Cancer diagnosis & prognosis最新文献

Background/aim: The standard treatment for local recurrence (LR) is radical resection where possible, and R0 resection is reportedly associated with improved prognosis. However, the surgery for LR is complex and difficult, resulting in a low resection rate of 13-23%. The aim of this study was to examine clinical characteristics of LR and survival outcome after R0 resection of LR.

Patients and methods: We retrospectively reviewed the medical records of 18 patients who underwent curative surgery for colorectal cancer LR at four hospitals between April 2016 and March 2024. We examined the perioperative outcomes and prognosis of LR treated with R0 resection.

Results: Pathological T4 was seen in 9 of 18 patients (50.0%), N-positive status in 12 (66.7%), and lymphovascular invasion in 15 (83.3%). Median interval from primary surgery to local recurrence was 24 months. Postoperative complications occurred in 9 patients (50.0%). Eight patients (44.4%) experienced re-recurrence, with peritoneal metastasis in 5 patients, liver metastasis in one, lung metastasis in one, and adrenal gland metastasis in one. Five-year RFS was 39.4% and 5-year OS was 52.2%.

Conclusion: Postoperative LR of colorectal cancer is expected to show relatively favorable prognosis with R0 resection. LR often occurs within 3 years, and careful follow-up is necessary for high-risk cases.

Background/aim: Neuroendocrine neoplasms (NEN) of the head and neck (HN) region are rare, with limited reported cases. NENs are classified into neuroendocrine tumors (NET) grades G1, G2, and G3, and neuroendocrine carcinomas (NECs), with varying treatment strategies. This study investigated patient outcomes of HN-NENs and proposed a treatment algorithm based on pathological classification.

Patients and methods: This retrospective study analyzed 24 HN-NEN cases treated at Kyushu University Hospital (2007-2023). Tumors were classified using the 2022 WHO criteria, and overall survival rates were evaluated using the Kaplan-Meier method.

Results: Among the 24 patients, 29% had NETs and 71% had NECs. The most common primary sites were the sinonasal cavity (42%) and larynx (29%). Seven-year survival rates were 100% for NET G1 and G2, 50% for NET G3, and 43% for NEC. Two NET cases treated with somatostatin analogs (SSA) and radionuclide therapy (PRRT) showed tumor reduction.

Conclusion: Prognosis of HN-NENs varies significantly by pathological grade. While NET G1 and G2 showed favorable outcomes, NET G3 and NEC had poorer survival. SSA and PRRT may be effective options for selected HN-NETs. A preliminary treatment algorithm is proposed to guide management, warranting validation in larger studies.

Background/aim: Cumulative evidence reveals the contribution of nuclear receptors in the development and progression of cancers. The present study aimed to investigate the expression of two nuclear receptors, farnesoid X receptor (FXR) and pregnane X receptor (PXR), in cholangiocarcinoma (CCA) tissues and the correlation of their expression with clinicopathological features.

Materials and methods: FXR and PXR expression was evaluated in 111 resected CCA patient samples using immunohistochemistry, and the association of its expression with clinicopathological parameters was analyzed. The effectiveness of the expression of these nuclear receptors in predicting patients' outcomes was also assessed.

Results: FXR and PXR positivity was noted in all examined samples, with their expression predominantly localized in the cytoplasm. Patients with intraductal papillary neoplasm of the bile duct had significantly lower FXR expression (p=0.042). Elevated FXR expression was also significantly associated with lymph node metastasis (p=0.006) and advanced tumor stage (p=0.007). The results of the log-rank test analysis showed that the survival time of the patients was not associated with the expression of these two nuclear receptors. However, the CCA patients presenting low FXR/PXR expression tended to have a longer overall survival (p=0.125).

Conclusion: FXR may contribute to the progression of CCA to more advanced stages. The prognostic significance of FXR and PXR expression appears relevant in CCA. These nuclear receptors may have a function in the prediction and treatment of this deadly disease.

Background/aim: This study evaluated the immunohistochemical expression of IRE1 and PERK in breast cancer and explored their associations with clinicopathologic characteristics and survival outcomes.

Patients and methods: A cohort of 72 breast cancer specimens and 16 controls was analyzed for IRE1 and PERK expression using immunohistochemistry. Associations with clinicopathological variables, hormone receptor status, tumor markers and survival outcomes were assessed using statistical analyses, including Kaplan-Meier survival curves and Cox proportional hazard models.

Results: IRE1 and PERK expression levels were significantly elevated in breast cancer tissues compared to controls (p<0.001). Strong positive correlation was observed between IRE1 and PERK expression (Spearman's ρ=0.55, p<0.001). High PERK expression was associated with older age (p=0.038) and tumor grade 3 (p=0.042), while high IRE1 expression correlated with advanced TNM stage (p<0.001), estrogen receptor (p=0.031), progesterone receptor (p=0.028), and human epidermal growth factor receptor 2 positivity (p=0.028), as well as increased Ki-67 index (p=0.003), suggesting a more aggressive tumor phenotype. IRE1 expression was significantly associated with sentinel lymph node positivity (p=0.001) but inversely related to axillary lymph node involvement (p=0.031). Multivariate Cox regression analysis revealed that high IRE1 expression [immunoreactivity score (IRS) 5-12] was linked to an increased mortality risk [hazard ratio (HR)=12.19, 95% confidence interval (CI)=0.99-150.35, p=0.05], and high PERK expression (IRS 4-12) was similarly associated with worse survival (HR=12.10, 95%CI=1.16-126.30, p=0.04). Tumor stage was the strongest predictor of mortality (HR=79.89, p<0.01).

Conclusion: High IRE1 and PERK expression levels are associated with aggressive tumor characteristics and reduced survival in breast cancer, underscoring the importance of the unfolded protein response in carcinogenesis and disease progression.

Background/aim: We investigated the biological properties of non-small cell lung cancer (NSCLC) using three-dimensional computed tomography (3D-CT) images.

Patients and methods: We measured the diameters of surgically resected NSCLCs in the direction to the hilum and in the direction orthogonal to the hilum on the two largest cross-sections using 3D images, and classified NSCLCs into three types according to their shape. Correlations between each type and clinicopathological factors were determined.

Results: We examined 369 cases: 129 Type A, 182 Type B, and 58 Type C. The tumor-shape types demonstrated significant correlations with histological type, tumor size, and pathological tumor size (pT), lymphatic invasion (Ly), and pleural invasion (pl) factors. There were significant correlations between Type A and adenocarcinoma (Ad), and between Type C and advanced T factor or larger size. The frequency of lymphatic invasion was increased in Type A but decreased in Type C, whereas pleural invasion was increased in Type C.

Conclusion: NSCLC tumor shapes showed biological properties according to each histological type, such as pleural invasion or lymphatic invasion.

Background/aim: Patients with early breast cancer typically have a relatively favorable prognosis, although recurrence still occurs in some cases. We hypothesized that nonvisualized lymphoscintigraphy (nonvLSG) during sentinel lymph node biopsy (SLNB) might signal lymphatic obstruction caused by tumor burden, potentially leading to poorer overall survival (OS) and relapse-free survival (RFS).

Patients and methods: This single-center retrospective cohort study included 247 patients with early breast cancer who underwent SLNB (between 1999 and 2003). Patients were grouped into visualized lymphoscintigraphy (vLSG) and nonvLSG cohorts. Clinical characteristics, SLNB outcomes, and survival data were analyzed over a median follow-up of 12.2 years (4 months-24 years). RFS and OS were compared using Kaplan‒Meier (K-M) and Cox regression analyses.

Results: Of the 247 patients, 223 (90.3%) had a vLSG, whereas 24 (9.7%) had a nonvLSG. Hormone receptor positivity was lower in the nonvLSG group (62.5% vs. 80.3%, p=0.03). K‒M survival analyses revealed no significant differences in OS or RFS between the vLSG and nonvLSG groups. Regarding OS, the log-rank test yielded p=0.927, and for RFS, p=0.762, indicating similar survival outcomes between the groups. At 20 years, estimated OS probabilities were 75% for the visualized group and 70% for the nonvisualized group, and RFS probabilities were approximately 70% for both groups.

Conclusion: Lymphoscintigraphy visualization status was not significantly associated with OS and RFS in patients with early breast cancer undergoing SLNB. This suggests that nonvisualization does not indicate a greater tumor burden or poorer prognosis. Clinically, this reassures that treatment strategies do not need to be adjusted solely based on nonvisualization in lymphoscintigraphy.

Non-small cell lung cancer (NSCLC) accounts for 85% of lung cancer cases and demonstrates limited responsiveness to traditional chemotherapy and radiation. Recent advancements in targeted therapies and immune checkpoint inhibitors (ICIs) have transformed NSCLC treatment, yet resistance mechanisms remain a challenge. Axl, a receptor tyrosine kinase over-expressed in NSCLC, drives tumor progression, epithelial-mesenchymal transition (EMT), and resistance to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) and ICIs. Preclinical studies highlight the efficacy of Axl inhibitors, such as bemcentinib, brigatinib, and enapotamab vedotin, in overcoming drug resistance and enhancing immune responses. Clinical trials combining Axl inhibitors with ICIs (e.g., pembrolizumab) show promise, particularly in STK11-mutant NSCLC, with manageable toxicity profiles. However, challenges persist in optimizing dosing, managing adverse events, and identifying predictive biomarkers. Ongoing research into combination strategies and biomarker-driven approaches aims to refine Axl-targeted therapies and improve outcomes for patients with advanced NSCLC.

Background/aim: Gastric cancer exhibits significant molecular differences across racial and ethnic groups, influencing prognosis and treatment response. This study aimed to compare the molecular characteristics of gastric cancer between Asian and White populations using data from The Cancer Genome Atlas (TCGA).

Patients and methods: TCGA data for gastric cancer patients were analyzed to identify differences in genetic mutations, copy number variations, and transcriptomic profiles between Asian and White populations. Bioinformatics tools and statistical analyses were used to assess molecular alterations and pathway enrichment.

Results: Distinct molecular patterns were observed between the two populations. Asian patients exhibited a higher prevalence of mutations in genes such as TP53 and ARID1A, while White patients showed increased alterations in KRAS and PIK3CA. Differences in immune-related gene expression and tumor microenvironment signatures were also noted, suggesting potential implications for targeted therapies and immunotherapy response.

Conclusion: Significant molecular differences exist in gastric cancer between Asian and White populations, showing the need for population-specific treatment strategies. These findings may inform personalized therapeutic approaches and contribute to the advancement of precision oncology.

Background/aim: Non-islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome associated with a variety of benign and malignant tumors. It is most commonly associated with tumors of epithelial or mesenchymal origin. Management of NICTH primarily involves resection of the underlying tumor, along with other therapies. We report a case of NICTH secondary to metastatic rectal adenocarcinoma. While NICTH has previously been associated with colorectal cancers, few cases (if any) have been reported in patients with primary rectal cancer.

Case report: We present the case of a 51-year-old male with a medical history of pre-diabetes, gastroesophageal reflux disease, and tobacco use disorder. He was admitted for evaluation of rapid weight loss and was found to have rectal thickening, along with lesions in the lungs, liver, pancreas, and other sites, raising concern for metastasis. He underwent a colonoscopy with biopsy, which confirmed primary rectal adenocarcinoma. During his inpatient stay, he experienced recurrent episodes of hypoglycemia. A diagnosis of NICTH was supported by the low levels of pro-insulin, insulin, C-peptide, IGF-I and an elevated IGF-II:IGF-I ratio. The patient was treated with corticosteroids, glucagon, continuous dextrose infusions, and parenteral nutrition to manage hypoglycemia.

Conclusion: This case highlights the importance of considering NICTH in the differential diagnosis for patients with unexplained or refractory hypoglycemia, especially when a notable mass or malignancy is suspected. It also highlights the need for a multimodal approach in managing the underlying hypoglycemia.

Background/aim: Vascular endothelial growth factor (VEGF) inhibitors, such as bevacizumab (Bev), are key in the pharmacological treatment of advanced hepatocellular carcinoma (HCC) but are associated with a high incidence of adverse events, including hypertension and proteinuria. Strategies to reduce proteinuria through blood pressure control are particularly important. A new angiotensin receptor neprilysin inhibitor (ARNI) (sacubitril/valsartan) was recently approved for the treatment of hypertension. ARNI exerts its antihypertensive effects through vasodilation, sympathomimetic inhibition, and natriuresis by enhancing the action of natriuretic peptides, together with suppression of the renin-angiotensin system by angiotensin II receptor blockers (ARB). Herein, the aim was to investigate the efficacy of ARNI for blood pressure control and proteinuria in advanced hepatocellular carcinoma (HCC) patients during treatment with atezolizumab plus Bev (Atez/Bev).

Patients and methods: We retrospectively identified patients with advanced HCC under Atez/Bev treatment, who experienced inadequate blood pressure control with ARB and were transitioned to ARNI. Data on estimated glomerular filtration rate (eGFR), urinary protein/creatinine ratio (UPCR), and Bev continuation were analyzed.

Results: The mean patient age was 76.6 years, and the liver background was hepatitis B virus (HBV) (n=1), hepatitis C virus (HCV) (n=4), or non-HBV/non-HCV (n=5). eGFR significantly improved from a mean of 52.87 to 59.46 ml/min/1.73 m² (p=0.006); UPCR decreased from 2.31 to 0.79 (p=0.025) after switching to ARNI. Among patients with UPCR ≥2 (n=5), switch from ARB to ARNI improved eGFR from 50.54 to 58.62 ml/min/1.73 m², (p=0.026), while UPCR decreased from a mean of 3.99 to 1.13 (p=0.025), allowing uninterrupted Bev treatment.

Conclusion: ARNI appears to support renal function preservation and proteinuria reduction during Atez/Bev therapy, allowing the continuation of Bev treatment.