Cancer diagnosis & prognosis最新文献

Background/aim: Central nervous system tumors have a very low incidence worldwide. However, they represent a significant cause of mortality and morbidity. Magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS) and magnetic resonance spectroscopy imaging (MRSI) techniques provide metabolic information complementary to anatomical alterations. The aim of this study was to characterize different metabolic patterns and determine treatment outcomes in glial brain tumors.

Patients and methods: Forty-four previously treated patients participated in this prospective study, including 20 cases of low-grade (LG) and 24 high-grade (HG), gliomas. All patients underwent conventional MRI combined with MRS and MRSI using a 1.5 Tesla (T) magnet.

Results: Distinct metabolic profiles were observed via MRS and MRSI compared to normal brain tissue. Among the LG tumors, 10 remained stable with mean choline (Cho)/ N-Acetyl Aspartate (NAA) and NAA/creatine (Cr) ratios of 1.49 (p=0.036) and 0.92 (p=0.038), respectively, while the other 10 progressed to HG, with Cho/NAA and Cho/Cr ratios of 2.24 (p=0.026) and 4.48 (p=0.016). Among HG tumors, 17 remained stable with similar metabolic profiles, while seven showed progression. Gliosis was identified in 21 cases, characterized by a Cho/NAA ratio of 1.57 (p=0.028) and NAA/Cr ratio of 1.36 (p=0.026). Radiation necrosis was observed in 14 tumors, with significant spectroscopic changes including Cho/Cr ratios of 2.14 (p=0.02) and 1.9 (p=0.003), and NAA/Cr ratios of 1.28 (p=0.001) and 0.49 (p=0.001) across SV-MRS and MV-MRSI modalities. Tumor recurrence was detected in 20 cases based on MRSI metabolic maps.

Conclusion: MRS and MRSI provide valuable metabolic information that complements MRI in the post-treatment evaluation of glial brain tumors. These techniques enhance the detection of tumor recurrence, progression, and radiation necrosis, thereby supporting clinical decision-making and optimizing patient management.

Background/aim: Although immune checkpoint inhibitors (ICIs) have demonstrated high therapeutic efficacy against malignant tumors, immune-related cardiovascular adverse events remain a significant concern. While myocarditis is a well-recognized complication, mild troponin elevations without clinical symptoms have been increasingly observed. The prognostic significance of such subclinical elevations remains unclear. This study aimed to evaluate the relationship between asymptomatic troponin elevation and early mortality in patients receiving ICIs without cardiac adverse events.

Patients and methods: This retrospective, single-center study included 108 patients who received ICIs and had high-sensitivity troponin T (hs-TnT) levels measured at baseline and after treatment initiation. Patients diagnosed with myocarditis or other overt cardiac events were excluded. The patients were categorized into two groups based on hs-TnT elevation after ICI therapy.

Results: Among the 108 patients, 26 (24.1%) exhibited hs-TnT elevation post-ICI without developing myocarditis or other cardiac diseases. The peak hs-TnT levels were significantly higher in these patients compared to those without elevation [28 (IQR=18-38) ng/l vs. 11 (8-13) ng/l, p<0.001], though still mildly elevated. Over a median follow-up of 174 days, 24 patients died, all due to cancer progression. Notably, those who died within one month of peak hs-TnT had higher levels than those who died after 1-3 or >3 months.

Conclusion: Subclinical troponin elevation is common in patients treated with ICIs. Higher troponin levels may be associated with earlier death; however, the underlying mechanisms remain unclear. Careful interpretation is needed and further research is required to clarify its prognostic value.

Background/aim: Poor nutritional status is one of the key contributing factors to sarcopenia, which negatively influences postoperative complications and clinical outcomes in patients with head and neck squamous cell carcinoma (HNSCC). This study aimed to investigate the potential association between sarcopenia and clinical outcomes in patients with recurrent and/or metastatic HNSCC treated with immune checkpoint inhibitors (ICIs).

Patients and methods: A retrospective review was conducted on the medical records of 119 patients with recurrent and/or metastatic HNSCC who received ICI therapy.

Results: The objective response rates (ORRs) were 30.7% in the non-sarcopenia group and 15.8% in the sarcopenia group, showing a statistically significant difference between the two groups (p=0.048). Patients with good performance status (PS), absence of sarcopenia, and distant metastasis exhibited significantly longer overall survival (OS) compared to those with poor PS, sarcopenia, and locoregional recurrence, respectively (p=0.014, p=0.003, p=0.026). Multivariate analysis identified sarcopenia and locoregional recurrence as independent prognostic factors for OS. The incidence of immune-related adverse events (irAEs) did not significantly differ between patients with and without sarcopenia.

Conclusion: These findings underscore the detrimental impact of sarcopenia on the efficacy of immune checkpoint inhibitor therapy in patients with recurrent and/or metastatic HNSCC. Careful consideration of sarcopenia is warranted in the clinical management of these patients.

Background/aim: Metastases of meningiomas are infrequent, and extracranial bone involvement is extremely rare. We describe a patient with femoral metastasis originating from an atypical brain meningioma.

Case report: A 55-year-old male had undergone five surgical procedures and Gamma Knife® radiosurgery for brain meningioma over five years. Four months after the final treatment he presented with spontaneous right-hip pain. Radiography showed a radiolucent lesion at the lesser trochanter; computed tomography confirmed cortical bone destruction. Positron emission tomography-computed tomography demonstrated abnormal uptake in the femur [Standardized Uptake Value (SUV) 3.3] and in residual intracranial tumor (SUV 9.9). Magnetic resonance imaging revealed low T1- and high T2-weighted signal intensities at the lesion. Open biopsy identified metastatic WHO grade II meningioma positive for epithelial membrane antigen and somatostatin receptor 2A, with a Ki-67 labelling index of approximately 10%. Wide resection of the proximal femur with endoprosthetic reconstruction was performed. Postoperatively, the patient experienced intracranial tumor recurrence and received radiation therapy. No local recurrence or additional metastases were observed during the three-year follow-up; the Enneking functional score was 60%.

Conclusion: We report on an extremely rare instance of metastasis to the femur in a case of atypical brain meningioma.

Background/aim: In patients with thyroid transcription factor-1 (TTF-1)-negative non-squamous non-small cell lung cancer (NS-NSCLC), the efficacy of pemetrexed and immunotherapy has been reported to be limited, and the optimal treatment strategy remains unclear. Recent studies have suggested that bevacizumab may improve outcomes; however, robust evidence is still lacking. This study aimed to clarify the clinical characteristics of responders to first-line treatment in patients with TTF-1-negative NS-NSCLC and identify predictive factors for treatment response, proposing an optimal treatment strategy.

Patients and methods: A retrospective analysis was conducted on patients with TTF-1-negative NS-NSCLC. Patients were classified into responder and non-responder groups based on first-line treatment efficacy, and predictive factors associated with treatment response were analyzed.

Results: Among the 29 patients included, seven (24.1%) were classified as responders. Platinum-based combination therapy was significantly more common in the responder group (p=0.023). The neutrophil-to-lymphocyte ratio was significantly lower in the responder group (p=0.001). Multivariate analysis demonstrated that the addition of bevacizumab was an independent predictor of treatment response (odds ratio=33.406; 95% confidence interval=1.288-860.210; p=0.035). Overall survival was significantly longer in the responder group compared to the non-responder group (p=0.008).

Conclusion: In the treatment of TTF-1-negative NS-NSCLC, platinum-based combination therapy, particularly with the addition of bevacizumab, improved response rates and led to prolonged survival.

Background/aim: Endometrial cancer (EC) is rare in premenopausal women. The aim of this study was to describe the demographic, clinical and pathological characteristics and compare survival in the light of pathological aspects of EC in young women.

Patients and methods: We performed a retrospective observational cohort study, analyzing data from 29 women up to 45 years of age diagnosed between 2003 and 2023 at our Institution.

Results: The most common risk factor for EC was excess weight (75% of patients), followed by nulliparity (62.1%), diabetes mellitus (20.7%) and hypertension (17.2%). Twenty-seven patients were submitted to total hysterectomy and salpingo-oophorectomy, and additional procedures were performed for half of the patients, in particular lymph node staging (46.4%), omentectomy (17.9%) and debulking (7.1%). The majority of tumors were low-grade endometrioid (79.3%). In six cases (21.4%), synchronous ovarian cancer occurred. EC was staged FIGO I-II in 22 patients (75.9%) and 13 (46.4%) received adjuvant therapy. Univariate survival analysis showed worse progressive-free and overall survival in patients with high-grade endometrioid tumor (median survival and standard deviation of 39.8±24.2 vs. 156.3±12.7 months, p=0.001; and 56.4±28.5 vs. 156.3±12.7 months, p=0.009, respectively); those with lymphovascular space invasion (68.6±21.9 vs. 161.3±12.5 months, p=0.011; and 79.2±22,5 vs. 161.3±12.5 months, p=0.035, respectively) and with FIGO stages III-IV (68.1±24.9 vs. 146.2±15.2 months, p=0.047; and 68.1±24.9 vs. 152.6±14.5 months, p=0.023, respectively).

Conclusion: Excess weight is a main risk factor for EC and the most prevalent risk factor in our study. In patients with EC, lymphovascular space invasion, poor tumor differentiation and FIGO stage III-IV are important factors associated with reduced progression-free and overall survival.

Background/aim: Enfortumab vedotin plus pembrolizumab (EVP) is a first-line treatment for metastatic urothelial carcinoma (mUC) based on the EV302 trial; however, patients receiving hemodialysis were excluded from this study. Therefore, evidence regarding the safety and efficacy of this combination therapy in patients undergoing hemodialysis is insufficient. We present a case of mUC in a patient undergoing hemodialysis treated with EVP.

Case report: A 72-year-old man underwent total urinary tract extirpation for high-grade UC and subsequently required hemodialysis. Four years later, he developed right ischial metastasis. First-line systemic therapy with enfortumab vedotin (EV) 1.25 mg/kg plus pembrolizumab (200 mg) was initiated, with infusions scheduled on nonhemodialysis days. The patient completed three cycles without any dose reduction. Treatment-related adverse events were limited to grade 2 pruritus and grade 1 fatigue, with no grade ≥3 adverse events. Restaging computed tomography after three cycles revealed enlargement of the ischial lesion, indicating progressive disease, and systemic therapy was discontinued.

Conclusion: A standard dose of EVP can be safely administered to patients on hemodialysis, with manageable toxicities comparable to those observed in nonhemodialysis patients. Although its antitumor efficacy was not confirmed, our experience suggests that EVP may remain a therapeutic option for selected dialysis patients with mUC.

Background/aim: Systemic therapy with immune checkpoint inhibitors for advanced hepatocellular carcinoma (HCC) treatment has demonstrated high response rates. Durvalumab plus tremelimumab (Dur/Tre) has been approved for HCC treatment and has become a first-line systemic therapy along with atezolizumab plus bevacizumab. However, there is early withdrawal owing to immune-related adverse effects, while others required sequential therapy owing to the lack of early therapeutic effects. Herein, we investigated the clinical characteristics of patients with progressive disease (PD) who were treated with Dur/Tre in addition to locoregional therapy.

Patients and methods: We retrospectively evaluated eight patients with HCC, who were treated with Dur/Tre in March 2025 and continued Dur/Tre until PD was treated with locoregional therapy. Additionally, immunological changes, and treatment efficacy during continuation therapy were also assessed. Treatment efficacy was evaluated using modified Response Evaluation Criteria in Solid Tumors (mRECIST).

Results: At Dur/Tre induction, patients (mean age, 76.88 years, all male) had alcoholic liver disease (n=3), nonalcoholic steatohepatitis (n=4), or hepatitis B virus (n=1). Six patients received Dur/Tre as first-line therapy, two were treated with atezolizumab plus bevacizumab as pretreatment, and the mean number of Dur/Tre cycles was 5.2. Neutrophil to lymphocyte ratio (NLR) was 2.14±1.51 at the time of Dur/Tre induction and worsened to 2.80±1.91 at the time of PD but significantly improved to 2.08±1.14 after locoregional therapy (p=0.047). Des-gamma-carboxy prothrombin (DCP) levels also decreased significantly after locoregional therapy (p=0.021). One patient responded partially, and seven achieved disease stability with continued treatment.

Conclusion: Continued Dur/Tre therapy may be effective in patients with improved NLR and DCP levels after adjunct locoregional therapy. Further studies involving larger patient cohort might determine strategic addition of locoregional therapy in PD.

Background/aim: Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer accounting for 75-85% of cases. Despite its favorable prognosis, 30-50% of patients develop regional lymph node metastases. Lymphatic vessel density (LVD) is a potential predictor of tumor progression, metastasis, and patient survival in PTC. This systematic review and meta-analysis evaluate the prognostic significance of LVD in PTC, focusing on intratumoral and peritumoral LVD and their association with nodal metastasis.

Materials and methods: A systematic review and meta-analysis were conducted following PRISMA guidelines and the Cochrane Handbook. Eligible studies included patients with PTC who underwent tumor resection and had LVD assessed via immunohistochemistry (D2-40, LYVE-1). Literature search was performed in MEDLINE, Cochrane Library, and PubMed. Two independent reviewers screened studies and extracted data, including survival outcomes and LVD measurements. Hazard ratios (HRs) and mean differences were calculated using fixed-effects or random-effects models, with heterogeneity assessed via I² statistics.

Results: A total of 21 studies were identified, with nine meeting eligibility criteria. Meta-analysis demonstrated a significant association between high overall LVD and increased nodal metastasis (summary mean difference: 2.64; 95%CI=1.45, 3.82; p<0.001, I²=30.6%). No statistically significant association was observed for intratumoral (summary HR=1.33; 95%CI=0.88-2.02; p=0.176, I²=74.3%) or peritumoral LVD (summary HR=1.58; 95%CI=0.51-4.89; p=0.429, I²=74.7%). Heterogeneity across studies suggested potential variability in LVD measurement techniques and patient populations.

Conclusion: This meta-analysis highlights the prognostic role of overall LVD in predicting nodal metastasis in PTC. However, intratumoral and peritumoral LVD did not show a significant correlation, indicating the need for further research. Standardization of LVD assessment and integration with molecular markers could enhance risk stratification and personalized treatment approaches in PTC management.

Background/aim: Angiomatoid fibrous histiocytoma (AFH) is a rare soft-tissue tumor that typically occurs in young individuals and often mimics hematomas or sarcomas. Its diagnosis is difficult due to nonspecific histological features, and identification of gene fusions such as EWSR1-CREB1 is crucial. We report a case definitively diagnosed using GenMineTOP, a dual DNA/RNA genomic profiling panel.

Case report: A 61-year-old woman presented with acute onset of pain and swelling in the right popliteal fossa, initially diagnosed as a hematoma. MRI revealed a 10-cm intramuscular mass with heterogeneous signal intensity and fluid-fluid levels. Needle biopsy showed no tumor cells. Despite transient improvement, the mass persisted and anemia worsened, prompting surgical excision. The tumor was resected with marginal margins, and histology revealed large atypical cells with unclear differentiation. Postoperative radiotherapy (60 Gy in 30 fractions) was administered under suspicion of sarcoma. GenMineTOP testing identified an EWSR1-CREB1 fusion gene. Reevaluation confirmed AFH with characteristic lymphoid cuffs and CD68 positivity. One year postoperatively, the patient remains free of recurrence and metastasis.

Conclusion: This case underscores the diagnostic challenges of AFH, particularly in older patients with deep-seated lesions mimicking hematomas. Dual DNA/RNA genomic profiling enabled definitive diagnosis and demonstrated its clinical utility in evaluating soft-tissue tumors with ambiguous histopathological features.