients with OPC treated with definitive RT or CRT, and survival outcomes were compared based on various factors, including BMI, CONUT score, CD8 expression, and HLA class II expression.

Results: We observed better overall survival (OS) rates in CD8-positive patients and those with higher HLA class II expression. The univariate analysis identified stage, p16 status, BMI, CONUT score, and CD8 expression as significantly associated with OS. In multivariate analysis, stage, BMI, and CONUT score remained significant predictors of OS. A risk scoring system was developed based on stage, p16 status, BMI, CONUT score, and CD8 expression. Patients were categorized into low-risk and high-risk groups, with significantly better survival in the low-risk group.

Conclusion: A combined risk score incorporating clinical, nutritional, and immune factors can improve the prediction of treatment outcomes for OPC patients. This risk stratification may enable personalized treatment plans and improve ΟS rates.

Background/aim: Background/Aim: Thrombocytopenia is a poor prognostic factor in patients with myeloma; however, the factors associated with thrombocytopenia have not been extensively discussed. This study aimed to investigate the clinical significance of thrombocytopenia, defined as 130×10³/μl or less, in patients with newly diagnosed multiple myeloma (NDMM) treated with proteasome inhibitors and/or immunomodulatory drugs.

Patients and methods: This is a retrospective review of medical records of myeloma patients treated between 2000 and 2021. A total of 241 patients were included in this study, with a median age of 72 years. Overall survival (OS) and time to next treatment (TTNT) were assessed using Kaplan-Meier analysis and Cox regression analysis. Prognostic factors were evaluated by univariate and multivariate analyses.

Results: The incidence of thrombocytopenia was 17.8%. In the median follow-up period of 46.6 months, OS and TTNT in the thrombocytopenia group were significantly shorter than those in the non-thrombocytopenia group using multivariate analysis (p<0.001 and p<0.001). C-reactive protein (CRP) level was not associated with thrombocytopenia, and high CRP predicted short OS and TTNT independently from thrombocytopenia. When the low (neither thrombocytopenia nor high CRP), intermediate (either thrombocytopenia or high CRP), and high (thrombocytopenia and high CRP) risk groups were defined, the OS and TTNT among these groups showed significant differences; the hazard ratios for survival in the high and intermediate risk groups were 7.022 and 2.598, and for TTNT, they were 4.216 and 1.887, respectively, compared to the low-risk group.

Conclusion: Thrombocytopenia was associated with the activity of NDMM and predicted prognosis in NDMM. When combined with high CRP levels, thrombocytopenia serves as a new indicator of poor prognosis in these patients.

Background/aim: Although the frequency of small bowel obstructions after liver surgery is generally considered low, previous studies have followed-up patients for less than a year, thus the incidence of small bowel obstructions several years after surgery is unknown. Furthermore, the rise in laparoscopic surgeries and the use of adhesion prevention materials may influence the occurrence of small bowel obstructions. This  study aimed to assess the incidence of small bowel obstructions within a five-year period following liver surgery and identify the associated risk factors.

Patients and methods: This case series analysis analyzed patients who underwent liver surgery between April 2012 and March 2014 from 32 participating hospitals. Multivariate analysis was conducted to examine risk factors for small bowel obstructions.

Results: A total of 953 patients were included in the analysis, and the incidence of small bowel obstructions was 1.6%. The incidence was significantly higher at 3.4% for surgeries related to metastatic liver cancer compared to other types of surgeries. Laparoscopic surgery had no significant effect on the incidence of SBO (p=0.72). There was no significant difference in the incidence of small bowel obstructions between surgeries that employed adhesion prevention materials and those that did not. Multivariable analysis revealed that longer surgical time and re-operation were independent risk factors for small bowel obstructions.

Conclusion: The incidence of small bowel obstructions following surgery for metastatic liver cancer is significantly higher compared to other liver surgeries. Neither laparoscopic surgery nor adhesion prevention materials reduce its occurrence. Longer surgical time and re-operation are independent risk factors for small bowel obstructions.

Background/aim: The recent development of minimally invasive surgery has led to transition from laparoscopic right colectomy (LC) to robot-assisted right colectomy (RC) in Japan. However, it is unclear whether the introduction of RC in municipal hospitals could be as safe as that in high-volume centers in Japan. Therefore, this retrospective study aimed to compare the short-term operative outcomes of RC and LC for right colon cancer at a local municipal hospital in Japan.

Patients and methods: Patients with stage I-IV right colon cancer who underwent elective RC or LC between January 2021 and July 2023 were retrospectively analyzed. Patients with double cancer and those who underwent delta anastomosis were excluded. Postoperative surveillance included patient interviews, physical examinations, tumor marker examinations, and whole-body computed tomography every six months.

Results: Forty patients were analyzed, and 24 (60%) and 16 (40%) patients assigned in the LC and RC groups, respectively, were compared. The operative time, bleeding, postoperative complications, and pathological examinations did not differ significantly between the LC and RC groups.

Conclusion: RC using overlapping anastomoses was comparable to LC in terms of short-term operative outcomes. The introduction of RC with overlapping anastomosis is a feasible surgical technique.

Background/aim: Surgery for colon cancer requires covering a wide area and performing both tumor resection and precise lymph node dissection. Robotic left-sided colectomy (RLC) has not been thoroughly established due to the rarity of descending colon cancer. Therefore, we investigated 19 patients who underwent RLC for left-sided colon cancer.

Patients and methods: Between January 2023 and July 2024, a total of 19 consecutive patients underwent robotic radical left colectomy, which included mobilization of the splenic flexure. We compared the intra- and postoperative factors between left-sided colectomy with and without stent placement.

Results: Total operative time (p=0.002), console time (p=0.001), and lymph node harvest time (p=0.001) were significantly different. The total operative time with stent placement was longer than that without stent placement (421.6 vs. 302.0, p<0.01). Console time with stent placement was longer than that without stent placement (315.0 vs. 202.0, p<0.01). More lymph nodes were harvested with stent placement than without (33.1 vs. 11.0, p<0.01).

Conclusion: We did not experience any conversions to open surgery, and two Grade II complications were observed according to the Clavien-Dindo classification. Both total operative and console times were longer in cases with stent placement compared to those without. Nevertheless, we safely performed robotic left colectomy, regardless of whether the left-sided colon cancer was treated with stent placement, even in cases where the anastomosis overlapped naturally. Our postoperative outcomes showed no anastomosis-related complications. Therefore, RLC reconstruction using an intracorporeal overlap anastomosis is feasible for left-sided colon cancer, both in terms of intraoperative and postoperative outcomes.

Background/aim: Ovarian tumors are a common type of neoplasm in women, with mature cystic teratomas being the most frequent variant. These tumors occur bilaterally in approximately 10% of cases. However, bilateral and multiple occurrences are rarely reported.

Case report: A 22-year-old nulliparous woman presented with amenorrhea and sudden, generalized, dull lower abdominal pain. Diagnostic imaging, including ultrasound and computed tomography (CT) scans, revealed large solid-cystic lesions in both ovaries, with internal hyperechoic foci consistent with fat and calcification, along with thin internal septations. A laparoscopic cystectomy was successfully performed, preserving ovarian function. Histopathological examination confirmed the presence of stratified keratinized squamous epithelium, sebaceous glands, hair follicles, mature adipose tissue, blood vessels, and lymphatic vessels within the resected cysts, with no evidence of malignancy.

Conclusion: This unique case provides valuable insights into the understanding and management of bilateral dermoid cysts, highlighting the importance of preserving ovarian function in young women.

Background/aim: Identifying prognostic and molecular markers as therapeutic targets for esophageal squamous cell carcinoma (ESCC) could enhance the efficacy of multidisciplinary treatments. While tissue expression of sirtuin 1 (SIRT1) has been linked to tumor progression in ESCC, prognostic significance of serum SIRT1 levels and their correlation with tissue SIRT1 remains unexplored. This study aimed to investigate the correlation between serum and tissue SIRT1 levels in patients with ESCC.

Patients and methods: A total of 38 patients diagnosed with ESCC who were untreated preoperatively were recruited for this study. SIRT1 expression in the surgical specimens was assessed through immunostaining, while serum SIRT1 levels were measured using an enzyme-linked immunosorbent assay. We analyzed the association between tissue and serum SIRT1 levels, clinicopathological features, and patient prognosis.

Results: Positive SIRT1 expression in tissue was significantly associated with deeper tumor depth (p=0.020). It was also significantly associated with poorer overall survival (OS) and relapse-free survival (RFS) (p=0.041 and p=0.012, respectively). Elevated serum SIRT1 levels were significantly correlated with increased tumor depth and weight loss (p=0.012 and p=0.030). While higher serum SIRT1 levels tended to be associated with poorer OS (p=0.069), no significant correlation was found between SIRT1 expression in tissue and its concentration in serum.

Conclusion: SIRT1 tissue expression may be a valuable prognostic marker in ESCC. However, the clinical significance of serum SIRT1 levels appears to differ from that of its tissue expression. Future research is required to clarify the role of serum SIRT1 in ESCC.

Androgen-deprivation therapy is an extremely effective treatment for progressive prostate cancer. Previously, the first-line treatment for progressive prostate cancer was combined androgen blockade (CAB). If the disease progressed to castration-resistant prostate cancer, the administration of androgen receptor signaling inhibitors (ARSIs) was recommended. When elevated serum prostate-specific antigen (PSA) levels are seen during CAB treatment, it is important to suspect antiandrogen withdrawal syndrome (AWS), discontinue CAB, and monitor the changes in the serum PSA levels. If a reduction in the patient's PSA levels is subsequently observed, antiandrogens should be discontinued and the patient should be followed, but if their PSA level rises they should be transitioned to ARSI treatment. Recently, there have been reports of withdrawal syndrome (WS) after ARSI treatment. With the increased use of ARSIs, such as abiraterone acetate, enzalutamide, apalutamide, and dalorutamide, it is necessary to consider ARSI WS when a patient's serum PSA level increases during ARSI treatment. Unnecessary treatment can be avoided if the confirmation of ARSI WS is prioritized. Conversely, if it is not confirmed there is a risk that second-line treatment will be delayed. This is a review of recent studies of ARSI WS. It also discusses future prospects in this field.