Cancer diagnosis & prognosis最新文献

Background: Multinodular/plexiform schwannoma is an exceedingly rare benign peripheral nerve sheath tumor that often arises in the dermis or subcutaneous tissue, particularly of the trunk and head and neck region. The ankle is an uncommon location for this peculiar condition.

Case report: A 50-year-old man without neurofibromatosis presented with a 10-year history of a slowly growing, occasionally painful mass in the medial aspect of the right ankle. Physical examination revealed a 5-cm, elastic-soft, poorly mobile, non-tender mass. Magnetic resonance imaging (MRI) showed multiple nodular lesions with intermediate signal intensity on T1-weighted sequences and heterogeneous high signal intensity on T2-weighted sequences. Contrast-enhanced MRI demonstrated strong and homogeneous enhancement. After core needle biopsy, the lesions were successfully treated by complete surgical enucleation. Histological examination confirmed the diagnosis of schwannoma consisting of predominantly Antoni A areas. The patient had no evidence of local recurrence and no aggravated neurological deficit at the latest follow-up.

Conclusion: This unique case provides valuable insights into the understanding and management of multinodular/plexiform schwannoma in the ankle.

Background/aim: While surgery is a major component of treatment for managing rectal cancer, some individuals opt against it, potentially affecting their chances of survival. This study investigated the clinical and demographic elements linked to the decision to refuse surgery and assessed the potential impact of this decision on overall survival (OS).

Patients and methods: We conducted a retrospective cohort study using the U.S. National Cancer Database to analyze factors linked to surgery refusal in patients with rectal cancer. Clinical, demographic and treatment characteristics were compared using Pearson chi-square and Wilcoxon rank-sum tests.

Results: Among the 115,066 patients with rectal cancer assessed for surgery, 2,675 individuals (2.3%) declined the procedure. Those who opted out were generally older, with a mean age of 71.9 years, exhibited a higher prevalence of comorbid conditions, and were from racial minority groups or groups with lower socioeconomic status (p<0.001). OS analysis revealed that the cohort who refused surgery demonstrated a lower OS rate, with only 46% surviving for 5 years, in contrast to a 62% 5-year survival rate among those who underwent surgery.

Conclusion: Patients with rectal cancer may decline surgical treatment due to factors such as older age, frailty, and socioeconomic challenges. Addressing these obstacles may increase treatment acceptance and potentially lead to improved survival rates.

Renal angiomyolipomas (AMLs) are typically benign, fat-rich mesenchymal tumours composed of vascular, smooth muscle, and adipose elements. However, rare fat-poor subtypes, particularly epithelioid angiomyolipoma (EAML), pose significant diagnostic and therapeutic challenges due to their malignant potential and morphological overlap with renal cell carcinoma (RCC). EAML represents less than 1% of AMLs but differs markedly in its biological behaviour, with a propensity for local invasion, lymphadenopathy, and distant metastasis, most commonly to the lungs and liver. Preoperative diagnosis is often delayed or incorrect, as imaging may fail to detect fat-deficient lesions, making histopathological evaluation necessary. EAML is defined by sheets of polygonal epithelioid cells with eosinophilic or clear cytoplasm, prominent nucleoli, and frequent mitotic figures. Genetic alterations in TSC1/TSC2 and activation of the mTOR pathway are central to pathogenesis, particularly in tuberous sclerosis complex-associated cases. Management hinges on surgical resection, yet recurrence and metastasis may occur years after nephrectomy. mTOR inhibitors have demonstrated efficacy in tumour reduction, especially in TSC-linked cases, while VEGF pathway inhibitors and immune checkpoint blockade represent promising but underexplored avenues. Prognostic features include tumour size >9 cm, necrosis, vascular invasion, and high epithelioid cell proportion. Given the rarity and aggressive potential of EAML, long-term surveillance and multidisciplinary care are essential. Continued research into molecular drivers and targeted therapies will be critical to improving diagnostic precision and patient outcomes.

Background/aim: The role of catenin β interacting protein 1 (CTNNBIP1), a negative regulator of the canonical Wnt/β-catenin signaling pathway, in luminal A and B breast cancer stem cells treated with hormone therapy is unknown. This study investigated the relationship between CTNNBIP1 and aldehyde dehydrogenase 1 family member A3 (ALDH1A3) expression and its impact on disease-specific survival in luminal A and B breast cancer. Given that high protein kinase ζ (PKCζ) expression, together with elevated CTNNBIP1 or ALDH1A3, is linked to poor prognosis in luminal B tumors, we also examined their combined influence.

Materials and methods: Gene expression and clinical data from the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC; n=2,509) were analyzed using Kaplan-Meier and Cox proportional hazards models. Findings were validated with The Cancer Genome Atlas Pan-Cancer Atlas (TCGA; n=1,084).

Results: CTNNBIP1 ^high ALDH1A3 ^high indicated a poor prognosis in patients with luminal B breast cancer treated with hormone therapy in the METABRIC dataset and aromatase inhibitors as hormone therapy in the TCGA data set, suggesting that high CTNNBIP1 and ALDH1A3 expression contributed to decreased effectiveness of hormone therapy in patients with luminal B breast cancer. PKC ζ ^high CTNNBIP1 ^high ALDH1A3 ^high was associated with a poor prognosis in patients with luminal B breast cancer treated with hormone therapy and aromatase inhibitors, suggesting that high PKC ζ , CTNNBIP1 and ALDH1A3 expression contributed to decreased effectiveness of hormone therapy in patients with luminal B breast cancer.

Conclusion: PKC ζ and CTNNBIP1 may be involved in the progression of ALDH1A3-positive luminal B breast cancer. In luminal B breast cancer, PKC ζ , CTNNBIP1 and ALDH1A3 could serve as molecular drug targets and prognostic biomarkers to predict the effectiveness of hormone therapy.

Background/aim: To date, several clinical trials have compared isoperistaltic and antiperistaltic anastomosis; however, in the context of robot-assisted surgery (RAS), a consensus on the optimal approach has yet to be established. This study aimed to compare the short-term outcomes of intracorporeal isoperistaltic and antiperistaltic side-to-side anastomoses in RAS for right-sided colon cancer.

Patients and methods: A retrospective subgroup analysis was conducted using a database collected from a Japanese multicenter prospective study. Patients diagnosed with curatively resectable right-sided colon cancer (cStage I-IIIC) who underwent RAS with intracorporeal anastomosis were included. Surgical and postoperative outcomes were compared between the isoperistaltic and antiperistaltic anastomosis groups.

Results: Among the 78 patients analyzed, 23 (29.5%) underwent antiperistaltic anastomosis and 55 (70.5%) underwent isoperistaltic anastomosis. There were no significant differences in age, sex, American Society of Anesthesiologists Physical Status score, previous abdominal surgical history, or clinical stage between the groups. Isoperistaltic anastomosis was more frequently performed in ascending and transverse colon cancers, whereas antiperistaltic anastomosis was more frequent in cecal cancers. Right hemicolectomy was significantly more frequent in the isoperistaltic group than in the antiperistaltic group (92.7% vs. 60.9%) (p=0.0014). The total operative time was longer in the antiperistaltic group, but the console and anastomosis times were comparable. No intraoperative complications, conversions, or transfusions were reported. Postoperative complication rates were similar between the two groups.

Conclusion: This study demonstrated equivalent short-term outcomes between intracorporeal isoperistaltic and antiperistaltic anastomoses in RAS for right-sided colon cancer. Both techniques appear to be safe and effective, supporting the recommendation that surgeons maintain proficiency in both methods to allow flexibility based on intraoperative conditions.

Background/aim: Prostate cancer (PCa) patients with an initial prostate-specific antigen (PSA) level >1,000 ng/ml at diagnosis represent a rare and high-risk subgroup for which prognostic factors remain poorly defined. Therefore, we investigated the clinical features of this population and identified predictors of overall survival (OS).

Patients and methods: The present study retrospectively analyzed 35 patients diagnosed with PCa and initial PSA >1,000 ng/ml at our institution between August 2013 and December 2024. Clinical characteristics, treatment courses, PSA responses, and survival outcomes were collected. A nadir PSA level ≤0.2 ng/ml and a 90% decline in PSA from baseline (PSA90) were evaluated. OS was estimated using the Kaplan-Meier method, and the impact of clinical variables on OS was assessed using univariate and multivariate Cox proportional hazards regression models.

Results: Median age was 74 years, and median initial PSA was 3,027 ng/ml. The median time to castration-resistant prostate cancer was 18.25 months, and median OS was 55.0 months. Univariate analyses revealed that PSA90 achievement correlated with longer OS, whereas age ≥75 years, an Eastern Cooperative Oncology Group performance status ≥1, elevated lactate dehydrogenase, and elevated C-reactive protein correlated with shorter OS. Multivariate analyses identified PSA90 achievement as the only independent predictor of prolonged OS (hazard ratio=0.13).

Conclusion: These results suggest the potential of PSA90 as a simple and valuable early biomarker for prognostic stratification in patients with PCa and initial PSA >1,000 ng/ml.

Background/aim: Although rituximab is used to treat a range of diseases, the high frequency of rituximab-associated infusion reactions (IRs) poses a clinical challenge. This study aimed to identify pre-treatment risk factors associated with rituximab-induced IRs using retrospective patient data.

Patients and methods: We retrospectively analyzed the medical records of patients treated with rituximab. Data were compared between patients with and without IRs.

Results: Among the variables assessed, an elevated C-reactive protein (CRP) level prior to rituximab administration was significantly associated with IR occurrence (odds ratio=2.591; 95% confidence interval=1.160-5.791; p=0.020).

Conclusion: Elevated pre-medication levels of CRP are a significant risk factor associated with the use of rituximab, thereby highlighting the need for close monitoring of patients receiving rituximab who present with elevated CRP levels prior to the initiation of therapy.

Background/aim: Metastatic breast cancer is a recalcitrant disease with a poor prognosis. Novel targets and therapies are necessary to improve the survival rate of patients with metastatic breast cancer. Previous pre-clinical and clinical studies, have demonstrated the effectiveness of oral recombinant methioninase (o-rMETase) against breast cancer. The present case report shows that combination treatment with radiation, immunotherapy, a low-methionine diet, and o-rMETase led to rapid eradication of extensive bone and other metastases in a patient with breast cancer.

Case report: A patient with breast cancer with extensive metastases to the liver, lymph nodes, pleura and bones was diagnosed using [¹⁸F]fluorodeoxyglucose positron emission tomography (FDG-PET). The patient was immediately started on systemic drug therapy with tamoxifen and leuprorelin, but it failed to suppress the tumor. Then, combination treatment with radiation, immunotherapy with biological response modifier (BRM)-activated killer (BAK), a low-methionine diet, and o-rMETase was started as second-line treatment. Five months after beginning of the combination treatment, the patient had a subsequent FDG-PET scan and extensive eradication of almost all metastases was observed, with only a metastasis remaining in the liver.

Conclusion: o-rMETase in combination with immunotherapy and irradiation eradicated extensive metastases in a patient with breast cancer. Further investigation of this combination treatment for breast cancer is necessary including clinical trials.

Background/aim: Biliary tract cancers (BTCs) have poor prognoses, with limited curative options beyond surgical resection. Adjuvant S-1 chemotherapy has shown survival benefits in Japanese patients undergoing resection for BTC. However, prognostic factors influencing survival in these patients remain uncertain. In this study, we aimed to investigate the efficacy of preoperative nutritional status using the Global Leadership Initiative on Malnutrition (GLIM) criteria as a prognostic factor in patients receiving adjuvant S-1 chemotherapy for BTC.

Patients and methods: In this retrospective study, excluding intrahepatic cholangiocarcinoma, we evaluated 58 patients who underwent curative surgery for BTC at Kobe University from 2013 to 2022, followed by adjuvant S-1 chemotherapy. Nutritional status was classified by GLIM criteria into normal/moderate and severe malnutrition groups. Overall (OS) and recurrence-free (RFS) survival were analyzed using Kaplan-Meier and Cox proportional hazards models.

Results: Of the 58 patients, 3.4% had no malnutrition, 72.5% had moderate malnutrition, and 24.1% had severe malnutrition. Patients with severe malnutrition had significantly worse 5-year OS (24.7% vs. 52.5%, p=0.0014) and RFS (34.3% vs. 52.0%, p=0.0066). Severe malnutrition was an independent prognostic factor for poorer OS (hazard ratio=3.40, 95% confidence interval=1.46-7.94; p=0.0047) and RFS (hazard ratio=2.48, 95% confidence interval=1.07-5.76; p=0.035). No significant difference in S-1 completion rates was observed.

Conclusion: Severe malnutrition, as defined by GLIM criteria, is a poor prognostic factor in patients with BTCs undergoing adjuvant S-1 chemotherapy.

Background/aim: Neurofibromatosis type 1 (NF1) is a genetic disorder characterized by the development of multiple tumors, including plexiform neurofibromas (PNFs), which often affect the craniofacial region and cause significant functional and aesthetic impairments. This report presents long-term surgical management of a patient with hemifacial diffuse PNF, complicated by the emergence of a rapidly enlarging midfacial tumor.

Case report: The patient was treated for hemifacial invasive diffuse plexiform neurofibroma. During follow-up, the patient developed a rapidly growing tumor suggesting malignant transformation. Histological analysis revealed plexiform and diffuse neurofibroma with necrosis. Defect coverage after resection was complex and required tissue replacement with a microvascular graft. In the further course, new neurofibromas developed in the oral transplant.

Conclusion: Surgical measures enable functional and aesthetic improvements despite extensive facial destruction caused by the tumor. Rapid tumor growth is a finding that requires immediate diagnosis in patients with NF1. Even in tumor-free transplants at the time of tissue transfer, (nodular) neurofibromas can develop at the recipient site.